A Virtual Reality Based Gait Rehabilitation System For Children With Cerebral Palsy.

Cerebral Palsy (CP) refers to a motor disorder that affects approximately one in every 400 live births in the UK. Living with CP can be challenging for both patients and their families. There are a range of established approaches used by physiotherapists to improve motor capacity in children with CP. Staffing and space allocation, however, can limit the number of rehabilitation sessions that can be offered. Treadmill training has been suggested as one approach to address some of these limitations. Walking using a treadmill can maintain or improve movement function, yet questions remain over the effectiveness of the programme and how to maintain motivation on the part of the child. The inclusion of a virtual reality (VR) environment into training is a possible approach to engage children who might otherwise lack the motivation needed to undertake rehabilitation. VR based lower extremity rehabilitation to improve standing (balance) and walking (gait) skills has been shown to be relevant for patients post stroke. VR has also been noted to help children with CP increase their self-confidence and motivation, resulting in improvements of upper extremity function. The potential for VR based lower extremity rehabilitation for CP has also been reported. It has been suggested, however, that most VR systems are not designed with rehabilitation in mind. Some have been designed specifically for use in rehabilitation, but these can be expensive which has limited their use. Consequently, VR based rehabilitation, particularly for gait assist, has not been reported or investigated in detail. The overall aim of the present work was to develop, design, and investigate the practicality of a virtual rehabilitation system (the Surrey Virtual Reality System - SVRS) suitable for routine clinical use in gait re-education for children with CP. For this work, the practicality evaluation was directed at: satisfaction (how enjoyable is it to use the SVRS); comfort (how easy is it for users to complete tasks, once they have learned the system); safety (how safe is it to use the equipment and what are side effects of using the system); and to some extent utility (to what extent the selected scenarios will benefit the rehabilitation of children with CP effectively). Therefore, pilot game scenarios were developed for training in balance and treadmill based walking. A Real-time Treadmill Speed Control Algorithm was developed as part of the SVRS, which may provide a more immersed and realistic treadmill training.The performance and the 3D presentation quality of the SVRS were first evaluated in 13 young able-bodied using questionnaires. The overall results were positive and showed that the SVRS provided safe and visually acceptable virtual training environments. The statistical results suggest that self selected ‘slow’ and ‘normal’ speeds were significantly higher when using the RTSCA. This may suggest that they walked more naturally or confidently on the treadmill when using the RTSCA as compared to the use of conventional treadmill speed control buttons. To investigate the ‘practicality’ of the SVRS in a clinical situation; three clinicians and two children with CP used it, the latter observed by their parent/guardian and a treating physiotherapist. Feedback was collected using both questionnaires and an open-discussion. The overall results show that the SVRS appears practical for rehabilitation purposes and the children with CP and the other able-bodied participants used the RTSCA safely. Further modification is required in the future research that should focus on formally examining the clinical effectiveness of the SVRS in children with CP. For example, providing a mechanism for clinicians to alter the virtual environment should be considered in order to meet the specific rehabilitation aims for patients