An intensive virtual reality program improves balance and functional mobility of adolescents with cerebral palsy

This study examined the effect of an intensive virtual reality (VR) intervention on balance and functional mobility in four adolescent males (mean age 16 years, range 13 years 9 months to 18 years 9 months) with cerebral palsy (CP) in a Gross Motor Classification System (GMFCS) level I. A single-subject multiple baseline experimental design (ABA) was used. Outcome measures were the Community Balance and Mobility Scale (CB&M), the Six-minute Walk Test (6MWT), the Timed Up and Down Stairs Test (TUDS) and the Gross Motor Function Measure (GMFM)-Dimension E. The participants were evaluated between three and six times in the baseline phase, five times in the intervention phase, and four times in the follow-up phase. The intervention consisted of an intensive 90-minute virtual reality-based balance training program for five consecutive days. Analysis consisted of visual and statistical analyses of graphed data as well as analyses of clinical significance. All adolescents demonstrated statistically significant improvements on the CB&M and the 6MWT during the intervention phase and these improvements were maintained the week following the intervention as well as at one month follow-up. Statistically significant improvements on TUDS scores were present in one adolescent at intervention and follow-up. One adolescent showed statistically significant improvements on the GMFM-dimension E and reached a ceiling effect on the GMFM-Dimension E at intervention and follow-up. For the CB&M, reliable changes in mean scores were recorded in three out of four adolescents in the intervention phase and in all adolescents in the follow-up phase. For the 6MWT, one adolescent reached the minimal detectable change (MDC) value in the intervention phase that demonstrates significance for the mean distance walked. Three adolescents reached the MDC value in the follow-phase. This study supports two major findings in adolescents with CP in GMFCS Level I. First, our data suggest that functional balance and mobility of these 13 to 18 year old adolescents with CP can improve with an intense, short duration VR intervention. Second, our data indicate that changes are maintained for at least one month following the VR training. For all participants, a causal relationship was established between the VR intervention and the significant improvements on the CB&M and the 6MWT. This relationship was maintained in the follow-up phase. The study provides evidence that balance and functional mobility are modifiable in ambulatory adolescents with CP in GMFCS Level I and that these adolescents have the potential to enhance their repertoire of complex movement strategies