The Effects of a 5-Day Virtual-Reality Based Exercise Program on Kinematics and Postural Muscle Activity in Youth with Cerebral Palsy

Abstract

Aims: To determine the effects of a 5-day virtual reality (VR)-based intervention on anticipatory and reactive mechanisms of postural control in children and adolescents with cerebral palsy (CP). Methods: Eleven youth with CP (GMFCS levels I and II), ages 7–17, were allocated to intervention (N = 5) and control (N = 6) groups. Both groups attended balance assessment sessions 1 week apart. Participants in the intervention group received 1-hour one-on-one physiotherapist-supervised VR balance games for 5 consecutive days between assessments. For balance assessments, participants stood erect with eyes open on a movable platform that translated progressively through four speeds in the anterior/posterior direction. Participants performed two trials each of experimenter-triggered and self-triggered perturbations. Postural muscle activity and kinematics were recorded. The Anchoring Index and body segment cross-correlations were calculated as an indication of body stabilization, and the number of steps taken to regain balance/avoid falling were counted. Mann–Whitney U tests for between group differences in change scores were undertaken with an accepted significance level of 0.01. Results: No consistent differences in change scores were identified between groups. Conclusions: There was no effect of a 5-day VR-based intervention on postural control mechanisms used in response to oscillating platform perturbations. Subsequent studies will further tailor VR interventions to patients’ functional balance needs.

Keywords:

• Anchoring index
• balance mechanisms
• cerebral palsy
• IREX
• postural control
• virtual reality

About the Authors

Dr Richard Mills was a PhD student at the University of Ottawa at the time of this study and is now a Lecturer in Biomechanics at Manchester Metropolitan University (Manchester, UK) in the Department of Sport and Exercise Sciences. His research focuses on understanding the development of mechanisms of balance and postural control, and how they are affected in special populations. Dr Danielle Levac is an assistant professor in the Department of Physical Therapy, Movement and Rehabilitation Sciences at Northeastern University (Boston, USA) where she directs the Rehabilitation Games & Virtual Reality Lab. Dr. Levac's research program focuses on exploring the benefits and challenges of novel motor skill learning in virtual environments. Dr Heidi Sveistrup's research focuses on understanding mechanisms underlying as well as rehabilitation and technology interventions for functional balance and mobility. She is a Full Professor of Rehabilitation Sciences in the Faculty of Health Sciences and the Director of the Motor Control Laboratory at the University of Ottawa.

Disclosure statement

The authors declare that they have no conflict of interest.

Additional information

Funding

This study was funded in part by a grant through the Ontario Federation for Cerebral Palsy (OFCP) and the University of Ottawa Faculty of Health Sciences.