Effect of Virtual Reality on Upper Extremity Function in Children With Cerebral Palsy: A Meta-analysis

Chen, Yu-ping; Lee, Shih-Yu; Howard, Ayanna M.

doi:10.1097/pep.0000000000000046

Cited by 86Cerebral Palsy and Movement DisordersStroke Rehabilitation and RecoveryBotulinum Toxin and Related Neurological Disorders

Effect of Virtual Reality on Upper Extremity Function in Children With Cerebral Palsy: A Meta-analysis

Chen, Yu-ping, Lee, Shih-Yu, Howard, Ayanna M.·2014·Pediatric Physical Therapy

DOI 10.1097/pep.0000000000000046

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Abstract

PURPOSE: To systematically examine the effect of virtual reality (VR) on upper extremity (UE) function in children with cerebral palsy (CP) and assess the association among VR effects and children's characteristics and an intervention protocol. METHOD: A systematic literature search was conducted in PubMed, CINAHL, Cochrane, and PsycINFO up to June 2013. Research studies involving children with CP that used VR as the intervention method and UE outcome measures were included. RESULTS: The search yielded 14 research articles, including 3 randomized controlled trials and 11 case series. Overall, VR provided a strong effect size (d = 1.00) when comparing pre- and postintervention. In subgroup analyses, younger children receiving home-based or laboratory-based VR and using an engineer-built VR system showed better improvement. CONCLUSIONS AND IMPLICATIONS: Virtual reality is a viable tool to improve UE function in children with CP. However, a more vigorous research design is needed to make a conclusive recommendation.

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In the authors' earlier meta-analysis, ICF-based effects were large for participation, small for activity, and medium for body structure and function.
“When the outcome variables were further broken down according to the ICF model, a large effect was reported in participation (d = 1.92), a small effect on activity (d = 0.46), and a medium effect on body structure and function (d = 0.70).16”
From Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (2018) · cites this paper as [16]
The authors' earlier meta-analysis found that VR produced a strong overall effect size of 1.00 when comparing post-VR with pre-VR interventions in children with CP.
“In our previous meta-analysis, 16 which included 3 randomized controlled trials (RCTs) and 11 case series that examined the effect of VR on arm function in children with CP, we found VR overall provided a strong effect size (d = 1.00) when comparing between post-VR and pre-VR interventions.”
From Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (2018) · cites this paper as [16]
The authors' earlier subgroup analyses found better effects for younger children, for home- or laboratory-based VR, and for engineer-built VR systems.
“In addition, the subgroup analyses showed younger children receiving home or laboratory-based VR and using an engineer-built VR system had a better effect.16”
From Effectiveness of Virtual Reality in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials (2018) · cites this paper as [16]

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BackgroundInfluential
Nintendo® Wii Therapy Improves Upper Extremity Motor Function in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis
Montoro-Cárdenas, D., Cortés-Pérez, I., Ibancos-Losada, M., Zagalaz-Anula, N., Obrero-Gaitán, E., & Osuna-Pérez, M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191912343 · Cited by 46 · see citing works
“Our study differs from previous reviews [34,66] as it is the first meta-analysis to assess the effect of NWT in this variety of UE motor dimensions.”
Result
Application of Virtual Reality-Assisted Exergaming on the Rehabilitation of Children with Cerebral Palsy: A Systematic Review and Meta-Analysis
Tobaiqi, M. A., Albadawi, E. A., Fadlalmola, H. A., & Albadrani, M. S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12227091 · Cited by 46 · see citing works
Home-based immersive virtual reality physical rehabilitation in paediatric patients for upper limb motor impairment: a feasibility study
Phelan, I., Carrion-Plaza, A., Furness, P. J., & Dimitri, P. (2023) · Virtual Reality · doi:10.1007/s10055-023-00747-6 · Cited by 44 · see citing works
“VR-supported rehabilitation has a high intrinsic motivational power that increases engagement and enjoyment of therapeutic routines for adults and children (Campo-Prieto et al. 2021; Chen et al. 2014; Laver et al. 2017).”
Effectivity of Virtual Reality to Improve Balance, Motor Function, Activities of Daily Living, and Upper Limb Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis
Komariah, M., Amirah, S., Abdurrahman, M. F., Handimulya, M. F. S., Platini, H., Maulana, S., Nugrahani, A. D., Mulyana, A. M., Qadous, S. G., Mediani, ‎. S., et al. (2024) · Therapeutics and Clinical Risk Management · doi:10.2147/tcrm.s432249 · Cited by 43 · see citing works
“46,47 Our study and several others show that VR has enormous benefits for treating children with CP and other medical conditions related to visual and cognitive problems or lack of spasticity.”
Background
Effect of a Home-Based Virtual Reality Intervention for Children with Cerebral Palsy Using Super Pop VR Evaluation Metrics: A Feasibility Study
Chen, Y., García-Vergara, S., & Howard, A. M. (2015) · Rehabilitation Research and Practice · doi:10.1155/2015/812348 · Cited by 38 · see citing works
“A recent meta-analysis of literature on the use of VR to treat arm function in children with CP reported that homebased interventions had better intervention effects than clinic-based interventions [24].”
BackgroundMethod
Feasibility of Pediatric Game-Based Neurorehabilitation Using Telehealth Technologies: A Case Report
Reifenberg, G., Gabrosek, G., Tanner, K. J., Harpster, K. L., Proffitt, R. M., & Persch, A. C. (2017) · American Journal of Occupational Therapy · doi:10.5014/ajot.2017.024976 · Cited by 37 · see citing works
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Kilcioğlu, S., Schiltz, B., Araneda, R., & Bleyenheuft, Y. (2023) · JMIR Serious Games · doi:10.2196/42067 · Cited by 38 · see citing works
“These findings were similar to the results of previous systematic reviews and meta-analyses [16,39-42].”
Result
Telehealth and Remote Interventions for Children With Cerebral Palsy: Scoping Review
Pagaki-Skaliora, M., Morrow, E. M., & Theologis, T. N. (2022) · JMIR Rehabilitation and Assistive Technologies · doi:10.2196/36842 · Cited by 35 · see citing works
“Finally, Chen et al [20] meta-analyzed 14 articles, which indicated that virtual reality improved outcomes for children with CP with a strong effect size.”
BackgroundMethodResultInfluential
Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – a pilot study
Martins, F., Massetti, T., Crocetta, T. B., Lopes, P. B., da Silva, A., Figueiredo, E. F., de Abreu, L. C., da Silva, T. D., & Monteiro, C. B. D. M. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s184510 · Cited by 32 · see citing works
“The greater the child’s motivation to perform the task was, the greater the level of engagement during practice and the better the performance during the task.10,43 Other studies have reinforced that the motivation of children with CP promotes greater engagement and emphasized that motivation and engagement are essent…”
BackgroundInfluential
Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives
Biddiss, E. A., Chan-Víquez, D., Cheung, S. T., & King, G. A. (2019) · Disability and Rehabilitation · doi:10.1080/09638288.2019.1613681 · Cited by 32 · see citing works
Effect of Virtual Reality on Balance Function in Children With Cerebral Palsy: A Systematic Review and Meta-analysis
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“Compared to traditional center-based rehabilitation, home-based VR therapy has the advantages of small space (traditional centers require dedicated rehabilitation) and low cost (traditional centerbased rehabilitation requires experienced therapists) (34, 35).”
Background
A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy
Martín-Ruiz, M.-L., Máximo-Bocanegra, N., & Oliva, L. L. (2016) · Sensors · doi:10.3390/s16040444 · Cited by 28 · see citing works
“intended to systematically evaluate the effect of VR in achieving mobility in the upper limbs, associating its effects to the importance of adhesion to treatment [29].”
Background
Effectiveness of virtual reality interventions of the upper limb in children and young adults with cerebral palsy: A systematic review with meta-analysis
Burin-Chu, S., Baillet, H., Leconte, P., Lejeune, L., Thouvarecq, R., & Benguigui, N. (2023) · Clinical Rehabilitation · doi:10.1177/02692155231187858 · Cited by 27 · see citing works
“5,7,8 14 Indeed, the characteristics of virtual environments favor the integration of important rehabilitation principles 15 in therapeutic interventions such as repetitive, intensive, and variable practice with increasing dif ﬁ culty and multisensory feedback.”
Background
Effect of Virtual Reality Technology on Attention and Motor Ability in Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis
Yu, C., Wang, C., Xie, Q., & Wang, C. (2024) · JMIR Serious Games · doi:10.2196/56918 · Cited by 26 · see citing works
The application of virtual reality to home-based rehabilitation for children and adolescents with cerebral palsy: A systematic review and meta-analysis
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Treatment and re/habilitation of children with cerebral palsy in India: a scoping review
Jindal, P., MacDermid, J. C., Rosenbaum, P., Rezze, B. D., Narayan, A., & Nayak, S. L. (2019) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14211 · Cited by 25 · see citing works
“com] Lower limb surgery (83,85,92,100,104, 123,125,131) Stem cell (1,2,78,108,109, 124,135,136) Medications (diazepam,asprin, vitamins) (17,63,88,94,134) Botulinum neurotoxin A (19,29,33,128) Upper limb surgery (101,121,123,137)”
Virtual Reality Technology in Complex Medical Rehabilitation of Patients with Disabilities (Review)
Воловик, М. Г., Владимирович, Б. В., Kuznetsov, A. N., Bazarov, D. I., & Polyakova, A. G. (2018) · Современные технологии в медицине · doi:10.17691/stm2018.10.4.21 · Cited by 22 · see citing works
“Numerous works focusing on the use of VR technologies in such children are devoted to both technological and medical aspects of rehabilitation [5, 6, 76].”
Background
Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses
Hu, Y., Yuan, X., Ye, P., Chang, C., Hu, Y., Zhang, W., & Li, K. (2023) · JMIR Serious Games · doi:10.2196/52022 · Cited by 30 · see citing works
The Effectiveness of a Computer Game-Based Rehabilitation Platform for Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial
Kanitkar, A., Szturm, T. J., Parmar, S. T., Gandhi, D. B. C., Rempel, G. R., Restall, G. J., Sharma, M., Narayan, A., Pandian, J. D., Naik, N., et al. (2017) · JMIR Research Protocols · doi:10.2196/resprot.6846 · Cited by 19 · see citing works
“There are different approaches to therapy for children with CP [10-17].”
The Effects of Constraint-Induced Movement Therapy on Functions of Cerebral Palsy Children.
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Home-Based Functional Electrical Stimulation-Assisted Hand Therapy Video Games for Children With Hemiplegia: Development and Proof-of-Concept
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Personalized rehabilitation for children with cerebral palsy
Tresser, S., Kuflik, T., Levin, I., & Weiss, P. L. (2021) · User Modeling and User-Adapted Interaction · doi:10.1007/s11257-021-09296-6 · Cited by 18 · see citing works
Conventional and Virtual Reality Mirror Therapies in Upper Obstetric Brachial Palsy: A Randomized Pilot Study
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The use of video games combined with conventional physical therapy in children with upper limb fractures: An exploratory study
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Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework
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Virtual Reality and Occupational Therapy
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Systematic review of the effectiveness of innovative, gamified interventions for cognitive training in paediatric acquired brain injury
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“Six of the 41 included meta-analyses included children, speci ﬁ cally with cerebral palsy (Chen et al., 2014; 2018; Ghai & Ghai, 2019; Johansen et al., 2020; Mekbib et al., 2020; Rutkowski et al., 2020; Warnier et al., 2020; Wiley et al., 2020; Wu et al., 2019).”
Efficacy of Virtual Reality-Based Rehabilitation Interventions to Improve Balance Function in Patients with Cerebral Palsy: A Systematic Review and Meta-analysis of RCTs
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“Some rehabilitation techniques are virtual reality-based interventions, described as “viable techniques” (10, 15), and “intensive training tools” based on the interactive stimulations provided by a computer system (11).”
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“To better apply MCP, scientists have developed various extraction methods [14], including water-alcohol precipitation extraction (traditional extraction method) [15–20], microwave-assisted extraction [21, 22], ultrasound-assisted extraction [23–25], enzymeassisted extraction [26–28], ultrasound and enzyme-assisted ext…”
Method
EFFECT OF VIRTUAL REALITY TRAINING ON BALANCE AND FUNCTIONALITY IN CHILDREN WITH CEREBRAL PALSY: A RANDOMIZED CONTROLLED TRIAL
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“This finding correlates with the findings of Chen et al. (2014) in which the authors performed a meta-analysis on 14 studies regarding the use of VR for physical therapy and found that each study reported at least one positive outcome pertaining to improving upper extremity functions.”
BackgroundResultInfluential
Virtual System Using Haptic Device for Real-Time Tele-Rehabilitation of Upper Limbs
Escobar, I., Gálvez, C., Corrales, G., Pruna, E., Pilatásig, M., & Montaluisa, J. (2018) · Lecture notes in computer science · doi:10.1007/978-3-319-95282-6_10 · Cited by 5 · see citing works
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“The ideal goal of using VR is to prepare children with CP to increase their participation in the actual environment by gradually overcoming the environmental limitations and adapting to all the constraints, which can be obtained through the transfer of task learning outcomes to the real environment [23].”
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“intense and repetitive practice in combination with positive auditory and visual feedback [17].”
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Interland4All – Using AR to Promote a Safe and Responsible Use of the Internet by Frail Children
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Virtual Reality in Nursing over the Past Ten Years: An Umbrel-la Review of Meta-Analyses (Preprint)Preprint
Hu, Y., Yuan, X., Ye, P., Chang, C., Hu, Y., Zhang, W., & Li, K. (2023) · doi:10.2196/preprints.52022
VIRTUAL REALITY AS A TRAINING TOOL IMPACT ON UPPER EXTREMITY FUNCTION IN CHILDREN WITH CEREBRAL PALSY: SYSTEMATIC REVIEW
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“Often, limited resources hinder the achievement of optimal therapy conditions and limit the dosages of rehabilitation measures (Chen et al., 2014).”
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Advancements and Applications of Medical Human Digital Twin Technology in Cerebral Palsy Diagnosis, Therapy, and Rehabilitation
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Integration of Virtual Reality Gamebased Upper Extremity Movement Measurement System for Cerebral Palsy Children Using Kinect
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Additional file 4 of Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework
Alharbi, M., Du, H., Harris, D., Wood, G., Dodd, H., & Buckingham, G. (2024) · Figshare · doi:10.6084/m9.figshare.26729950
Additional file 2 of Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework
Alharbi, M., Du, H., Harris, D., Wood, G., Dodd, H., & Buckingham, G. (2024) · Figshare · doi:10.6084/m9.figshare.26729944
Additional file 1 of Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework
Alharbi, M., Du, H., Harris, D., Wood, G., Dodd, H., & Buckingham, G. (2024) · Figshare · doi:10.6084/m9.figshare.26729941
Additional file 3 of Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework
Alharbi, M., Du, H., Harris, D., Wood, G., Dodd, H., & Buckingham, G. (2024) · Figshare · doi:10.6084/m9.figshare.26729947
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Effectiveness of Virtual Reality for Upper Extremity Function and Motor Performance of Children With Cerebral Palsy: A Systematic Review
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The Impact of Virtual-Reality-Based Physiotherapy on Upper Limb Function in Children with Cerebral Palsy
Wojtowicz, Z., Czech, K., Lechowska, A., & Paprocka, J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14197040 · Cited by 2 · see citing works
VIRTUAL REALITY AS A TRAINING TOOL IMPACT ON UPPER EXTREMITY FUNCTION IN CHILDREN WITH CEREBRAL PALSY: SYSTEMATIC REVIEW
Mezaraupa, M., Jamonte, L., & Ceire, U. (2024) · Education Innovation Diversity · doi:10.17770/eid2024.1.7937
Effects of Virtual Reality-Based Rehabilitation on Upper Extremity Function among Children with Cerebral Palsy
Chang, H. J., Ku, K. H., Park, Y. S., Park, J. G., Cho, E. S., Seo, J. S., Kim, C. W., & Se Hwi, O. (2020) · Healthcare · doi:10.3390/healthcare8040391 · Cited by 34 · see citing works

Authors: Chen, Y.-P., Lee, S.-Y., & Howard, A. M.
Affiliations: Georgia Institute of Technology (US)
ORCID: Lee, Shih-Yu
Howard, Ayanna M.
Venue: Pediatric Physical Therapy
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2014
Volume: 26
Issue: 3
Pages: 289-300
ISSN: 0898-5669 (ISSN-L)
DOI: 10.1097/pep.0000000000000046
OpenAlex: W2032911697
Cited by: 86
References: 50
Citations by year: 2026: 1 · 2025: 5 · 2024: 11 · 2023: 13 · 2022: 9 · 2021: 5 · 2020: 8 · 2019: 13 · 2018: 6 · 2017: 6 · 2016: 5 · 2015: 2 · 2014: 2
FWCI: 0.69
Type: journal article
Language: en
Open access: closed
Locations: Pediatric Physical Therapy (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
Keywords: virtual reality, cerebral palsy, upper limb function, children, motor rehabilitation, home-based intervention, age effects
MeSH terms: Activities of Daily Living, Age Factors, Cerebral Palsy, Child, Computer Simulation, Humans, User-Computer Interface, Recovery of Function, Physical Therapy Modalities, Upper Extremity

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Effect of Virtual Reality on Upper Extremity Function in Children With Cerebral Palsy: A Meta-analysis

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Integrity signals

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