Children with Cerebral Palsy, Hemiplegia, Virtual Reality Therapy Pt 3

Each Week OT expert, Sarit Tresser will be giving an in-depth insightful analysis into the various ways Health Games aid both children and adults with disabilities. Tune in to receive first-hand input from a professional in the field of child development

Cerebral palsy is a paralysis of two limbs of the same type. In the vast majority of cases, it demonstrates partial or complete paralysis of the lower limbs of both legs.

The goal of treatment will determine how to use the virtual environment. Some of the goals can be improving balance, coordination, posture or transitions between poses.

The child’s level of functioning also affects the game selected for the patient and the nature of treatment and goals. Working with a high-functioning child who can stand and walk, can use the virtual environment to work on static and dynamic balance skills.

How do we use the virtual environment to achieve these goals?

If we want to achieve footwork, we place the camera on the floor in front of the child’s legs. We’ll attach the sensor to the boy’s foot by using the strip of the sensor to put it on easily.  A sensor can be attached to one foot or two, depending on the therapeutic purpose we define and the abilities of the child.

From that moment, the child control the game by moving his feet. This way we can work with the child on the detaching the floor from the ground (with or without support of the upper limb), maintaining balance and posture of the body. You can work sitting or standing, and by so, to change the difficulty level and purpose of the activity. While sitting the therapy will focus on muscle work against gravity, coordination, control and regulation of the movement of the legs.Standing up, the challenge is greater and make the child lifting the leg up, down and sideways while maintaining balance.

Balloon blast game of Timocco particularlarly suitable for this purpose, since it requires the child to move laterally (right / left) at a certain height, which can be controlled by the therapist. That is, the game encourages the child to cut one (can you say that?) leg off the floor, every time another foot, moving it left and right to move a pin towards a balloon to blow it up. Change the camera angle up to make the child lift the leg higher, change it downwards for a lower movement of the legs. controlling game characteristics allow the analyst to rate the level of difficulty of the task. Initial experience for the child should set a small number of balloons, to allow him to rest and experience success in a short time. Later we will increase the number of balloons and increase difficulty level, and make the balloons swift by the wind so the child will be required to match his legs movements to the changing location of the balloons.

Sometimes the goal will not be working directly with the legs but improving dual tasking ability while standing. Since standing and stability are not an automatic skill for those children, addition of another task, such as upper limb work will add a significant challenge and will require child to deal with two tasks at the same time – standing steady on his feet and using his hands simultaneously.

This challenge meets the children every day in a variety of activities. Ability to involve hands movement or engage in intellectual / playful / social activity while standing or walking is a significant challenge in the lives of these children.

The advantage of virtual reality in this therapeutic context lies in the high involvement of the child in the game and the fact that he absorbed in the game and sometimes “forgets” about the disability. In this way, we can help the child to develop automatic standing so that while standing the attention can be directed to another activity.

* It is important to emphasize that a therapist should accompany the process in order to help the child develop good posture and ensure that an adaptive standing is being developed without any ab-normal postures.