Virtual Reality Mediated Upper Extremity rehabilitationPatients With Cerebral Palsy
Condition: Cerebral Palsy; Upper Extremity Paresis
MeSH terms: Cerebral Palsy; Paresis
Study type: Interventional

Summary: 
      Cerebral palsy (CP) refers to a group of permanent disorders that occur in the brain of the
      fetus or infant, which are non-progressive, cause movement and posture disorder along with
      activity limitation.

      The upper extremity is frequently affected in patients with CP. The prevalence of upper
      extremity involvement has been reported between 60-83% in different studies.

      Virtual reality applications have been increasing recently in the field of neurological
      rehabilitation. In this study, researchers aimed to investigate the effectiveness of virtual
      reality-mediated upper extremity rehabilitation in patients with hemiplegic cerebral palsy.
    

Detailed description: 
      Cerebral Palsy (CP) is a group of permanent disorders of movement and posture development due
      to non-progressive damage to the developing fetal or infant brain, causing activity
      limitation. Motor disorders in CP are mostly accompanied by sensory and perceptual problems,
      cognitive disorders, communicative and perceptual problems, epilepsy and secondary
      musculoskeletal problems. CP is one of the most common causes of disability in childhood.
      Brain damage that causes CP can occur in the prenatal, perinatal or postnatal period.
      Accompanying epilepsy, cognitive disorders, learning impairment, communication problems,
      perception limitation, behavioral problems, visual disturbances, hearing disorders, oral
      motor function problems, dysphagia, constipation, gastroesophageal reflux disease, dental
      problems, urinary symptoms, osteoporosis can be seen in patients with CP.

      Technologies that are developing in rehabilitation are increasingly being used. Among these
      technologies, the use of virtual reality by trained physiatrists and physiotherapists
      provides an environment where children with cerebral palsy can exercise. In addition to
      intense exercise, simultaneous visual and auditory feedback can be received. Virtual reality
      can also provide a comparison between the degree of movement children perform in the real
      world and the degree of movements they observe in the virtual environment. All these features
      make virtual reality a potentially viable tool for improving the motor skills of children
      with CP.

      Virtual reality-based rehabilitation is an emerging treatment modality for the motor
      rehabilitation of children with cerebral palsy. Neuroplasticity studies have shown that
      neurological development is positively associated with active participation and motivation
      during virtual reality-based rehabilitation intervention. In addition to motivation, virtual
      therapy also improves neural reorganization that optimizes rehabilitation outcomes in
      children with cerebral palsy. The virtual scenario seems to encourage motor learning, the
      retention of learned skills, and the transfer of skills to real-world situations. In many
      studies, improvement in posture, balance, upper extremity functions, joint control and
      walking has been detected with virtual therapy. Increased 'biofeedbacks' in neuromotor
      rehabilitation allowed therapists to methodologically design and control their intervention
      strategies.

      40 patients with a diagnosis of Cerebral Palsy who applied to the Pediatric Rehabilitation
      Unit of Istanbul University Istanbul Faculty of Medicine, Department of Physical Medicine and
      Rehabilitation, who meet the inclusion criteria will be included in this randomized,
      controlled, single blind and prospectively planned study. At the beginning of the study, 40
      hemiplegic CP patients who meet the inclusion criteria will be randomized into two groups
      according to the random order created by the computer program after being numbered according
      to the order of application to Istanbul University, Istanbul Faculty of Medicine, Department
      of Physical Medicine and Rehabilitation, Pediatric Rehabilitation Unit. Upper extremity
      rehabilitation (bimanually 3 days a week for 6 weeks and 45 minutes per session) and
      physiotherapy (TG: Treatment Group) will be given to the first group accompanied by virtual
      reality, and only physiotherapy (CG: Control Group) will be given to the second group.

      When the power analysis was performed to calculate the number of patients and when the
      results obtained from other studies were taken into account, it was concluded that at least
      18 patients should be included in each group to obtain 0.95 power at 95% confidence interval.
      Considering that few people will be excluded from the study during the study, it was found
      appropriate to include 20 patients in each group and to start the study with a total of 40
      people. Before starting the study, the patients will be informed about the study and their
      consent will be obtained and demographic characteristics such as age, height and weight will
      be evaluated.

      Participants and their parents will be informed in writing and verbally about the purpose,
      duration and method of application of the research, and the "Informed Consent Form" will be
      signed after their consent is obtained.

      The study is planned to be carried out in a single center in the Department of Physical
      Medicine and Rehabilitation of Istanbul University Istanbul Medical Faculty.

      The virtual reality technology to be used in the study has temporary side effects such as
      nausea, vomiting, and dizziness, and side effects to increase epileptic seizures. For this
      reason, patients with uncontrolled epileptic seizures were excluded from the study. If
      effects such as nausea, vomiting and dizziness develop during the intervention, the session
      will be terminated and symptomatic treatment will be given.
    

Intervention name(s): Virtual reality mediated upper extremity rehabilitation; Classical exercise therapy for upper extremities
Intervention type(s): Other; Other
Intervention description(s): Game-based exercise will be applied for different range of motion of the upper extremity. Gamified exercise program consisting of 4 different scenarios will be applied 3 days a week for 6 weeks to the patients in the virtual reality group. A session takes an average of 45 minutes.
Games to be applied;
Finger flexion-extension (10 minutes / session)
Wrist flexion, extension, ulnar and radial deviation (10 minutes / session)
Forearm pronation and supination (10 minutes / session)
Elbow flexion-extension-shoulder internal and external rotation (15 minutes / session) will have scenarios controlled with. All patients participating in the study will receive exercise therapy in the form of upper extremity stretching, range of motion, and fine skill training 2 days a week for 6 weeks. Each session takes an average of 45 minutes.; All patients participating in the study will receive exercise therapy in the form of upper extremity stretching, range of motion, and fine skill training 2 days a week for 6 weeks. Each session takes an average of 45 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The virtual reality group will be given upper extremity rehabilitation via virtual reality glasses (3 days a week for 6 weeks and 45 minutes each session) and upper extremity exercises 2 days a week, while the control group will only be given upper extremity exercises 2 days a week.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: virtual reality; rehabilitation; gamification