Could an Immersive Virtual Reality Training Improve Navigation Skills in Children with Cerebral Palsy? A Pilot Controlled Study

Abstract

Children with cerebral palsy (CP) suffer deficits in their motor, sensory, and cognitive abilities, as well as in their visuospatial competences. In the last years, several authors have tried to correlate the visuospatial abilities with the navigational ones. Given their importance in everyday functions, navigation skills have been deeply studied using increasingly cutting-edge techniques such as virtual reality (VR). However, to our knowledge, there are no studies focused on training using immersive VR (IVR) in children with movement disorders. For this reason, we proposed an IVR training to 35 young participants with CP and conceived to improve their navigation skills in a “simil-real” environment while playing on a dynamic platform. A subgroup performed a part of the training which was specifically dedicated to the use of the allocentric strategy (i.e., looking for landmarks) to navigate the virtual environment. We then compared the children’s navigation and spatial skills pre- and post-intervention. All the children improved their visual–spatial abilities; particularly, if the IVR activities specifically trained their ability to look for landmarks and use them to navigate. The results of this work highlight the potential of an IVR training program to increase the navigation abilities of patients with CPs.

The Role of Immersive Virtual Reality Interventions in Pediatric Cerebral Palsy: A Systematic Review across Motor and Cognitive Domains

“…Our studies highlighted that VR could be a useful tool to enhance functional outcomes in children suffering from PC. Rehabilitation based on VR, within a multimodal perspective of rehabilitation (motor, cognitive, and sensory), improves motor learning processes through implicit learning, concrete tasks, and focused attention [23][24][25][26][27]. Furthermore, directing the patient's attention to the outcomes of their movements using sounds, visual stimuli, or point-earning, all possible in VR games, is more effective than focusing on the movement itself.…”

“…Our review demonstrates how immersive VR can be used in children with CP for a wide range of outcomes: motor (large motor, posture and walking, dexterity, symmetry of bimanual movements) and cognitive (visuo-spatial skills, planning skills, perceptual organization, visuo-motor coordination and self-control, rather than visuospatial memory), as well as non-cognitive/non-motor outcomes such as composition, such as increase in height, lean mass, and skeletal muscle mass [23][24][25][26][27][28][29][30][31][32][33][34][35][36].…”

“…All children had the opportunity to complete the experimental rehabilitation session, demonstrating that the VR system can be compatible with different levels of motor skills. Moreover, rehabilitation through virtual reality tools has also led to significant results in the cognitive domain, as demonstrated by the study of Nossa et al, who highlighted improvements in visuospatial abilities in children with CP through VR training performed using the GRAIL system [24]. The tool was statistically significant for the Labyrinth subtest (WISH-III).…”

“…The methodological quality of the included studies varied, with total scores ranging from 4 to 7. While some studies achieved relatively high scores [23][24][25][26][27][31][32][33][34][35][36], indicating good methodological rigor, others scored lower [28][29][30]37], suggesting potential limitations in study design or execution. Overall, the quality of evidence across the reviewed studies appears to be moderate to good, with most studies demonstrating satisfactory methodological quality according to the NOS criteria [22].…”

“…Of the fifteen included studies, many of them deal with the GRAIL system [23][24][25][26][27]; other studies used immersive VR systems like CAREN [28,29], Oculus Rift [30,31], and VR with a horse riding simulation [32,33]. Finally, two studies used VR with double tapis-roulant [34,35].…”