Full-Immersive Virtual Reality for Lower Limb Strength and Balance in Children With Hemiplegic Cerebral Palsy

Full-Immersive Virtual Reality for Lower Limb Strength and Balance in Children With Hemiplegic Cerebral Palsy: A Randomized Controlled Trial

Hemiplegic cerebral palsy (HCP) is a neurological disorder that affects one side of the body, resulting in muscle weakness and impaired balance. Virtual reality (VR) is a promising tool in pediatric rehabilitation due to its engaging and interactive nature. Aim: To investigate the effect of VR on lower-limb muscle strength and balance in children with HCP. Methods:30 children with HCP aged 7-10 years were randomly allocated to two equal groups. The control group received a selected physical therapy program, whereas the study group received the same program combined with fully immersive VR training. The total treatment period was 8 weeks. Lower-limb muscle strength was assessed using a Lafayette hand-held dynamometer. The Five Times Sit-to-Stand Test was used to assess functional lower-limb strength, and the Pediatric Balance Scale was used to assess balance.

Cerebral palsy (CP) comprises a group of disorders resulting from injury to the developing brain, affecting motor function and postural control. Hemiplegic cerebral palsy (HCP) predominantly impacts one side of the body, accounting for approximately 38% of all cases of CP. Weakness is more prominent in distal muscle groups, with the hip extensors, knee extensors, and ankle dorsiflexors demonstrating more weakness than their antagonistic muscle groups. Virtual reality (VR) has been implemented in the treatment of children having CP. VR rehabilitation facilitates training across various complexity levels, while providing feedback within a safe and controlled setting. VR allows therapists to regulate the duration and intensity of tasks that are not feasible in the actual world. This study aimed to investigate the effect of fully immersive VR as an adjunct to the rehabilitation program of children with HCP for improving the clinical outcomes of lower-limb strength and balance. G*POWER statistical software (version 3.1.9.2) was utilized with α=0.05, 80% power, and an allocation ratio of N2/N1 = 1. For this study, a minimum sample of 30 children, 15 in each group, was considered adequate, based on Modified Ashworth Scale Grade 1, 1+, and Gross Motor Function Classification System. The control group received a selected physical therapy program 60 minutes and were conducted three times weekly for 8 consecutive weeks. The study group received a similar program of the control group along with VR-based training for 20-30 minutes each, three times weekly, across 8-week duration. Lafayette hand-held dynamometer, Five repetition sit to stand test, and Pediatric Balance Scale was utilized for evaluation.

Inclusion Criteria:

1. Their Ages ranged from 7to10 years chronologically.
2. Both genders will be included.
3. They are able to understand and follow simple verbal commands or instructions included in both assessment and training procedures.
4. Their degree of spasticity will range from 1 to 1+ according to the Modified Ashworth Scale
5. Their motor function will be at level I according to Gross Motor Function Classification System

Exclusion Criteria:

• Bony joint limitation or skeletal deformities in lower limb.
• Surgeries (Tenotomy or muscle transfer in the affected lower limb) at last 6 months before the study.
• Botox injection at last 6 months before the study.
• Visual or auditory abnormalities.