Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy Efficacy of home-based virtual cycling training on bone mineral density in ambulatory children with cerebral palsy Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot, randomized controlled trial Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy. A Low-Cost Video Game Applied for Training of Upper Extremity Function in Children with Cerebral Palsy: A Pilot Study Effects of Nintendo Wii™ Training on Occupational Performance, Balance, and Daily Living Activities in Children with Spastic Hemiplegic Cerebral Palsy: A Single-Blind and Randomized Trial. Randomized controlled trial of web-based multimodal therapy for unilateral cerebral palsy to improve occupational performance. Spared Primary Motor Cortex and The Presence of MEP in Cerebral Palsy Dictate the Responsiveness to tDCS during Gait Training Impact of multi-modal web-based rehabilitation on occupational performance and upper limb outcomes: pilot randomized trial in children with acquired brain injuries. Effects of interactive games on motor performance in children with spastic cerebral palsy Effect of a single session of transcranial direct-current stimulation combined with virtual reality training on the balance of children with cerebral palsy: a randomized, controlled, double-blind trial Can balance in children with cerebral palsy improve through use of an activity promoting computer game? A pilot single-blind multicentre randomized controlled trial to evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on the arm function of children with spastic cerebral palsy An external focus of attention enhances balance learning in older adults. Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy. Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial Does Nintendo Wii Balance Board improve standing balance? A randomized controlled trial in children with cerebral palsy. Effectiveness of a low-cost virtual reality system for children with developmental delay: a preliminary randomised single-blind controlled trial. Use of Virtual Reality to Improve Upper-Extremity Control in Children With Cerebral Palsy: A Single-Subject Design Effects of modified constraint-induced movement therapy in virtual environment on upper-limb function in children with spastic hemiparetic cerebral palsy: a randomised controlled trial. Sitting playfully: does the use of a centre of gravity computer game controller influence the sitting ability of young people with cerebral palsy? Video-game based therapy performed by children with cerebral palsy: a cross-over randomized controlled trial and a cross-sectional quantitative measure of physical activity. Upper limb training using Wii Sports Resort™ for children with hemiplegic cerebral palsy: a randomized, single-blind trial
[ Purpose ] The purpose of the study was to evaluate the effects of conventional neurological treatment and a virtual reality training program on eye-h and coordination in children with cerebral palsy . [ Subjects ] Sixteen children ( 9 males , 7 females ) with spastic diplegic cerebral palsy were recruited and r and omly assigned to the conventional neurological physical therapy group ( CG ) and virtual reality training group ( VRG ) . [ Methods ] Eight children in the control group performed 45 minutes of therapeutic exercise twice a week for eight weeks . In the experimental group , the other eight children performed 30 minutes of therapeutic exercise and 15 minutes of a training program using virtual reality twice a week during the experimental period . [ Results ] After eight weeks of the training program , there were significant differences in eye-h and coordination and visual motor speed in the comparison of the virtual reality training group with the conventional neurological physical therapy group . [ Conclusion ] We conclude that a well- design ed training program using virtual reality can improve eye-h and coordination in children with cerebral palsy Summary The 12-week home-based virtual cycling training ( hVCT ) improved lower limb muscle strength and areal bone mineral density ( aBMD ) than the control program in children with cerebral palsy ( CP ) . A muscle strengthening program , rather than general physical activity , is more specific in enhancing aBMD for these children . A novel hVCT is an effective and efficient strategy that enhances lower limb bone density in these children . Introduction This is the first study to assess the efficacy of a novel hVCT program on bone density for children with spastic CP using a well- design ed r and omized controlled trial . Methods Twenty-seven ambulatory children with spastic CP , aged 6–12 years , were r and omly assigned to the hVCT group ( n = 13 ) or control group ( n = 14 ) . Outcome measures —motor function [ Gross Motor Function Measure-66 ( GMFM-66 ) ] , muscle strength ( curl up scores and isokinetic torque of knee extensor and flexor muscle ) and aBMD of the lumbar and distal femur — were administered before and immediately after the 12-week intervention . Results Analysis of covariance results show that the hVCT group had greater distal femur aBMD and isokinetic torques of knee extensor and flexor muscles than the control group at posttreatment ( p < 0.05 ) . However , curl up scores , GMFM-66 , and lumbar aBMD at posttreatment did not differ between the two groups . Conclusions Analytical findings suggest that the muscle strengthening program is more specific in enhancing bone density for children with CP than general physical activity . Thus , the proposed 12-week hVCT protocol is an effective and efficient strategy for improving lower limb aBMD in these children ABSTRACT Objective : To assess the effect of interactive video gaming ( IVG ) with Nintendo Wii ( Wii ) supplemented to conventional therapy in rehabilitation of children with cerebral palsy ( CP ) . Design : R and omized , controlled , assessor-blinded study . Participants : Children with CP ; 10 children each in the control and intervention groups . Intervention : IVG using Wii , given as a supplement to conventional therapy , for 45 min per day , 6 days a week for 3 weeks . The children in the control group received conventional therapy alone . Outcome Measures : Posture control and balance , upper limb function , visual-perceptual skills , and functional mobility . Results : Significant improvement in upper limb functions was seen in the intervention group but not in the control group . Improvements in balance , visual perception , and functional mobility were not significantly different between control and intervention groups . Conclusions : Wii-based IVG may be offered as an effective supplement to conventional therapy in the rehabilitation of children with CP Independent walking is an important goal of clinical and community-based rehabilitation for children with cerebral palsy ( CP ) .  Virtual reality-based rehabilitation therapy is effective in motivating children with CP . This study investigated the effects of treadmill training with virtual reality on gait , balance , muscular strength , and gross motor function in children with CP . Eighteen children with spastic CP were r and omly divided into the virtual reality treadmill training ( VRTT ) group ( 9 subjects , mean age , 10.2 years ) and treadmill training ( TT ) group ( 9 subjects , mean age , 9.4 years ) . The groups performed their respective programs as well as conventional physical therapy 3 times/week for 8 weeks . Muscle strength was assessed using a digitalized manual muscle tester . Gross motor function was assessed using the Gross Motor Functional Measure ( GMFM ) . Balance was assessed using the Pediatric Balance Scale ( PBS ) . Gait speed was assessed using the 10-meter walk test ( 10MWT ) , and gait endurance was assessed using the 2-minute walk test ( 2MWT ) . After training , gait and balance was improved in the VRTT compared to the TT group ( P < 0.05 ) . Muscular strength was significantly greater in the VRTT group than the TT group , except for right hamstring strength . The improvements in GMFM ( st and ing ) and PBS scores were greater in the VRTT group than the TT group ( P < 0.05 ) . Furthermore , the VRTT group showed the higher values of 10MWT and 2MWT compared to the TT group ( P < 0.05 ) . In conclusion , VRTT programs are effective for improving gait , balance , muscular strength , and gross motor function in children with CP BACKGROUND This study compared the effects of Nintendo Wii-Fit ® balance-based video games and conventional balance training in children with mild cerebral palsy ( CP ) . METHODS This r and omized controlled trial involved 30 ambulatory pediatric patients ( aged 5 - 18 years ) with CP . Participants were r and omized to either conventional balance training ( control group ) or to  Wii-Fit balance-based video games training ( Wii group ) . Both group received neuro-developmental treatment ( NDT ) during 24 sessions . In addition , while the control group received conventional balance training in each session , the Wii group played Nintendo Wii Fit games such as ski slalom , tightrope walk and soccer heading on balance board . Primary outcomes were Functional Reach Test ( forward and sideways ) , Sit-to-St and Test and Timed Get up and Go Test . Nintendo Wii Fit balance , age and game scores , 10 m walk test , 10-step climbing test and Wee-Functional Independence Measure ( Wee FIM ) were secondary outcomes . RESULTS After the treatment , changes in balance scores and independence level in activities of daily living were significant ( P < 0.05 ) in both groups . Statistically significant improvements were found in the Wii-based game group compared with the control group in all balance tests and total Wee FIM score ( P < 0.05 ) . CONCLUSION Wii-fit balance-based video games are better at improving both static and performance-related balance parameters when combined with NDT treatment in children with mild CP The aim of the present study was to determine the user satisfaction of the EyeToy for the training of the upper limb in children with cerebral palsy ( CP ) .  User satisfaction was measured in 12 children with CP , using a postexperience question naire , primarily based on a presence question naire . In general , children with CP were satisfied with and motivated by the EyeToy training . In addition , a first evaluation study was performed to determine the effect of this training method on the upper limb function . Ten children with CP were r and omly assigned to the intervention ( mean age 11 years , 9 months ; SD 2,3 ) and the control group ( mean age 12 years , 3 months ; SD 3,2 ) . After a treatment period of 6 weeks , the intervention group completed a  user satisfaction question naire . Functional outcome was measured using the Melbourne Assessment scores . Percentage scores of the Melbourne Assessment of 7 of the 10 children were the same or changed only 1 % to 2 % from baseline to followup . However , in the experimental group , two children improved more , 9 % and 13 % respectively . In conclusion , it can be said that the EyeToy is a motivational training tool for the training of children with CP and has the potential to improve upper extremity function OBJECTIVE This study aim ed at assessing how the addition of Nintendo Wii ™ ( NW ) system to the traditional therapy influences occupational performance , balance , and daily living activities in children with spastic hemiplegic Cerebral Palsy ( CP ) . MATERIAL S AND METHODS The present study is a single-blind and r and omized trial involving 24 children aged 6 - 14 years , classified as level I or II on the Gross Motor Function Classification System . The children were allocated into two groups : an intervention and a control group , and their families participated in the study . The activity performance analysis of the children was undertaken by using the Canadian Occupational Performance Measure ( COPM ) , functional balance was measured with the Pediatric Balance Scale ( PBS ) , and activities of daily living were assessed with Pediatric Evaluation of Disability Inventory ( PEDI ) . Twenty-four children with CP were r and omly divided into two groups : intervention ( n = 12 ) and control group ( n = 12 ) . All children in both groups continued their traditional physiotherapy program twice a week , 45 minutes per session , whereas the participants in the intervention group , additionally , were trained with NW , two other days of the week for 12 weeks , with each session lasting for 30 minutes . RESULTS Self-care , mobility , PEDI total , PBS , and performance of COPM scores increased in the NW group after intervention . Self-care , mobility , and total PEDI increased in the control group as well . However , there was no statistically significant difference found between the groups , except for PBS ( P < 0.05 ) . CONCLUSIONS NW contributed to the implementation of occupational performance , daily living activities , and functional balance . We recommend that NW could be used in the rehabilitation program to engage play-based activities with fun AIM The study aim ed to investigate the effectiveness of a web-based therapy programme , ' Move it to improve it ' ( Mitii ( ™ ) ) , in children with unilateral cerebral palsy ( UCP ) on occupational performance , upper limb function , and visual perception . METHOD Participants ( n=102 ) were matched in pairs and r and omized to intervention ( Mitii for 20wks ; 26 males , mean age 11y 8mo [ 2y 4mo ] , Manual Ability Classification System level I=11 , II=39 , III=1 ) or control ( st and ard care ; 25 males , mean age 11y 10mo [ 2y 5mo ] , Manual Ability Classification System level I=13 , II=37 ) . Outcomes were the Assessment of Motor and Process Skills ( AMPS ) , Assisting H and Assessment , Jebsen-Taylor Test of H and Function ( JTTHF ) , Melbourne Assessment of Unilateral Upper Limb Function ( MUUL ) , Canadian Occupational Performance Measure ( COPM ) , and Test of Visual Perceptual Skills ( TVPS-3 ) . RESULTS Participants completed on average 32.4 hours of Mitii ( range 3.7 - 74.7h ) . The Mitii group demonstrated significantly greater post-intervention scores than the comparison group on the AMPS , JTTHF dominant upper limb , COPM , and TVPS-3 . The differences between groups were not clinical ly significant . There were no differences between groups on measures of impaired upper limb function . INTERPRETATION Mitii delivers individualized , web-based therapy at home and has potential to increase therapy dose . Mitii can be considered as an option to enhance occupational performance and visual perception for children with UCP The current priority of investigations involving transcranial direct current stimulation ( tDCS ) and neurorehabilitation is to identify biomarkers associated with the positive results of the interventions such that respondent and non-respondent patients can be identified in the early phases of treatment . The aims were to determine whether : ( 1 ) present motor evoked potential ( MEP ) ; and ( 2 ) injuries involving the primary motor cortex , are associated with tDCS-enhancement in functional outcome following gait training in children with cerebral palsy ( CP ) . We review ed the data from our parallel , r and omized , sham-controlled , double-blind studies . Fifty-six children with spastic CP received gait training ( either treadmill training or virtual reality training ) and tDCS ( active or sham ) . Univariate and multivariate logistic regression analyses were employed to identify clinical , neurophysiologic and neuroanatomic predictors associated with the responsiveness to treatment with tDCS .  MEP presence during the initial evaluation and the subcortical injury were associated with positive effects in the functional results . The logistic regression revealed that present MEP was a significant predictor for the six-minute walk test ( 6MWT ; p = 0.003 ) and gait speed ( p = 0.028 ) , whereas the subcortical injury was a significant predictor of gait kinematics ( p = 0.013 ) and gross motor function ( p = 0.021 ) . In this preliminary study involving children with CP , two important prediction factors of good responses to anodal tDCS combined with gait training were identified . Apparently , MEP ( integrity of the corticospinal tract ) and subcortical location of the brain injury exerted different influences on aspects related to gait , such as velocity and kinematics AIMS To determine whether the multi-modal web-based rehabilitation ' Move it to improve it ' ( Mitii ) is more effective than wait list control ( usual care ) to improve occupational performance , upper limb function , and visual perception in children with acquired brain injury ( ABI ) . METHOD Fifty-eight r and omly allocated children ( 53 % males ; mean age 11y 11mo , SD 2y 6mo ; Manual Abilities Classification Scale equivalent I=32 , II=24 , III=2 ; mean Full-scale IQ 75.8 , SD 16.2 ) received either 20 weeks of Mitii ( n=29 ) or usual care ( n=29 ) . Mitii comprised upper limb , cognitive , visual perception , and gross motor tasks , recommended for 30 minutes per day , 6 days per week , over 20 weeks . Outcomes were the Assessment of Motor and Process Skills ( AMPS ) , Melbourne Assessment of Unilateral Upper Limb Function , Jebsen-Taylor Test of H and Function , Test of Visual Perceptual Skills , Assisting H and Assessment ( AHA ) , and Canadian Occupational Performance Measure . The primary comparison at 20 weeks between groups on the AMPS process and motor measures used generalized estimating equations . RESULTS Groups were equivalent at baseline . Participants completed on average 17.6 hours ( range 0 - 46h ) of Mitii . There were no differences between groups on the primary outcome ( AMPS process : estimated mean difference -0.1 , 95 % CI -0.3 to 0.2 , p=0.589 ; and AMPS motor : estimated mean difference 0.2 , 95 % CI -0.1 to 0.5 , p=0.192 ) . There were no differences between groups on overall visual perception , upper limb , and occupational performance outcomes . INTERPRETATION Mitii led to negligible changes on all primary and secondary outcomes compared with usual care . This likely reflects the small dose achieved and poses questions around the acceptability and feasibility of home-delivered Mitii in this population of children with ABI [ Purpose ] Motor control and muscle strength impairments are the prime reasons for motor behavior disorders in children with spastic cerebral palsy . These impairments lead to histological changes in muscle growth and the learning of motor skills . Therefore , such children experience reduced muscle force generation and decreased muscle flexibility . We investigated the effect of training with Nintendo Wii Fit games on motor performance in children with spastic cerebral palsy . [ Subjects and Methods ] Forty children with cerebral palsy spastic diplegia aged 6–10 years diagnosed with level-3 functional capabilities according to the Gross Motor Classification System ( GMFCS ) were enrolled . Participants were divided r and omly into equal groups : group ( A ) that practice d with the Nintendo Wii Fit game for at least 20 minutes/day for 12 weeks and group ( B ) that underwent no training ( control group ) . The Movement Assessment Battery for Children-2 ( mABC-2 ) was used to assess motor performance , because it mainly involves motor tasks very similar to those involved in playing Nintendo Wii Fit games , e.g. , goal -directed arm movements , balancing , and jumping . [ Results ] There were significant improvements in the subscales of the motor performance test of those who practice d with the Nintendo Wii , while the control group showed no significant changes . [ Conclusion ] Using motion interactive games in home rehabilitation is feasible for children with cerebral palsy [ Purpose ] The aim of the present study was to investigate the effects of a single session of transcranial direct current stimulation combined with virtual reality training on the balance of children with cerebral palsy . [ Subjetcs and Methods ] Children with cerebral palsy between four and 12 years of age were r and omly allocated to two groups : an experimental group which performed a single session of mobility training with virtual reality combined with active transcranial direct current stimulation ; and a control group which performed a single session of mobility training with virtual reality combined with placebo transcranial direct current stimulation . The children were evaluated before and after the training protocol s. Static balance ( sway area , displacement , velocity and frequency of oscillations of the center of pressure on the anteroposterior and mediolateral axes ) was evaluated using a force plate under four conditions ( 30-second measurements for each condition ) : feet on the force plate with the eyes open , and with the eyes closed ; feet on a foam mat with the eyes open , and with the eyes closed . [ Results ] An increase in sway velocity was the only significant difference found . [ Conclusion ] A single session of anodal transcranial direct current stimulation combined with mobility training elicited to lead to an increase in the body sway velocity of children with cerebral palsy INTRODUCTION This study aim ed to evaluate if use of an activity promoting computer game , used in the home ( Nintendo Wii Fit ; Nintendo Co Ltd , Japan ) , could influence balance related outcome measures in children with cerebral palsy . METHOD Eighteen children with hemiplegic or diplegic cerebral palsy were recruited for the study . A r and omised cross-over design was used with children tested at baseline , after five weeks of playing Wii Fit games and after five weeks without any intervention . Outcome measures of interest included : performance on the modified sensory organisation test , reactive balance test and rhythmic weight shift test . RESULTS No significant difference was observed between testing occasions for any of the balance measures investigated ( p > 0.05 ) . CONCLUSION Our results suggest that use of a Nintendo Wii balance board and Wii Fit software for a minimum of thirty minutes per day in the patient 's own home , over a five week period , is not effective as a balance training tool in children with cerebral palsy Objective : To evaluate the potential benefits of computer-assisted arm rehabilitation gaming technology on arm function of children with spastic cerebral palsy . Design : A single-blind r and omized controlled trial design . Power calculations indicated that 58 children would be required to demonstrate a clinical ly important difference . Setting : Intervention was home-based ; recruitment took place in regional spasticity clinics . Participants : A total of 15 children with cerebral palsy aged five to 12 years were recruited ; eight to the device group . Interventions : Both study groups received ‘ usual follow-up treatment ’ following spasticity treatment with botulinum toxin ; the intervention group also received a rehabilitation gaming device . Main measures : ABILH AND -kids and Canadian Occupational Performance Measure were performed by blinded assessors at baseline , six and 12 weeks . Results : An analysis of covariance showed no group differences in mean ABILH AND -kids scores between time points . A non-parametric analysis of variance on Canadian Occupational Performance Measure scores showed a statistically significant improvement across time points ( χ2 ( 2,15 ) = 6.778 , p = 0.031 ) , but this improvement did not reach minimal clinical ly important difference . Mean daily device use was seven minutes . Recruitment did not reach target owing to unanticipated staff shortages in clinical services . Feedback from children and their families indicated that the games were not sufficiently engaging to promote sufficient use that was likely to result in functional benefits . Conclusion : This study suggests that computer-assisted arm rehabilitation gaming does not benefit arm function , but a Type II error can not be ruled out Studies with young adults have shown that an external focus of attention ( i.e. , on the movement effect ) results in more effective motor learning and greater automaticity than an internal focus ( i.e. , on one 's own body movements ) . The present study examined whether instructions inducing an external versus internal attentional focus would differentially affect the learning of a balance task in 32 older adults ( 24 females and 8 males , mean age : 69.4 years ) , divided equally , by number and gender , into two groups . The task required participants to st and on a balance platform ( stabilometer ) tilting to the left and right , and to try to keep the platform as close to horizontal as possible during each 30-s trial . The external focus group was instructed to concentrate on keeping markers on the platform horizontal , while the internal focus group was instructed to concentrate on keeping their feet horizontal . The dependent variable was time in balance ( i.e. , platform movements within ± 5 ° ) . Participants performed 10 practice trials on day 1 , with focus reminders given before each trial . Learning was assessed by a retention test , consisting of five trials without instructions , performed 1 day later . The external focus group outperformed the internal focus group in retention [ F(4 , 120)=3.46 , p=.01 ] . The results demonstrate that the learning benefits of an external attentional focus are generalizable to older learners This study is the first well- design ed r and omized controlled trial to assess the effects of a novel home-based virtual cycling training ( hVCT ) program for improving muscle strength in children with spastic cerebral palsy ( CP ) . Twenty-eight ambulatory children with spastic CP aged 6 - 12 years were r and omly assigned to an hVCT group ( n=13 ) or a control group ( n=15 ) . Outcome measures , including gross motor function of the Bruininks-Oseretsky Test of Motor Proficiency ( BOTMP ) and muscle strength ( isokinetic torque of knee extensor and flexor muscle ) , were administered before and immediately after the 12-week intervention . Analysis of covariance ( ANCOVA ) at post-treatment showed that , compared to the control group , the hVCT group had significantly higher isokinetic torque in the knee extensor and flexor muscles at 60 ° /s and 120 ° /s angular velocities ( p<0.05 ) . At post-treatment , the hVCT group also showed greater isokinetic strength improvement in the knee flexor than in the knee extensor at 60 ° /s ( knee flexor : 41 % ; knee extensor : 19 % ) and at 120 ° /s ( knee flexor : 36 % ; knee extensor : 30 % ) . However , the BOTMP scores at post-treatment did not differ between the two groups . Although the proposed 12-week hVCT protocol does not improve gross motor function , it enhances knee muscle strength in children with CP . The protocol obtains larger gains in the knee flexor than in the knee extensor at different angular velocities . The study findings will help clinicians to provide more effective and efficient strategies for muscle strength training in children with CP ABSTRACT The authors ' aim was to investigate the effects of continuous transcranial direct current stimulation ( tDCS ) combined with virtual reality training on static and functional balance in children with cerebral palsy ( CP ) . Twenty children with CP ( 6 girls and 14 boys ; M age = 7 years 6 months ± 2 years ) were r and omly allocated to two groups . The experimental group received active tDCS and the control group received sham stimulation during the 10 sessions of virtual reality mobility training protocol s. The children were evaluated on 3 occasions ( preintervention , postintervention , and 1-month follow-up ) . Static balance was evaluated using a force plate under 4 conditions : feet on force plate with ( a ) eyes open and ( b ) with eyes closed , and feet on foam mat with ( c ) eyes open and ( d ) with eyes closed . Functional balance was evaluated using the Pediatric Balance Scale and the Timed Up and Go Test . The analyses demonstrated statistically significant postintervention and follow-up effects favoring the experimental group over the control group with regard to the Pediatric Balance Scale , Timed Up and Go Test , and area of oscillation of the center of pressure when st and ing on the force plate with eyes open . The present findings suggest that tDCS can potentiate the effects of virtual reality training on static and functional balance among children with CP BACKGROUND Evidence on the effect of systemic exercise programs to improve the st and ing balance with the Nintendo Wii system is very limited and its post-treatment effectiveness is unknown in cerebral palsy ( CP ) patients . AIM Primary aim was to compare the effect of Nintendo Wii balance board ( Wii-therapy ) and st and ard physiotherapy ( SPT ) , on the performance of st and ing balance in children and adolescents with CP . Secondary aim was to determine the post-treatment effectiveness of Wii-therapy and SPT . DESIGN Two-arm , matched-pairs , parallel-groups , r and omized , controlled clinical trial . SETTING Outpatient Rehabilitation Centre in the city of Talca . POPULATION Patients with CP type spastic hemiplegia ( SHE ) and spastic diplegia ( SDI ) , aged 7 to 14 years , and level I or II of GMFCS or GMFCS-ER . Were excluded patients with FSIQ<80 , epilepsy , previous surgeries and application of Botulinum Toxin-A in the lower limb , uncorrected vision and hearing disorders . METHODS Thirty-two CP patients ( 10.7±3.2 years old ) were r and omly assigned to either Wii-therapy ( SDI=7 ; SHE=9 ) or SPT intervention ( SDI=7 ; SHE=9 ) . In each group , patients received three sessions per week over a period of 6 weeks . St and ing balance was assessed at baseline and every 2 weeks . Additionally , two follow-up assessment s ( 4 additional weeks ) were performed to determine post-treatment effectiveness . St and ing balance was quantified on force platform obtaining the outcomes area of center-of-pressure ( CoP ) sway ( CoPSway ) , st and ard deviation in the medial-lateral ( SDML ) and the anterior-posterior ( SDAP ) directions , and velocity in both directions ( VML and VAP ) . RESULTS Compared to SPT , Wii-therapy significantly reduced the CoPSway ( P=0.02 ) and SDAP in the eyes-open condition ( P=0.01 ) . However , the effects wane after 2 - 4 weeks . Post-hoc analysis revealed that only SHE children benefited from Wii-therapy . CONCLUSIONS Wii-therapy was better than SPT in improving st and ing balance in patients with CP , but improves the balance only in SHE patients .  Also , Wii-therapy effectiveness waned 2 - 4 weeks after the end the intervention . CLINICAL REHABILITATION IMPACT A systematic exercise program like Wii-therapy using the Nintendo Wii Balance Board device can be considered to improves the st and ing balance in patients with CP , specifically in the SHE type . This program is easy to transfer to physiotherapists and rehabilitation centers OBJECTIVES Physical and occupational therapists have started to use the Nintendo Wii ™ gaming system with adults and children as part of their regular treatment . Despite the growing use of the Wii and trend towards evidence -based practice , limited evidence is available on the effectiveness of virtual reality using the Wii for children with developmental delay . The purpose of this study was to determine the feasibility and preliminary effectiveness of a low-cost gaming system for young children with developmental delay . STUDY DESIGN Single-blind , r and omised controlled trial . PARTICIPANTS AND SETTING Forty children with developmental delay ( age 39 to 58 months ) who attended a segregated or integrated preschool participated in this study . All children 's parents read and signed an informed consent form approved by the institutional review board . Children were assigned at r and om to an experimental ( Wii ) group ( n=20 ) or a control group ( n=20 ) . INTERVENTION Two weekly sessions for 10 weeks using Nintendo Wii Sports ™ and Nintendo Wii Fit ™ , including balance , strength training and aerobics games . MAIN OUTCOME MEASURES Participants were evaluated 1 week before and 1 week after the programme by a blinded investigator . Primary outcomes were gait speed , timed up and go test , single leg stance test , five-times-sit-to-st and test , timed up and down stairs test , 2-minute walk test and grip strength . The Gross Motor Function Measure ( GMFM ) was used to assess gross motor skills . RESULTS The two groups were homogenous regarding all parameters at baseline . The Wii training was feasible and enjoyable for those in the experimental group . There were no adverse effects or injuries reported over 267 training sessions . Comparison of groups following the intervention indicated that the experimental group showed significant improvements compared with the control group in single leg stance test { mean difference 1.03 [ st and ard deviation ( SD ) 1.7 ] , 95 % confidence interval ( CI ) 0.2 to 1.9 ; P=0.017 } , right grip strength [ mean difference 1.11 ( SD 1.84 ) , 95 % CI 0.15 to 2.06 ; P=0.024 ] and left grip strength [ mean difference 0.90 ( SD 1.67 ) , 95 % CI 0.03 to 1.77 ; P=0.043 ] . Although changes in other outcome measures were not significant between the study groups , there were trends towards greater improvements in the experimental group compared with the control group . CONCLUSION This study supports use of the Wii as a feasible , safe and potentially effective therapeutic tool to augment the rehabilitation of young children with developmental delay . The potential application of the Wii to increase the intensity of therapy or as a rehabilitation tool in children 's homes and rural setting s is an area worthy of investigation . The promising results of this study suggest that further studies are warranted to vali date the potential benefits of a low-cost commercially available gaming system as a treatment strategy to supplement rehabilitation of children with disabilities Background and Purpose : Virtual reality ( VR ) creates an exercise environment in which the intensity of practice and positive feedback can be systematic ally manipulated in various context s. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy ( CP ) . Participants : Four children with spastic CP were recruited . Method : A single-subject design ( A-B with follow-up ) was used . All children were evaluated with 3 baseline , 4 intervention , and 2 follow-up measures . A 4-week individualized VR training program ( 2 hours per week ) with 2 VR systems was applied to all children . The outcome measures included 4 kinematic parameters ( movement time , path length , peak velocity , and number of movement units ) for mail-delivery activities in 3 directions ( neutral , outward , and inward ) and the Fine Motor Domain of the Peabody Developmental Motor Scales – Second Edition ( PDMS-2 ) . Visual inspection and the 2-st and ard-deviation – b and method were used to compare the outcome measures . Results : Three children who had normal cognition showed improvements in some aspects of reaching kinematics , and 2 children ’s change scores on the PDMS-2 reached the minimal detectable change during the intervention . The improvements in kinematics were partially maintained during follow-up . Discussion and Conclusion : A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP , especially in children with normal cognition and good cooperation . The training effects were retained in some children after the intervention OBJECTIVE To determine effects of implementing a practice period of modified constraint-induced movement therapy in a virtual environment on upper limb function in children with spastic hemiparetic cerebral palsy . METHODS In a single-blinded , r and omised , controlled trial , 32 participants ( 18 female , 14 male ) received 18 hours training in 3 different groups ( virtual reality , modified constraint-induced movement therapy , and a combination group ) . The fourth group was a control group . Training sessions occurred every other day , 3 times per week for 4-week . Each session lasted for 1.5 hours . Assessment sessions were conducted before , after , and 3-month after treatment period using pediatric motor activity log and the speed and dexterity subtest of the bruininks-oseretsky test of motor proficiency . Data analysis was conducted by ANOVA with repeated measures using SPSS 16.0 with alpha levels set at P < 0.05 . RESULTS Significantly higher gains were observed in the combination therapy group for the amount of limb use ( mean change , 2.72 ) , quality of movement ( mean change , 2.79 ) , and speed and dexterity ( mean change , 1.74 ) at post-test . These gains were maintained at the 3-month follow-up assessment . CONCLUSIONS Modified constraint-induced movement therapy in a virtual environment could be a promising rehabilitation procedure to enhance the benefits of both virtual reality and constraint-induced therapy techniques Purpose : An investigative study to examine whether sitting ability could be improved through the use of a suite of computer games operated by leaning in one of four directions in a seated position . Method : Young people with cerebral palsy played with a suite of computer games controlled using a sitting platform that can detect changes in the distribution of pressure . A r and omized cross-over trial with two periods of three months involving intervention or no intervention was used . Sitting ability was measured at the beginning and end of each period with participants acting as their own controls . Results : Statistically significant improvements were seen in two elements of box sitting using the Chailey levels ( shoulder girdle position and spinal profile ) and in five elements of the Sitting Assessment for Children with Neuromotor Dysfunction across both reach and rest phases of the assessment . Conclusions : The study provides evidence to suggest that a meaningful and engaging therapeutic activity , such as using computer games controlled by leaning the upper body , can help to improve sitting ability in children with neuromotor dysfunction . Further work is required to underst and fully what effects such activities have on the various components of sitting ability . Implication s for Rehabilitation Children with a neuromotor dysfunction such as Cerebral Palsy have less opportunities to play and have difficulty using st and ard computer based gaming equipment . Games consoles that require body movement such as the Nintendo Wii and Kinect are being purchased by Schools , Rehabilitation Centres and by Families with a number of aims . In a small sample this study indicates that using such equipment may improve some aspects of sitting ability BACKGROUND Previous studies reported controversial results about the efficacy of video-game based therapy ( VGT ) in improving neurorehabilitation outcomes in children with cerebral palsy ( CP ) . AIM Primary aim was to investigate the effectiveness of VGT with respect to conventional therapy ( CT ) in improving upper limb motor outcomes in a group of children with CP . Secondary aim was to quantify if VGT leads children to perform a higher number of movements . DESIGN A cross-over r and omized controlled trial ( RCT ) for investigating the primary aim and a cross-sectional study for investigating the secondary aim of this study . SETTING S Out patients . POPULATION INCLUSION CRITERIA clinical diagnosis of CP , age between 4 and 14 years , level of GMFC between I and IV . EXCLUSION CRITERIA QI<35 , severe comorbidities , incapacity to st and even with an external support . METHODS Twenty-two children with CP ( 6.89±1.91-year old ) were enrolled in a cross-over RCT with 16 sessions of VGT ( using Xbox with Kinect device ) and then 16 of CT or vice versa . Upper limb functioning was assessed using the Quality of Upper Extremities Skills Test ( QUEST ) and h and abilities using Abilh and -kids score . According to the secondary aim of this study a secondary cross-sectional study has been performed . Eight children with CP ( 6.50±1.60-year old ) were enrolled into a trial in which five wireless triaxial accelerometers were positioned on their forearms , legs and trunk for quantifying the physical activity during VGT vs. CT .  RESULTS QUEST scores significantly improved only after VGT ( P=0.003 ) , and not after CT ( P=0.056 ) . The reverse occurred for Abilh and -kids scores ( P=0.165 vs. P=0.013 , respectively ) . Quantity of performed movements was three times higher in VGT than in CT ( + 198 % , P=0.027 ) . CONCLUSION VGT result ed effective in improving the motor functions of upper limb extremities in children with CP , conceivably for the increased quantity of limb movements , but failed in improving the manual abilities for performing activities of daily living which benefited more from CT . CLINICAL REHABILITATION IMPACT VGT performed using the X-Box with Kinect device could enhance the number of upper limb movements in children with CP during rehabilitation and in turn improving upper limb motor skills , but CT remained superior for improving performances in manual activities of daily living Objective : To investigate whether Wii Sports Resort ™ training is effective and if any benefits are maintained . Design : R and omized , single-blind trial . Participants : Sixty-two hemiplegic children with cerebral palsy ( 6–13 years ) . Intervention : Experimental group undertook six weeks of home-based Wii Sports Resort ™ training plus usual therapy , while the control group received usual therapy . Main measures : Outcomes were coordination , strength , h and function , and carers ’ perception of h and function , measured at baseline , six , and 12 weeks by a blinded assessor . Results : There was a trend of mean difference ( MD ) for the experimental group to have more grip strength by six ( MD 4.0 N , 95 % confidence interval ( CI ) −0.8 to 8.8 , p = 0.10 ) and 12 ( MD 4.1 N , 95 % CI −2.1 to 10.3 , p = 0.19 ) weeks , and to have a higher quantity of h and function according to carers ’ perception by six ( MD 4.5 N , 95 % CI −0.7 to 9.7 , p = 0.09 ) and strengthened by 12 ( MD 6.4 , 95 % CI 0.6 to 12.3 , p = 0.03 ) weeks than the control group . There was no difference between groups in coordination and h and function by six or 12 weeks . Conclusion : Wii ™ training did not improve coordination , strength , or h and function . Beyond the intervention , carers perceived that the children used their h and s more
Background Research ers recently investigated the effectiveness of virtual reality ( VR ) in helping children with cerebral palsy ( CP ) to improve motor function .
A systematic review of r and omized controlled trials ( RCTs ) using a meta‐analytic method to examine the effectiveness of VR in children with CP was thus needed .
Purpose The purpose of this study was to up date the current evidence about VR by systematic ally examining the research literature .