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. 2024;17(1):107-123.
doi: 10.3233/PRM-230028.

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results

Paolo Meriggi  1 , Martina Mandalà  1 , Mattia Randazzo  1 , Elena Brazzoli  1 , Anna Castagna  1 , Valentina Di Giusto  1 , Anna Cavallini  1 , Alberto Marzegan  1 , Tiziana Lencioni  1 , Ivana Olivieri  1   2
Affiliations

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results

Paolo Meriggi et al. J Pediatr Rehabil Med. 2024.

Abstract

Purpose: Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions.

Methods: Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment.

Results: At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data.

Conclusion: The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

Keywords: Virtual reality; hemiplegic children; rehabilitation; unilateral cerebral palsy; upper limb function.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Pictures of CARE Lab (left) and of a child playing the Bubble 1 game (right).
Fig. 2
Fig. 2
The satisfaction questionnaire used to collect feedback from children after each session. Please note that the figure reports the English translation of the original Italian version that was actually administered.
Fig. 3
Fig. 3
A simple example of the efficiency index.
Fig. 4
Fig. 4
Pictures of the screen taken during each of the five games used in the rehabilitation sessions.
Fig. 5
Fig. 5
Mean Melbourne Assessment 2 (MA2) scores (average of all four items) for each participant.
Fig. 6
Fig. 6
Histogram reporting the items in the ABILHAND-Kids with a performance improvement.
Fig. 7
Fig. 7
Mean trend of range of movement (ROM) of shoulder and elbow during two items of the Melbourne Assessment 2 (MA2), respectively at T0 (blue lines) and T1 (red lines), while the gray areas represent the control group reference. Column A = Reach forward (MA2 Item 1); Column B = Reach to brush from forehead to back of neck (MA2 Item 10).
Fig. 8
Fig. 8
Graph on the overall two-dimensional (2D) length of the trajectories, for each participant in each session [1–10].
Fig. 9
Fig. 9
Movements of the hand in a given game. Black lines represent the trajectory of the hand; yellow circles represent the position of the target hit.
Fig. 10
Fig. 10
Efficiency index in Game 4 for each child according to the different sessions.
See this image and copyright information in PMC

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