Virtual Reality Training With Sensory Integration On The Gross Motor Functions Of Lower Limb
Condition: Cerebral Palsy Spastic Diplegia
MeSH terms: Muscle Spasticity; Cerebral Palsy
Study type: Interventional

Summary: 
      The objectives of this study are To determine the effect of virtual reality on balance and
      gross motor functions of the lower limb in spastic diplegic cerebral palsy. To determine the
      effect of virtual reality with sensory input on balance and gross motor functions of the
      lower limb in spastic diplegic cerebral palsy. To compare the effects of virtual reality
      training with and without sensory input on balance and gross motor functions of the lower
      limb in spastic diplegic CP. Its is a Randomized control trial (RCT) done at Physiotherapy
      department of Railway General Hospital Rawalpindi and National Institute of rehabilitation
      Medicine.44 individuals (calculated using epi tool) 22 individuals in each group. Individuals
      who met the inclusion criteria will be included in this study. All participants will go
      through randomization and divided into two groups Experimental and Control groups.
      Pre-intervention assessment is made for both groups. Then intervention will be applied to
      both groups. estimated time of treatment protocol will be 40 min/day, 1 time / d, 3
      times/week for 6 weeks. Subjects will be evaluated at baseline, then 3rd week and 6th-week
      assessment will be the final
    

Detailed description: 
      Cerebral Palsy(CP) is a common non-progressive disorder that occurs due to any injury or
      aberration to the developing central nervous system. It refers to the disorders that stem
      from primary brain lesion leading to musculoskeletal and nervous abnormalities in the
      pediatric population. Cerebral palsy has a global incidence of 1-3.5 cases per 1000 live
      births. The most prevalent type is spastic diplegia which occurs in 30-40% of spastic
      cerebral palsy. According to motor impairment, it is classified into spastic, dyskinetic and
      ataxic cerebral palsy. The children with cerebral palsy have very poor control of voluntary
      muscle activity. Therefore training of selective motor control in children with cerebral
      palsy is an important part of physiotherapy intervention. Children are often not amenable to
      the conventional exercise program but studies have demonstrated that children show high
      interest and stimulation to virtual reality training. Virtual reality is a virtual
      environment system that enables a person to witness situations and actions similar to
      real-life. Therapists use Virtual reality systems to create a fascinating environment to gain
      targeted therapeutic goals. Sensory integration, on the other hand, is a therapeutic approach
      that involves active therapy and activities involving graded sensory experiences. It provides
      keen proprioceptive and tactile experiences. Sensory integration therapy usually involves
      balls, rolls, hammock, trampolines and altering surfaces. Children with spastic diplegia have
      gross and fine motor, sensory, cognitive impairments. This results in reduced ability to
      adjust the body and balance it with movements. Postural control demands active sensorimotor
      control. Exercise with mini-trampoline is designed for balance training to improve static and
      dynamic balance and postural adjustment in children with spastic diplegia. According to a
      study in 2016, Virtual reality training can effectively improve the gross motor function of
      the lower limbs in children with spastic diplegia in comparison to conventional therapy. As
      claimed by a study in, 2006 VR training in combination with conventional exercise therapy in
      spastic CP improves exercise compliance and enhance exercise effectiveness. It is a simple
      and executable approach which can be used by any skilled therapist as an independent
      treatment method to improve the outcome.

      According to a study, sensory integration therapy had a measurable effect in children with
      spastic diplegic cerebral palsy who suffer from a sensory-motor deficit. A study observed the
      effects of sensory integration therapy in children with cerebral palsy and concluded that
      sensory integration therapy has a positive effect on gross motor function in spastic diplegic
      CP in sitting and standing positions. Whereas, the control group with only home exercise
      program showed no significant improvement.In 2018 compared the effects of rebound exercises
      and simple balance training on balance of spastic diplegic children. The assessments
      suggested that balance was improved in both groups but the group under study showed a
      significant difference and concluded that rebound exercises improve the balance and postural
      control. The past research records are evident that therapists have worked with either
      Virtual reality training or Sensory integration therapy for the rehabilitation of Spastic
      Diplegic children. The two protocols have not been complimented for rehabilitation. So the
      aim of this study is to observe and determine the combined effect of these two treatment
      protocols to get the results and improve the gross motor function in lower limbs of CP
      children.
    

Intervention name(s): VR training + Sensory Integration therapy + conventional therapy; VR training + conventional therapy
Intervention type(s): Other; Other
Intervention description(s): After the baseline assessment,
Coconut ShootersVR - 5 min/day
Ninja flipVR - 5 min/day.
Sensory integration training include Exercises on BOSU ball and mini-trampoline. It will involve:
Passive bouncing with child standing with his/her feet shoulder width apart for 2.5 and 2.5 minutes on both.
Active bouncing (the child bounces and therapist will control the rate) for 2.5 and 2.5 minutes on both.
Mini-squat exercises with feet apart and feet together for 2.5 and 2.5 minutes on both.
Conventional exercises include:
passive stretching exercises for the hip flexors, hip adductors, hamstring, and calf muscle; stretching will be applied for 30 sec with 30 sec rest for each muscle group within pain limit.
Strengthening of abdominal and back muscles, hip abductions and knee joint extensors and ankle dorsiflexors will be performed.; After the baseline assessment,
The Your Shape: Fitness Evolved 2012TM game is selected for VR training (walking and walking with obstacles) for 8 min
Coconut ShootersVR - 8 min/day
Ninja flipVR - 8 min/day
Conventional Therapy - 20 min per day
Passive stretching exercises for the hip flexors, hip adductors, hamstring, and calf muscle; stretching will be applied for 30 sec with 30 sec rest 3-5 times for each muscle group within pain limit.
Strengthening of abdominal and back muscles, hip abductions and knee joint extensors and ankle dorsiflexors will be performed.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Virtual Reality; Spastic Diplegic Cerebral Palsy; Sensory Integration