The Effect of Virtual Reality Games on the Gross Motor Skills of Children with Cerebral Palsy: A Meta-Analysis of Randomized Controlled Trials

Zhanbing Ren, Jinlong Wu, Zhanbing Ren, Jinlong Wu

Abstract

This review aimed to systematically evaluate the rehabilitatitive effect of Virtual Reality Games (VRGs) for gross motor skills of children with cerebral palsy (CP), and to give scientific grounds for the formulation of rehabilitation therapy for these children. To this end, the literature in Chinese databases (CNKI and Wanfang Data) as well as the databases of other countries (Web of Science, PubMed, EBSCOhost, Informit, Scopus, Science Direct and ProQuest) from the establishment dates of these databases to June 3rd 2019 was retrieved in order to collect randomized controlled trials with regard to the intervention effect of VRGs and traditional therapy on gross motor skills of children with CP, and the literature was screened as per inclusion and exclusion criteria. The PEDro scale was then used to evaluate the methodological quality of the included literature, and the software Review Manager 5.3 was employed to analyze the combined effect size. As a result, 7 randomized controlled trials and 234 children with CP were included. Meta-analysis showed that VRGs could improve gross motor skills of children with CP. Combined effect size of gross motor skills SMD = 0.37 [95% CI = (0.06, 0.68), p = 0.02)]. In conclusion, the VRG intervention program can enhance gross motor skills of children with CP to some extent. In view of the limitations regarding methodologies and the quality and quantity of the literature in this research, more quality randomized controlled trials are needed so as to draw convincing conclusions of effect of VRG intervention on gross motor skill development of children with CP in future studies.

Keywords: cerebral palsy; gross motor skill; virtual reality games.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of literature screening.
Figure 2
Figure 2
Effects of VRGs on Gross Motor Skills of Children with CP.

References

    1. Xiujie C., Li S. Definition, classification and diagnostic conditions of cerebral palsy children. Chin. J. Phys. Med. Rehabil. 2007;5:309.
    1. Ping L., Zekai L., Deng A. Research progress of family support in children with cerebral palsy. Chin. J. Nurs. 2013;4:365–367.
    1. Gormley M.J. Treatment of neuromuscular and musculoskeletal problems in cerebral palsy. Pediatr. Rehabil. 2001;4:5–16.
    1. Bilde P.E., Kliim-Due M., Rasmussen B., Petersen L.Z., Petersen T.H., Nielsen J.B. Individualized, home-based interactive training of cerebral palsy children delivered through the Internet. BMC Neurol. 2011;11:32. doi: 10.1186/1471-2377-11-32.
    1. Yuanchun R., Linlin Z., Fang W. Characteristics of physical, behavioral and cognitive functions of children with different levels of gross motor development. J. Beijing Sport Univ. 2013;3:79–84.
    1. Juras G., Brachman A., Michalska J., Kamieniarz A., Pawlowski M., Hadamus A., Bialoszewski D., Blaszczyk J., Slomka K.J. Standards of Virtual Reality Application in Balance Training Programs in Clinical Practice: A Systematic Review. Games Health J. 2019;8:101–111. doi: 10.1089/g4h.2018.0034.
    1. Massion J., Alexandrov A., Frolov A. Why and how are posture and movement coordinated? Prog. Brain Res. 2004;143:13–27.
    1. van der Heide J.C., Fock J.M., Otten B., Stremmelaar E., Hadders-Algra M. Kinematic characteristics of postural control during reaching in preterm children with cerebral palsy. Pediatr. Res. 2005;58:586–593. doi: 10.1203/01.pdr.0000176834.47305.26.
    1. Nudo R.J. Recovery after brain injury: Mechanisms and principles. Front. Hum. Neurosci. 2013;7:887. doi: 10.3389/fnhum.2013.00887.
    1. Jensen J.L., Marstrand P.C., Nielsen J.B. Motor skill training and strength training are associated with different plastic changes in the central nervous system. J. Appl. Physiol. (1985) 2005;99:1558–1568. doi: 10.1152/japplphysiol.01408.2004.
    1. Nielsen J.B., Cohen L.G. The Olympic brain. Does corticospinal plasticity play a role in acquisition of skills required for high-performance sports? J. Physiol. 2008;586:65–70. doi: 10.1113/jphysiol.2007.142661.
    1. Dodd K.J., Taylor N.F., Graham H.K. A randomized clinical trial of strength training in young people with cerebral palsy. Dev. Med. Child. Neurol. 2003;45:652–657. doi: 10.1111/j.1469-8749.2003.tb00866.x.
    1. Ryan J.M., Cassidy E.E., Noorduyn S.G., O’Connell N.E. Exercise interventions for cerebral palsy. Cochrane Database Syst. Rev. 2017;6:D11660. doi: 10.1002/14651858.CD011660.pub2.
    1. Ketelaar M., Vermeer A., Hart H., van Petegem-van B.E., Helders P.J. Effects of a functional therapy program on motor abilities of children with cerebral palsy. Phys. Ther. 2001;81:1534–1545. doi: 10.1093/ptj/81.9.1534.
    1. Novak I., McIntyre S., Morgan C., Campbell L., Dark L., Morton N., Stumbles E., Wilson S.A., Goldsmith S. A systematic review of interventions for children with cerebral palsy: State of the evidence. Dev. Med. Child Neurol. 2013;55:885–910. doi: 10.1111/dmcn.12246.
    1. Katz-Leurer M., Rotem H., Keren O., Meyer S. The effects of a ‘home-based’ task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clin. Rehabil. 2009;23:714–724. doi: 10.1177/0269215509335293.
    1. Qi L., Zhang A. Players’ experience space composition and emotional characteristics in 3D somatosensory games. Prog. Brain Res. 2012;12:191.
    1. Ashkenazi T., Laufer Y., Orian D., Weiss P.L. Effect of training children with Developmental Coordination Disorders in a virtual environment compared with a conventional environment; Proceedings of the International Conference on Virtual Rehabilitation; Philadelphia, PA, USA. 26–29 August 2013.
    1. Palaus M., Marron E.M., Viejo-Sobera R., Redolar-Ripoll D. Neural Basis of Video Gaming: A Systematic Review. Front. Hum. Neurosci. 2017;11:248. doi: 10.3389/fnhum.2017.00248.
    1. You S.H., Jang S.H., Kim Y.H., Hallett M., Ahn S.H., Kwon Y.H., Kim J.H., Lee M.Y. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: An experimenter-blind randomized study. Stroke. 2005;36:1166–1171. doi: 10.1161/01.STR.0000162715.43417.91.
    1. Tarakci D., Ersoz H.B., Tarakci E., Razak O.A. Effects of Nintendo Wii-Fit((R)) video games on balance in children with mild cerebral palsy. Pediatr. Int. 2016;58:1042–1050. doi: 10.1111/ped.12942.
    1. Chen L., Lo W.L., Mao Y.R., Ding M.H., Lin Q., Li H., Zhao J.L., Xu Z.Q., Bian R.H., Huang D.F. Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review. Biomed. Res. Int. 2016;2016:7309272. doi: 10.1155/2016/7309272.
    1. Harris K., Reid D. The influence of virtual reality play on children’s motivation. Can. J. Occup. Ther. 2005;72:21–29. doi: 10.1177/000841740507200107.
    1. Fehlings D., Switzer L., Findlay B., Knights S. Interactive computer play as “motor therapy” for individuals with cerebral palsy. Semin. Pediatr. Neurol. 2013;20:127–138. doi: 10.1016/j.spen.2013.06.003.
    1. Chen Y.P., Lee S.Y., Howard A.M. Effect of virtual reality on upper extremity function in children with cerebral palsy: A meta-analysis. Pediatr. Phys. Ther. 2014;26:289–300. doi: 10.1097/PEP.0000000000000046.
    1. Hocking D.R., Farhat H., Gavrila R., Caeyenberghs K., Shields N. Do Active Video Games Improve Motor Function in People With Developmental Disabilities? A Meta-analysis of Randomized Controlled Trials. Arch. Phys. Med. Rehabil. 2019;100:769–781. doi: 10.1016/j.apmr.2018.10.021.
    1. Zou L.Y., Loprinzi P.D., Yeung A.S., Zeng N., Huang T. The beneficial effects of mind-body exercises for people with mild cognitive impairment: A systematic review with meta-analysis. Arch. Phys. Med. Rehabil. 2019;100:1556–1573. doi: 10.1016/j.apmr.2019.03.009.
    1. Zou L.Y., Sasaki J.E., Zeng N., Wang C.Y., Sun L. A systematic review with meta-analysis of mindful exercises on rehabilitive outcomes among stroke patients. Arch. Phys. Med. Rehabil. 2018;99:2355–2364. doi: 10.1016/j.apmr.2018.04.010.
    1. Guanjian L., Wu T. Forest Plot and Clinical Significance of Meta-analysis. Chin. J. Evid.-Based Med. 2014;3:198–201. doi: 10.3969/j.issn.1672-2531.2004.03.011.
    1. Zou L., Zhang Y., Yang L., Loprinzi P.D., Yeung A.S., Kong J., Chen K.W., Song W., Xiao T., Li H. Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2019;8:628. doi: 10.3390/jcm8050628.
    1. AlSaif A.A., Alsenany S. Effects of interactive games on motor performance in children with spastic cerebral palsy. J. Phys. Ther. Sci. 2015;27:2001–2003. doi: 10.1589/jpts.27.2001.
    1. Cho C., Hwang W., Hwang S., Chung Y. Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. Tohoku J. Exp. Med. 2016;238:213–218. doi: 10.1620/tjem.238.213.
    1. Rgen M., Akbayrak T., Gunel M., Cankaya O., Guchan Z., Turkyilmaz E. Investigation of the effects of the NintendoWii-Fit training on balance and advanced motor performance in children with spastic hemiplegic cerebral palsy: A Randomized Controlled Trial. Int. J. Ther. Rehabil. Res. 2016;5:146. doi: 10.5455/ijtrr.000000157.
    1. Ren K., Gong X.M., Zhang R., Chen X.H. Effects of virtual reality training on limb movement in children with spastic diplegia cerebral palsy. Zhongguo Dang Dai Er Ke Za Zhi. 2016;18:975–979.
    1. Yanyan X. Effects of virtual reality training combined with repeated transcranial magnetic stimulation on limb motor function in children with cerebral palsy. J. Qiqihar Med Univ. 2019;11:213–218.
    1. Pin T.W., Butler P.B. The effect of interactive computer play on balance and functional abilities in children with moderate cerebral palsy: A pilot randomized study. Clin. Rehabil. 2019;33:704–710. doi: 10.1177/0269215518821714.
    1. Chen C.L., Chen C.Y., Liaw M.Y., Chung C.Y., Wang C.J., Hong W.H. Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy. Osteoporos. Int. 2013;24:1399–1406. doi: 10.1007/s00198-012-2137-0.
    1. Chiu H.C., Ada L., Lee H.M. Upper limb training using Wii Sports Resort for children with hemiplegic cerebral palsy: A randomized, single-blind trial. Clin. Rehabil. 2014;28:1015–1024. doi: 10.1177/0269215514533709.
    1. Xiaoke Z., Yue Z., Du S. Effect of Motion Observation Training Based on Active Video Games on Motor Function of Children with Spastic Cerebral Palsy. Chin. J. Phys. Med. Rehabil. 2018;12:916–918.
    1. Zan G., Tao Z., Stodden D. Children’s physical activity levels and psychological correlates in interactive dance versus aerobic dance. J. Transp. Health. 2013;2:146–151.
    1. Pasco D., Roure C., Kermarrec G., Pope Z., Gao Z. The effects of a bike active video game on players’ physical activity and motivation. J. Sport Health Sci. 2017;6:25–32. doi: 10.1016/j.jshs.2016.11.007.
    1. Zan G., Pope Z., Lee J.E., Stodden D., Roncesvalles N., Pasco D., Huang C.C., Du F. Impact of exergaming on young children’s school day energy expenditure and moderate-to-vigorous physical activity levels. J. Transp. Health. 2017;6:15–20.
    1. Zan G., Podlog L., Huang C. Associations among children’s situational motivation, physical activity participation, and enjoyment in an active dance video game. J. Transp. Health. 2013;2:122–128.
    1. Guest E.W. Children’s motor skill competence, physical activity, fitness, and health promotion. J. Sport Health Sci. 2019;8:95.
    1. Gao Z. Fight fire with fire? Promoting physical activity and health through active video games. J. Sport Health Sci. 2017;6:1–3. doi: 10.1016/j.jshs.2016.11.009.
    1. Gao Z., Zeng N., Pope Z.C., Wang R., Yu F. Effects of exergaming on motor skill competence, perceived competence, and physical activity in preschool children. J. Sport Health Sci. 2019;8:106–113. doi: 10.1016/j.jshs.2018.12.001.
    1. Kai L., Fan H. The Application and Research of VR Game Design in Children Autistic Disorder. Sci. Educ. Artic. Collect. (Issue End Mon.) 2018;11:165–166.
    1. Zhiwei L. Kinect-based Somatosensory Rehabilitation System Design for Autistic Children. Hebei Univ. 2018;1:66.
    1. Ruihuan C., Cuiyan W. A Study on the Application of Active Video Games in Autistic Children Intervention. J. Suihua Univ. 2017;10:92–95.
    1. Xianmei L., Liu Y. A Case Study on the Intervention of Active Video Games in Attention Deficit of Autistic Children. J. Suihua Univ. 2017;7:1–7.
    1. Xianmei L., Yanhong L., Xiaoyi H. A Study on the Application of Active Video Games to the Intervention in the Motor Skills of Autistic Children. Mod. Spec. Educ. 2016;20:36–42.
    1. Yanhong L., Xianmei L., Xiaoyi H. Research and Inspiration of Active Video Games for Autistic Children Abroad. Chin. J. Spec. Educ. 2015;5:51–56.
    1. Hocking D.R., Caeyenberghs K. What is the Nature of Motor Impairments in Autism, Are They Diagnostically Useful, and What Are the Implications for Intervention? Curr. Dev. Disorders Rep. 2017;4:19–27. doi: 10.1007/s40474-017-0109-y.
    1. Gomez A.N., Venegas M.A., Zapata R.V., Lopez F.M., Maudier V.M., Pavez-Adasme G., Hemandez-Mosqueira C. Effect of an intervention based on virtual reality on motor development and postural control in children with Down Syndrome. Rev. Chil. Pediatr. 2018;89:747–752.
    1. Silva V., Campos C., Sa A., Cavadas M., Pinto J., Simoes P., Machado S., Murillo-Rodriguez E., Barbosa-Rocha N. Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome. J. Intellect. Disabil. Res. 2017;61:755–765. doi: 10.1111/jir.12384.
    1. Hammond J., Jones V., Hill E.L., Green D., Male I. An investigation of the impact of regular use of the Wii Fit to improve motor and psychosocial outcomes in children with movement difficulties: A pilot study. Child Care Health Dev. 2014;40:165–175. doi: 10.1111/cch.12029.
    1. Salem Y., Gropack S.J., Coffin D., Godwin E.M. Effectiveness of a low-cost virtual reality system for children with developmental delay: A preliminary randomised single-blind controlled trial. Physiotherapy. 2012;98:189–195. doi: 10.1016/j.physio.2012.06.003.
    1. Greg P., Geng P., Liang G. Introduction to Human Motor Development. People’s Education Press; Beijing, China: 2008.
    1. Gordon C., Roopchand-Martin S., Gregg A. Potential of the Nintendo Wii as a rehabilitation tool for children with cerebral palsy in a developing country: A pilot study. Physiotherapy. 2012;98:238–242. doi: 10.1016/j.physio.2012.05.011.
    1. Bei J., Xia C. Analysis of the status quo of children’s writing ability. J. Bio-Education. 2018;1:30–33.
    1. Snider L., Majnemer A., Darsaklis V. Virtual reality as a therapeutic modality for children with cerebral palsy. Dev. Neurorehabil. 2010;13:120–128. doi: 10.3109/17518420903357753.
    1. van der Heide J.C., Begeer C., Fock J.M., Otten B., Stremmelaar E., van Eykern L.A., Hadders-Algra M. Postural control during reaching in preterm children with cerebral palsy. Dev. Med. Child Neurol. 2004;46:253–266. doi: 10.1111/j.1469-8749.2004.tb00480.x.
    1. Sgandurra G., Ferrari A., Cossu G., Guzzetta A., Fogassi L., Cioni G. Randomized trial of observation and execution of upper extremity actions versus action alone in children with unilateral cerebral palsy. Neurorehabilit. Neural Repair. 2013;27:808–815. doi: 10.1177/1545968313497101.
    1. Zou L.Y., Han J., Li C.X., Yeung A.S., Hui S.C., Tsang W.W.N., Ren Z.B., Wang L. Effects of Tai Chi on lower limb proprioception in adults aged over 55: A systematic review and meta-analysis. Arch. Phys. Med. Rehabil. 2019;100:1102–1113. doi: 10.1016/j.apmr.2018.07.425.
    1. Zou L., Sasaki J.E., Wei G.-X., Huang T., Yeung A.S., Neto O.B., Chen K.W., Hui S.C. Effects of Mind–Body Exercises (Tai Chi/Yoga) on Heart Rate Variability Parameters and Perceived Stress: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2018;7:404. doi: 10.3390/jcm7110404.
    1. Mastmeyer A., Wilms M., Fortmeier D., Schroder J., Handels H. Real-TimeUltrasound Simulation for Training of US-Guided Needle Insertion in Breathing Virtual Patients. Stud. Health Technol. Inform. 2016;220:219–226.
    1. Gibson J.J. The Ecological Approach to Visual Perception. Houghton-Mifflin; Boston, MA, USA: 1979.
    1. Thelen E., Smith L.B. A Dynamic Systems Approach to the Development of Cognition and Action. MIT Press; Cambridge, MA, USA: 1994.

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