Improvement of movement function using bespoke virtual reality based computer games

Children with cerebral palsy suffer from primary abnormalities that affect their ability to control movement of body segments. There is evidence that the core (trunk and pelvis) of the body activates prior to the periphery (extremities) during human movement, and so improvement in controlling the core first, then the periphery, could lead to carrying out activities of daily living more effectively. Virtual rehabilitation is developing as a method for the training and assessment of movement function, with evidence suggesting games controlled by the periphery can lead to improvements in activities of daily living, but virtual rehabilitation on the core is scarce. Study One (feasibility study) assessed the changes in gait in response to a six week virtual reality intervention training the core in children with cerebral palsy diplegia (n = 5), using a laboratory based virtual reality system. Improvement in selective motor control of the core occurred after VR training, represented by increased VR game performance (maximum settled speed). Participants showed that single plane trunk movement was better controlled than cross plane trunk movement, trunk rotation was better controlled than trunk tilt, and the trunk was controlled better than the pelvis. Changes in game performance did not transfer to improvements in gait as measured using the Gait Deviation Index. Study Two used a portable virtual reality system in primary schools to train the core and periphery in children with cerebral palsy. A randomised, cross-over design on children with cerebral palsy (n = 8) found that VR game performance improved after receiving VR training, represented by an increase in maximum settled speed and a reduction in variation of pass distance. Single plane movement of the trunk was better controlled than cross plane movement during each assessment, ankle control was better than knee control at each assessment, and control of peripheral segments was better than control of core segments. There were no significant differences in performance of the sit -to-stand movement in response to core training (one week) followed by peripheral training (one week), or when training order was reversed. Overall, Study One and Study Two found no improvements in activities of daily living. Low levels of exposure to virtual reality training, inappropriate outcome measures, in addition to low sample sizes, may have reduced the effect on performance of activities of daily living. Study Two demonstrated that portable virtual reality training is feasible in schools, and can be provided on a daily basis to children with movement difficulties. Overall, the findings provide an important insight into virtual reality training aimed at improving control of the core and periphery in children with cerebral palsy.

Name dc:type.qualificationname

phd

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

Liverpool John Moores University

Year dc:date.issued

2012

Author dc:creator

• Foster, R

• QA75 Electronic computers. Computer science
• QA76 Computer software
• RJ Pediatrics