Accepted for/Published in: JMIR Serious Games
Date Submitted: Aug 20, 2022
Date Accepted: Jul 18, 2023
Short to Long Term Effects of Virtual Reality on Motor Skill Learning in Children with Cerebral Palsy: A Systematic Review and Meta-analysis
ABSTRACT
Background:
Many studies have started integrating virtual reality (VR) into neurorehabilitation for children with cerebral palsy (CP). The results of the effects of VR on motor skill learning, including the short- to long-term results of relevant studies, need to be pooled in a generic framework.
Objective:
This systematic review and meta-analysis aims to investigate the effects of therapies including VR on motor skill learning in children with CP in the short-term and medium- to long-term.
Methods:
Two examiners followed the inclusion and exclusion criteria of the “Participant, Intervention, Control, and Outcome” framework. Randomized (RCTs) and non-randomized (non-RCTs) controlled trials were considered if they compare VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore were searched. The Modified Downs and Black assessment assessed the methodological quality of included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible.
Results:
Seven RCTs, two non-RCTs, and 258 children with CP were included. The priority focus of 7 out of 9 studies was upper limb functions. There is a remarkable effect of adding VR to conventional therapies in the short-term on upper limb functions when compared to conventional therapies (P = .04, standardized mean difference [SMD] = 0.39, 95% confidence interval [CI] = 0.01 to 0.76). The overall effect was still in favor of the VR group in the medium- to long-term (P = .06, SMD = 0.37, 95% CI = -0.02 to 0.77). For balance (P = .06, SMD = 1.04, 95% CI = -0.04 to 2.12), gross motor functions (P = .30, SMD = 2.85, 95% CI =-2.57 to 8.28), and daily life activities outcomes (P = .21, SMD = 0.29, 95% CI =-0.16 to 0.74), the overall effect in the short-term showed a trend towards favoring the VR group.
Conclusions:
VR seems to have additional benefits on motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in CP were quite limited. Future research with balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning. Clinical Trial: PROSPERO CRD42021227734
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