Short- to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children With Cerebral Palsy: 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, must be pooled in a generic framework.

Objective: This systematic review and meta-analysis aimed to investigate the short- to long-term effects of therapies including VR on motor skill learning in children with CP.

Methods: Two examiners followed the inclusion and exclusion criteria of the "Participant, Intervention, Control, and Outcome" framework. Randomized controlled trials (RCTs) and non-RCTs were considered if they compared VR-included interventions with control groups on motor functions and daily life activities in children with CP. PubMed, ScienceDirect, Embase, and IEEE Xplore databases were searched. The modified Downs and Black assessment was used to assess the methodological quality of the included studies. Meta-analyses and subgroup analyses for RCTs were conducted whenever possible.

Results: A total of 7 RCTs, 2 non-RCTs, and 258 children with CP were included. The priority focus of 78% (7/9) of the studies was upper limb functions. There was a significant short-term effect of adding VR to conventional therapies on upper limb functions when compared with conventional therapies (P=.04; standardized mean difference [SMD]=0.39, 95% CI 0.01-0.76). The overall medium- to long-term effects showed a trend toward favoring the VR group, although the difference was not statistically significant (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 also showed a trend toward favoring the VR group, but these results were not statistically significant.

Conclusions: VR seems to have additional benefits for motor skill learning in children with CP. Studies with follow-up outcomes of VR training focusing on balance and gross motor functions in patients with CP were quite limited. Future research on balance and gross motor function outcomes should target particularly long-term results of therapies including VR on motor skill learning.

Trial registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021227734; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227734.

Keywords: cerebral palsy; daily life activities; long-term effect; motor functions; motor skill learning; virtual reality.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of the study selection process. VR: virtual reality.

Figure 2

Forest plot of the postintervention upper limb functions outcomes [32-34,36]. Control group: conventional therapy; IV: inverse variance; VR group: virtual reality with conventional therapy.

Figure 3

Forest plot of the follow-up upper limb functions outcomes (from 6 to 12 weeks after completion of the intervention) [32-34,36]. Control group: conventional therapy; IV: inverse variance; VR group: virtual reality with conventional therapy.

Figure 4

Forest plot of the postintervention balance and trunk control outcomes [30,31]. Control group: conventional therapy; IV: inverse variance; VR group: virtual reality with conventional therapy.

Figure 5

Forest plot of the postintervention gross motor functions outcomes [30,31]. Control group: conventional therapy; IV: inverse variance; VR group: virtual reality with conventional therapy.

Figure 6

Forest plot of the postintervention activities of daily life outcomes [30,33]. Control group: conventional therapy; IV: inverse variance; VR group: virtual reality with conventional therapy.