Immersive Virtual Reality to Improve Walking Abilities in Cerebral Palsy: A Pilot Study

Abstract

Immersive virtual reality (IVR) offers new possibilities to perform treatments in an ecological and interactive environment with multimodal online feedbacks. Sixteen school-aged children (mean age 11 ± 2.4 years) with Bilateral CP-diplegia, attending mainstream schools were recruited for a pilot study in a pre-post treatment experimental design. The intervention was focused on walking competences and endurance and performed by the Gait Real-time Analysis Interactive Lab (GRAIL), an innovative treadmill platform based on IVR. The participants underwent eighteen therapy sessions in 4 weeks. Functional evaluations, instrumental measures including GAIT analysis and parental questionnaire were utilized to assess the treatment effects. Walking pattern (stride length left and right side, respectively p = 0.001 and 0.003; walking speed p = 0.001), endurance (6MWT, p = 0.026), gross motor abilities (GMFM-88, p = 0.041) and most kinematic and kinetic parameters significantly improved after the intervention. The changes were mainly predicted by age and cognitive abilities. The effect could have been due to the possibility of IVR to foster integration of motor/perceptual competences beyond the training of the walking ability, giving a chance of improvement also to older and already treated children.

Virtual Reality Enhances Gait in Cerebral Palsy: A Training Dose-Response Meta-Analysis

“…In terms of movement kinematics, we presume that the explicit multisensory (i.e., visual–auditory–proprioceptive) feedback concerning the movement execution within the virtual environment could have allowed the patients to specifically time and control their movement patterns [see guidance hypothesis (61, 62)], thereby promoting a smooth movement pattern with reduced musculoskeletal co-contraction (18). In this review, several studies reported enhancement in gait kinematic scores (45, 50, 63, 64), which usually are adversely affected in children with cerebral palsy.…”

“…5.7 ± 1.4 out of 10, indicating, on average, a “good” quality of the studies. Here, one study scored 9 (40), one study scored 8 (41), three scored 7 (39, 42, 43), two scored 6 (44, 45), six scored 5 (37, 46–50), and three studies scored 4 (38, 51, 52). The risk of biasing across the studies has been illustrated in Figure 2.…”

Pengembangan Desain Treadmill Sebagai Alat Latihan Berjalan Pada Cerebral Palsy Dengan Memanfaatkan Realitas Virtual

“…Ini dikarenakan keraguan terapis terhadap desain dan penggunaan kacamata realitas virtual yang kurang aman dan belum bisa memenuhi standar untuk digunakan pada CP. Dibalik kekhawatiran itu, telah banyak penelitian yang menunjukkan bahwa penggunaan realitas virtual dapat menjanjikan teknologi rehabilitasi yang lebih baik [6], [7], [8], [9], dan [10].…”

Immersive virtual reality interferes with default head-trunk coordination strategies in young children

“…This paradigm led to stronger sensory recalibration (32) and recruited different adaptation mechanisms (33) than non-immersive sensory alterations. Thanks to the recent development of lightweight HMDs, the use of VR has expanded to numerous applications designed for children, including neurodevelopmental research (30,(34)(35)(36), neurorehabilitation (37)(38)(39)(40), or distraction from painful medical procedures (41,42). Yet, the majority of these applications offer none or limited interactions with the virtual environment.…”