IMPACT OF VIRTUAL REALITY AND HAPTIC FEEDBACK BASED INTERVENTION ON HAND FUNCTION OF CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

C. Goyal^1,2, W. Naqvi²

¹Government Physiotherapy College, Paediatric Physiotherapy, Raipur, India, ²Datta Meghe Institute of Higher Education and Research, Physiotherapy, Wardha, India

Background: Virtual reality (VR) is an advanced technology that provides real-life like experience. It is emerging as a tool for rehabilitation. Although, promising results have been obtained by its use in geriatric population and in adults with stroke, there are limited studies on children with hemiplegic type of cerebral palsy (CP), specifically. During VR experience, haptic feedback (HF) enhances fine tuning of motor responses.
Hemiplegic CP is one of the most common subtypes of CP. It is characterised by weakness of one side of the body and usually upper extremity (UE) impairment is more than lower extremity. As long-term management is required, there is a need for exploring interventions that tap the inherent motivation of children to use both hands.

Purpose: Aim of this study was to investigate the effect of VR and HF based intervention on UE function and functional independence in children with hemiplegic CP. This would help to address the issue of disuse of paretic UE by children.

Methods: Inclusion criteria comprised diagnosis of hemiplegic CP, 6- 12 years of age, ability to understand commands, Gross Motor Function Classification System (GMFCS) level I-III and Manual Ability Classification System (MACS) level I-III. Exclusion criteria included epilepsy, history of BOTOX treatment in past 3 months, history of surgery in past 6 months and participation in another trial. Total 56 school-aged participants were divided into 2 groups, namely, experimental and control, with an allocation ratio of 1:1.
After the ethical approval, this interventional study was registered at Clinical Trial Registry – India. The protocol of the study was published in a PubMed/Medline and Scopus indexed journal. The study design is randomised, active controlled trial.
During 6 weeks of intervention, children in the experimental group received VR and HF based intervention for 30 minutes along with conventional physiotherapy for 30 minutes in each session. Children in the control group received 60 minutes of conventional physiotherapy only. There were 5 sessions per week. Nine-hole peg test (9HPT) and box and block test (BBT) were used as primary outcome measures to evaluate upper extremity function. ABILHAND kids and functional independence measure for children (WeeFIM) were used as secondary outcome measures to evaluate functional independence.
Statistical analysis was done by using descriptive and inferential statistics using Chi square test, Student’s paired and unpaired t-test, Wilcoxon signed rank test and Mann Whitney U test. p< 0.05 was considered as level of significance.

Results: There was significant improvement in all outcome measures in both groups. However, the improvement in the UE function and functional independence was significantly more in the experimental group than in the control group.

Conclusions: VR and HF based intervention is effective in improving UE function and functional independence of children with hemiplegic CP.

Implications: Children with hemiplegic CP are often ambulatory but UE function remains primary concern of parents as children tend to avoid the use of paretic extremity. Based on motor-learning principles, VR with HF seems to be an engaging and enjoyable intervention that taps the neuroplastic potential by motivating the children to use both hands.

Funding acknowledgements: The work was unfunded.

Keywords:
Hemiplegic cerebral palsy
Virtual reality
Haptic feedback

Topics:
Paediatrics: cerebral palsy
Innovative technology: information management, big data and artificial intelligence
Neurology

Did this work require ethics approval? Yes

Institution: Datta Meghe Institute of Medical Sciences

Committee: Institutional Ethics Committee

Ethics number: DMIMS(DU)/IEC/2020-21/131