DEVELOPING IMMERSIVE GAMIFICATION TECHNOLOGY SYSTEM FOR REHABILITATION OF PAEDIATRIC PATIENTS WITH CEREBRAL PALSY WITH MOBILITY LIMITATIONS (PHASE 1 TRIAL)

M.E. Aguila^1,2, C. Tee^3,2, J.C. Boque^4,2, F. Concepcion², J.R. Gonzales^5,2, I.T. Salido², M.E. Jacinto², M. Tee^6,2, V.M. Anlacan^7,8,2, R.D. Jamora^7,2, J. Caro^4,2

¹College of Allied Medical Professions, University of the Philippines, Department of Physical Therapy, Manila, Philippines, ²Augmented Experience Ehealth Laboratory, University of the Philippines Manila, Manila, Philippines, ³College of Medicine, University of the Philippines Manila, Department of Pediatrics, Manila, Philippines, ⁴College of Engineering, University of the Philippines Diliman, Department of Computer Science, Quezon City, Philippines, ⁵University of the Philippines Manila-Philippine General Hospital, Manila, Philippines, ⁶College of Medicine, University of the Philippines Manila, Department of Physiology, Manila, Philippines, ⁷College of Medicine - Philippine General Hospital, University of the Philippines Manila, Department of Neurosciences, Manila, Philippines, ⁸Philippine General Hospital, University of the Philippines Manila, Center for Memory and Cognition, Manila, Philippines

Background: Virtual reality (VR) technology has increasingly been integrated in rehabilitation of children with cerebral palsy (CP). More evidence is required to substantiate its potential as part of standard care.

Purpose: The purpose of this trial was to develop an effective immersive gamification technology system (ImGTS) using concepts of VR that can potentially be integrated in the rehabilitation of children with CP with mobility limitations. This trial aimed to determine the safety, acceptability, and usability of the ImGTS among healthy children.

Methods: This parallel randomised clinical trial tested the ImGTS prototype among 30 healthy children aged 6–12 years. The participants underwent four sessions using the ImGTS with a head mounted display (HMD) system (n=15) or semi-cave automatic virtual environment (semi-CAVE) system (n=15). Safety and acceptability were assessed using the Virtual Reality Sickness Questionnaire and the Place Probe questionnaire, respectively. Usability was assessed by observing behaviours indicating effectiveness, efficiency, and satisfaction. Qualitative data were analysed using thematic analysis. Quantitative data were analysed using descriptive statistics.

Results: The ImGTS comprising three VR games were developed primarily targeting balance (alien invasion), leg strength (lock ‘em up), and gait (walkey moley). Participants randomly assigned to use the HMD were mostly female (53%) with a mean (SD) age of 10.07 (1.81) years. Participants randomly assigned to use the semi-CAVE were mostly male (53%) with a mean (SD) age of 8.33 (2.92) years. An average of 2.5 (16.68%) and 1.62 (10.75%) participants reported symptoms over the four sessions after using HMD and semi-CAVE, respectively. The most common symptom for both groups was fatigue. Participants in both groups felt that the virtual environment was ‘big’, 'full’, ‘colorful’, ‘moving’, ‘responsive’, ‘touchable’, ‘beautiful’, ‘pleasant’, ‘relaxing’, ‘harmless’, ‘exciting’, ‘interesting’, ‘memorable’, ‘meaningful’, ‘understandable’, and ‘significant’. Participants in the HMD and semi-CAVE groups used identical words to describe their overall VR experience — ‘fun’, ‘exciting’, ‘happy’, ‘beautiful’, and ‘relaxing’. Features of the environment (‘bowling’, ‘robot’, and ‘alien’) were also used as descriptors of the experience. Feelings of presence were generally high for both groups, higher for semi-CAVE group (ranging from 3.5 out of 5 for suspension of disbelief to 4.83 for attention allocation and spatial situation model) than HMD group (ranging from 3.38 for suspension of disbelief to 4.52 for attention allocation). Participants in both groups completed the games with little to no difficulty and with a mean satisfaction score of 4.95 out of 5 across four sessions.

Conclusions: The ImGTS, comprising three VR games and using either the head-mounted display or semi-CAVE systems, was safe, acceptable, and usable among healthy children.

Implications: This trial is an initial step to adding evidence on the use of ImGTS as a rehabilitation tool in pursuit of better health outcomes for children with CP. Results of this trial inform the design and methods of succeeding phases when the ImGTS prototype will be tested on children with CP for safety, acceptability, usability, and clinical effectiveness.

Keywords:
Virtual reality
Health technology
Cerebral palsy

Topics:
Innovative technology: robotics
Paediatrics: cerebral palsy

Did this work require ethics approval? Yes

Institution: University of the Philippines Manila

Committee: Research Ethics Board

Ethics number: UPMREB-2021-371-01