Virtual Reality gaming to improve upper limb functionality in children with Cerebral Palsy

Cerebral Palsy (CP) is known as a neurological disorder that involves multiple
permanent movement and posture constraints. Approximately 1 in 500 neonates are
born with CP, resulting in a worldwide population of 17 million people (1).
Nearly 50% of CP cases happens to express either unilateral or bilateral
impaired hand- and arm function, both having major impact on quality of life
(2).
Children with CP often have a diminished awareness of remaining upper limb
capacity (3). Besides, they develop a learned non-use, which represents
suppressed movement of the affected limb (4-5). Beating learned non-use is a
major target in upper limb rehabilitation interventions, however difficult to
achieve. Each time individuals perform activities of daily living (ADLs) with
their affected upper limb, they experience negative feedback and possibly even
failure in performing certain actions. This may ultimately lead to a
progressive suppression (5). Therefore, it is a great challenge to encourage
the use of affected upper limbs in daily life.
One of the most promising ways to reduce learned non-use is constraint-induced
movement therapy (CIMT). During CIMT, the non-affected (or less affected) upper
limb is constrained, resulting in a forced use of the affected limb.
Subsequently, individuals have to perform ADLs with their affected limb,
thereby improving their skills.
One relatively new technology that is becoming more regularly applied in
rehabilitation practice is Virtual Reality (VR). In a way, VR-based gaming
shows some similarities to CIMT. VR games are controlled either uni- or
bimanually. When unimanually-controlled games are performed with the affected
upper limb, movements of the unaffected hand are completely ineffective. This
mimics the principle of forced use. To some degree, also bimanually-controlled
games result in a forced use of the affected upper limb.
Additionally, VR could help in the engagement in rehabilitation programs, as
virtual environments and gaming increases enjoyment and motivation (7, 8) and
therefore therapy adherence (9). Accordingly, VR-based gaming may have the
potential to improve upper limb functionality in children with CP. Therefore,
this study aims to investigate the feasibility of a home-based VR intervention
to improve upper limb functionality in children with CP.

The goal of this study is to examine the feasibility of a home-based VR
intervention to improve upper limb functionality in patients with CP.

Primary research question:
1. Is VR-based gaming a feasible method to provide a rehabilitation
intervention for children with CP?
* Do participants achieve a satisfying amount of rehabilitation practice,
indicating good therapy compliance?
* Is the Oculus Quest VR headset usable for rehabilitation?

Secondary research question:
2. Does VR-based rehabilitation using commercially-available games result in an
improved upper limb functionality in children with CP.

Other objectives:
3. Determine interrater reliability, test-retest reliability and construct
validity of the Upper Limb Reaching Test (ULRT) in children with CP.

Study type: Feasibility study.
Study duration: Approximately 9 months.
Setting: Sint Maartenskliniek & home-setting of participants.

The risks in this study are neglectable. Furthermore, participants may improve
their occupational- and/or functional ability of their hand and arm.