EFFECTIVENESS OF COMPUTER SIMULATION ON POSTURAL BALANCE IN CEREBRAL PALSY.- A SYSTEMIC REVIEW.
Main Article Content
Keywords
Computer simulation training, virtual reality, robotics, electromechanical, artificial intelligence, physical therapy, rehabilitation, postural balance, cerebral palsy.
Abstract
There is scarcity of literature stating the effective rehabilitation program to treat postural balance issues in CP. So this review was under taken to rule out the difference in the effectiveness of computer simulation and other rehabilitation or physical therapy interventions on postural balance in cerebral palsy children studied over the last 05 years.
Goals-We set out to gain an overview of the evidence from randomized controlled trials on the improvement of postural balance in cerebral palsy children. A further aim was to estimate the relative efficacy of the various interventions, taking effect modifiers into account.
All RCTs of parallel-group design and randomised crossover studies that compared computer simulations with other interventions were included. We combined comparable interventions and approaches into treatment categories. To refine the search strategy, we used filters like RCT’s articles for last 05 years, articles published in English language and articles with paediatric balance scale as a primary outcome to measure postural balance were included. Studies with no treatment focused on balance component, more than two computer simulation given at once, exoskeleton devices used without computer feedback system, control group deprived of and treatment. For risk of bias PEDRO scale was used
Qualitative Synthesis For studies that did not provide sufficient quantitative data for the meta-analysis, the qualitative synthesis highlighted consistent improvements in postural balance due to computer simulation interventions. These interventions were generally well- received by participants, with few adverse effects reported.
Sensitivity Analysis-Sensitivity analyses excluding lower-quality studies confirmed the robustness of the findings, with minimal change in pooled effect sizes. This indicates the reliability and consistency of the results.
Overall Effectiveness- The collective results from the included studies demonstrate that computer simulation interventions significantly improve postural balance in children with cerebral palsy. The pooled effect size of 0.85 indicates a large and clinically meaningful impact, highlighting the potential of these innovative rehabilitation tools.
Intervention Types
-Virtual Reality (VR), Gaming Balance Boards) Personalized Balance Games. The subgroup analysis revealed that younger children (ages 5-8) showed slightly larger improvements compared to older children. This suggests that early intervention might be more beneficial in enhancing postural balance, possibly due to greater neuroplasticity at a younger age.
Quality of Studies The inclusion criteria ensured that only high-quality studies (PEDro score ≥ 6) were considered. The developed pedal switches can assist children with CP in training ankle dorsiflexion.
References
2. Chinniah et al. - 2020 - Effects of horse riding simulator on sitting motor.pdf.
3. Centres for Disease Control and Prevention. 27 December 2013. ttps://www.cdc.gov/ncbddd/ cp/data. html. Accessed 21 October 2014.
4. Stokes M. Neurological physiotherapy. London; Philadelphia: Mosby; 1998.
5. Cauraugh JH, Naik SK, Hsu WH, Coombes SA, Holt KG. Children with cerebral palsy: a systematic review and meta-analysis on gait and electrical stimulation. ClinRehabil 2010;24(11):963-978.
6. Nur, Z. Z., Saat, N. Z. M., & Kamaralzaman, S. (2016). Postural control influence on upper extremity function among children with cerebral palsy (CP): A literature review. Journal Sains Kesihatan Malaysia, 14(2), 11–21.
7. Pallavi, S., Sharma, S. D., Jamwal, A., Digra, S., & Saini, G. (2019). Clinical profile of patients with cerebral palsy – A hospital-based study. International Journal of Scientific Study, 7(1), 196–200.
8. Surana BK, Ferre CL, Dew AP, Brandao M, Gordon AM, Moreau NG. Effectiveness of Lower-Extremity Functional Training (LIFT) in Young Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2019 Oct;33(10):862–72.
9. Novak I, McIntyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013;55:885-910.
10. Novak I. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. J Child Neurol. 2014;29:1141-1156.
11. Wan G, Hsieh HC, Lin CH, Lin HY, Lin CY, Chiu WH. An Accessible Training Device for Children With Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng Publ IEEE Eng Med Biol Soc. 2021;29:1252–8
12. K. Cleary, R. Monfaredi, T. Salvador, H. F. Talari, C. Coley, and S. Kovelman, “PedBotHome: Robotically-assisted ankle rehabilitation system for children with cerebral palsy,” in Proc. IEEE Int. Rehabil. Robot., Jun. 2019, pp. 13–20, doi: 10.1109/ICORR.2019.8779468.
13. D. Pinto-Fernandez et al., “Performance evaluation of lower limb exoskeletons: A systematic review,” IEEE Trans. Neural Syst. Rehabil. Eng., vol. 28, no. 7, pp. 1573–1583, Jul. 2020, doi: 10.1109/TNSRE. 2020.2989481.
14. L. D. Mewasingh, T. Sékhara, K. Pelc, A.-M. Missa, G. Cheron, and B. Dan, “Motor strategies in standing up in children with hemiplegia,” Pediatric Neurol., vol. 30, no. 4, pp. 257–261, Apr. 2004.
15. T. Massetti, T. D. da Silva, D. C. Ribeiro, S. R. P. Malheiros, and F. M. Favero, “Motor learning through virtual reality in cerebral palsy–a literature review,” Med. Exp., vol. 1, pp. 302–306, Mar. 2014.
16. Kachmar O, Kushnir A, Fedchyshyn B, Cristiano J, O’Flaherty J, Helland K, et al. Personalized balance games for children with cerebral palsy: A pilot study. J Pediatr Rehabil Med. 2021;14(2):237–45
17. Niiler TA. Assessing dynamic balance in children with cerebral palsy. In: Miller F, Bachrach S, Lennon N, et al., eds. Cerebral palsy. NY: Springer; 2018. pp. 1–32.
18. Carlberg EB, Hadders-Algra M. Postural dysfunction in children with cerebral palsy: some implications for therapeutic guidance. Neural Plast.2005; 12: 221–8.
19. Donker SF, Ledebt A, Roerdink M, et al. Children with cerebral palsy exhibit greater and more regular postural sway than typically developing children. Exp Brain Res. 2008; 3: 363– 70.
20. Wiemeyer J, Hardy S. Serious games and motor learning: concepts, evidence, technology. In: Bredl K, Bösche W, eds. Serious games and virtual worlds in education, professional development, and healthcare. Hershey, PA: IGI Global; 2013. pp. 197–220
21. Nicholson S. A RECIPE for Meaningful Gamification. In: Reiners T, Wood L, eds. Gamification in education and business. NY: Springer; 2015. pp. 1–20.
22. Velasco MA, Raya R, Muzzioli L, et al. Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games. Biomed Eng Online.2017; 16(Suppl 1): 74
23. Hsieh HC. Preliminary Study of the Effect of Training With a Gaming Balance Board on Balance Control in Children With Cerebral Palsy: A Randomized Controlled Trial. Am J Phys Med Rehabil. 2020 Feb;99(2):142–8.
24. S. Hassani et al., “One-minute walk and modified timed up and go tests in children with cerebral palsy: Performance and minimum clinically important differences,” Develop. Med. Child Neurol., vol. 56, no. 5, pp. 482–489, May 2014.
25. B. Bonnecháre, L. Omelina, B. Jansen, and J. S. van Sint, “Balance improvement after physical therapy training using specially developed serious games for cerebral palsy children: Preliminary results,” Disability Rehabil., vol. 39, pp. 403–406, May 2016.
26. M. Roostaei, P. Raji, G. Morone, B. Razi, and K. Khademi-Kalantari, “The effect of dual-task conditions on gait and balance performance in children with cerebral palsy: A systematic review and meta-analysis of observational studies,” J. Bodywork Movement Ther., vol. 26, pp. 448–462, Dec. 2021.
27. Cattagni T, Scaglioni G, Laroche D, Van Hoecke J, Gremeaux V, Martin A. Ankle muscle strength discriminates fallers from non-fallers. Front Aging Neurosci. 2014;6:336. doi: 10.3389/fnagi.2014.00336.
28. Amelio, E., & Manganotti, P. (2010). Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: A placebo-controlled study. Journal of Rehabilitation Medicine, 42(4), 339–343. doi:10.2340/16501977-0522
29. Blottner, D., & L€ uck, G. (2001). Just in time and place: NOS/NO system assembly in neuromuscular junction formation. Microscopy Research and Technique, 55(3), 171–180. doi:10.1002/ jemt.1168
30. Manganotti, P., & Amelio, E. (2005). Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke, 36(9), 1967–1971. doi:10.1161/ 01.STR.0000177880.06663.5c
31. Leone, J. A., & Kukulka, C. G. (1988). Effects of tendon pressure on alpha motoneuron excitability in patients with stroke. Physical Therapy, 68(4), 475–480. doi:10.1093/ptj/68.4.475.
32. Burtner, P. A., Woollacott, M. H., & Qualls, C. (1999). Stance balance control with orthoses in a group of children with spastic cerebral palsy. Developmental Medicine & Child Neurology, 41(11), 748–757. doi:10.1017/S0012162299001516
33. Pohl, M., & Mehrholz, J. (2006). Immediate effects of an individually designed functional anklefoot orthosis on stance and gait in hemiparetic patients. Clinical Rehabilitation, 20(4), 324–330.
34. Lam, W., Leong, J. C. Y., Li, Y., Hu, Y., & Lu, W. (2005). Biomechanical and electromyographic evaluation of ankle foot orthosis and dynamic ankle foot orthosis in spastic cerebral palsy. Gait & Posture, 22(3), 189–197. doi:10.1016/j.gaitpost.2004.09.011
35. Lucareli, P. R., Lima Mde, O., Lucarelli, J. G., & Lima, F. P. (2007). Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis. Clinics, 62(1), 63–68.
36. Dursun, E., Dursun, N., & Alican, D. (2002). Ankle-foot orthoses: Effect on gait in children with cerebral palsy. Disability and Rehabilitation, 24(7), 345–347. doi:10.1080/0963820110090724
37. Hayek, S., Hemo, Y., Chamis, S., Bat, R., Segev, E., Wientroub, S., & Yzhar, Z. (2007). The effect of community-prescribed ankle–foot orthoses on gait parameters in children with spastic cerebral palsy. Journal of Children’s Orthopaedics, 1(6), 325–332. doi:10.1007/s11832-007-0055-z
38. Elnaggar RK, Abd-Elmonem AM. Effects of Radial Shockwave Therapy and Orthotics Applied with Physical Training on Motor Function of Children with Spastic Diplegia: A Randomized Trial. Phys Occup Ther Pediatr. 2019;39(6):692–707.
39. Fransson, P.A.; Gomez, S.; Patel, M.; Johansson, L. Changes in multi-segmented body movements and EMG activity while standing on firm and sponge support surfaces. Eur. J. Appl. Physiol. 2007, 101, 81–89.
40. Surkar, S.M.; Hoffman, R.M.; Harbourne, R.; Kurz, M.J. Cognitive-Motor Interference Heightens the Prefrontal Cortical Activation and Deteriorates the Task Performance in Children with Hemiplegic Cerebral Palsy. Arch. Phys. Med. Rehabil. 2021, 102, 225–232.
41. Peungsuwan, P.; Parasin, P.; Siritaratiwat, W.; Prasertnu, J.; Yamauchi, J. Effects of Combined Exercise Training on Functional Performance in Children with Cerebral Palsy: A Randomized-Controlled Study. Pediatric Phys. Ther. 2017, 29, 39–46.
42. Kelders, S.M.; Sommers-Spijkerman, M.; Goldberg, J. Investigating the Direct Impact of a Gamified Versus Nongamified Well-Being Intervention: An Exploratory Experiment. J. Med. Internet Res. 2018, 20, e247.
43. Palmer, K.K.; Chinn, K.M.; Robinson, L.E. Using achievement goal theory in motor skill instruction: A systematic review. Sports Med. 2017, 47, 2569–2583.
44. Szturm T, Parmar ST, Mehta K, Shetty DR, Kanitkar A, Eskicioglu R, et al. Game-Based Dual-Task Exercise Program for Children with Cerebral Palsy: Blending Balance, Visuomotor and Cognitive Training: Feasibility Randomized Control Trial. Sensors. 2022 Jan 19;22(3):761.
45. Fregni F, Boggio PS, Brunoni AR. Neuromodulação Terapêutica. Princípios e Avanços da Estimulação Cerebral Não Invasiva em Neurologia, Reabilitação, Psiquiatria e Neuropsicologia. São Paulo, Brazil: Sarvier; 2012.
46. Wagner T, Fregni F, Fecteau S, Grodzinsky A, Zahn M, Pascual-Leone A. Transcranial direct current stimulation: a computer-based human model study. Neuroimage. 2007;35:1113-1124.
47. Duarte Nde A, Grecco LA, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct- current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial. PLoS One. 2014;9:e105777. doi:10.1371/journal.pone.0105777.
48. Grecco LAC, Duarte NAC, Mendonça ME, et al. Transcranial direct current stimulation during treadmill training in children with cerebral palsy: a randomized controlled double blind clinical trial. Res Dev Disabil. 2014;35:2840-2848.
49. de Almeida Carvalho Duarte N, Collange Grecco LA, Delasta Lazzari R, Pasini Neto H, Galli M, Santos Oliveira C. Effect of Transcranial Direct Current Stimulation of Motor Cortex in Cerebral Palsy: A Study Protocol. Pediatr Phys Ther Off Publ Sect Pediatr Am Phys Ther Assoc. 2018 Jan;30(1):67–71
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Abhijit Satralkar (PT)
(Principal, AIMS College of Physiotherapy, Dombivli, Maharashtra, India)
Dr. Suvarna Ganvir (PT)
(Professor & HOD, Department of Neurophysiotherapy, DVVPF’s College of Physiotherapy, Ahilyanagar, Maharashtra, India)