JMIR Publications

ABSTRACT

Background:

Obstetric brachial palsy (OBP) is a pathology caused by complications during childbirth, as a result of cervical spine elongation, which affects the motor and sensory innervation of the upper limbs. The most common lesion occurs on the C5 and C6 nerve branches and is known as Erb-Duchenne palsy. The least common is where all nerve roots are affected (C5-D1), which has the worst prognosis. The use of virtual reality (VR) is common in neurological rehabilitation for the evaluation and treatment of physical deficits.

Objective:

This systematic review aimed to assess the efficacy of VR in the rehabilitation of upper limb function in patients with OBP.

Methods:

A search was performed in several scientific databases, including PubMed, Web of Science, PEDro, Cochrane, MEDLINE, Scopus, and CINAHL, without language or date restrictions, and including articles published up until February 2022. Inclusion criteria were: (1) Children under 18 years of age diagnosed with OBP, (2) VR therapy used in addition to conventional therapy or isolated, (3) VR therapy compared to conventional therapy, (4) outcomes related to OBP rehabilitation intervention (5) randomized clinical trials (RCTs). The PEDro scale was used to assess the methodological quality of the studies, and the Cochrane Collaboration tool was used to assess the risk of bias. Review Manager 5.4 statistical software was used to perform the meta-analysis.

Results:

Five RCTs were included in this systematic review, with three providing information for the meta-analysis. A total of 138 subjects were analyzed. All studies used semi-immersive or non-immersive VR systems. The statistical analysis showed significant results for the Mallet Scoring System (MSS) subtests (global external rotation, SMD -0.54, 95% CI -0.94 to -0.13; hand to neck subtest, SMD -0.98, 95% CI -1.53 to -0.43; hand to spine subtest, SMD -0.45, 95% CI -0.84 to -0.05; and hand to mouth subtest, SMD -1.03, 95% CI -1.44 to -0.62), Active Movement Scale (AMS) subtests (shoulder flexion, SMD -1.35, 95% CI -1.94 to -0.77; shoulder abduction, SMD -0.83, 95% CI -1.34 to -0.31; and shoulder external rotation, SMD -0.91, 95% CI -1.43 to -0.40) and range of movement (ROM) of shoulder movements, such as abduction (SMD -1.21, 95% CI -1.67 to -0.74) and external rotation (SMD -1.27, 95% CI -1.73 to -0.82).

Conclusions:

VR therapy has the potential to improve rehabilitation outcomes in patients with OBP, specifically in functional activity, strength and ROM. However, due to the limited number of analyzed studies, additional studies with larger sample sizes and long-term results are required to further validate VR as a therapeutic option for OBP.