Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis

Renato S Melo, Andrea Lemos, Alexandre Delgado, Maria Cristina Falcão Raposo, Karla Mônica Ferraz, Rosalie Barreto Belian, Renato S Melo, Andrea Lemos, Alexandre Delgado, Maria Cristina Falcão Raposo, Karla Mônica Ferraz, Rosalie Barreto Belian

Abstract

Background: Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.

Objective: The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.

Methods: A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.

Results: Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I2 = 0%).

Conclusion: Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.

Keywords: child; deaf; deafness; exercise therapy; exergaming; hearing impairment; motor skills disorders; rehabilitation; vestibular disease; walking.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the studies analyzed in this systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).
Figure 2
Figure 2
Risk of bias summary of the included trials assessed using the Cochrane risk-of-bias tool.
Figure 3
Figure 3
Risk of bias of each included trial assessed using the Cochrane risk-of-bias tool [61,62,63].
Figure 4
Figure 4
Forest plot of the comparison between the use of virtual reality-based games versus traditional balance exercises to improve the balance of adolescents with SNHL, represented by the number of falls or exits from the Flamingo position, measured by the Flamingo Balance test [62,63].

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