Virtual Reality-Assisted Rehabilitation for Adolescents with Cerebral Palsy: A Systematic Review and Meta-Analysis

Background/Objectives: Cerebral palsy is a lifelong neurodevelopmental condition associated with motor impairment and activity limitation, and adolescence is a clinically important period during which functional decline or plateau may occur. Virtual reality-assisted rehabilitation may provide task-specific practice with augmented feedback and enhanced engagement. This systematic review and meta-analysis aimed to evaluate the effects of virtual reality-assisted rehabilitation on functional outcomes in adolescents aged 10 to 19 years with cerebral palsy. Methods: Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched from inception to 25 February 2026 for studies enrolling adolescents with cerebral palsy or mixed-age samples with extractable adolescent data. Two reviewers independently screened studies and extracted data. Primary domains were lower-limb/balance-related function and upper-limb function. Within-group pre-post standardised mean differences were pooled using random-effects models, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Eight studies including 83 participants were eligible; seven studies including 68 participants contributed to the meta-analysis. The pooled effect was small and uncertain for lower-limb/balance-related outcomes (Hedges' g = 0.21, 95% confidence interval -0.17 to 0.58) and moderate for upper-limb outcomes (Hedges' g = 0.47, 95% confidence interval 0.09 to 0.84). The overall pooled estimate was positive after virtual reality-assisted rehabilitation (Hedges' g = 0.34, 95% confidence interval 0.07 to 0.60). Certainty of evidence for both primary domains was very low. Conclusions: Virtual reality-assisted rehabilitation may be associated with post-intervention functional gains in adolescents with cerebral palsy, with more consistent findings for upper-limb than lower-limb/balance-related outcomes. However, the certainty of evidence was very low, and the predominantly pre-post evidence cannot establish comparative treatment efficacy. VR-assisted rehabilitation may be considered an adjunct to conventional rehabilitation to increase task-specific practice and engagement, but adolescent-focused controlled studies with harmonised outcomes and clinically meaningful follow-up are needed.