Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review

• Published in: Journal of hand therapy 2019-10, Vol.32 (4), p.426-434.e1
• Main Authors: Rathinam, Chandrasekar, Mohan, Vikram, Peirson, Janet, Skinner, Jane, Nethaji, Kalidass Subash, Kuhn, Isla
• Format: Article
• Language: English
• Subjects: Cerebral palsy; Cerebral Palsy - physiopathology; Cerebral Palsy - rehabilitation; Children; Classification; Computer applications; Computer games; Hand; Hand - physiopathology; Hand function; Hands; Humans; ICF; Intervention; Literature reviews; Motor ability; Motor skill; Motor Skills Disorders - physiopathology; Motor Skills Disorders - rehabilitation; Paralysis; Physical therapy; Physical Therapy Modalities; Studies; Systematic review; Therapeutic applications; Virtual Reality
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2018.01.006

Systematic review. Children with cerebral palsy (CP) may have limited use of their hands for functional activities and for fine motor skills. Virtual reality (VR) is a relatively new and innovative approach to facilitate hand function in children with CP. The primary purpose of this study was to determine the effectiveness of VR as an intervention to improve hand function in children with CP compared to either conventional physiotherapy or other therapeutic interventions. The secondary purpose was to classify the outcomes evaluated according to the International Classification of Functioning, Disability and Health (ICF) dimensions. A International prospective register of systematic reviews (PROSPERO)-registered literature search was carried out in August 2015 in MEDLINE, CINAHL, ERIC, HealthSTAR, AMED, BNI, Embase, PsycINFO, PEDro, Cochrane Central Register, DARE, OTSeeker, REHABDATA, HaPI, CIRRIE, and Scopus. PRISMA guidelines were followed. Only randomized controlled trials (RCTs) were included, and their methodological qualities were examined using the Cochrane collaboration's risk of bias (RoB) tool. A narrative synthesis was performed. The 6 RCTs published on this topic provide conflicting results. Four studies reported improved hand function (2 low RoB, 1 high RoB, and 1 unclear RoB), whereas 2 studies reported no improvement. All of the RCTs reported the activity element of ICF, but no study explicitly described the effect of VR intervention based on the ICF model. The role of VR ti imrpove hand fucntion in children with CP is unclear due to limited evidence; use as an adjunct has some support. •This review finds weak evidence to support the use of virtual reality in isolation as a therapeutic intervention to improve hand function; it may be helpful when used as an adjunct to existing therapy.•The included randomized controlled trials did not use the International Classification of Functioning, Disability and Health adequately.•More high-quality trials with consistent use of outcome measures and better description of interventions are needed before the role of virtual reality in the rehabilitation of hand function in people with cerebral palsy can be defined.