JMIR Publications

ABSTRACT

Background:

Hemiplegic cerebral palsy (CP) predominantly affects upper extremity function in children. Conventional therapies, though effective, often face challenges with low engagement and poor long-term adherence in pediatric populations. Virtual reality (VR) technology, through immersion and gamification, may address these limitations by enhancing training motivation and facilitating neuroplasticity.

Objective:

This study aimed to evaluate the adjunctive efficacy of VR-based intervention combined with conventional therapy for upper limb functional recovery specifically in children with hemiplegia.

Methods:

Following PRISMA guidelines and prospectively registered with PROSPERO, we systematically searched multiple electronic databases through April 15, 2026. Fourteen randomized controlled trials involving 480 children aged 12 and under were included in the synthesis. Outcomes were analyzed using Hedges’ g and pooled through fixed-effect or random-effects models depending on heterogeneity.

Results:

VR-integrated interventions demonstrated a statistically significant improvement in upper limb activity (SMD 0.29; 95% CI 0.00 to 0.57) with minimal heterogeneity. While grip strength also showed a significant improvement (MD 0.47; 95% CI 0.09 to 0.85), sensitivity analysis revealed this finding lacked robustness and was influenced by baseline imbalances in specific studies. Positive trends were observed for dexterity, motor control, and activities of daily living, though these did not reach formal statistical significance. No serious adverse events were reported.

Conclusions:

VR combined with conventional therapy significantly enhances upper limb functional performance in children with hemiplegic CP by increasing motivation and engagement. These findings support the precision integration of immersive technologies into pediatric neurorehabilitation protocols, though further high-quality investigation is needed to confirm the long-term impact on fine motor control.