虛擬實境對腦性麻痺兒童伸取行為之訓練療效: 個案報告

Virtual reality (VR) is a computer technology that artificially generates sensory information in a form that people perceive as real-world objects and events. It has been proposed that VR can improve upper-extremity function in children with cerebral palsy (CP) by decreasing physical disabilities, precisely adjusting the difficulty of task and feedback, enhancing motivation and manipulating perceptual information. The purpose of this study was to investigate the training effects of VR on reaching behavior in a child with CP. This case was a 6-year-old boy with spastic quadriplegic CP who had good cooperation and normal cognition. A single-subject A-B-A design was used. The case received 3 baseline, 4 intervention, and 2 follow-up measures. He received a 4-week (3 times a week) individualized VR training using VR-hand function training system and Eyetoy-play system with therapist's manual guidance. The outcome measures included (1) four reaching kinematic parameters (movement time (MT), path, peak velocity (PV), and number of movement units (MU)) in 2 activities (pegboard and mail-delivery) at 3 directions (abduction, adduction, and forward); (2) touching a swing ball; and (3) the fine motor domain of Peabody Development Motor Scale-2nd edition (PDMS2). Visual inspection and 2-standard deviation band method were used to compare the outcome measures between the two adjacent phases. Improvements were found in the kinematic parameters in all directions from baseline to intervention, and the effects were maintained in some directions from intervention to follow-up. Improvement was also shown in the ability to touch a swing ball, but the effect was not maintained from intervention to follow-up. Furthermore, there was an increase (11 points) in the PDMS2 scores from baseline to intervention and an increase (1 point) from intervention to follow-up. This case study demonstrated the potential effect of VR training program to improve the upper-extremity function in children with CP. The training effects might retain for 1 month post intervention.