The Effctiveness Of Virtual Reality Intervention On Upper Limb Function And The Brain Functional Connectivity In Children With Cerebral Palsy

Objectives: The first aim is to investigate the effect of virtual reality intervention(VR)on the upper limb and hand function in children with spastic cerebral palsy(CP);The second aim is to explore whether the related cerebral cortex network remodeling based on VR rehabilitation.Methods: We collected 46 patients with CP who were hospitalized in Paediatric Rehabilitation Department in Yunnan Disabled Persons Rehabilitation Center from May 2022 to December 2022.According to the inclusion and exclusion criteria,the enrolled children were divided into two groups by using the single-blind randomized control method,With the 13 cases of lossed during treatment.Finally,we have 33 enrolled subjects randomized allocated in experimental group(n=18)and control group(n=15).Rehabilitation therapy based on VR technology and conventional rehabilitation therapy were used in the experimental group,while the control group only received conventional rehabilitation therapy.Both group subjects received 4weeks intervention.Peabody development motor scale-2(PDMS-2),and the melboume assessment-2(MA-2)were used as the primary outcome assessment tools before and after treatment.Beery-Buktenica developmental test of visual-motor integration(Berry VMI)as secondary outcome assessment tool,to evaluate the motor function of the upper limbs,visual-motor integration ability of children;functional near-infrared spectroscopy(fNIRS)was used to analyze the changes of brain network connectivity before and after treatment in the experimental group and the control group.Results: Primary outcome measures were higher in the experimental group after 4weeks of treatment(P<0.05),and the upper limb function was improved.In the control group,other evaluation outcomes were higher than those before treatment except for visual perception in Berry VMI and the grasp score test in PDMS-2(P<0.05).Compared with the two groups after treatment,PDMS-2 grip(P=0.015)and MA2 joint range of motion(P=0.035)showed that the experimental group was higher than the control group,while the other outcomes showed no statistical difference between the two groups(P>0.05).2.In the experimental group and the control group,there was no significant enhancement of brain network connections before and after treatment in the resting state.In the experimental group,functional connections between the right temporoparietal occipital area and superior temporal gyrus were enhanced after treatment in the VR paradigm(P=0.04).Conclusions: The upper limb motor function of children with CP can be improved by VR-based rehabilitation therapy combined conventional rehabilitation therapy.VR upper limb rehabilitation has a more significant effect than conventional rehabilitation on the improvement of the upper limb and hand grip and joint range of motion in children with spastic CP.In children with CP,the strength of functional connections of the cerebral cortex can be changed after VR treatment.