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A prospective case series evaluating the effectiveness of a virtual reality therapy home-based system to improve hand function in children with hemiplegia

D FEHLINGS MD MSC 1, 3, 2, T CHAU 1,4,

1. Bloorview Research Institute, Bloorview Kids Rehab, Toronto, ON, Canada;
2. Bloorview Kids Rehab, Toronto, ON, Canada;
3. Department of Paediatrics, University of Topronto, Toronto, ON, Canada;
4. University of Toronto, Toronto, ON, Canada

Background/Objectives: Studies show benefits of institution-based virtual reality therapy (VRT) for hemiplegia. This study evaluates an inexpensive home based VRT system consisting of a PlayStation2, Eye Toy and engineered chair. The system is powered by the child holding down a button on the chair using their non-hemiplegic hand, thereby requiring the use of the hemiplegic hand to play the games in virtual environments.
Objectives: (1) To evaluate the effectiveness of the VRT system to improve hemiplegic upper extremity function, and (2) To conduct a usability assessment of the VRT system

Design: A prospective intervention study design.

Participants and Setting: Fifteen children (mean age 8.8 years ± 2.3) with hyemiplegic cerebral palsy were recruited from an ambulatory setting of a tertiary pediatric rehabilitation centre.

Materials/Methods: Outcomes were obtained at baseline and 2 months following VRT intervention. The participants were asked to play on the VRT system for at least 0.5h/day over 2 months. The primary outcome was the Assisting Hands Assessment (AHA). Secondary function measures included the QUEST, PEDI, PMAL, COPM and grip strength. Statistical analyses included two-tailed paired t-tests and a correlation of relationship of change in function to amount of usage. A qualitative questionnaire on child/parent experience assessed usability.

Results: Fifteen children completed the study with an average daily usage of 0.16 h/day, SD=0.11. Improvements were noted on the AHA (mean change=3.9, SD=5.2) which showed statistical significance (r=2.79, p=0.02). Other secondary measures showed no significant change (p values ranging from 0.1 to 0.3). There was no significant relationship between change on the AHA and time played. Parents reported that their child enjoyed playing on the VRT with their hemiplegic hand. Usability issues included game stoppage independent of button compression by the child.

Conclusions/Significance: The improvement in hand function reflected by the AHA following home-based VRT intervention is encouraging. The innovative design of the chair promoting hemiplegic hand use, allows the system to be used in the home without the direct supervision of therapists. Addressing usability issues may enchance compliance. Greater changes in function may be fostered by developing specific VRT games that require distal hand rather than proximal arm movements.


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