Full-Immersive Virtual Reality for Lower Limb Strength and Balance in Children With Hemiplegic Cerebral Palsy

Cerebral palsy (CP) comprises a group of disorders resulting from injury to thedeveloping brain, affecting motor function and postural control. Hemiplegic cerebralpalsy (HCP) predominantly impacts one side of the body, accounting for approximately 38%of all cases of CP. Weakness is more prominent in distal muscle groups, with the hipextensors, knee extensors, and ankle dorsiflexors demonstrating more weakness than theirantagonistic muscle groups. Virtual reality (VR) has been implemented in the treatment ofchildren having CP. VR rehabilitation facilitates training across various complexitylevels, while providing feedback within a safe and controlled setting. VR allowstherapists to regulate the duration and intensity of tasks that are not feasible in theactual world. This study aimed to investigate the effect of fully immersive VR as anadjunct to the rehabilitation program of children with HCP for improving the clinicaloutcomes of lower‐limb strength and balance. G*POWER statistical software (version3.1.9.2) was utilized with α=0.05, 80% power, and an allocation ratio of N2/N1 = 1. Forthis study, a minimum sample of 30 children, 15 in each group, was considered adequate,based on Modified Ashworth Scale Grade 1, 1+, and Gross Motor Function ClassificationSystem. The control group received a selected physical therapy program 60 minutes andwere conducted three times weekly for 8 consecutive weeks. The study group received asimilar program of the control group along with VR‐based training for 20‐30 minutes each,three times weekly, across 8‐week duration. Lafayette hand‐held dynamometer, Fiverepetition sit to stand test, and Pediatric Balance Scale was utilized for evaluation.