Effect of Dual Task Virtual Reality Training on Hand Function , Attention and Activity of Daily Life in Children With Hemiplegia

Effect of Dual-task Virtual Reality Training on Hand Function, Attention and Activity of Daily Life in Children With Hemiplegia

this study will be conducted to evaluate the effect of dual task virtual reality training on hand function (bilateral hand use and upper limb coordination), attention (divided and sustained) and activity of daily life in children with hemiplegic cerebral palsy.

Children with hemiplegia represent about 25% of all CP children. One of the most debilitating symptoms of hemiplegia, which may occur in more than 80 of children suffering from CP, is dysfunction of the upper limbs, especially the arms and hands.

Hand function is significantly compromised in children with hemiplegic CP. As a result, children with hemiplegic CP typically find it difficult to use the affected upper extremity.These children learn how to do tasks using their non-involved upper extremity (developmental disuse).Hemiplegic children have difficulty in using both hands together.This deficit limits their participation and require assistance in activities of daily living such as dressing, eating, and playing.The ability of hemiplegic children to reach, hold, and manipulate objects with their hands is one of their biggest challenges.Children with hemiplegia often show slower reaction times, reduced concentration, and difficulty maintaining focus during motor tasks. These attentional challenges limit the ability to coordinate movements, particularly during bimanual or dual-task activities.

Virtual Reality (VR) is an effective and engaging tool in the rehabilitation of children with CP. It offers interactive, multisensory environments that enhance motor learning and neuroplasticity through repetitive, task-specific practice. VR improves upper limb function, coordination, attention, and motivation while promoting bimanual training and daily functional skills more effectively than traditional therapy.Although VR based training has gained increasing interest in recent years, little studies have been conducted to evaluate it's dual task application .So the purpose of the current study is to evaluate the effect of dual task VR training on hand function , attention and activity of daily life in children with hemiplegic CP.

Inclusion Criteria:

• Their age will be ranged from 7-12 years.
• Their degree of spasticity will be ranged from 1 to 1according to the Modified Ashworth Scale
• They will be on level 1 or II on Gross Motor Function Classification System (GMFCS)
• Their manual ability to handle objects in daily activities will be at level II according to Manual Ability Classification System (MACS)
• Children can understand and follow instructions.

Exclusion Criteria:

• The participants will be excluded if they have one of the following criteria:
• Severe sensory ,visual, auditory and cognitive impairments.
• Structural or fixed soft tissue deformities of the upper extremities.
• Botulinum toxin injections within the last six months.
• Unstable seizures.