The Effect of Wii-Based Interactive Virtual Games on Spasticity, Gait, Balance, and Trunk Control of Children with Mild Cerebral Palsy: A Randomized Controlled Trial

Yıl 2024, Sayı: 24, 1019 - 1028, 30.12.2024

Sefa Eldemir , Selvin Balki

https://doi.org/10.38079/igusabder.1534336

Öz

Aim: The purpose of this study was to examine the impact of Nintendo Wii treatment (NWT) on spasticity, balance, gait, and trunk control in individuals with mild cerebral palsy (CP).
Method: This randomized controlled trial included a total of 35 individuals with mild CP: the Nintendo Wii therapy group (WiiG, n:17) and the control group (CG, n:18). The individuals in both groups received conventional physiotherapy (CPT) for 40 minutes in two sessions per week for 8 consecutive weeks. The WiiG received Nintendo Wii Treatment (NWT) for 20 minutes in two sessions per week for 8 consecutive weeks using the Nintendo Wii Fit gaming console in addition to CPT. The Modified Ashworth Scale (MAS), Functional Forward Reach Test (FFRT), Functional Sideways Reach Test (FSRT), 10-meter walking test (10-mWT), and Trunk Impairment Scale (TIS) were evaluated before and after the intervention. Group x time interaction was demonstrated using the ANOVA (2×2 factorial Analysis of Variance).
Results: Right elbow flexor MAS decreased only in the WiiG (p=0.035) but did not differ between both groups (p>0.05). Furthermore, FFRT, FSRT, 10-mWT, and all sub-tests of TIS scores improved in the WiiG (p<0.05), while only TIS-Trunk Coordination increased in the CG (p=0.023).
Conclusion: NWT in addition to conventional physiotherapy, has positive effects on balance, gait, and trunk control in the rehabilitation process of CP. More research is needed to better understand the effects of NWT on spasticity.

Anahtar Kelimeler

Cerebral palsy, spasticity, balance, gait, trunk control, virtual reality, physiotherapy

Hafif Serebral Palsili Çocuklarda Wii Tabanlı Etkileşimli Sanal Oyunların Spastisite, Yürüyüş, Denge ve Gövde Kontrolü Üzerindeki Etkisi: Randomize Kontrollü Çalışma

Öz

Amaç: Bu çalışmanın amacı hafif serebral palsili (SP) bireylerde Nintendo Wii tedavisinin (NWT) spastisite, denge, yürüyüş ve gövde kontrolü üzerine etkisini araştırmaktır.
Yöntem: Bu randomize kontrollü çalışmaya hafif SP'li toplam 35 kişi dahil edildi: Nintendo Wii teedavi grubu (WiiG, n:17) ve kontrol grubu (CG, n:18). Her iki gruptaki bireylere 8 hafta boyunca haftada iki seans olmak üzere 40 dakika süreyle Konvansiyonel Fizyoterapi (KFT) uygulandı. WiiG, CPT'ye ek olarak 8 hafta boyunca haftada iki seans 20 dakika Nintendo Wii Fit oyun konsolu kullanılarak NWT aldı. Modifiye Ashworth Ölçeği (MAS), Fonksiyonel İleri Uzama Testi (FİUT), Fonksiyonel Yan Uzama Testi (FYUT), 10 metre yürüme testi (10-mYT) ve Gövde Bozukluk Ölçeği (GBÖ) tedavi öncesi ve sonrasında değerlendirildi. Grup x zaman etkileşimi ANOVA (2×2 faktöriyel Varyans Analizi) kullanılarak gösterilmiştir.
Bulgular: WiiG sağ dirsek fleksör MAS azaldı (p=0,035) ancak her iki grup arasında farklılık göstermedi (p>0.05). Ayrıca, FFRT, FSRT, 10-mWT ve TIS'in tüm alt test puanları WiiG'de iyileşirken (p<0.05), CG'de sadece TIS-Gövde Koordinasyonu arttı (p=0.023).
Sonuç: Geleneksel fizyoterapiye ek olarak NWT'nin SP rehabilitasyonunda denge, yürüme ve gövde kontrolü üzerinde olumlu etkileri vardır. NWT'nin spastisite üzerindeki etkilerini daha iyi anlamak için daha fazla çalışma yapılmalıdır.

Anahtar Kelimeler

Serebral palsi, spastisite, denge, yürüme, gövde kontrolü, sanal gerçeklik, fizyoterapi

Kaynakça

• 1. Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. American Family Physician. 2020;101(4):213-220.
• 2. Flett PJ. Rehabilitation of spasticity and related problems in childhood cerebral palsy. Journal of Paediatrics and Child Health. 2003;39(1):6-14. doi: 10.1046/j.1440-1754.2003.00082.x .
• 3. Papavasiliou AS. Management of motor problems in cerebral palsy: a critical update for the clinician. European Journal of Paediatric Neurology. 2009;13(5):387-396. doi: 10.1016/j.ejpn.2008.07.00.
• 4. Kallem Seyyar G, Aras B, Aras O. Trunk control and functionality in children with spastic cerebral palsy. Developmental Neurorehabilitation. 2019;22(2):120-125. doi: 10.1080/17518423.2018.1460879.
• 5. Dobson F, Morris ME, Baker R, et al. Gait classification in children with cerebral palsy: a systematic review. Gait & Posture. 2007;25(1):140-152.
• 6. Zanon MA, Pacheco RL, Latorraca CdOC, et al. Neurodevelopmental treatment (Bobath) for children with cerebral palsy: a systematic review. Journal of Child Neurology. 2019;34(11):679-686. doi: 10.1177/088307381985223.
• 7. Cortes-Perez I, Gonzalez-Gonzalez N, Peinado-Rubia AB, et al. Efficacy of robot-assisted gait therapy compared to conventional therapy or treadmill training in children with cerebral palsy: a systematic review with meta-analysis. Sensors. 2022;22(24):9910. doi: 10.3390/s22249910.
• 8. Massetti T, Da Silva TD, Crocetta TB, et al. The clinical utility of virtual reality in neurorehabilitation: a systematic review. Journal of Central Nervous s-System Disease. 2018;10:1179573518813541. doi: 10.1177/1179573518813541.
• 9. Montoro‐Cárdenas D, Cortés‐Pérez I, Zagalaz‐Anula N, et al. Nintendo Wii Balance Board therapy for postural control in children with cerebral palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2021;63(11):1262-1275. doi: 10.1111/dmcn.14947.
• 10. Gatica-Rojas V, Méndez-Rebolledo G. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases. Neural Regeneration Research. 2014;9(8):888-896. doi:10.4103/1673-5374.131612.
• 11. Kassee C, Hunt C, Holmes MW, et al. Home-based Nintendo Wii training to improve upper-limb function in children ages 7 to 12 with spastic hemiplegic cerebral palsy. Journal of Pediatric Rehabilitation Medicine. 2017;10(2):145-154. doi:10.3233/PRM-170439.
• 12. Warnier N, Lambregts S, Port IVD. Effect of virtual reality therapy on balance and walking in children with cerebral palsy: a systematic review. Developmental Neurorehabilitation. 2020;23(8):502-518. doi: 10.1080/17518423.2019.1683907.
• 13. Ravi D, Kumar N, Singhi P. Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: an updated evidence-based systematic review. Physiotherapy. 2017;103(3):245-258. doi: 10.1016/j.physio.2016.08.004.
• 14. Chen Y, Fanchiang HD, Howard A. Effectiveness of virtual reality in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials. Physical Therapy. 2018;98(1):63-77. doi: 10.1093/ptj/pzx107.
• 15. Wu J, Loprinzi PD, Ren Z. The rehabilitative effects of virtual reality games on balance performance among children with cerebral palsy: a meta-analysis of randomized controlled trials. International Journal of Environmental Research and Public Health. 2019;16(21):4161. doi: 10.3390/ijerph16214161.
• 16. Jha KK, Karunanithi GB, Sahana A, et al. Randomised trial of virtual reality gaming and physiotherapy on balance, gross motor performance and daily functions among children with bilateral spastic cerebral palsy. Somatosensory & Motor Research. 2021;38(2):117-126. doi: 10.1080/08990220.2021.1876016.
• 17. Gatica-Rojas V, Cartes-Velásquez R, Méndez-Rebolledo G, et al. Effects of a Nintendo Wii exercise program on spasticity and static standing balance in spastic cerebral palsy. Developmental Neurorehabilitation. 2017;20(6):388-391.
• 18. Park SH, Son SM, Choi JY. Effect of posture control training using virtual reality program on sitting balance and trunk stability in children with cerebral palsy. NeuroRehabilitation. 2021;48(3):247-254. doi: 10.3233/NRE-201642.
• 19. Compagnone E, Maniglio J, Camposeo S, et al. Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). Res Dev Disabil. 2014;35(11):2651-2657. doi: 10.1016/j.ridd.2014.07.005.
• 20. Mutlu A, Livanelioglu A, Gunel MK. Reliability of Ashworth and Modified Ashworth scales in children with spastic cerebral palsy. BMC Musculoskelet Disord. 2008;9:44. doi: 10.1186/1471-2474-9-44.
• 21. Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatr Phys Ther. 2003;15(2):84-92. doi: 10.1097/01.PEP.0000067885.63909.5C.
• 22. Pirpiris M, Wilkinson AJ, Rodda J, et al. Walking speed in children and young adults with neuromuscular disease: comparison between two assessment methods. J Pediatr Orthop. 2003;23(3):302-307.
• 23. Sæther R, Jørgensen L. Intra- and inter-observer reliability of the Trunk Impairment Scale for children with cerebral palsy. Res Dev Disabil. 2011;32(2):727-739. doi: 10.1016/j.ridd.2010.11.007.
• 24. Sajan JE, John JA, Grace P, Sabu SS, Tharion G. Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: A pilot, randomized controlled trial. Dev Neurorehabil. 2017;20(6):361-367. doi: 10.1080/17518423.2016.1252970.
• 25. Tarakci D, Ersoz Huseyinsinoglu B, Tarakci E, Razak Ozdincler A. Effects of Nintendo Wii-Fit® video games on balance in children with mild cerebral palsy. Pediatr Int. 2016;58(10):1042-1050. doi: 10.1111/ped.12942.
• 26. Al-Nemr A, Kora AN. Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy. Acta Neurol Belg. 2024;124(3):843-851. doi: 10.1007/s13760-023-02430-8.
• 27. Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep. 2008;7(1):39-44. doi: 10.1097/01.CSMR.0000308663.13278.69.