Table 1.
Characteristics of Included Studies
| Study | Country | Design | Subjects | Age Mean (SD) | Measurement | Intervention | Type of VR | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CG (n) | IG (n) | Male (%) | Condition | Platforms and Type | Methods | Frequency and Time | ||||||
| Tarakci et al (2016)21 | Turkey | Parallel group- RCT | 15 | 15 | 63.0 | Diplegic, hemiplegic, dyskinetic cerebral palsy | IG: 10.46 (2.69) CG:10.53 (2.79) |
Daily activity using Wee FIM | Nintendo Wii-fit | Slalom; wire-walking; football game | Neurodevelopmental therapy + VRGs treatment; 20 min/time, twice per week, 12 weeks in total; 480 min | Non-immersive |
| Choi et al (2021)22 | Korea | Parallel group- RCT | 38 | 40 | 48.0 | Cerebral palsy and other brain injuries | 5.3 (8.3) | Upper limb function using ULPRS | RAPAEL Smart Kids | The device is a band-like wrist attachment that includes two inertial measurement unit sensors positioned on the dorsum of the hand and distal forearm, along with the appropriate software | Intervention 30 min virtual reality, 5 days per week for 4 weeks | Semi-immersive |
| Sajan et al (2016)32 | India | Parallel group- RCT | 10 | 10 | 55.0 | Spastic diplegic, triplegic, and quadriplegic spastic cerebral palsy | IG: 12.4 (4.93) CG: 10.6 (3.78) |
Balance using Pediatric Berg’s Balance Scale assessment. Upper Limb Function using QUEST. |
Nintendo Wii-fit remote control game | Boxing; tennis | Regular rehabilitation + VRGs treatment; 30 min/time,6 times/week, 3 weeks in total; 540 min | Non-immersive |
| Chen et al (2013)33 | Taiwan | Parallel group- RCT | 14 | 13 | 66.6 | Spastic cerebral palsy | IG: 8.7 (2.1) CG: 8.6 (2.2) |
Motor funcing using GMFM | The Eloton SimCycle Virtual Cycling System (Eloton, Inc., NV, USA) | Warm-up exercises, loaded sit-to-stand exercises, progressive resistance cycling, and a cool-down exercise | The hVCT group cycled for 40 min per day, thrice a week, for 12 weeks. | Non-immersive |
| Farr et al (2019)34 | England | Parallel group- RCT | 15 | 15 | N/A | Bilateral or unilateral spastic cerebral palsy | IR 5–16 | Motor function using GMFM | Nintendo Wii-fit | Home-therapy program | 12 weeks home therapy program | Non-immersive |
| Han and Ko (2010)35 | Korea | 10 | 10 | 50.0 | Paralytic hemiplegia | IG: 9.50 (2.46) CG: 8.90 (2.37) |
Balance using PBS Daily activity using WeeFIM |
Nintendo Wii | Strength training treatment + VRGs treatment; | 15 min/time, 3 days/week, 12 weeks in total; 540 min | Non-immersive | |
| Rostami HR et al (2012)37 | Iran | Parallel group- RCT | 8 | Divided into 3 groups: VR Group: 8; CIMT: 8; VR+CIMT: 8 | 43.7 | Spastic Hemiparetic cerebral palsy | VR: 92 (77–110) mCIMT: 100 (74–124) VR+mCIMT: 98 (87–128); CL: 96 (74–140) |
Motor funcing using PMAL | The VR environment was generated by an E-Link Evaluation and Exercise System (Version 6 software) provided by Biometrics Ltd. | During exercises, children were seated on an adjustable chair. Children selected their favorite games. Children were asked and encouraged to practice and play games in a virtual environment just by the affected hand. | The intervention program consisted of an individualized 18-hour VR program every other day, 3 times weekly for 4 weeks. Each VR session continued for 1.5 hours. | Non-immersive |
| Sahin et al (2019)36 | Turkey | Parallel group- RCT | 30 | 30 | N/A | Unilate spastic cerebral palsy (hemiplegia spastic) | IG:10.5 (3.62) CG: 10.06 (3.24) |
Daily activity using PMAL | Kinect Xbox | Air challenge; boxing trainer; wall breaker; jet run; super kick | 8-week period, twice a week, and for a session duration of 45 minutes | Non-immersive |
| Atasavun and Baltaci (2016)38 | Turkey | Parallel group- RCT | 12 | 12 | N/A | Hemiplegic spastic cerebral palsy | IR: 6–14 | Balance using PBS | Nintendo Wii fit | Wii basketball game, Wii football game, Wii boxing game | Regular rehabilitation treatment + VRGs treatment; 30 min/time, 2 days/week, 12 weeks in total; 720 min | Semi-immersive |
| Lazzari et al (2016)39 | Italy | Parallel group- RCT | 10 | 10 | 70.0 | Sepastic cerebral Palsy | IG: 7.6 (2.2) CG: 7.4; (2.0) |
Balance using PBS | Xbox 360 Kinect | The physiotherapist placed the braces. The gait-assistance device was evaluated, and adjustments were made, when necessary, to achieve the proper length. | Consisted of 10 sessions (five per week for two weeks) of VR mobility training combined with active or sham tDCS. | Semi-immersive |
| Grecco et al (2015)23 | Brazil | Parallel group- RCT | 10 | 10 | 55.0 | Spastic Diparetic Cerebral Palsy | IG: 8.2 (1.6) CG: 8.8 (1.1) |
Motor function using GMFM | Xbox 360 Kinect | Gait training involving VR with the application of anodal tDCS over the primary motor cortex of the contralateral hemisphere to the lower limb with greater motor impairment | Five weekly 20-minute sessions were conducted.Over two consecutive weeks (total: 10 sessions). | Fully immersive |
| Cho et al (2016)27 | Korea | Parallel group- RCT | 9 | 9 | N/A | Spastic cerebral palsy | IG: 10.2 (3.4) CG: 9.4 (3.8) |
Balance using PBS Motor function using GMFM |
Nintendo Wii-fit | VR treadmill training (VRTT) | The patient will undergo general physical therapy for 30 minutes daily, thrice a week, for eight weeks. | Semi-immersive |
| Jha et al (2021)26 | India | Parallel group- RCT | 19 | 19 | 60.0 | Diplegia spastic cerebral palsy | IG: 8.94 (1.92) CG: 8.72 (1.68) |
Balance using PBS Motor function using GMFM Daily activity using WeeFIM |
Kinect Xbox | The therapy consists of Kinect-based VR gaming in combination with balance-specific physiotherapy. | The therapy program is designed to be conducted over 6 weeks, with each session lasting 60 minutes. The therapy is typically conducted 4 days a week. | Semi-immersive |
| Sharan et al (2012)29 | India | Parallel group- RCT | 8 | 8 | N/A | Post-operative cerebral palsy | IG: 8.88 (3.23) CG: 10.38 (4.41) |
Balance using PBS | Nintendo Wii fit | Depending on children’s abilities | Depending on game types, 3 days/time, 3 weeks in total | Semi-immersive |
| Tarakci et al (2019)30 | Turkey | Parallel group- RCT | 15 | 15 | 57.0 | Cerebral palsy (CP) | IG: 10.93 (4.09) CG: 11.06 (3.23) |
Upper limb function using CHAQ | LeapMotion Controller based training (LMCBT) | CatchAPet; Leapball | 1-hour sessions 3 times a week for 8 weeks | Semi-immersive |
| Hsieh H (2018)31 | Taiwan | RCT | 20 | 20 | N/A | Diplegic and quadriplegic cerebral palsy | IG: 7.33 (1.31) CG: 7.41 (1.54) |
Balance using BBS | Computer + joystick (the software Scratch) | Flower watering, monkey eating bananas, killing mosquitoes with a swatter | Regular rehabilitation treatment + VRGs treatment; 40 min/time, 5 times/week,12 weeks in total; 2400 min | Non-immersive |
| Avcil et al (2021)25 | Turkey | Parallel group RCT | 15 | 15 | 45.0 | Hemiplegic Cerebral palsy | IG: 9.4 (1.9) CG: 9.5 (1.9) |
Upper limb function using CHAQ | Nintendo Wii and Leap Motion Controller (LMC) | Specific games were employed, specifically tennis and boxing games, to improve elbow and shoulder functions. These games provided feedback through remote control, sound, and vibration notifications. | 30 minutes every day for 20 weeks | Semi-immersive |
| Urgen et al (2016)24 | Turkey | Parallel group- RCT | 15 | 15 | N/A | Spastic hemiplegia cerebral palsy | IG: 11.07 (2.37) CG: 11.33 (2.19) |
Balance using PBS Motor function using GMFM |
Nintendo Wii fit | Ski jumping; snowball fight; jogging; the oblique city; penguin slides; perfect 10; guideway; header | Regular rehabilitation treatment + VRGs treatment; 40 min/time, twice per week, 9 weeks in total; 720 min | Semi-immersive |
| Wang et al (2021)28 | Taiwan | Parallel group- RCT | 10 | 10 | 35.0 | Hemiplegiacerebral palsy | IG: 102.67 (25.05) CG: 102.78 (25.84) Month |
Daily activity using WeeFIM | Nintendo Wii | Home-based CIT (constraint-induced therapy) | 2.25 hr per session and two sessions per week (4.5 hr per week) for 8 weeks (36 hr in total) | Semi-immersive |
Abbreviations: CG, control group; IG, intervention group; IR, interval ranges; Wee FIM, Wee-Functional Independence Measure, ULPRS, The Upper Limb Physician’s Rating Scale; QUEST, the Box and Block Test and the Quality of Upper Extremity Skills Test; GMFM, Gross Motor Function Measure; PBS, Pediatric Balance Scale; PMAL, The Pediatric Motor Activity Log; BBS, Berg Balance Scale.