Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review.

STUDY DESIGN Systematic review. INTRODUCTION Children with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP. PURPOSE OF THE STUDY The primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions. METHODS A International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed. RESULTS The 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model. CONCLUSION The role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support.

[1]  Hamid Reza Rostami,et al.  Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: a randomised controlled trial. , 2012, NeuroRehabilitation.

[2]  Grigore C. Burdea,et al.  Maintained Hand Function and Forearm Bone Health 14 Months After an In-Home Virtual-Reality Videogame Hand Telerehabilitation Intervention in an Adolescent With Hemiplegic Cerebral Palsy , 2011, Journal of child neurology.

[3]  Heidi Sveistrup,et al.  Feasibility, Motivation, and Selective Motor Control: Virtual Reality Compared to Conventional Home Exercise in Children with Cerebral Palsy , 2006, Cyberpsychology Behav. Soc. Netw..

[4]  Robert Riener,et al.  Virtual Reality Aided Training of Combined Arm and Leg Movements of Children with CP , 2013, MMVR.

[5]  Annet J Dallmeijer,et al.  Manual ability and its relationship with daily activities in adolescents with cerebral palsy. , 2010, Journal of rehabilitation medicine.

[6]  M. Morris,et al.  Management of upper limb dysfunction in children with cerebral palsy: a systematic review , 2001, European journal of neurology.

[7]  Laura Luna-Oliva,et al.  Kinect Xbox 360 as a therapeutic modality for children with cerebral palsy in a school environment: a preliminary study. , 2013, NeuroRehabilitation.

[8]  H. Chiu,et al.  Effects of Virtual Reality in Children with Cerebral Palsy: A Systematic Review , 2015 .

[9]  Maarten J. IJzerman,et al.  A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study , 2008, Cyberpsychology Behav. Soc. Netw..

[10]  M. Jung,et al.  The effects of virtual reality-based bilateral arm training on hemiplegic children's upper limb motor skills. , 2016, NeuroRehabilitation.

[11]  A. P. Moore,et al.  Botulinum toxin type A in the treatment of lower limb spasticity in cerebral palsy. , 2000, The Cochrane database of systematic reviews.

[12]  Anke I R Kottink,et al.  Wii™-habilitation of upper extremity function in children with Cerebral Palsy. An explorative study , 2013, Developmental neurorehabilitation.

[13]  A. Bialocerkowski.  Assessment of the upper limb in cerebral palsy: validity and reliability of the revised VOAA‐DDD , 2013, Developmental medicine and child neurology.

[14]  A. Basu,et al.  Early Intervention to Improve Hand Function in Hemiplegic Cerebral Palsy , 2015, Front. Neurol..

[15]  M. Arner,et al.  Hand function in cerebral palsy. Report of 367 children in a population-based longitudinal health care program. , 2008, The Journal of hand surgery.

[16]  Denise Reid,et al.  The Use of Virtual Reality with Children with Cerebral Palsy: A Pilot Randomized Trial , 2006 .

[17]  R. Baker,et al.  A Systematic Review of Common Physiotherapy Interventions in School-Aged Children with Cerebral Palsy , 2010, Physical & occupational therapy in pediatrics.

[18]  Deepak Sharan,et al.  Virtual reality based therapy for post operative rehabilitation of children with cerebral palsy. , 2012, Work.

[19]  M. Wallen,et al.  Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy (UPDATE). , 2010, The Cochrane database of systematic reviews.

[20]  J. C. Belloti,et al.  Electrical stimulation therapy for children with cerebral palsy , 2017 .

[21]  Louise Ada,et al.  Upper limb training using Wii Sports Resort™ for children with hemiplegic cerebral palsy: a randomized, single-blind trial , 2014, Clinical rehabilitation.

[22]  J. Wasiak,et al.  Constraint-induced movement therapy in the treatment of the upper limb in children with hemiplegic cerebral palsy. , 2007, The Cochrane database of systematic reviews.

[23]  Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy. , 2006, Developmental medicine and child neurology.

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

[25]  Ryanne J. M. Lemmens,et al.  Arm hand skilled performance in cerebral palsy: activity preferences and their movement components , 2014, BMC Neurology.

[26]  A. Mirelman,et al.  Virtual reality for rehabilitation in Parkinson's disease. , 2014, The Cochrane database of systematic reviews.

[27]  Ayanna M. Howard,et al.  Effect of Virtual Reality on Upper Extremity Function in Children With Cerebral Palsy: A Meta-analysis , 2014, Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association.

[28]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[29]  M. Leonardi,et al.  Systematic Literature Review on ICF From 2001 to 2013 in the Nordic Countries Focusing on Clinical and Rehabilitation Context , 2015, Journal of clinical medicine research.

[30]  P. Weiss,et al.  Virtual Reality in the Assessment and Treatment of Children With Motor Impairment: A Systematic Review , 2011 .

[31]  Jane Galvin,et al.  Does intervention using virtual reality improve upper limb function in children with neurological impairment: A systematic review of the evidence , 2011, Brain injury.

[32]  R. Boyd,et al.  Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial , 2012, BMC Pediatrics.

[33]  Arve Opheim,et al.  Walking function, pain, and fatigue in adults with cerebral palsy: a 7‐year follow‐up study , 2009, Developmental medicine and child neurology.

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

[35]  D. Fehlings,et al.  Interactive computer play as "motor therapy" for individuals with cerebral palsy. , 2013, Seminars in pediatric neurology.