Use of virtual reality in rehabilitation of movement in children with hemiplegia − A multiple case study evaluation

Abstract

Purpose: To evaluate the feasibility and therapeutic effect of engaging children of differing neuromotor and cognitive ability in a virtual reality (VR) tabletop workspace designed to improve upper-limb function. Method: Single-subject experimental design with multiple baselines was employed. Four children with hemiplegia participated in VR-based training between nine and 19, 30-minute sessions, over three-four weeks. Outcomes were assessed from the perspective of the International Classification of Functioning, Disability and Health; considering body function, activity performance and participation. Upper-limb performance was assessed using system-measured variables (speed, trajectory and accuracy) and standardized tests. Trend analyses were employed to determine trends on system variables between baseline phase and treatment phases. Standardised measures were compared between pre- and post-training. Results: Two children made progress across system variables with some translation to daily activities. Performance of the other two children was more variable, however, they engaged positively with the system by the end of the treatment phase. Conclusions: The VR (RE-ACTION) system shows promise as an engaging rehabilitation tool to improve upper-limb function of children with hemiplegia, across ability levels. Trade-offs between kinematic variables should be considered when measuring improvements in movement skill. Larger trials are warranted to evaluate effects of augmented feedback, intensity and duration of training, and interface type to optimise the system’s effectiveness.

Implications for Rehabilitation

• The RE-ACTION system shows promise as a relatively low-cost solution to support therapies for upper-limb function and activity participation for children with hemiplegia and associated conditions.

• The combination of goal-directed tasks, augmented feedback, and engaging exploratory environments is a potentially quite powerful rehabilitation solution for children.

• Increased task engagement supported positive outcomes of the International Classification of Functioning, Disability and Health − Children and Youth version, including body function and activity levels as well as enhanced participation.

• Larger experimental trials are required to test the capacity of the system to progress the skills of children with multiple disabilities.

Keywords::

• Hemiplegia
• virtual reality
• children
• cerebral palsy
• upper-extremity

Acknowledgements

We are extremely grateful to the children and their families who were the inspiration behind this project and to those who gave so much of their time to participate in this study. We would like to thank Jonathan Duckworth for object design consultation and Ross Eldridge for his untiring and enthusiastic responses to remedy the technical glitches which occurred in adapting the ELEMENTS system for paediatric use. We also wish to thank Dr Jean-Pierre Lin and Caron Coleman for their support for project implementation and assistance with data collection.

Declaration of interest: The authors report no conflicts of interest. This project was funded by a grant from the Guy’s and St Thomas’ Charity and an NIHR research training fellowship award to the first author. The first author was also supported by a Ministry of Immigration and Absorption grant in the preparation of this manuscript.

Notes

¹The family of LZ travelled 70 miles for each session.