Use of virtual reality in rehabilitation of movement in children with hemiplegia − A multiple case study evaluation

Purpose: To evaluate the feasibility and therapeutic effect of engaging children of differing neuromotor and cognitive ability in a virtual reality (VR) tabletop workspace designed to improve upper-limb function. Method: Single-subject experimental design with multiple baselines was employed. Four children with hemiplegia participated in VR-based training between nine and 19, 30-minute sessions, over three-four weeks. Outcomes were assessed from the perspective of the International Classification of Functioning, Disability and Health; considering body function, activity performance and participation. Upper-limb performance was assessed using system-measured variables (speed, trajectory and accuracy) and standardized tests. Trend analyses were employed to determine trends on system variables between baseline phase and treatment phases. Standardised measures were compared between pre- and post-training. Results: Two children made progress across system variables with some translation to daily activities. Performance of the other two children was more variable, however, they engaged positively with the system by the end of the treatment phase. Conclusions: The VR (RE-ACTION) system shows promise as an engaging rehabilitation tool to improve upper-limb function of children with hemiplegia, across ability levels. Trade-offs between kinematic variables should be considered when measuring improvements in movement skill. Larger trials are warranted to evaluate effects of augmented feedback, intensity and duration of training, and interface type to optimise the system’s effectiveness. Implications for Rehabilitation The RE-ACTION system shows promise as a relatively low-cost solution to support therapies for upper-limb function and activity participation for children with hemiplegia and associated conditions. The combination of goal-directed tasks, augmented feedback, and engaging exploratory environments is a potentially quite powerful rehabilitation solution for children. Increased task engagement supported positive outcomes of the International Classification of Functioning, Disability and Health − Children and Youth version, including body function and activity levels as well as enhanced participation. Larger experimental trials are required to test the capacity of the system to progress the skills of children with multiple disabilities.

[1]  J. L. Mory.  Characterizing functional limitations in children using the International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) , 2010 .

[2]  M. Law,et al.  PARENT COMPLIANCE WITH THERAPEUTIC INTERVENTIONS FOR CHILDREN WITH CEREBRAL PALSY , 1993, Developmental medicine and child neurology.

[3]  M. Landers.  Treatment-induced neuroplasticity following focal injury to the motor cortex , 2004, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[4]  Celeratlon Line b,et al.  The Statistical Analysis of Single-Subject Data : A Comparative Examination , 2006 .

[5]  E. Mattsson,et al.  Postnatal cerebral infection leading to hemiplegic cerebral palsy: Functional limitations and disability of 13 children in Sweden , 2008, Disability and rehabilitation.

[6]  Daniel J Goble,et al.  Deficits in the ability to use proprioceptive feedback in children with hemiplegic cerebral palsy , 2009, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[7]  Paul Dourish,et al.  Seeking a Foundation for Context-Aware Computing , 2001, Hum. Comput. Interact..

[8]  R. Hemayattalab,et al.  Effects of frequency of feedback on the learning of motor skill in individuals with cerebral palsy. , 2010, Research in developmental disabilities.

[9]  S. Berweck,et al.  Cortical Neuromodulation by Constraint-Induced Movement Therapy in Congenital Hemiparesis: An fMRI Study , 2007, Neuropediatrics.

[10]  Virgil G Mathiowetz,et al.  Box and Block Test of Manual Dexterity: Norms for 6–19 Year Olds , 1985 .

[11]  Wen-Yu Liu,et al.  Anticipatory Postural Adjustments in Children with Cerebral Palsy and Children with Typical Development , 2007, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[12]  F L Mastaglia,et al.  Raised corticomotor excitability of M1 forearm area following anodal tDCS is sustained during robotic wrist therapy in chronic stroke. , 2009, Restorative neurology and neuroscience.

[13]  Clinical Incidence of Sensory Integration Difficulties in Adults with Learning Disabilities and Illustration of Management , 2003 .

[14]  A. Eliasson,et al.  Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. , 2005, Developmental medicine and child neurology.

[15]  Timothy D. Lee,et al.  Motor Control and Learning: A Behavioral Emphasis , 1982 .

[16]  A. Saykin,et al.  In-home virtual reality videogame telerehabilitation in adolescents with hemiplegic cerebral palsy. , 2010, Archives of physical medicine and rehabilitation.

[17]  A. Majnemer,et al.  Virtual reality as a therapeutic modality for children with cerebral palsy , 2010, Developmental neurorehabilitation.

[18]  K. Newell,et al.  Intermittency in the control of continuous force production. , 2000, Journal of neurophysiology.

[19]  Patrice L. Weiss,et al.  Virtual reality based intervention in rehabilitation: relationship between motor and cognitive abilities and performance within virtual environments for patients with stroke , 2004 .

[20]  A. Eliasson,et al.  Development and evidence of validity for the Children’s Hand‐use Experience Questionnaire (CHEQ) , 2011, Developmental medicine and child neurology.

[21]  William Harwin,et al.  Robot Aided Therapy: Challenges Ahead for Upper Limb Stroke Rehabilitation , 2004 .

[22]  D. Steenbeek,et al.  Goal attainment scaling in paediatric rehabilitation: a critical review of the literature , 2007, Developmental medicine and child neurology.

[23]  Dawn M. Nilsen,et al.  Motor imagery training in hemiplegic cerebral palsy: a potentially useful therapeutic tool for rehabilitation , 2009, Developmental medicine and child neurology.

[24]  K. Löwing,et al.  Activity focused and goal directed therapy for children with cerebral palsy – Do goals make a difference? , 2009, Disability and rehabilitation.

[25]  Peter H. Wilson,et al.  Virtual reality in acquired brain injury upper limb rehabilitation: Evidence-based evaluation of clinical research , 2009, Brain injury.

[26]  Giovanni Pezzulo,et al.  Coordinating with the Future: The Anticipatory Nature of Representation , 2008, Minds and Machines.

[27]  P. Maruff,et al.  Motor Imagery Training Ameliorates Motor Clumsiness in Children , 2002, Journal of child neurology.

[28]  Gavin Williams,et al.  Upper limb virtual rehabilitation for traumatic brain injury: Initial evaluation of the elements system , 2010, Brain injury.

[29]  Robert W Armstrong,et al.  Definition and classification of cerebral palsy , 2007, Developmental medicine and child neurology.

[30]  A. Mutlu,et al.  Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy , 2009, European Journal of Pediatrics.

[31]  A. Eliasson,et al.  Experiences of use of the cerebral palsy hemiplegic hand in young persons treated with upper extremity surgery. , 2007, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[32]  S. Masiero,et al.  Robotic-assisted rehabilitation of the upper limb after acute stroke. , 2007, Archives of physical medicine and rehabilitation.

[33]  O. Flodmark,et al.  Clinical and MRI correlates of cerebral palsy: the European Cerebral Palsy Study. , 2006, JAMA.

[34]  Paris Jean Aicardi,et al.  Diseases of the Nervous System: Clinical Neuroscience and Therapeutic Principles , 2004, European Child & Adolescent Psychiatry.

[35]  Hiroshi Ishii,et al.  Tangible bits: towards seamless interfaces between people, bits and atoms , 1997, CHI.

[36]  V. Mathiowetz,et al.  Reliability and validity of grip and pinch strength evaluations. , 1984, The Journal of hand surgery.

[37]  C. Morris.  Development of the Gross Motor Function Classification System (1997) , 2008, Developmental medicine and child neurology.

[38]  Jennifer A. Schmidt,et al.  Self-Esteem and Family Challenge: An Investigation of Their Effects on Achievement , 2003 .

[39]  J. Eyre,et al.  Corticospinal tract development and its plasticity after perinatal injury , 2007, Neuroscience & Biobehavioral Reviews.

[40]  L. Rönnqvist,et al.  Kinematic analysis of unimanual reaching and grasping movements in children with hemiplegic cerebral palsy. , 2007, Clinical biomechanics.

[41]  Albert A. Rizzo,et al.  Analysis of assets for virtual reality applications in neuropsychology , 2004 .

[42]  Mark Hallett,et al.  Cortical reorganization induced by virtual reality therapy in a child with hemiparetic cerebral palsy , 2005, Developmental medicine and child neurology.

[43]  R. H. Jebsen,et al.  An objective and standardized test of hand function. , 1969, Archives of physical medicine and rehabilitation.

[44]  B Hagberg,et al.  The changing panorama of cerebral palsy in Sweden. IX. Prevalence and origin in the birth‐year period 1995–1998 , 1996, Acta paediatrica.

[45]  P. Grimaud.  [Cerebral palsy]. , 1972, Pediatrie.

[46]  A. Eliasson,et al.  The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. , 2006, Developmental medicine and child neurology.

[47]  Andrea Gaggioli,et al.  Grasping Virtual Objects: a Feasibility Study for an Enactive Interface Application in Stroke , 2006, PsychNology J..

[48]  Steven L Wolf,et al.  Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. , 2006, Developmental medicine and child neurology.

[49]  Peter Levine,et al.  Modified Constraint-Induced Therapy in Acute Stroke: A Randomized Controlled Pilot Study , 2005, Neurorehabilitation and neural repair.

[50]  Richard M. Eastgate,et al.  Mixed reality environments in stroke rehabilitation: Interfaces across the real/virtual divide , 2007 .

[51]  Bert Steenbergen,et al.  Activity limitation in hemiplegic cerebral palsy: evidence for disorders in motor planning. , 2006, Developmental medicine and child neurology.

[52]  L. Wendt,et al.  The Changing Panorama of Cerebral Palsy in Sweden , 1989, Acta paediatrica Scandinavica.

[53]  R. McDonald,et al.  The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy , 2004 .

[54]  Nigel Foreman,et al.  Improving spatial functioning in children with cerebral palsy using computerized and traditional game tasks , 2003, Disability and rehabilitation.

[55]  K. Ottenbacher,et al.  Strategies for evaluating clinical change: implications for practice and research. , 1984, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[56]  Tien-Yow Chuang,et al.  Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design , 2007, Physical Therapy.

[57]  A. Gordon,et al.  Efficacy of a hand–arm bimanual intensive therapy (HABIT) in children with hemiplegic cerebral palsy: a randomized control trial , 2007, Developmental medicine and child neurology.

[58]  H. Levin,et al.  Assessing and inducing neuroplasticity with transcranial magnetic stimulation and robotics for motor function. , 2006, Archives of physical medicine and rehabilitation.

[59]  S. Wolf,et al.  Repetitive Task Practice: A Critical Review of Constraint-Induced Movement Therapy in Stroke , 2002, The neurologist.

[60]  B. Dan,et al.  A report: the definition and classification of cerebral palsy April 2006 , 2007, Developmental medicine and child neurology. Supplement.

[61]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[62]  Jean-Louis Thonnard,et al.  ABILHAND-Kids , 2004, Neurology.

[63]  R. Goodman,et al.  The longitudinal stability of psychiatric problems in children with hemiplegia. , 1998, Journal of child psychology and psychiatry, and allied disciplines.

[64]  Jenny Ziviani,et al.  Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia , 2009, Pediatrics.

[65]  L. Lucca.  Virtual reality and motor rehabilitation of the upper limb after stroke: a generation of progress? , 2009, Journal of rehabilitation medicine.

[66]  K. Himmelmann,et al.  The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth‐year period 1999–2002 , 2010, Acta paediatrica.