The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review

Pereira, Kharinni Uchôa; Silva, Michelle Zampar; Pfeifer, Luzia Iara

doi:10.1590/1984-0462/2023/41/2021283

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Brasil

Revista Paulista de Pediatria

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Brasil

Español English

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ORIGINAL ARTICLE • Rev. paul. pediatr. 41 • 2023 • https://doi.org/10.1590/1984-0462/2023/41/2021283 copy

The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review

A utilização da realidade virtual na estimulação da função manual em crianças com paralisia cerebral: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To identify in national and international literature the use of virtual reality to develop manual skills of children with cerebral palsy.

Methods:

This is a systematic review carried out in the PubMed database, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and the Online System for Search and Analysis of Medical Literature (Ovid Medline) using the keywords “cerebral palsy”, “virtual reality”, “occupational therapy”, “child”, “daily activities/activities of daily living”, in English and in Portuguese. The selected articles had their methodological quality evaluated through the Physiotherapy Evidence Database (PEDro scale).

Results:

228 studies were selected, as they included children with cerebral palsy undergoing treatment with exposure to virtual reality to improve manual function in daily activities. Studies on other themes, incomplete, and duplicated reviews were excluded. Three evaluators conducted the study selection process and included 14 articles in the analysis.

Conclusions:

The findings suggest that virtual reality therapy has contributed to an improvement in the manual function of children with cerebral palsy, constituting a useful resource for a supporting intervention to enhance traditional therapies.

Keywords:
Cerebral palsy; Virtual reality; Hand; Physical functional performance; Daily activities

Authors/year	Sample	PEDro scale
Acar et al.²⁹29. Acar G, Altun GP, Yurdalan S, Polat MG. Efficacy of neurodevelopmental treatment combined with the Nintendo(®) Wii in patients with cerebral palsy. J Phys Ther Sci. 2016;28:774-80. https://doi.org/10.1589/jpts.28.774 https://doi.org/10.1589/jpts.28.774... 2016	CP (30): (6-15 years)	7
Gerber et al.³⁴34. Gerber CN, Kunz B, van Hedel HJ. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study. J Neuroeng Rehabil. 2016;13:33. https://doi.org/10.1186/s12984-016-0141-x https://doi.org/10.1186/s12984-016-0141-... 2016	CP (13), neuropathy (1); ABI (1): (5-18 years)	2
Kirshner et al.³⁷37. Kirshner S, Weiss PL, Tirosh E. Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task. Res Dev Disabil. 2016;49-50:247-57. https://doi.org/10.1016/j.ridd.2015.11.025 https://doi.org/10.1016/j.ridd.2015.11.0... 2016	CP (15), TD (19): (12 years)	4
van Hedel et al.³⁵35. van Hedel HJ, Häfliger N, Gerber CN. Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study. J Neuroeng Rehabil. 2016;13:93. https://doi.org/10.1186/s12984-016-0200-3 https://doi.org/10.1186/s12984-016-0200-... 2016	CP (15), Stroke (4), TBI (4), Encephalitis (2), others (9): (5-20 years)	2
Eckert et al.³³33. Eckert M, Gómez-Martinho I, Meneses J, Martínez JF. New approaches to exciting exergame-experiences for people with motor function impairments. Sensors (Basel). 2017;17:354. https://doi.org/10.3390/s17020354 https://doi.org/10.3390/s17020354... 2017	EG = CP (1), hypotonia (1), BMD (1), DMD (2), FSH (2), PPS (1): (5-50 years), CG/TD (8): (7-13 years)	3
Hung et al.¹⁷17. Hung JW, Chang YJ, Chou CX, Wu WC, Howell S, Lu WP. Developing a suite of motion-controlled games for upper extremity training in children with cerebral palsy: a proof-of-concept study. Games Health J. 2018;7:327-34. https://doi.org/10.1089/g4h.2017.0141 https://doi.org/10.1089/g4h.2017.0141... 2017	CP (13): (5-15 years)	3
Beretta et al.³¹31. Beretta E, Cesareo A, Biffi E, Schafer C, Galbiati S, Strazzer S. Rehabilitation of upper limb in children with acquired brain injury: a preliminary comparative study. J Healthc Eng. 2018;2018:4208492. https://doi.org/10.1155/2018/4208492 https://doi.org/10.1155/2018/4208492... 2018	Hemiplegia from severe brain injury (18): (4-8 years)	3
Biffi et al.³²32. Biffi E, Maghini C, Cairo B, Beretta E, Peri E, Altomonte D, et al. Movement velocity and fluidity improve after Armeo® spring rehabilitation in children affected by acquired and congenital brain diseases: an observational study. Biomed Res Int. 2018;2018:1537170. https://doi.org/10.1155/2018/1537170 https://doi.org/10.1155/2018/1537170... 2018	CP (21), ABI (22): (5-18 years)	3
Martins et al.³⁹39. Martins FP, Massetti T, Crocetta TB, Lopes PB, Silva AA, Figueiredo EF, et al. Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – a pilot study. Neuropsychiatr Dis Treat. 2019;15:417-28. https://doi.org/10.2147/NDT.S184510 https://doi.org/10.2147/NDT.S184510... 2019	EG/CP (10); CG/TD (10): (6-19 years)	4
Şahin et al.²⁸28. Şahin S, Köse B, Aran OT, Ağce ZB, Kayıhan H. The effects of virtual reality on motor functions and daily life activities in unilateral spastic cerebral palsy: a single-blind randomized controlled trial. Games Health J. 2020;9:45-52. https://doi.org/10.1089/g4h.2019.0020 https://doi.org/10.1089/g4h.2019.0020... 2020	EG/CP (30); CG/CP (30); (7-16 years)	9
Bortone et al.³⁰30. Bortone I, Barsotti M, Leonardis D, Crecchi A, Tozzini A, Bonfiglio L, et al. Immersive virtual environments and wearable haptic devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil. 2020;17:144. https://doi.org/10.1186/s12984-020-00771-6 https://doi.org/10.1186/s12984-020-00771... 2020	CP or DD (8): (18 years)	8
Daoud et al.³⁶36. Daoud MI, Alhusseini A, Ali MZ, Alazrai R. A game-based rehabilitation system for upper-limb cerebral palsy: a feasibility study. Sensors (Basel). 2020;20:2416. https://doi.org/10.3390/s20082416 https://doi.org/10.3390/s20082416... 2020	EG/CP (6): (10 years or +) CG/TD (20): (18 years or +)	4
Leal et. al.⁴⁰40. Leal AF, Silva TD, Lopes PB, Bahadori S, Araújo LV, Costa MV, et al. The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) – a cross-sectional randomized study. J Neuroeng Rehabil. 2020;17:59. https://doi.org/10.1186/s12984-020-00689-z https://doi.org/10.1186/s12984-020-00689... 2020	EG/CP (28); CG/TD (28); (6-15 years)	4
MacIntosh et al.³⁸38. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: a randomized single-case experimental design feasibility study. PLoS One. 2020;15:e0234767. https://doi.org/10.1371/journal.pone.0234767 https://doi.org/10.1371/journal.pone.023... 2020	CP (19): (8-18 years)	2

Authors	Virtual reality equipment	Games
Acar et al.²⁹29. Acar G, Altun GP, Yurdalan S, Polat MG. Efficacy of neurodevelopmental treatment combined with the Nintendo(®) Wii in patients with cerebral palsy. J Phys Ther Sci. 2016;28:774-80. https://doi.org/10.1589/jpts.28.774 https://doi.org/10.1589/jpts.28.774...	Nintendo Wii	Tennis, baseball and boxing.
Gerber et al.³⁴34. Gerber CN, Kunz B, van Hedel HJ. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study. J Neuroeng Rehabil. 2016;13:33. https://doi.org/10.1186/s12984-016-0141-x https://doi.org/10.1186/s12984-016-0141-...	YouGrabber® system, portable version	Exergames and Hamster Splash
Kirshner et al.³⁷37. Kirshner S, Weiss PL, Tirosh E. Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task. Res Dev Disabil. 2016;49-50:247-57. https://doi.org/10.1016/j.ridd.2015.11.025 https://doi.org/10.1016/j.ridd.2015.11.0...	IREX 2D Camera Tracking VR System	Meal-Maker Virtual Environment
van Hedel et al.³⁵35. van Hedel HJ, Häfliger N, Gerber CN. Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study. J Neuroeng Rehabil. 2016;13:93. https://doi.org/10.1186/s12984-016-0200-3 https://doi.org/10.1186/s12984-016-0200-...	YouGrabber® system	Airplane game
Eckert et al.³³33. Eckert M, Gómez-Martinho I, Meneses J, Martínez JF. New approaches to exciting exergame-experiences for people with motor function impairments. Sensors (Basel). 2017;17:354. https://doi.org/10.3390/s17020354 https://doi.org/10.3390/s17020354...	Blender Game Engine Platform with Kinect Sensor	The Ladder, The Boat, Whack-a-Mole and The Paper-Bird
Hung et al.¹⁷17. Hung JW, Chang YJ, Chou CX, Wu WC, Howell S, Lu WP. Developing a suite of motion-controlled games for upper extremity training in children with cerebral palsy: a proof-of-concept study. Games Health J. 2018;7:327-34. https://doi.org/10.1089/g4h.2017.0141 https://doi.org/10.1089/g4h.2017.0141...	Computer with Scratch software and Kinect2Scratch software + Kinect/Windows Sensor;	Howell; Hungry Shark and Hungry Ant
Beretta et al.³¹31. Beretta E, Cesareo A, Biffi E, Schafer C, Galbiati S, Strazzer S. Rehabilitation of upper limb in children with acquired brain injury: a preliminary comparative study. J Healthc Eng. 2018;2018:4208492. https://doi.org/10.1155/2018/4208492 https://doi.org/10.1155/2018/4208492...	Armeo®Spring	Armeo®Spring (game)
Biffi et al.³²32. Biffi E, Maghini C, Cairo B, Beretta E, Peri E, Altomonte D, et al. Movement velocity and fluidity improve after Armeo® spring rehabilitation in children affected by acquired and congenital brain diseases: an observational study. Biomed Res Int. 2018;2018:1537170. https://doi.org/10.1155/2018/1537170 https://doi.org/10.1155/2018/1537170...	Armeo®Spring	Vertical capture
Martins et al.³⁹39. Martins FP, Massetti T, Crocetta TB, Lopes PB, Silva AA, Figueiredo EF, et al. Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – a pilot study. Neuropsychiatr Dis Treat. 2019;15:417-28. https://doi.org/10.2147/NDT.S184510 https://doi.org/10.2147/NDT.S184510...	Computer with webcam	Real task: timing. Virtual task: MoveHero
Şahin et al.²⁸28. Şahin S, Köse B, Aran OT, Ağce ZB, Kayıhan H. The effects of virtual reality on motor functions and daily life activities in unilateral spastic cerebral palsy: a single-blind randomized controlled trial. Games Health J. 2020;9:45-52. https://doi.org/10.1089/g4h.2019.0020 https://doi.org/10.1089/g4h.2019.0020...	Computer + Microsoft Kinect v 1.0t sensor;	Aerial challenge; boxing coach; wall break; Jet run; super kick
Bortone et al.³⁰30. Bortone I, Barsotti M, Leonardis D, Crecchi A, Tozzini A, Bonfiglio L, et al. Immersive virtual environments and wearable haptic devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil. 2020;17:144. https://doi.org/10.1186/s12984-020-00771-6 https://doi.org/10.1186/s12984-020-00771...	Equipment VERA	Moneybox and Marble; Labyrinth game
Daoud et al.³⁶36. Daoud MI, Alhusseini A, Ali MZ, Alazrai R. A game-based rehabilitation system for upper-limb cerebral palsy: a feasibility study. Sensors (Basel). 2020;20:2416. https://doi.org/10.3390/s20082416 https://doi.org/10.3390/s20082416...	Computer + Kinect sensor for Windows v2	Collect stars
Leal et. al.⁴⁰40. Leal AF, Silva TD, Lopes PB, Bahadori S, Araújo LV, Costa MV, et al. The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) – a cross-sectional randomized study. J Neuroeng Rehabil. 2020;17:59. https://doi.org/10.1186/s12984-020-00689-z https://doi.org/10.1186/s12984-020-00689...	Computer with touchscreen + Kinect sensor	Verification limit
MacIntosh et al.³⁸38. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: a randomized single-case experimental design feasibility study. PLoS One. 2020;15:e0234767. https://doi.org/10.1371/journal.pone.0234767 https://doi.org/10.1371/journal.pone.023...	ICP	ICP game

Authors	Intervention period	Session time
Acar et al.²⁹29. Acar G, Altun GP, Yurdalan S, Polat MG. Efficacy of neurodevelopmental treatment combined with the Nintendo(®) Wii in patients with cerebral palsy. J Phys Ther Sci. 2016;28:774-80. https://doi.org/10.1589/jpts.28.774 https://doi.org/10.1589/jpts.28.774...	Twice a week for six weeks	45’ (GNW 15’ + routine 30’ ND); and routine GND
Gerber et al.³⁴34. Gerber CN, Kunz B, van Hedel HJ. Preparing a neuropediatric upper limb exergame rehabilitation system for home-use: a feasibility study. J Neuroeng Rehabil. 2016;13:33. https://doi.org/10.1186/s12984-016-0141-x https://doi.org/10.1186/s12984-016-0141-...	Two weeks (185 min ± 45 min); Three weeks with varying frequencies	1st meeting with standardized instruction for parents and patient (45’) + home training: 1st week. 5 days/week. for 30’ + 2nd week. with free time.
Kirshner et al.³⁷37. Kirshner S, Weiss PL, Tirosh E. Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task. Res Dev Disabil. 2016;49-50:247-57. https://doi.org/10.1016/j.ridd.2015.11.025 https://doi.org/10.1016/j.ridd.2015.11.0...	Single session	90’
van Hedel et al.³⁵35. van Hedel HJ, Häfliger N, Gerber CN. Quantifying selective elbow movements during an exergame in children with neurological disorders: a pilot study. J Neuroeng Rehabil. 2016;13:93. https://doi.org/10.1186/s12984-016-0200-3 https://doi.org/10.1186/s12984-016-0200-...	Single session	3 steps of 90’’: wide path, narrow 50%, narrow 80% + 30” gap between each step = total 330”
Eckert et al.³³33. Eckert M, Gómez-Martinho I, Meneses J, Martínez JF. New approaches to exciting exergame-experiences for people with motor function impairments. Sensors (Basel). 2017;17:354. https://doi.org/10.3390/s17020354 https://doi.org/10.3390/s17020354...	Single session OT run the four tested games	Not informed
Hung et al.¹⁷17. Hung JW, Chang YJ, Chou CX, Wu WC, Howell S, Lu WP. Developing a suite of motion-controlled games for upper extremity training in children with cerebral palsy: a proof-of-concept study. Games Health J. 2018;7:327-34. https://doi.org/10.1089/g4h.2017.0141 https://doi.org/10.1089/g4h.2017.0141...	Twice a week for 12 weeks	60’: VR (30’) + conventional 30” OT
Beretta et al.³¹31. Beretta E, Cesareo A, Biffi E, Schafer C, Galbiati S, Strazzer S. Rehabilitation of upper limb in children with acquired brain injury: a preliminary comparative study. J Healthc Eng. 2018;2018:4208492. https://doi.org/10.1155/2018/4208492 https://doi.org/10.1155/2018/4208492...	Ft: five times a week for four weeks CIMT: four times a week for four weeks VR: five times a week for four weeks	Ft: 45’ CIMT: at least 3 h/day VR: 45’
Biffi et al.³²32. Biffi E, Maghini C, Cairo B, Beretta E, Peri E, Altomonte D, et al. Movement velocity and fluidity improve after Armeo® spring rehabilitation in children affected by acquired and congenital brain diseases: an observational study. Biomed Res Int. 2018;2018:1537170. https://doi.org/10.1155/2018/1537170 https://doi.org/10.1155/2018/1537170...	Ft: 20 sessions for four weeks VR: 20 sessions for four weeks	Ft: 45’ VR: 45’
Martins et al.³⁹39. Martins FP, Massetti T, Crocetta TB, Lopes PB, Silva AA, Figueiredo EF, et al. Analysis of motor performance in individuals with cerebral palsy using a non-immersive virtual reality task – a pilot study. Neuropsychiatr Dis Treat. 2019;15:417-28. https://doi.org/10.2147/NDT.S184510 https://doi.org/10.2147/NDT.S184510...	Single session	8’
Şahin et al.²⁸28. Şahin S, Köse B, Aran OT, Ağce ZB, Kayıhan H. The effects of virtual reality on motor functions and daily life activities in unilateral spastic cerebral palsy: a single-blind randomized controlled trial. Games Health J. 2020;9:45-52. https://doi.org/10.1089/g4h.2019.0020 https://doi.org/10.1089/g4h.2019.0020...	Twice a week for eight weeks	45’
Bortone et al.³⁰30. Bortone I, Barsotti M, Leonardis D, Crecchi A, Tozzini A, Bonfiglio L, et al. Immersive virtual environments and wearable haptic devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study. J Neuroeng Rehabil. 2020;17:144. https://doi.org/10.1186/s12984-020-00771-6 https://doi.org/10.1186/s12984-020-00771...	VR: twice a week for four weeks + rest break of four weeks + traditional therapy twice a week for four weeks	15’
Daoud et al.³⁶36. Daoud MI, Alhusseini A, Ali MZ, Alazrai R. A game-based rehabilitation system for upper-limb cerebral palsy: a feasibility study. Sensors (Basel). 2020;20:2416. https://doi.org/10.3390/s20082416 https://doi.org/10.3390/s20082416...	180 sessions each group: CP: 12 OT 16 periods (10–15 sessions). TD: three periods (60 sessions)	A game session followed by a 2’ relaxation period
Leal et. al.⁴⁰40. Leal AF, Silva TD, Lopes PB, Bahadori S, Araújo LV, Costa MV, et al. The use of a task through virtual reality in cerebral palsy using two different interaction devices (concrete and abstract) – a cross-sectional randomized study. J Neuroeng Rehabil. 2020;17:59. https://doi.org/10.1186/s12984-020-00689-z https://doi.org/10.1186/s12984-020-00689...	Single session	30’ between acquisition phase, rest, retention phase; transfer phase.
MacIntosh et al.³⁸38. MacIntosh A, Desailly E, Vignais N, Vigneron V, Biddiss E. A biofeedback-enhanced therapeutic exercise video game intervention for young people with cerebral palsy: a randomized single-case experimental design feasibility study. PLoS One. 2020;15:e0234767. https://doi.org/10.1371/journal.pone.0234767 https://doi.org/10.1371/journal.pone.023...	Five times a week for four weeks	1st of 60’; + 3 OT 6 visits (20’–30’)

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[1] *Corresponding author. E-mail: luziara@fmrp.usp.br (L. I. Pfeifer).