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Published on: March 8, 2018
Virtual reality rehabilitation in children with brain injury: a randomized controlled trial
Ja Young Choi1,2, Sook-Hee Yi3, Lijuan Ao4
1Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Daejeon, Korea.
Insights
Virtual reality rehabilitation using wearable sensors significantly improved upper-limb function in children with brain injury. This system enhanced dexterity and daily living activities, especially in those with severe motor impairments.
Area of Science:
- Pediatric Rehabilitation
- Neurorehabilitation
- Biomedical Engineering
Background:
- Brain injury in children, including cerebral palsy, often impairs upper-limb function.
- Traditional occupational therapy provides benefits but may have limitations in engagement and intensity.
- Innovative rehabilitation technologies are needed to enhance motor recovery.
Purpose of the Study:
- To evaluate the efficacy of a virtual reality (VR) rehabilitation system with wearable multi-inertial sensors for improving upper-limb function in children with brain injury.
- To compare the VR intervention combined with occupational therapy against conventional occupational therapy alone.
Main Methods:
- A multicentre, single-blind, randomized controlled trial involving 80 children (aged 3-16 years) with brain injury.
- Intervention group: 30 minutes VR + 30 minutes occupational therapy.
- Control group: 60 minutes occupational therapy, for 20 sessions over 4 weeks.
- VR system utilized games with wearable inertial sensors for wrist and forearm movements.
- Outcome measures included the Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2), Upper Limb Physician's Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and 3D motion analysis.
Main Results:
- Both groups showed significant improvement post-treatment.
- The VR group demonstrated superior improvements in upper-limb dexterity (MA-2 scores), activities of daily living performance, and forearm supination (kinematic analysis, p<0.05).
- Children with more severe motor impairments in the VR group experienced greater functional gains.
Conclusions:
- The VR rehabilitation system, featuring wearable inertial sensors for intensive, interactive, and repetitive motor training, is effective for children with brain injury.
- VR rehabilitation offers advantages over conventional therapy in enhancing dexterity, daily function, and active forearm supination.
- VR therapy shows particular promise for children with more significant motor deficits.
Aim:
To investigate the efficacy of a virtual reality rehabilitation system of wearable multi-inertial sensors to improve upper-limb function in children with brain injury.
Method:
Eighty children (39 males, 41 females) with brain injury including cerebral palsy aged 3 to 16 years (mean age 5y 8mo, SD 2y 10mo) were assessed as part of a multicentre, single-blind, randomized controlled trial. The intervention group received a 30-minute virtual reality intervention and a 30-minute session of conventional occupational therapy while the control group received 60 minutes of conventional occupational therapy per session, with 20 sessions over 4 weeks. The virtual reality rehabilitation system consisted of games promoting wrist and forearm articular movements using wearable inertial sensors. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2), Upper Limb Physician's Rating Scale, Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and computerized three-dimensional motion analysis were performed.
Results:
Both groups (virtual reality, n=40; control, n=38) significantly improved after treatment compared to baseline; however, the virtual reality group showed more significant improvements in upper-limb dexterity functions (MA-2, virtual reality group: Δ=10.09±10.50; control: Δ=3.65±6.92), performance of activities of daily living, and forearm supination by kinematic analysis (p<0.05). In the virtual reality group, children with more severe motor impairment showed significant improvements compared to those with less severe impairment.
Interpretation:
The virtual reality rehabilitation system used in this study, which consists of wearable inertial sensors and offers intensive, interactive, and repetitive motor training, is effective in children with brain injury.
What This Paper Adds:
Both virtual reality rehabilitation and conventional occupational therapy were effective for upper-limb training. Virtual reality training was superior in improving dexterity, performance of activities of daily living, and active forearm supination motion. The effect of virtual reality training was significant in children with more severe motor impairments.
