Rehabilitation of children with hemiparesis: a pilot study on the use of virtual reality.

BACKGROUND: A wide range of treatments have been used to improve upper arm motor performances in children with congenital hemiplegia. Recent findings are suggesting that virtual reality based intervention could be a promising tool also in pediatric rehabilitation. METHODS: Six patients with congenital hemiplegia (age: 4-16 years) were recruited among those treated in the Child Neuropsychiatry and Rehabilitation Unit of the IRCCS "Santa Maria Nascente" (Milan, Italy), for a preliminary investigation about using nonimmersive virtual reality for upper limb rehabilitation. Ten sessions using VRRS system (Khymeia, Padova, Italy) were weekly administered as a part of the rehabilitative treatment. Melbourne Assessment of Unilateral Limb Movement, Ashworth Scale, and Arm's PROM were selected as main outcome measures. At the end of treatment, participants filled in an ad hoc satisfaction questionnaire. RESULTS: All subjects completed the proposed treatment, and they also gave a positive judgment regarding this rehabilitative method. Melbourne score increased in all patients. CONCLUSION: Our findings seem to support the evidence that VR treatment could be a promising and engaging tool for pediatric rehabilitation. However, the limited size of the population and the small number of sessions require further investigations and RCTs to confirm our positive results.

Listening to the patient as a possible route to cost-effective rehabilitation: a case report.

INTRODUCTION: Adolescents with cerebral palsy often do not need a specific rehabilitative treatment; however, when specific needs are expressed, clinicians should listen and try to answer them. CASE PRESENTATION: We present the case of a 17-year-old Italian male patient with hemiplegia who had received standard physiotherapy and, ultimately, after a period of adapted physical activity performed in a group, was under consideration for discharge. However, due to unsatisfactory hand control, he asked for help to reach a personal goal, the ability to drive a motorbike, without surgery. Functional taping showed efficacy, but was neither cost-effective nor practical for the patient and his family; by contrast, a dynamic orthosis associated with training in a real-life environment was instead successful. CONCLUSION: The present case underlines the importance of considering solutions involving the motivation and compliance of the patient in order to improve his activity and participation.