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Virtual reality as a therapeutic modality for children with cerebral palsy
Abstract
OBJECTIVE: The evidence for using virtual reality (VR) with children with cerebral palsy (CP) was examined. METHODS: A search of 13 electronic databases identified all types of studies examining VR as an intervention for children with CP. The most recent article included was published in October 2008. For each study, the quality of the methods was assessed using the appropriate scale. A total of 19 articles were retrieved. Thirteen studies from 11 articles were included in the final analysis. RESULTS: Outcomes documented brain reorganization/plasticity, motor capacity, visual-perceptual skills, social participation and personal factors. Two studies were randomized controlled trials. These reported conflicting results regarding motor outcomes. Twelve of the 13 studies presented positive outcomes in at least one domain. CONCLUSIONS: VR has potential benefits for children with CP. However, the current level of evidence is poor and empirical data is lacking. Future methodologically rigorous studies are required.
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“A review of virtual reality use by children with CP, which included motor but not postural control outcomes, agrees that substantial benefits could be gained from using virtual reality; however, the current evidence is weak. 66”
From Exercise interventions improve postural control in children with cerebral palsy: a systematic review (2015) · cites this paper as [66]
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A systematic review of interventions for children with cerebral palsy: state of the evidence
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Dewar, R., Love, S., & Johnston, L. M. (2015) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.12660 · Cited by 242
“Virtual reality is used in rehabilitation to achieve therapy goals within a play environment.(66) Out of eight studies, three were level II or III (Table I).”
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“The reviewers suggested that in addition to high level randomised trials with larger sample sizes, it would be useful to clarify the sub-groups of the population that would most benefit as the presentation of CP is so varied [20].”
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Effects of Nintendo Wii‐Fit ® video games on balance in children with mild cerebral palsy
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“” It is obvious that its potential uses in the field of rehabilitation are vast, and yet the literature currently available is limited.(24) The great advantage of IVG in rehabilitation, especially among children, is the fact that it provides opportunities for active learning in an environment that is motivating, chall…”
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“child to come to the clinic or lab for practice [1,2].”
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“Several systematic reviews and one meta-analysis investigated the impact of virtual reality interventions on upper limb motor recovery in children and adolescents with CP [13,22,27,33-35].”
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Sharan, D., Ajeesh, P. S., Rameshkumar, R., Mathankumar, M., Paulina, R. J., & Manjula, M. (2012) · WORK: A Journal of Prevention, Assessment & Rehabilitation · doi:10.3233/wor-2012-0667-3612 · Cited by 101
“A study stated that VR has potential benefits for children with neurological disorders and could positively affect the brain reorganization/plasticity, motor capacity, visualperceptual skills, social participation and personal factors [14].”
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Weiss, P. L., Tirosh, E., & Fehlings, D. L. (2014) · Journal of Child Neurology · doi:10.1177/0883073814533007 · Cited by 112
“These attributes have been reviewed in great detail elsewhere.(7,12-15) It is also important to recognize that virtual reality is not a single entity.”
BackgroundResultTransfer of motor learning from virtual to natural environments in individuals with cerebral palsy
Monteiro, C. B. D. M., Massetti, T., da Silva, T. D., van der Kamp, J., de Abreu, L. C., Leone, C., & Savelsbergh, G. J. P. (2014) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2014.06.006 · Cited by 98
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“Meta-regressions (using a method-of-moments model) or subgroup meta-analyses were used to examine the following potential moderator variables: (1) children’s age, (2) CP type, (3) intervention weekly dosage, (4) intervention length, (5) total intervention duration, (6) intervention setting, (7) VR system, (8) research…”
BackgroundMethodVirtual reality rehabilitation in children with brain injury: a randomized controlled trial
Choi, J. Y., Yi, S., Ao, L., Tang, X., Xu, X., Shim, D., Yoo, B., Park, E. S., & Rha, D. (2020) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.14762 · Cited by 89
“Several studies demonstrated that using virtual reality has benefits for children with neurological impairments to improve upper-limb function.(6,7) However, in a recent”
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“[41] also showed that VR games could improve the visual perception and movement stability of children with CP.”
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Therapists’ Perceptions of Social Media and Video Game Technologies in Upper Limb Rehabilitation
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“Studies have examined video gaming as an intervention to target a range of impairments, including balance, mobility, cognition, and upper extremity functioning [3-5].”
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“30 Common treatment strategies to curb motor dysfunctions in cerebral palsy include training with virtual reality, 31 biocueing, 32 physical/occupational therapy, 33 physical exercise, 34 treadmill, 35 and orthosis.”
Ren, Z., & Wu, J. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16203885 · Cited by 77
“[61] also believed that VRGs could better the visual perception and movement stability of children with CP.”
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“The child interacted with the game via a hand-held controller or footplate which was connected back to the computer to provide real-time artificial sensory feedback to the child about their performance [40].”
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“7 In light of this information, the aim of our study is to investigate via Kinect the effects of VR on children with unilateral spastic cerebral palsy (USCP), particularly the effects on their gross and fine motor functions and independence in daily living activities.”
Burden on Caregivers of Children with Cerebral Palsy: Predictors and Related Factors
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“24,48,49 The results of this review, which is only based on control trials of at least moderate quality (Table 2), also exhibit ambiguous findings.”
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“VR solutions that are engineered to accommodate the reduced capabilities of children with neurological deficits do offer advantages over traditional rehabilitation; above all, by providing a motivating and engaging exercise environment that can be scaled to individual needs and encourage repeated practice of functiona…”
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“Recent reviews of paediatric motor rehabilitation literature have summarized the evidence for VR interventions, concluding that further higher-quality research is required to substantiate the initial promising findings [1, 2, 10].”
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Motor learning and virtual reality
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Wii-habilitation as balance therapy for children with acquired brain injury
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“Overall, there was conflicting evidence for the effectiveness of VR interventions in improving outcomes at the International Classification of Functioning, Disability and Health (ICF) levels of body structures and functions in children with CP [21].”
BackgroundChronic obstructive pulmonary disease and heart rate variability: a literature update
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Interactive Computer Play as “Motor Therapy” for Individuals With Cerebral Palsy
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“,[27,28] which considered the level of evidence of studies, with an “excellent” score of 9–10, “good” score of 6–8, “fair” of 4–5 and “poor” score of <4.”
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“Its use has progressively increased among healthcare professionals in order to provide maximum support and to improve quality of care of adult and pediatric patients (Snider et al., 2010; Maggio et al., 2019).”
BackgroundTechnology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review
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“VR has been applied successfully as a therapeutic modality to train physical and motor skills following stroke [18–21], in children with cerebral palsy [22], and individuals with Parkinson’s disease [23].”
MethodChen, Y., García-Vergara, S., & Howard, A. M. (2015) · Rehabilitation Research and Practice · doi:10.1155/2015/812348 · Cited by 38
“Virtual reality (VR) systems offer a way to create an interactive, motivating environment for intensive training practice for children with CP [15, 16]: these systems can provide immediate feedback as players see themselves immersed in the virtual world and can observe themselves as they move.”
BackgroundPreterm birth and leisure participation: A synthesis of the literature
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“VR has demonstrated utility in cognitive retraining in cerebral palsy [10], motor retraining in stroke [11], balance and control in vestibular disorders [12], balance and mobility in traumatic brain injury [13], and community training skills in acquired brain injury [14].”
BackgroundAran, O. T., Şahın, S., Köse, B., Ağce, Z. B., & Kayıhan, H. (2019) · International Journal of Rehabilitation Research · doi:10.1097/mrr.0000000000000378 · Cited by 41
“There is an increase in the usage of VR in the rehabilitation area in the last two decades due to its intervention and assessment usability (Snider et al., 2010).”
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Facilitating the Implementation of Virtual Reality-Based Therapies in Pediatric Rehabilitation
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“Several reviews summarize the promising evidence in the field of pediatric VR/AVG rehabilitation (Sandlund et al., 2009; Snider et al., 2010; Weiss et al., 2014); however, the integration of VR/AVG systems and other interactive technologies within clinical practice can include many challenges.”
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“The use of VR training for children with cerebral palsy has been studied intently to demonstrate the effects on subjects with limited ability or other impairments of body structure and function who are unable to participate in other rehabilitation programs [16].”
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A survey of research trends in assistive technologies using information modelling techniques
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“Virtual reality as assistive technology Virtual reality has become an influential learning tool for students suffering from autism and cerebral palsy [157,171].”
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“However, it should be noted that VR as an intervention for individuals with CP is relatively new, and although research is rapidly evolving, its benefits and limitations have not been extensively researched.(13,18) In systematic literature reviews, Chen et al(9,19) examined the effect of VR function in children with C…”
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“Different studies suggest that VR therapy had a positive impact on the therapeutic modality for people, as it indicates benefits in activity and participation, brain reorganization, motor skills or visual-spatial outcomes, and personal factors [4].”
BackgroundMotor learning through virtual reality in cerebral palsy - a literature review
Massetti, T., da Silva, T. D., Papa, D. C. R., Malheiros, S. R. P., Ré, A. H. N., Fávero, F. M., & Monteiro, C. B. D. M. (2014) · Medical Express · doi:10.5935/medicalexpress.2014.06.04 · Cited by 32
“Some authors have reviewed studies on cerebral palsy and VR; Snider et al.7 carried out a literature review observing the results of VR as a therapeutic modality for children with CP.”
BackgroundMethodInfluentialEffects of Virtual Reality in Children with Cerebral Palsy: A Systematic Review
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“Snider and colleagues [94] recently reviewed and analyzed 13 studies of VR training in CP (all but two conducted by Professor Denise Reid at the Neurorehabilitation and virtual Reality Laboratory at the University of Toronto).”
InfluentialMastery motivation in adolescents with cerebral palsy
Majnemer, A., Shikako‐Thomas, K., Lach, L., Shevell, M. I., Law, M., & Schmitz, N. (2013) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2013.07.002 · Cited by 32
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“Some studies showed that VR-based rehabilitation facilitated perceptual training and task completion in a virtual environment similar to reality but with a higher predictability and activity control (19, 24, 25).”
BackgroundVirtual reality applications in neurorehabilitation
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Impaired visually guided weight-shifting ability in children with cerebral palsy
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“Several studies have shown that VR technology has a positive effect on motor intervention for children with developmental disabilities [11,12].”
BackgroundReal-Time Static Gesture Recognition for Upper Extremity Rehabilitation Using the Leap Motion
Gieser, S. N., Boisselle, A., & Makedon, F. S. (2015) · Lecture notes in computer science · doi:10.1007/978-3-319-21070-4_15 · Cited by 25
Integrating New Technologies into the Treatment of CP and DCD
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“functional actions [63].”
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“The level of evidence which each study add to the literature was evaluated by modified Sackett scale which adapted to rank studies according to their PEDro scores [31].”
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Zondervan, D. K., Secoli, R., Darling, A. M., Farris, J., Furumasu, J., & Reinkensmeyer, D. J. (2015) · Assistive Technology · doi:10.1080/10400435.2015.1012607 · Cited by 18
Metadata
- Authors
- Snider, L., Majnemer, A., & Darsaklis, V.
- Affiliations
- McGill University (CA)
- Corresponding author
- Snider, Laurie
- Venue
- Developmental Neurorehabilitation
- Publisher
- Informa UK Limited
- Published
- 2010-01
- Volume
- 13
- Issue
- 2
- Pages
- 120-128
- ISSN
- 1363-8491 (ISSN-L)
- 1751-8423
- 1751-8431
- OpenAlex
- W2068620558
- Cited by
- 211
- References
- 37
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 8 · 2023: 11 · 2022: 13 · 2021: 14 · 2020: 13 · 2019: 18 · 2018: 16 · 2017: 13 · 2016: 13 · 2015: 10 · 2014: 22 · 2013: 18 · 2012: 16
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Developmental Neurorehabilitation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- McGill University Health Centre
- Topics
- Health Sciences › Medicine › Rehabilitation › Cerebral Palsy and Movement Disorders
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Computer Science › Human-Computer Interaction › Virtual Reality Applications and Impacts
- Keywords
- virtual reality, cerebral palsy, children, motor capacity, neuroplasticity, visual perceptual skills, social participation (health and rehabilitation), rehabilitation, quality of evidence
- MeSH terms
- Brain, Cerebral Palsy, Child, Computer Simulation, Humans, Magnetic Resonance Imaging, Motivation, Motor Skills, Neuronal Plasticity, Self Concept, Social Behavior, User-Computer Interface, Visual Perception, Treatment Outcome
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