Virtual Reality Therapy for Hemiplegia: Childs Play

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Virtual Reality Therapy for Hemiplegia Childs
Play!

• Darcy Fehlings MD MSc FRCP(C)
• Sophie Lam-Damji OT
• OACRS October 2007

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Overview

• Clinical Features of Hemiplegia
• Constraint Therapy versus Virtual Reality Therapy
  (VRT)
• VRT Evidence in Hemiplegia
• VRT New Research Directions

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Hemiplegia MCA Infarct
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M. Rang
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Constraint Therapy Disadvantages

• Loss of independence
• Frustration
• Risk of falls
• Timing (hard to do during school year)
• Repeated constraint treatments to maintain
  efficacy?

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Virtual Reality Therapy (VRT)

• Definition an immersive and interactive computer
  experience that enables the user to perform
  movements on a simulated system and shows the
  effects in real time
• Some similarities in the approach of constraint
  and VRT for children with hemiplegia
• Advantage of VRT FUN

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Theoretical Framework of VRT in Hemiplegia

• VRT elicits desired motor activities to promote
  practice
• Potential gains are hypothesized in motor
  control, and decreased limb neglect
• Motor gains can be associated with cortical
  reorganization

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Lofty IdeasIs there Evidence?Paediatric Studies

• Reid et al. 2002 pilot study evaluating VR
  therapy in 3 children with SQCP improved
  self-perception (before/after) and seating
  posture ?RCT report pending
• You et al. 2005 case report of child with
  hemiplegia receiving VR therapy demonstrating
  improved activation of sensorimotor cortex post
  VR therapy on fMRI, and improved ADL

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Evidence Adults

• Virtual Reality in Chronic Stroke A Randomized
  Trial Sung et al. Stroke, 2005 36 1166-1171
• 10 adults with chronic stroke randomized to VR
  (60 minutes/day, 5 days/week/4 weeks) or control
• Results impvt in walking outcome, shift in
  laterality index from ipsilateral to
  contralateral in VR tx subjects

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Research Idea

• Develop a system that is inexpensive and portable
  for use in the home
• Design the VRT System to promote the exclusive
  use of the hemiplegic hand to play the VRT games

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Potential Advantages of Home-based VRT

• System is less expensive
• Decreased visits to Rehab Centres
• Decreased need for one to one therapy sessions
• Decreased parental supervision of home-based
  therapy activities
• Child has fun doing the activities
• High level of acceptability by
  child/parent/health professional

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Research Objectives

• To develop a low cost home-based system that is
  applicable to children gt4 years with a wide-range
  of hemiplegic hand ability
• To evaluate the effectiveness of VRT to improve
  hand function in children with hemiplegia
• To evaluate the maintenance of change over time
• To evaluate the central mechanism of action of
  VRT using functional MRI and MEG

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The Research Team

• Darcy Fehlings (PI)/Developmental Pediatrician
• Tom Chau (PI)/Ka Lun Tam Rehabilitation Engineers
• Sophie Lam-Damji/Occupational Therapist
• William Li/Kenneth Tse/Rehabilitation Engineering
  Students

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Virtual Reality Therapy System

• Sony Play Station 2
• Eye Toy Camera
• TV
• Chair with buttons
• Control Box
• Fingerprint Recognition System

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Virtual Reality Therapy System (VRThs)
2007/09/20
Division Pediatric Rounds
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Research to date

• Usability Assessment at Bloorview - completed
• In Home Usability Assessment - completed
• Prospective Study - funded and underway
• Next Steps
• RCT evaluating the effectiveness of VRT to
  improve hand function
• Functional MRI evaluation of Cortical
  Reorganization