Can Virtual Reality games improve scores on clinical balance scales in children with cerebral palsy: Preliminary results of a randomized controlled clinical trial.
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Can Virtual Reality games improve scores on clinical balance scales in children with cerebral palsy: Preliminary results of a randomized controlled clinical trial ⁎
Pieter Meynsa,d, , Jaap Harlaara,c, Laura van de Polb, Frederik Barkhofb, Annemieke Buizera a
VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands VU University Medical Center, Amsterdam, The Netherlands c TU Delft, Delft, The Netherlands d Hasselt University, Diepenbeek, Belgium b
1. Introduction Due to their sensorimotor disorders, children with cerebral palsy (CP) typically experience poor balance control during standing and walking [1]. Virtual Reality (VR) is increasingly used in balance rehabilitation since literature has indicated some promising effects on for instance motivation [2] and functional outcomes [3] in several patient populations. Some preliminary studies have investigated the effect of VR training on balance in children with CP, however, they describe mixed results [4,5]. The contradictory findings could be the result of insufficient power due to small sample size and use of different measures of balance. 2. Research question Can 6 weeks VR home-training promote balance control on a range of clinical scales in children with CP? 3. Methods In this registered RCT (NTR6034), 41 children with spastic CP will be recruited (7−14 years old) and randomly distributed in the intervention or control group (ratio of 31/10 in intervention/control group). Children with CP are included if they (1) are diagnosed with bilateral spastic CP, (2) have GMFCS level II, (3) had no surgical interventions (e.g. orthopaedic, selective dorsal rhizotomy) in the past twelve months, and (4) had no Botulinum Toxin A injections in the past six months. VR home-training comprises X-box One & Kinect (Microsoft) training for 6 weeks. Children exercise using Kinect sports games with a focus on balance (tennis, football, bowling) 5×/week for 30 min/session. Patients in the control group do not receive VR training. Balance is assessed with several clinical scales; i.e. Pediatric Balance Scale (PBS) – 14-item measure which examines functional balance in the context of everyday tasks (on 56 points), balance subscale of the Bruininks−Oseretsky test for Motor Proficiency 2nd edition (BOT-2) – 9-item subscale which examines static and dynamic balance for use by
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Corresponding author.
http://dx.doi.org/10.1016/j.gaitpost.2017.06.390
0966-6362/ © 2017 Published by Elsevier B.V.
practitioners and researchers to diagnose motor impairments and evaluate interventions (on 37 points), and the Trunk Control Measurement Scale (TCMS) – 15-item scale for postural control which assesses static and dynamic aspects of trunk control (on 58 points). As the RCT has just started (i.e. five children have been recruited), we present preliminary data of three children that performed the baseline measurement and measurement after 6 weeks (post-training). 4. Results All three boys were allocated to the intervention group. Table 1 provides their baseline and post-training scores on the clinical balance scales. All participants improved on two out of the three scales. 5. Discussion We present the protocol of our RCT and the results of our first included participants. We assessed balance using multiple clinical balance scales to be able to compare our results to previous studies. From our preliminary results, it seems that balance might be improved using VR home-training for 6 weeks in some children with CP. However, it appears from these three patients that VR training might result in improvements of different aspects of balance (lower Table 1
PBS BOT-2 (balance) TCMS
Baseline Post-training Baseline Post-training Baseline Post-training
Participant 1 (10y 7 mo)
Participant 2 (9y 9mo)
Participant 3 (8y 0mo)
41 46 0 11 39 36
51 49 2 7 34 43
51 50 9 17 25 42
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References
limb versus trunk control); e.g. participant 1 increased most on PBS (i.e. more than the minimal clinically important difference [MCID] of 3.66 points on the PBS [6]) but showed a decrease on the TCMS, while participant 2 and 3 increased most on the TCMS (i.e. 9 and 17 points out of the possible 58; MCID not available) but showed a (negligible) decrease on the PBS. Assuming that a single mechanism of keeping balance would be sensitive to training, the use of multiple measures of balance might thus provide some insight in the contrasting results of previous studies.
[1] [2] [3] [4] [5] [6]
2
Bruijn, Res. Dev. Disabil. 34 (2013) 1689–1699. Meyns, Dev. Neurorehabil. 9 (2017) 1–20. Tatla, Dev. Med. Child Neurol. 55 (2013) 593–601. Jelsma, Dev. Neurorehabil. 16 (2013) 27–37. Brien, Pediatr. Phys. Ther. 23 (2011) 258–266. Chen, Res. Dev. Disabil. 34 (2013) 916–922.
