Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy

Abstract

Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy (CP). Virtual reality-based rehabilitation therapy is effective in motivating children with CP. This study investigated the effects of treadmill training with virtual reality on gait, balance, muscular strength, and gross motor function in children with CP. Eighteen children with spastic CP were randomly divided into the virtual reality treadmill training (VRTT) group (9 subjects, mean age, 10.2 years) and treadmill training (TT) group (9 subjects, mean age, 9.4 years). The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks. Muscle strength was assessed using a digitalized manual muscle tester. Gross motor function was assessed using the Gross Motor Functional Measure (GMFM). Balance was assessed using the Pediatric Balance Scale (PBS). Gait speed was assessed using the 10-meter walk test (10MWT), and gait endurance was assessed using the 2-minute walk test (2MWT). After training, gait and balance was improved in the VRTT compared to the TT group (P < 0.05). Muscular strength was significantly greater in the VRTT group than the TT group, except for right hamstring strength. The improvements in GMFM (standing) and PBS scores were greater in the VRTT group than the TT group (P < 0.05). Furthermore, the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group (P < 0.05). In conclusion, VRTT programs are effective for improving gait, balance, muscular strength, and gross motor function in children with CP.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta‐analysis

“…compared treadmill training with treadmill training enhanced with virtual reality, and a significantly larger effect was noted in the virtual reality group in walking speed and endurance. The authors concluded that virtual reality provides strong motivation, increasing concentration for participants and leading to enhanced outcomes . This is supported in the findings of Gharib et al., who showed that treadmill training with feedback on gait performance leads to large effect increases in walking speed.…”

“…Effect sizes for all studies are shown in Figure . The MCID for increase in walking speed (0.1m/s), was achieved after intervention in 12 studies . Level IV and V studies supported this positive effect of increase in walking speed as a result of gait training.…”

“…GMFM or subcategories of this measure were reported in 11 studies . Three studies reported the overall GMFM score, of which two found a statistically significant within‐group change and intergroup improvement favouring intervention, in addition exceeding the reported MCID of 1.3, while one study found no significant change in this measure .…”

The Effect of Task-oriented Training on Mobility Function, Postural Stability in Children with Cerebral Palsy

“…Gait training on the treadmill improved the isokinetic muscular strength of the children with cerebral palsy and increased the proportion of muscles in their body composition (Cho et al, 2016). Repeated performance of a task has the potential to train motor performance aspects such as coordination, balance, strength, endurance, and physical conditioning (Bunton et al, 1993).…”

Virtual Reality and Occupational Therapy

“…On the other hand, walking ability or strength is generally researched according to lower extremity activity. Recent studies focused on combination with VR system and robot-assisted gait training (RAGT), and they are emphasized the useful interventions which applies together [38,39].…”