Role of Virtual Reality in Hand Rehabilitation for Children With Cerebral Palsy
Condition: Physical Disability; Cerebral Palsy
MeSH terms: Paralysis; Cerebral Palsy
Study type: Interventional

Summary: 
      Cerebral Palsy (CP) is a neurodevelopmental dysfunction which is permanent, non-progressive,
      and caused by brain insult or injury.Although the basic finding of CP is having motor
      function problems, visual, auditory, cognitive and behavioural problems are also seen in
      CP.Having these problems interfere the functional independence of children with CP, so their
      daily life of activities is limited.One of the way of increasing the functional independence
      of these children is providing them hand rehabilitation.In the event of having hand
      rehabilitation, children would achieve more daily living skills.Although having hand
      rehabilitation is crucial for these children, they would lose their motivation on this by the
      time because rehabilitation is a long process,For that reason, new therapy techniques are
      tried by therapists to motivate these children during their rehabilitation seances.Virtual
      reality rehabilitation is one of these new techniques used for designing enjoyable and
      effective seances.Especially leap motion sensors are preferred to create virtual environment,
      because they are cheap, portable, touchless and easy to use.These sensors can detect hand
      movements and recognize hand gestures by using infrared.Our study was aimed to investigate
      the effect of fine motor grip studies in virtual reality environment on performance based
      hand skills in children with CP.Thirty two children with CP (6-18) were included in this
      study.Children were randomly assigned into two equal-sized groups: control and study
      groups.Participants in both groups received a neurodevelopmental therapy program.The study
      group additionally received virtual reality rehabilitation programme. In control group,
      neurodevelopmental treatment was provided 45 mins,2 d/week for 2 successive months.In study
      group, neurodevelopmental treatment was provided 30 mins and virtual rehabilitation programme
      was provided 15 mins, 2 d/week for 2 successive months. To evaluate the performance based
      hand skills; Box and Block Test, Nine Hole Peg Test and Pink Tower (Montessori) Test were
      used.
    

Detailed description: 
      Cerebral palsy (CP) can be defined as a permanent, non-progressive, motor function, posture
      and developmental disorder that causes movement limitation due to a lesion that can occur in
      the brain due to prenatal, perinatal and postnatal reasons.Although the etiology of the
      disease cannot be determined precisely, the reasons causing SP; It is stated that it occurs
      in prenatal, perinatal and postnatal periods. Sometimes, more than one factor can be found
      together.Another common problem in individuals with CP is seen in upper extremity functions,
      and limiting upper extremity functions also affects the independence of daily living
      activities. The condition of the hand in the early period of rehabilitation has an important
      place for upper extremity functions in the future.In this respect, it is very important to
      include a program to develop manual skills in the rehabilitation process in order to make
      children with CP more independent in daily life activities.Neurodevelopmental Treatment
      Approach, widely used in the treatment of children with Cerebral Palsy; It is a method that
      tries to control sensorimotor components of muscle tone, reflexes, abnormal movement
      patterns, postural control, sensory-perception and memory problems with special
      techniques.Virtual reality is a three-dimensional simulation that makes you feel to be in any
      "place" and provides this by giving various inputs to our sensory organs. According to motor
      control and motor learning theory, it is important to carry out repetitive, target-oriented
      studies that increase motivation in the rehabilitation of children with Cerebral Palsy and it
      is important to include games and entertainment in the treatment program. To achieve this,
      making virtual reality a component of rehabilitation can cause the treatment process to be
      more functional and effective.Research has shown that computer games designed for a specific
      purpose can increase the motivation of children to increase the use of the affected
      extremities and positively improve the strength and functionality of the affected
      muscles.Leap Motion Sensors have been developed to detect hand movements. It can detect the
      movement of the hand by emitting infrared rays in a restricted area. Physiotherapists have
      stated that virtual reality rehabilitation applied with Leap Motion Sensors can be an
      effective method that increases motivation in the treatment process in children with special
      needs.Our study was aimed to investigate the effect of fine motor grip studies in virtual
      reality environment on performance based hand skills in children with CP.After the approval
      of the ethics committee, children with cerebral palsy were included in the study.Parental
      approval was obtained.Reports from Health Council was examined to check diagnosis of
      children.The study was performed in three centers: University of Abant Izzet Baysal, Silivri
      Rehabilitation Center and Reyhan Rehabilitation Center.Thirty two children with CP (6-18)
      were included in this study.Exclusion criteria were; epilepsy history, cognitive problems,
      visual impairment, having problem on holding and releasing the objects.Children were randomly
      assigned into two equal-sized groups: control and study groups.Participants in both groups
      received a neurodevelopmental therapy program.The study group additionally received virtual
      reality rehabilitation programme.As a normal developmental treatment method, functional
      skills exercises, inhibition of abnormal movement patterns, sensory-motor integration in
      purposeful movements, stretching and strengthening exercises, and daily life activities were
      trained.As a virtual reality treatment method, object catching, firefly, bee-batting games
      were used, which improved performance-dependent dexterity by integrating leap motion sensors
      into the laptop.In control group, neurodevelopmental treatment was provided 45 mins,2
      days/week for 2 successive months.In study group, neurodevelopmental treatment was provided
      30 mins and virtual rehabilitation programme was provided 15 mins, 2 days/week for 2
      successive months.In virtual reality treatment, each game was studied for 5 minutes and 3
      games for a total of 15 minutes.Before and after the study, tests that measure
      performance-related dexterity were applied and the previous and next results of the groups
      were compared.SPSS statistics program was used for statistical evaluation of data belonging
      to participants.In statistical evaluations, p <0.05 was considered as significant.In the data
      analysis of the study, in order to select the appropriate statistical analysis, whether the
      distribution of the data is suitable for normal distribution was determined by the
      "one-sample Kolmogorov-Smirnov" test."Independent T Test" was used to compare age, height,
      body weight, the measures pre-treatment and post-treatment, .Gender and affected sides were
      compared by using "Chi-Square Test".
    

Intervention name(s): Leap Motion Sensor; Neurodevelopmental Treatment Approach
Intervention type(s): Device; Other
Intervention description(s): As a virtual reality treatment method, leap motion sensor was integrated with laptop computer and participants played object capture, firefly, bee-batting games to improve performance based hand skills.; It is a method that tries to control sensorimotor components of muscle tone, reflexes, abnormal movement patterns, postural control, sensory-perception and memory problems with special techniques.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: cerebral palsy; virtual rehabilitation; hand rehabilitation; leap motion