Research and Innovation, Sussex Community NHS Trust, Brighton, England.
Brighton and Sussex Medical School, Brighton, England.
Disabil Rehabil. 2021 Jan;43(1):85-97. doi: 10.1080/09638288.2019.1618400. Epub 2019 May 25.
Evidence is increasing for effective virtual reality therapy for motor rehabilitation for children with Cerebral Palsy. We assessed the feasibility of a virtual reality therapy mode of intervention, appropriateness of measures, and potential cost-effectiveness.
A 12-week, 2-group, parallel-feasibility trial (ISRCT 17624388) using Nintendo Wii Fit at home. Children aged 5-16, with ambulatory Cerebral Palsy, who were able to follow simple instructions were randomised to two groups; one supported by physiotherapists (individualised activity programme), the other unsupported with children having free choice (control). Children were assessed in clinic at baseline, week 6, and week 12 by blinded assessors. Feasibility of the intervention was assessed via recruitment, adherence, and usefulness of measurement tools.
Forty-four children were eligible (out of 48 approached): 31 consented, 30 were randomised, 21 completed the study; 10 in the supported group and 11 in the unsupported group. Nine children discontinued from tiredness, after-school activities, homework, surgery, technical difficulties or negative system feedback. The supported group completed 19 of 36 (IQR 5-35) possible sessions; the unsupported group 24 of 36 sessions (IQR 8-36). Gross Motor Function Measure scores varied by Cerebral Palsy severity after the intervention. There were no adverse events.
Virtual reality therapy offers potential as a therapeutic adjunct for children with Cerebral Palsy, warranting substantive confirmatory study. Gross Motor Function Measure, with modifications to improve sensitivity, appeared appropriate as a primary measure, with Timed up and Go test secondary. The intervention was inexpensive costing £20 per child. An explanatory trial to evaluate the clinical/cost-effectiveness of commercial system virtual reality therapy is feasible with minor methodological adaptation. Implications for rehabilitation Home-based interactive computer gaming was feasible, safe and cost effective as a therapy adjunct. Discontinue if additional pressures are present: imminent surgery, family resilience to technical difficulties, negative system feedback, after-school activities. Change in Gross Motor Function Measurement scores varied by severity of Cerebral Palsy.
越来越多的证据表明，虚拟现实疗法对脑瘫儿童的运动康复具有显著效果。本研究旨在评估虚拟现实疗法模式的干预的可行性、措施的适宜性以及潜在的成本效益。
这是一项为期 12 周的、2 组平行的可行性试验（ISRCT 17624388），使用任天堂 Wii Fit 在家中进行。纳入的患儿年龄为 5-16 岁，能行走且患有脑瘫，可遵循简单的指令。他们被随机分为两组：一组接受物理治疗师的支持（个体化活动方案），另一组则没有支持，让患儿自由选择（对照组）。在基线、第 6 周和第 12 周，由盲法评估人员对患儿进行评估。通过招募、依从性和测量工具的有用性来评估干预措施的可行性。
44 名患儿符合条件（48 名受邀患儿中的 44 名）：31 名患儿同意参与，30 名患儿被随机分组，21 名患儿完成了研究；支持组 10 名患儿，无支持组 11 名患儿。9 名患儿因疲劳、课外活动、家庭作业、手术、技术困难或系统负面反馈而退出。支持组完成了 36 次治疗中的 19 次（IQR 5-35），无支持组完成了 36 次治疗中的 24 次（IQR 8-36）。干预后，粗大运动功能测量评分因脑瘫严重程度而异。没有出现不良事件。
虚拟现实疗法为脑瘫患儿提供了一种潜在的治疗辅助手段，值得进一步进行大规模的验证性研究。改良后的粗大运动功能测量评估方法具有较高的敏感性，可作为主要评估指标，辅以计时起立行走测试。该干预措施的成本较低，每名患儿的费用为 20 英镑。通过对商业系统虚拟现实疗法的临床/成本效益进行解释性试验，在进行少量方法学调整的情况下是可行的。
家庭互动式计算机游戏作为一种治疗辅助手段，是可行的、安全的且具有成本效益的。如果存在其他压力（如即将进行的手术、家庭对技术困难的适应能力、系统的负面反馈、课外活动），则应停止治疗。脑瘫严重程度的不同会导致粗大运动功能测量评分的变化。
