THE EFFECT OF VIRTUAL REALITY GAMES (HEAD MOUNTED DISPLAY-HMD) ON THE FUNCTIONALITY OF CHILDREN AND ADOLESCENTS WITH CEREBRAL PALSY

A. Karamolegkos¹, E. Skordilis¹

¹National and Kapodistrian University of Athens, School of Physical Education and Sport Science, Athens, Greece

Background: Cerebral Palsy (CP) is considered a neurological disorder caused by a non-progressive brain injury or malformation that occurs while the child’s brain is under development. CP primarily affects body movement and muscle coordination (Rosenbaum et al., 2007). Physiotherapy aims to inhibit the pathological reflexes, to facilitate the physiological reactions and to deal with the pathological muscle tone through manipulations and positions of the child. Some of the treatments that is used by physiotherapists are the Bobath-Neurodevelopmental Therapy (NDT), the Propioceptive Neuromuscular Facilitation (PNF), Constrained Induced Movement Therapy (CIMT), hydrotherapy, horse riding therapy and treatments based on technology such as virtual reality (VR) games (Levitt, 2010). Only recently VR games have been added in the rehabilitation programs of children with CP. They offer a pleasant and enjoyable experience where childern receive their treatment safely and have fun at the same time. There are enough studies that shows the beneficial impact of using VR games in addition to traditional physiotherapy programs (Cho et al., 2016; Urgen et al., 2016). A new VR games device, the Head Mounted Display (HMD), are considered the future of gaming because they provide the most immersive experience. However, a review of literature didn't show enough studies that evaluate the effect of HMD in the functionality and rehabilitation of children, adolescents and adults with cerebral palsy or another neuromuscular disorder.

Purpose: ​​​​The present study was designed to evaluate the effect of a VR games program, via HMD, on the functionality of children and adolescents with CP as an addition to their physiotherapy programs.

Methods: Eight children (10-11 years old) with CP (GMFCS I-III), who attended physiotherapy programs at a rehabilitation center in Attica, Greece participated in a study with a duration of 8 weeks and frequency once per week. The experimental group (n₁=4) participated in the VR program, which included playing two games, while continuing its physiotherapy. On the other hand, the control group (n₂=4) only attended its scheduled physiotherapy. Pre and post exercise tests were performed in order to assess variables that correspond on the International Classification of Functioning and Health domains (ICF).

Results: ​​​​​​​​The results of the ANCOVA analysis showed a significant improvement in the ability to change body position (F=19.271, p=.007, η²=.794) and in the elbow extension range of motion (F=7.089, p=.045, η²=.586) and limited impact on walking (distance traveled) and gross motor function. No significant improvement was found in spasticity, range of motion of relevant joints, walking speed, and in movement. In addition, high levels of pleasure were observed and no episodes of dizziness and fatigue were recorded.

Conclusions: In conclusion, integrating VR games with the use of HMD devices in physiotherapy programs can have a beneficial effect on the functioning of children with CP while providing them with enjoyable experiences without adverse effects.

Implications: The study showed the importance of enjoyment and development that physiotherapy programs for children with CP presently need. More research may be conducted in order to have reliable evidence that supports the use of VR-HMD games in the rehabilatation of children with CP.

Funding acknowledgements: This study was self funded.

Keywords:
Cerebral palsy
Virtual reality
Functioning

Topics:
Paediatrics: cerebral palsy
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: National and Kapodistrian University of Athens

Committee: GREGORY BOGDANIS

Ethics number: 1095/16-01-2019