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Hao J, Huang B, Remis A, He Z. The application of virtual reality to home-based rehabilitation for children and adolescents with cerebral palsy: A systematic review and meta-analysis. Physiother Theory Pract 2024; 40:1588-1608. [PMID: 36847396 DOI: 10.1080/09593985.2023.2184220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Home-based rehabilitation enables children and families to participate in therapeutic activities built into their daily routines without the barriers of arrangement and transportation to facilities. Virtual reality is an emerging technology which has shown promising outcomes in rehabilitation. PURPOSE This systematic review aims to examine the feasibility and effects of virtual reality-enhanced home rehabilitation on Body functions and structures, Activity, and Participation outcomes in children and adolescents with cerebral palsy. METHODS Interventional studies were searched across five biomedical databases on November 26, 2022. Two independent reviewers conducted study selection, data extraction, and quality assessment. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tools were used to evaluate the quality of included studies. Meta-analysis was performed to examine the effects of the intervention. RESULTS Eighteen studies were included in this review. Home-based virtual reality rehabilitation appears feasible with effects on upper extremity and gross motor function, strength, bone density, cognition, balance, walking, daily activity performance, and participation. Meta-analyses revealed significant improvements in hand function (SMD = 0.41, p= .003), gross motor function (SMD = 0.56, p= .0002), and walking capacity (SMD = 0.44, p= .01) following home-based virtual reality intervention. CONCLUSION Home-based virtual reality may serve as an adjunct to conventional facility-based therapy to promote participation in therapeutic exercises and maximize rehabilitation outcomes. Further properly designed randomized controlled trials using valid and reliable outcome measures with adequately powered sample sizes are warranted to enhance the current body of evidence using home-based virtual reality in cerebral palsy rehabilitation.
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Affiliation(s)
- Jie Hao
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Biying Huang
- Department of Health and Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, United States
| | - Andréas Remis
- Department of Physical Medicine and Rehabilitation, Gate Parkway Primary Care Center, Jacksonville
| | - Zhengting He
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore
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Barkın K, Ege T, Özgün KK, Koray K, Sedef Ş. How does therapist guided game-based intervention program effect motor skills in children with Attention Deficit Hyperactivity Disorder?: Single blind randomised study design. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 137:104495. [PMID: 37001250 DOI: 10.1016/j.ridd.2023.104495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Virtual reality and game-based approaches to the rehabilitation process also brought an opportunity to design more accessible intervention programs.It was seen that many studies utilized trademarked and commercially available games, which were not originally designed as rehabilitation tools but were administrated by a rehabilitation professional to achieve the maximum therapeutic value. AIMS Study aims to investigate the effects of a Self-oriented game based program(SGBP)and Therapist Guided Game-based Intervention Program(TGGIP) on the motor skills of children with Attention Deficit Hyperactivity Disorder(ADHD). METHODS AND PROCEDURES This study was designed as a single-blind, randomized, controlled trial. A total of 176 children with ADHD participated in the study and were randomly divided into two groups (TGGIP and SGBP). Intervention in both groups was done with a telerehabilitation methodology. OUTCOMES AND RESULTS According to the within-group comparisons of pre- and post-intervention BOT2-BF scores, there were significant increases in all sub-scores and the total score(p < 0.05). The comparison of the BOT2-BF all sub-scores and the total score changes between the groups showed significantly higher in TGGIP. CONCLUSION AND IMPLICATIONS TGGIP was found to be more effective compared to SGBP in improving motor skills of children with ADHD.TGGIP that we designed acts as a facilitator for therapists in using trademarked and easily accessible games for structured and supervised virtual reality and game-based rehabilitation.
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Affiliation(s)
- Köse Barkın
- University of Health Sciences Turkey, Faculty of Gülhane Health Science, Department of Occupational Therapy, Ankara, Turkey.
| | - Temizkan Ege
- Hacettepe University, Faculty of Health Science, Department of Occupational Therapy, Ankara, Turkey
| | - Kara Kaya Özgün
- Akdeniz University, Faculty of Health Sciences Department of Physical Therapy and Rehabilitation, Antalya, Turkey
| | - Kara Koray
- University of Health Sciences Turkey, Antalya Education and Research Hospital, Department of Child Psychiatry, Antalya, Turkey
| | - Şahin Sedef
- Hacettepe University, Faculty of Health Sciences, Occupational Therapy Department, Ankara, Turkey
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Crebbin K, Grisbrook T, Elliott C, Thornton A. The Use of Serious Gaming to Improve Sensorimotor Function and Motivation in People with Cerebral Palsy: A Systematic Review. Games Health J 2023; 12:169-197. [PMID: 36161972 DOI: 10.1089/g4h.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this systematic review was to review the evidence for serious gaming interventions in improving sensorimotor function in children and adults with cerebral palsy (CP). Seven databases were searched with terms related to serious gaming and CP. Articles were evaluated according to the Downs and Black rating scale and important principles of serious gaming defined by Whyte et al. Extracted data included the population, intervention, serious gaming elements, outcomes, and authors' conclusions. Fifty-seven articles were identified for inclusion. Participants' ages ranged from 3 to 57 years. Interventions tested included commercial videogames as well as specially designed games. Most interventions had themed content, short-term goals, rewards, feedback, and multiple games. Outcome measures and study designs were inconsistent between studies. Sensorimotor function results of noncomparative studies were positive or neutral overall, but results of comparative studies were more mixed. We concluded that serious gaming interventions may be a useful adjunct to treatment as they are noninvasive, were not associated with deterioration in most cases, and may improve compliance. More comparative studies need to be completed to assess compliance and treatment outcomes. Future games should also aim to adhere more closely to the principles of serious gaming.
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Affiliation(s)
- Kayley Crebbin
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiffany Grisbrook
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Catherine Elliott
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Ashleigh Thornton
- UWA Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
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4
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Effects of object size and task goals on reaching kinematics in a non-immersive virtual environment. Hum Mov Sci 2022; 83:102954. [DOI: 10.1016/j.humov.2022.102954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/26/2022] [Accepted: 04/14/2022] [Indexed: 11/18/2022]
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Liu W, Hu Y, Li J, Chang J. Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis. Front Public Health 2022; 10:865474. [PMID: 35548088 PMCID: PMC9081327 DOI: 10.3389/fpubh.2022.865474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/28/2022] [Indexed: 12/12/2022] Open
Abstract
Virtual Reality (VR) therapy is popular in treating children with Cerebral Palsy (CP) as a new technology for rehabilitation. Nevertheless, no substantial evidence supporting VR therapy promotion has been developed to date. This study aimed to investigate the effects of VR therapy on balance in children with CP. We conducted a systematic search in PubMed and Web of Science (updated to December 30, 2021). The systematic review and meta-analysis included all randomized controlled trials that included children with CP. A total of 18 RCT studies were eligible for inclusion in the systematic review, and meta-analysis was performed on 16 of them. Results showed that the VR intervention was beneficial for balance (SMD 0.47 [95% CI, SD 0.28, 0.66]). We concluded that VR therapy interventions for children with CP have positive effects. However, cautious implementation is needed in clinical applications.
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Affiliation(s)
- Wei Liu
- School of Physical Education, Xuzhou Kindergarten Teachers College, Xuzhou, China
- Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Yuanyan Hu
- School of Mathematics and Statistics, Yunlin Normal University, Yunlin, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
- *Correspondence: Junfeng Li
| | - Jindong Chang
- Institute of Motor Quotient, Southwest University, Chongqing, China
- Jindong Chang
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Goyal C, Vardhan V, Naqvi W. Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review. Cureus 2022; 14:e21693. [PMID: 35237486 PMCID: PMC8882342 DOI: 10.7759/cureus.21693] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/25/2022] Open
Abstract
Cerebral palsy (CP) is the most common cause of motor disability in the pediatric population, with hemiplegia as one of the most widely seen subtypes of spastic CP. Although most of the children with hemiplegic CP are independent ambulators, deficits in hand function of the affected side remain a major concern of caregivers and children themselves. Children use the unaffected upper extremity to compensate for the weakness in the affected one, which consequently leads to the disuse of the hemiparetic upper extremity. Interactive virtual environments can enhance the activation of brain areas during training by providing feedback that can catalyze neuroplastic changes for improved function. Although numerous studies have been conducted on the impact of virtual reality (VR)-based rehabilitation in adults with stroke, studies on its use in the pediatric population are scarce. The three broad categories of VR systems based on the type of human-computer interactions are feedback-focused, gesture-based, and haptic-based. Preliminary studies have shown promising results of VR intervention in improving motor function, including upper extremity function, in children with hemiplegic CP. It is an engaging and entertaining intervention that adds an advantage of high compliance due to motivation. The current literature consists of studies with highly heterogeneous groups of participants and small sample sizes. Further investigation on children with a specific type of CP with advanced VR systems technology is warranted.
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Affiliation(s)
- Chanan Goyal
- Pediatric Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND.,Pediatric Physiotherapy, Government Physiotherapy College, Raipur, IND
| | - Vishnu Vardhan
- Cardiorespiratory Physiotherapy, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Waqar Naqvi
- Community Physiotherapy, N.K.P. Salve Institute of Medical Sciences, Nagpur, IND
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Cheng M, Anderson M, Levac DE. Performance Variability During Motor Learning of a New Balance Task in a Non-immersive Virtual Environment in Children With Hemiplegic Cerebral Palsy and Typically Developing Peers. Front Neurol 2021; 12:623200. [PMID: 33790848 PMCID: PMC8005528 DOI: 10.3389/fneur.2021.623200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Motor impairments contribute to performance variability in children with cerebral palsy (CP) during motor skill learning. Non-immersive virtual environments (VEs) are popular interventions to promote motor learning in children with hemiplegic CP. Greater understanding of performance variability as compared to typically developing (TD) peers during motor learning in VEs may inform clinical decisions about practice dose and challenge progression. Purpose: (1) To quantify within-child (i.e., across different timepoints) and between-child (i.e., between children at the same timepoint) variability in motor skill acquisition, retention and transfer in a non-immersive VE in children with CP as compared to TD children; and (2) To explore the relationship between the amount of within-child variability during skill acquisition and learning outcomes. Methods: Secondary data analysis of 2 studies in which 13 children with hemiplegic CP and 67 TD children aged 7-14 years undertook repeated trials of a novel standing postural control task in acquisition, retention and transfer sessions. Changes in performance across trials and sessions in children with CP as compared to TD children and between younger (7-10 years) and older (11-14 years) children were assessed using mixed effects models. Raw scores were converted to z-scores to meet model distributional assumptions. Performance variability was quantified as the standard deviation of z-scores. Results: TD children outperformed children with CP and older children outperformed younger children at each session. Older children with CP had the least between-child variability in acquisition and the most in retention, while older TD children demonstrated the opposite pattern. Younger children with CP had consistently high between-child variability, with no difference between sessions. Within-child variability was highest in younger children, regardless of group. Within-child variability was more pronounced in TD children as compared to children with CP. The relationship between the amount of within-child variability in performance and performance outcome at acquisition, retention and transfer sessions was task-specific, with a positive correlation for 1 study and a negative correlation in the other. Conclusions: Findings, though preliminary and limited by small sample size, can inform subsequent research to explore VE-specific causes of performance variability, including differing movement execution requirements and individual characteristics such as motivation, attention and visuospatial abilities.
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Affiliation(s)
- Minxin Cheng
- Rehabilitation Games and Virtual Reality Laboratory, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Michael Anderson
- Department of Biology, Macalester College, St. Paul, MN, United States
| | - Danielle E Levac
- Rehabilitation Games and Virtual Reality Laboratory, Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
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Handelzalts S, Ballardini G, Avraham C, Pagano M, Casadio M, Nisky I. Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic. Front Neurorobot 2021; 15:617636. [PMID: 33679364 PMCID: PMC7925397 DOI: 10.3389/fnbot.2021.617636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/07/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
| | - Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Chen Avraham
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Mattia Pagano
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Ilana Nisky
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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9
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Warnier N, Lambregts S, Port IVD. Effect of Virtual Reality Therapy on Balance and Walking in Children with Cerebral Palsy: A Systematic Review. Dev Neurorehabil 2020; 23:502-518. [PMID: 31674852 DOI: 10.1080/17518423.2019.1683907] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: To investigate the effect of Virtual Reality Therapy (VRT) on balance and walking in children with cerebral palsy (CP). Method: A systematic search in Pubmed and Embase was performed until the 9th of July 2019. Articles were included if the population consisted of children with CP and data on balance and/or walking were reported. Results were pooled in two meta-analyses. Results: 26 articles were included. For 'balance' 5 and for 'walking' 4 were used for the meta-analyses. The meta-analyses showed a significant result in favor of VRT for balance, SMD 0.89 [95% CI, SD 0.14, 1.63] and for walking, SMD 3.10 [95% Cl, SD 0.78, 5.35]. Interpretation: VRT seems a promising intervention for rehabilitation in children with CP. The meta-analysis confirmed this positive effect. These results must be interpreted with caution due to differences in the interventions used, the lack of randomized-controlled trials, and the relatively small groups.
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Affiliation(s)
- Nadieh Warnier
- Rijndam Revalidatie centrum , Rotterdam, LJ, Netherlands
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Biddiss E, Chan-Viquez D, Cheung ST, King G. Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives. Disabil Rehabil 2019; 43:133-147. [PMID: 31104517 DOI: 10.1080/09638288.2019.1613681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings. METHODS A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis. RESULTS Features of the technology and the intervention influence feelings of autonomy (e.g., personalization), competence (e.g., calibration), and relatedness (e.g., social play, virtual therapist/coach). There may be multiple and differently valued goals in interactive computer play-based interventions (e.g., game- and therapy-focused) that, if disconnected or unmet, negatively impact engagement. Multiplayer interactions, real-time feedback and progress tracking provide information that influences self-regulation and engagement over time. CONCLUSIONS Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy. Implications for rehabilitation The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies. Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization) and the intervention (e.g., interactions with therapists, social play). Increased effort should be directed towards ensuring that interactive computer play-based interventions and technologies reward and reinforce efforts towards therapy goals.
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Affiliation(s)
- Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Daniela Chan-Viquez
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Stephanie T Cheung
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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Abstract
BACKGROUND Cerebral palsy (CP) is a neurodevelopmental disorder resulting from an injury to the developing brain. It is the most common form of childhood disability with prevalence rates of between 1.5 and 3.8 per 1000 births reported worldwide. The primary impairments associated with CP include reduced muscle strength and reduced cardiorespiratory fitness, resulting in difficulties performing activities such as dressing, walking and negotiating stairs.Exercise is defined as a planned, structured and repetitive activity that aims to improve fitness, and it is a commonly used intervention for people with CP. Aerobic and resistance training may improve activity (i.e. the ability to execute a task) and participation (i.e. involvement in a life situation) through their impact on the primary impairments of CP. However, to date, there has been no comprehensive review of exercise interventions for people with CP. OBJECTIVES To assess the effects of exercise interventions in people with CP, primarily in terms of activity, participation and quality of life. Secondary outcomes assessed body functions and body structures. Comparators of interest were no treatment, usual care or an alternative type of exercise intervention. SEARCH METHODS In June 2016 we searched CENTRAL, MEDLINE, Embase, nine other databases and four trials registers. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of children, adolescents and adults with CP. We included studies of aerobic exercise, resistance training, and 'mixed training' (a combination of at least two of aerobic exercise, resistance training and anaerobic training). DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and potentially relevant full-text reports for eligibility; extracted all relevant data and conducted 'Risk of bias' and GRADE assessments. MAIN RESULTS We included 29 trials (926 participants); 27 included children and adolescents up to the age of 19 years, three included adolescents and young adults (10 to 22 years), and one included adults over 20 years. Males constituted 53% of the sample. Five trials were conducted in the USA; four in Australia; two in Egypt, Korea, Saudi Arabia, Taiwan, the Netherlands, and the UK; three in Greece; and one apiece in India, Italy, Norway, and South Africa.Twenty-six trials included people with spastic CP only; three trials included children and adolescents with spastic and other types of CP. Twenty-one trials included people who were able to walk with or without assistive devices, four trials also included people who used wheeled mobility devices in most settings, and one trial included people who used wheeled mobility devices only. Three trials did not report the functional ability of participants. Only two trials reported participants' manual ability. Eight studies compared aerobic exercise to usual care, while 15 compared resistance training and 4 compared mixed training to usual care or no treatment. Two trials compared aerobic exercise to resistance training. We judged all trials to be at high risk of bias overall.We found low-quality evidence that aerobic exercise improves gross motor function in the short term (standardised mean difference (SMD) 0.53, 95% confidence interval (CI) 0.02 to 1.04, N = 65, 3 studies) and intermediate term (mean difference (MD) 12.96%, 95% CI 0.52% to 25.40%, N = 12, 1 study). Aerobic exercise does not improve gait speed in the short term (MD 0.09 m/s, 95% CI -0.11 m/s to 0.28 m/s, N = 82, 4 studies, very low-quality evidence) or intermediate term (MD -0.17 m/s, 95% CI -0.59 m/s to 0.24 m/s, N = 12, 1 study, low-quality evidence). No trial assessed participation or quality of life following aerobic exercise.We found low-quality evidence that resistance training does not improve gross motor function (SMD 0.12, 95% CI -0.19 to 0.43, N = 164, 7 studies), gait speed (MD 0.03 m/s, 95% CI -0.02 m/s to 0.07 m/s, N = 185, 8 studies), participation (SMD 0.34, 95% CI -0.01 to 0.70, N = 127, 2 studies) or parent-reported quality of life (MD 12.70, 95% CI -5.63 to 31.03, n = 12, 1 study) in the short term. There is also low-quality evidence that resistance training does not improve gait speed (MD -0.03 m/s, 95% CI -0.17 m/s to 0.11 m/s, N = 84, 3 studies), gross motor function (SMD 0.13, 95% CI -0.30 to 0.55, N = 85, 3 studies) or participation (MD 0.37, 95% CI -6.61 to 7.35, N = 36, 1 study) in the intermediate term.We found low-quality evidence that mixed training does not improve gross motor function (SMD 0.02, 95% CI -0.29 to 0.33, N = 163, 4 studies) or gait speed (MD 0.10 m/s, -0.07 m/s to 0.27 m/s, N = 58, 1 study) but does improve participation (MD 0.40, 95% CI 0.13 to 0.67, N = 65, 1 study) in the short-term.There is no difference between resistance training and aerobic exercise in terms of the effect on gross motor function in the short term (SMD 0.02, 95% CI -0.50 to 0.55, N = 56, 2 studies, low-quality evidence).Thirteen trials did not report adverse events, seven reported no adverse events, and nine reported non-serious adverse events. AUTHORS' CONCLUSIONS The quality of evidence for all conclusions is low to very low. As included trials have small sample sizes, heterogeneity may be underestimated, resulting in considerable uncertainty relating to effect estimates. For children with CP, there is evidence that aerobic exercise may result in a small improvement in gross motor function, though it does not improve gait speed. There is evidence that resistance training does not improve gait speed, gross motor function, participation or quality of life among children with CP.Based on the evidence available, exercise appears to be safe for people with CP; only 55% of trials, however, reported adverse events or stated that they monitored adverse events. There is a need for large, high-quality, well-reported RCTs that assess the effectiveness of exercise in terms of activity and participation, before drawing any firm conclusions on the effectiveness of exercise for people with CP. Research is also required to determine if current exercise guidelines for the general population are effective and feasible for people with CP.
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Affiliation(s)
- Jennifer M Ryan
- Brunel University LondonInstitute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
| | | | - Stephen G Noorduyn
- McMaster UniversityCanChild Centre for Childhood Disability Research1280 Main Street West, Rm. 2C1McMaster UniversityHamiltonONCanadaL8S 4L8
| | - Neil E O'Connell
- Brunel UniversityDepartment of Clinical Sciences/Health Economics Research Group, Institute of Environment, Health and SocietiesKingston LaneUxbridgeMiddlesexUKUB8 3PH
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12
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Lee BH. Clinical usefulness of augmented reality using infrared camera based real-time feedback on gait function in cerebral palsy: a case study. J Phys Ther Sci 2016; 28:1387-91. [PMID: 27190489 PMCID: PMC4868249 DOI: 10.1589/jpts.28.1387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/26/2015] [Indexed: 12/01/2022] Open
Abstract
[Purpose] This study investigated the effects of real-time feedback using infrared camera
recognition technology-based augmented reality in gait training for children with cerebral
palsy. [Subjects] Two subjects with cerebral palsy were recruited. [Methods] In this
study, augmented reality based real-time feedback training was conducted for the subjects
in two 30-minute sessions per week for four weeks. Spatiotemporal gait parameters were
used to measure the effect of augmented reality-based real-time feedback training.
[Results] Velocity, cadence, bilateral step and stride length, and functional ambulation
improved after the intervention in both cases. [Conclusion] Although additional follow-up
studies of the augmented reality based real-time feedback training are required, the
results of this study demonstrate that it improved the gait ability of two children with
cerebral palsy. These findings suggest a variety of applications of conservative
therapeutic methods which require future clinical trials.
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Affiliation(s)
- Byoung-Hee Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University: 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
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