VIRTUAL REALITY APPLICATIONS IN CHILDREN WITH DOWN SYNDROME: A TRADITIONAL REVIEW

Yıl 2025, Cilt: 6 Sayı: 3, 164 - 171, 30.09.2025

Emine Nacar , Merve Karakurt , Selvin Balki

Öz

Abstract
Down syndrome (DS) is a genetic disorder caused by trisomy of the 21st chromosome. Children with DS may have balance and coordination disorders, abnormal movement patterns, decreased muscle tone and delays in motor development compared to typically developing peers. Various rehabilitation methods such as sensory integration, neurodevelopmental therapy and vestibular stimulation are used to treat these motor skill problems. However, one of the most important difficulties in the rehabilitation process is the lack of motivation, which negatively affects the process. In recent years, Virtual Reality (VR) based therapies have emerged as an innovative approach for rehabilitative interventions in children diagnosed with DS. This technology offers a complementary feature to traditional methods, while at the same time supporting long-term engagement by making treatment processes more enjoyable. Clinical studies show that VR has the potential to improve muscle power, joint mobility, motor coordination, attention capacity, and cognitive problem-solving abilities decision-making skills, balance and posture. However, although the use of VR technology has been proposed during the therapeutic management of children with DS, studies have generally focused on other neurological disorders such as autism spectrum disorder, attention deficit and hyperactivity disorder, cerebral palsy. Research on the effects of VR in the rehabilitation of children with DS has been insufficiently addressed in current literature. In this review study, the aims of using VR therapies in children with DS were discussed and their effects on gross motor functions such as balance, coordination, speed, agility as well as fine motor functions based on upper extremity skills were evaluated.

Anahtar Kelimeler

Down syndrome , virtual reality , augmented reality , motor skills

DOWN SENDROMLU ÇOCUKLARDA SANAL GERÇEKLİK UYGULAMALARI: GELENEKSEL DERLEME

Öz

Öz
Down Sendromu (DS), 21. kromozomun trizomisinden kaynaklanan genetik bir bozukluktur. DS’li çocuklarda, tipik olarak gelişen akranlarına kıyasla denge ve koordinasyon bozuklukları, anormal hareket paternleri, azalmış kas tonusu ve motor gelişimde gecikmeler görülebilir. Bu motor beceri problemlerini tedavi etmek için duyu bütünleme, nörogelişimsel terapi ve vestibüler stimülasyon gibi çeşitli rehabilitasyon yöntemleri kullanılmaktadır. Ancak rehabilitasyon sürecindeki en önemli zorluklardan biri, süreci olumsuz etkileyen motivasyon eksikliğidir. Son yıllarda, Sanal Gerçeklik (VR) tabanlı terapiler, DS’li çocukların rehabilitasyonunda yenilikçi bir yaklaşım olarak öne çıkmaktadır. Bu teknoloji, geleneksel yöntemlere tamamlayıcı bir özellik sunarken, aynı zamanda tedavi süreçlerini daha eğlenceli hale getirerek uzun vadeli katılımı desteklemektedir. Klinik çalışmalar, VR'nin kas gücünü, hareket aralığını, koordinasyonu, dikkat süresini, problem çözme ve karar verme becerilerini, dengeyi ve duruşu iyileştirme potansiyeline sahip olduğunu göstermektedir. Bununla birlikte, VR teknolojisinin DS’li çocukların rehabilitasyonunda kullanımı önerilse de, çalışmalar genellikle otizm spektrum bozukluğu, dikkat eksikliği ve hiperaktivite bozukluğu, serebral palsi gibi diğer nörolojik bozukluklara odaklanmıştır. Literatürde DS’li çocukların rehabilitasyonunda VR’nin etkileri üzerine yapılan araştırmalar sınırlıdır. Bu derleme çalışmasında, VR terapilerinin DS’li çocuklarda kullanım amaçları ele alınmış ve denge, koordinasyon, hız, çeviklik gibi kaba motor fonksiyonların yanı sıra üst ekstremite becerileri temelinde ince motor fonksiyonlar üzerindeki etkileri değerlendirilmiştir.

Anahtar Kelimeler

Down sendromu , sanal gerçeklik , artırılmış gerçeklik , motor beceri

Kaynakça

• Adamovich, S. V., Fluet, G. G., Tunik, E., & Merians, A. S. (2009). Sensorimotor training in virtual reality: a review. NeuroRehabilitation, 25(1), 29-44. https://doi.org/10.3233/NRE-2009-0497
• Antonarakis, S. E. (1998). 10 Years ofGenomics, Chromosome 21, and Down Syndrome. Genomics, 51(1), 1-16. https://doi.org/10.1006/geno.1998.5335 Balaban, Ö., Nacır, B., Erdem, H., & Karagöz, A. (2009). Denge fonksiyonunun değerlendirilmesi. J Phys Med Rehabil Sci, 12(3), 133-139.
• Beqaj, S., Tërshnjaku, E. E., Qorolli, M., & Zivkovic, V. (2018). Contribution of physical and motor characteristics to functional performance in children and adolescents with Down syndrome: A preliminary study. Medical science monitor basic research, 24, 159. https://doi.org/10.12659/MSMBR.910448
• Berg, P., Becker, T., Martian, A., Danielle, P. K., & Wingen, J. (2012). Motor control outcomes following Nintendo Wii use by a child with Down syndrome. Pediatric physical therapy, 24(1), 78-84. https://doi.org/10.1097/PEP.0b013e31823e05e6
• Bull, M. J. (2020). Down syndrome. New England Journal of Medicine, 382(24), 2344-2352.
• Chen, C. C., Ringenbach, S., & Albert, A. (2014). Assisted cycling exercise improves fine manual dexterity in persons with Down's syndrome. Journal of Applied Research in Intellectual Disabilities, 27(3), 264-272. https://doi.org/10.1111/jar.12061
• Choi, Y. M. (2015). Comparison of grip and pinch strength in adults with dexterity limitations to normative values. Procedia Manufacturing, 3, 5326-5333. https://doi.org/10.1016/j.promfg.2015.07.637
• Connolly, B. H., & Michael, B. T. (1986). Performance of retarded children, with and without Down syndrome, on the Bruininks Oseretsky Test of Motor Proficiency. Physical therapy, 66(3), 344-348. https://doi.org/10.1093/ptj/66.3.344
• das Neves Cardoso, A. C., de Campos, A. C., Dos Santos, M. M., Santos, D. C. C., & Rocha, N. A. C. F. (2015). Motor performance of children with Down syndrome and typical development at 2 to 4 and 26 months. Pediatric physical therapy, 27(2), 135-141. https://doi.org/10.1097/PEP.0000000000000120
• Finbråten, A. K., Martins, C., Andersen, G. L., Skranes, J., Brannsether, B., Júlíusson, P. B., Syversen, U., Stevenson, R. D., & Vik, T. (2015). Assessment of body composition in children with cerebral palsy: a crosssectional study in N orway. Developmental Medicine & Child Neurology, 57(9), 858-864. https://doi.org/10.1111/dmcn.12752
• Gallahue, D. L., Ozmun, J. C., & Goodway, J. D. (2013). Compreendendo o desenvolvimento motor-: bebês, crianças, adolescentes e adultos. AMGH Editora.
• Ghafar, M. A. A., & Abdelraouf, O. R. (2017). Effect of virtual reality versus traditional physical therapy on functional balance in children with down syndrome: A randomized comparative study. Int. J. Physiother. Res, 5, 2088-2094. https://dx.doi.org/10.16965/ijpr.2017.146
• Giuriato, M., Gatti, A., Pellino, V. C., Bianchi, A., Zanelli, S., Pirazzi, A., Cavallo, C., Quatrale, A., Gazzarri, A. A., & Vandoni, M. (2025). A Tele‐Coaching Pilot Study: An Innovative Approach to Enhance Motor Skills in Adolescents with Down Syndrome. Journal of Applied Research in Intellectual Disabilities, 38(2), e70036. https://doi.org/10.1111/jar.70036
• Gómez Álvarez, N., Venegas Mortecinos, A., Zapata Rodríguez, V., López Fontanilla, M., Maudier Vásquez, M., Pavez-Adasme, G., & Hemández-Mosqueira, C. (2018). Efecto de una intervención basada en realidad virtual sobre las habi lidades motrices básicas y control postural de niños con Síndrome de Down. Revista chilena de pediatría, 89(6), 747-752. http://dx.doi.org/10.4067/S0370- 41062018005001202
• Hashemi, A., & Arabameri, E. (2019). The Effect of Two Methods of Motor Program and Computer Games on the Fine Motor Skills in Children with Down Syndrome Disorder. International Journal of Motor Control and Learning, 1(1), 53-62. https://dor.isc.ac/dor/20.1001.1.27173283.2019.1.1.3.2
• Jobling, A., & Cuskelly, M. (2006). Young people with Down syndrome: A preliminary investigation of health knowledge and associated behaviours. Journal of Intellectual and Developmental Disability, 31(4), 210- 218. https://doi.org/10.1080/13668250600999186
• Kiphard, E. (1974). Körper-koordinations-test für kinder KTK: manual Von Fridhelm Schilling. Weinhein: Beltz Test.
• Lauteslager, P. E. (2004). Children with Down's syndrome: Motor development and intervention. Heeren Loo Zorggroep.
• Lin, H.-C., & Wuang, Y.-P. (2012). Strength and agility training in adolescents with Down syndrome: A randomized controlled trial. Research in developmental disabilities, 33(6), 2236-2244. https://doi.org/10.1016/j.ridd.2012.06.017
• Määttä, T., Määttä, J., Tervo-Määttä, T., Taanila, A., Kaski, M., & Iivanainen, M. (2011). Healthcare and guidelines: a population-based survey of recorded medical problems and health surveillance for people with Down syndrome. Journal of Intellectual and Developmental Disability, 36(2), 118-126. https://doi.org/10.1080/13668250.2011.570253
• Martins, M. R. I., Fecuri, M. A. B., Arroyo, M. A., & Parisi, M. T. (2013). Avaliação das habilidades funcionais e de auto cuidado de indivíduos com síndrome de Down pertencentes a uma oficina terapêutica. Revista CEFAC, 15, 361-365. https://doi.org/10.1590/S1516- 18462012005000088
• Memon, A. G., Ali, S., Adnan, Q., & Tahir, S. (2024). Effects of virtual reality on static and dynamic balance among individuals with down syndrome. Journal of Liaquat University of Medical & Health Sciences, 23(02), 116- 120. https://doi.org/10.22442/jlumhs.2024.01057
• Morris, J. K., Alberman, E., Mutton, D., & Jacobs, P. (2012). Cytogenetic and epidemiological findings in Down syndrome: England and Wales 1989–2009. American journal of medical genetics Part A, 158(5), 1151-1157. https://doi.org/10.1002/ajmg.a.35248
• Oster-Granite, M. L., Parisi, M. A., Abbeduto, L., Berlin, D. S., Bodine, C., Bynum, D., Capone, G., Collier, E., Hall, D., & Kaeser, L. (2011). Down syndrome: national conference on patient registries, research databases, and biobanks. Molecular genetics and metabolism, 104(1-2), 13-22. https://doi.org/10.1016/j.ymgme.2011.07.005
• Padia, N., Bose, M., & Parab, S. (2023). Determinants of hand function in children and adolescent with Down Syndrome-a scoping review. Journal of Hand Therapy, 36(3), 622-631. https://doi.org/10.1016/j.jht.2022.07.010
• Perez-Marcos, D. (2018). Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation. Journal of neuroengineering and rehabilitation, 15, 1-8. https://doi.org/10.1186/s12984-018-0461-0
• Pikora, T. J., Bourke, J., Bathgate, K., Foley, K.-R., Lennox, N., & Leonard, H. (2014). Health conditions and their impact among adolescents and young adults with Down syndrome. PloS one, 9(5), e96868. https://doi.org/10.1371/journal.pone.0096868
• Rahman, S. A., & Rahman, A. (2010). Efficacy of virtual reality-based therapy on balance in children with Down syndrome. World Applied Sciences Journal, 10(3), 254-261.
• Reid, D. T. (2002). Benefits of a virtual play rehabilitation environment for children with cerebral palsy on perceptions of self-efficacy: a pilot study. Pediatric rehabilitation, 5(3), 141-148. https://doi.org/10.1080/1363849021000039344
• Reis, J. R. G., Neiva, C. M., Pessoa Filho, D. M., Ciolac, E. G., Verardi, C. E. L., da Cruz Siqueira, L. O., de Freitas Gonçalves, D., da Silva, G. R., Hiraga, C. Y., & Tonello, M. G. M. (2017). Virtual reality therapy: Motor coordination and balance analysis in children and teenagers with Down syndrome. European Journal of Human Movement, 38, 53-67.
• Sacks, B., & Buckley, S. (2003). What do we know about the movement abilities of children with Down syndrome? Down Syndrome News and Update, 2(4), 131-141. https://doi.org/10.3104/updates.193
• Shelton, A. R., & Malow, B. (2021). Neurodevelopmental disorders commonly presenting with sleep disturbances. Neurotherapeutics, 18(1), 156-169. http://www.elsevier.com/openaccess/userlicense/1.0/
• SILVA, D. R. d., & Ferreira, J. S. (2001). Intervenções na Educação Física em crianças com Síndrome de Down. Revista da Educação Física/UEM, 12(1), 69-76.
• Sinaga, P., Prananta, M. S., & Fadlyana, E. (2016). Score of fine motor skill in children with Down syndrome using Nintendo Wii. Althea Medical Journal, 3(3), 371-375. https://doi.org/10.15850/amj.v3n3.882
• Snider, L., Majnemer, A., & Darsaklis, V. (2010). Virtual reality as a therapeutic modality for children with cerebral palsy. Developmental neurorehabilitation, 13(2), 120-128. https://doi.org/10.3109/17518420903357753
• Suarez-Villadat, B., Sadarangani, K. P., & Villagra, A. (2023). Effectiveness of exergames programme to modify body composition and health-related physical fitness in adolescents with down syndrome after COVID-19 quarantine. European Journal of Sport Science, 23(11), 2210-2220. https://doi.org/10.1080/17461391.2023.2214805
• Ulrich, D. A., Ulrich, B. D., Angulo-Kinzler, R. M., & Yun, J. (2001). Treadmill training of infants with Down syndrome: evidence-based developmental outcomes. Pediatrics, 108(5), e84-e84. https://doi.org/10.1542/peds.108.5.e84
• Umar, A. B., Yakasai, A. M., Danazumi, M. S., Shehu, U. T., Badaru, U. M., & Kaka, B. (2021). Assessment of family needs of children with cerebral palsy in Northern- Nigeria: A cross-sectional study. Journal of Pediatric Rehabilitation Medicine, 14(2), 265-274. https://doi.org/10.3233/PRM-200696
• Uyanik, M., Bumin, G., & Kayihan, H. (2003). Comparison of different therapy approaches in children with Down syndrome. Pediatrics international, 45(1), 68-73. https://doi.org/10.1046/j.1442-200X.2003.01670.x
• Uyanik, M., & Kayihan, H. (2010). Down syndrome: Sensory integration, vestibular stimulation and neurodevelopmental therapy approaches for children. Stone JH, Blouin M. International Encyclopedia of Rehabilitation, 9.
• Valentini, D., Di Camillo, C., Mirante, N., Vallogini, G., Olivini, N., Baban, A., Buzzonetti, L., Galeotti, A., Raponi, M., & Villani, A. (2021). Medical conditions of children and young people with Down syndrome. Journal of Intellectual Disability Research, 65(2), 199- 209. https://doi.org/10.1111/jir.12804
• Volman, M. J., Visser, J. J., & Lensvelt-Mulders, G. J. (2007). Functional status in 5 to 7-year-old children with Down syndrome in relation to motor ability and performance mental ability. Disability and rehabilitation, 29(1), 25- 31. https://doi.org/10.1080/09638280600947617
• Wang, P. P., Doherty, S., Rourke, S. B., & Bellugi, U. (1995). Unique profile of visuo-perceptual skills in a genetic syndrome. Brain and Cognition, 29(1), 54-65. https://doi.org/10.1006/brcg.1995.1267
• Wu, Z., & Li, Y. (2020). New frontiers in probing the dynamics of purinergic transmitters in vivo. Neuroscience research, 152, 35-43. https://doi.org/10.1016/j.neures.2020.01.008
• Wuang, Y.-P., Chiang, C.-S., Su, C.-Y., & Wang, C.-C. (2011). Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome. Research in developmental disabilities, 32(1), 312-321. https://doi.org/10.1016/j.ridd.2010.10.002
• Yunus, F. T. (2024). The Effect of Sensory-Motor Virtual Reality on Balance in Children with Clinical Down Syndrome. Jurnal Kedokteran Diponegoro (Diponegoro Medical Journal), 13(2). https://doi.org/10.14710/dmj.v13i2.42137
• Zolghadr, H., Yahyaei, M., Sedaghati, P., & Ahmadabadi, S. (2025). The impact of exercise interventions on postural control in individuals with Down syndrome: a systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 17(1), 35. https://doi.org/10.1186/s13102-025-01096-4