Journal of Modern Rehabilitation 2017. 11(1):23-30.

Virtual Reality Practice, Computer Games, and Improvement of Cerebral Palsy Balance: A Single Subject Study
Samira Boroumand, Afsoon Hassani Mehraban, Mahdi Dadgou, Parvin Raji


Introduction: Virtual reality is a novel technology which creates attractive environment using computer hardware and software. In these virtual realities people can actively participate and use their motor and cognitive abilities. Current study aimed at investigating effect of virtual reality on the balance of children with cerebral palsy.
Material and Methods: This research is a single subject study with ABA design conducted on three children with cerebral palsy (GMFCSΙ level). Basic phase and intervention phase of investigation lasted for 2 and 4 weeks, respectively. Intervention sessions were repeated 3 times per week like base line phase. In each intervention session, children performed different computer games for 21 minutes. These games require center of pressure displacement in the frontal and sagittal planes. Follow-up phase was implemented 2 to 3 months after completion of intervention phase. Changes were measured using following measurement tools: pediatric reach test (PRT), Timed Up and Go (TUG), 10-meter walking (10MW) and subtest of balance and lower limb strength test, including Bruininks-Oseretsky of Motor Proficiency (BOMP). Finally results were investigated using visual analysis and C Statistics.
Results: Comparison of PRT tests and subtest of balance and lower limb strength test, including BOMP suggested significant improvement in static balance (P=0.000), jumping ability, and dynamic balance of children participating in the research and durability of this improvement in follow-up phase, though investigation of TUG and 10MW test results showed no significant improvement.
Conclusion: Results in this research showed that using virtual reality can improve balance in children with cerebral palsy.


Virtual reality, Balance, Child, Cerebral palsy

Full Text:



Krägeloh-Mann I, Cans C. Cerebral palsy update. Brain and Development. 2009; 31(7):537–44. doi: 10.1016/j.braindev.2009.03.009

Soleimani F, Vameghi R, Hemmati S, Biglarian A, Sourtiji H. Survey on types and associated disorders of cerebral palsy in eastern and northern districts of Tehran. Archives of Rehabilitation. 2011; 12(3):75-82.

Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: The definition and classification of cerebral palsy April 2006. Developmental Medicine & Child Neurology. 2007; 109(109):8-14. PMID: 17370477

Tarakci D, Ozdincler AR, Tarakci E, Tutuncuoglu F, Ozmen M. Wii-based balance therapy to improve balance function of children with cerebral palsy: A pilot study. Journal of Physical Therapy Science. 2013; 25(9):1123–7. doi: 10.1589/jpts.25.1123

Woollacott MH, Shumway Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: What are the underlying problems and what new therapies might improve balance. Neural Plasticity. 2005; 12(2-3):211–9. doi: 10.1155/np.2005.211

Pavão SL, dos Santos AN, Woollacott MH, Rocha NACF. Assessment of postural control in children with cerebral palsy: A review. Research in Developmental Disabilities. 2013; 34(5):1367–75. doi: 10.1016/j.ridd.2013.01.034

Kembhavi G, Darrah J, Magill Evans J, Loomis J. Using the Berg Balance Scale to distinguish balance abilities in children with cerebral palsy. Pediatric Physical Therapy. 2002; 14(2):92–9. doi: 10.1097/00001577-200214020-00005

Harris K, Reid D. The influence of virtual reality play on children's motivation. Canadian Journal of Occupational Therapy. 2005; 72(1):21-9. doi: 10.1177/000841740507200107

Flynn S, Palma P, Bender A. Low tech virtual reality improves function in individuals with central nervous system injury. Journal of Neurologic Physical Therapy. 2006; 30(4):210–1. doi: 10.1097/01.npt.0000281304.16905.61

Rahman SA, Rahman A. Efficacy of virtual reality based therapy on balance in children with Down syndrome. World Applied Sciences Journal. 2010; 10(3):254-61.

Salem Y, Gropack SJ, Coffin D, Godwin EM. Effectiveness of a low cost virtual reality system for children with developmental delay: A preliminary randomised single blind controlled trial. Physiotherapy. 2012; 98(3):189–95. doi: 10.1016/

Radtka S, Hone R, Brown C, Mastick J, Melnick ME, Dowling GA. Feasibility of computer based videogame therapy for children with cerebral palsy. Games for Health Journal . 2013; 2(4):222–8. doi: 10.1089/g4h.2012.0071

Broeren J, Rydmark M, Sunnerhagen KS. Virtual reality and haptics as a training device for movement rehabilitation after stroke: A single case study. Archives of Physical Medicine and Rehabilitation. 2004; 85(8):1247–50. doi: 10.1016/j.apmr.2003.09.020

Yang S, Hwang WH, Tsai YC, Liu FK, Hsieh LF, Chern JS. Improving balance skills in patients who had stroke through virtual reality treadmill training. American Journal of Physical Medicine & Rehabilitation. 2011; 90(12):969–78. doi: 10.1097/phm.0b013e3182389fae

Yen CY, Lin KH, Hu MH, Wu RM, Lu TW, Lin CH. Effects of virtual reality augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: A randomized controlled trial. Physical Therapy. 2011; 91(6):862–74. doi: 10.2522/ptj.20100050

Gutiérrez RO, Galán del Río F, Cano de la Cuerda R, Diego A, Isabel M, González RA, et al. A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation. 2013; 33(4):545-54. doi: 10.3233/NRE-130995.

Tatla SK, Radomski A, Cheung J, Maron M, Jarus T. Wii-habilitation as balance therapy for children with acquired brain injury. Developmental Neurorehabilitation. 2012; 17(1):1–15. doi: 10.3109/17518423.2012.740508

Luna Oliva L, Ortiz Gutiérrez RM, Cano de la Cuerda R, Piédrola RM, Alguacil Diego IM, Sánchez Camarero C, et al. Kinect Xbox 360 as a therapeutic modality for children with cerebral palsy in a school environment: a preliminary study. NeuroRehabilitation. 2013; 33(4):513-21.

Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera Bowlby P. Use of a low cost, commercially available gaming console (wii) for rehabilitation of an adolescent with cerebral palsy. Physical Therapy. 2008; 88(10):1196–207. doi: 10.2522/ptj.20080062

Gil Gómez JA, Lloréns R, Alcañiz M, Colomer C. Effectiveness of a Wii balance board based system (eBaViR) for balance rehabilitation: A pilot randomized clinical trial in patients with acquired brain injury. Journal of NeuroEngineering and Rehabilitation . 2011; 8(1):30. doi: 10.1186/1743-0003-8-30

Williams EN, Carroll SG, Reddihough DS, Phillips BA, Galea MP. Investigation of the timed “Up & Go” test in children. Developmental Medicine & Child Neurology. 2007; 47(8):518–24. doi: 10.1111/j.1469-8749.2005.tb01185.x

Gan SM, Tung LC, Tang YH, Wang CH. Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabilitation and Neural Repair. 2008; 22(6):745–53. doi: 10.1177/1545968308316474

Thompson P, Beath T, Bell J, Jacobson G, Phair T, Salbach NM, et al. Test-retest reliability of the 10-metre fast walk test and 6-minute walk test in ambulatory school-aged children with cerebral palsy. Developmental Medicine & Child Neurology. 2008; 50(5):370–6. doi: 10.1111/j.1469-8749.2008.02048.x

Chrysagis N, Skordilis EK, Koutsouki D. Validity and clinical utility of functional assessments in children with cerebral palsy. Archives of Physical Medicine and Rehabilitation. 2014; 95(2):369–74. doi: 10.1016/j.apmr.2013.10.025

Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatric Physical Therapy. 2003; 15(2):84–90. doi: 10.1097/01.pep.0000067885.63909.5c

Flegel J, HA Kolobe T. Predictive validity of the test of infant motor performance as measured by the Bruininks Oseretsky test of motor proficiency at school age. Physical Therapy. 2002; 82(8):762-71. PMID: 12147006

Biometrics Ltd Catalogue. Operating Manual E-LINK: evaluation & Exercise systems. Newport: Biometrics Ltd. 2012.

Hartveld A, Hegarty J. Frequent weightshift practice with computerised feedback by cerebral palsied children — four single-case experiments. Physiotherapy. 1996; 82(10):573–80. doi: 10.1016/s0031-9406(05)66300-6

Jelsma J, Pronk M, Ferguson G, Jelsma Smit D. The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy. Developmental Neurorehabilitation. 2012; 16(1):27–37. doi: 10.3109/17518423.2012.711781

Brien M, Sveistrup H. An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy. Pediatric Physical Therapy. 2011; 23(3):258–66. doi: 10.1097/pep.0b013e318227ca0f

Siconolfi Morris GC. Use of a video game based balance training intervention on the balance and function of children with developmental disabilities [PhD Dissertation]. Lexington: University of Kentucky; 2012.

Ramstrand N, Lygnegård F. Can balance in children with cerebral palsy improve through use of an activity promoting computer game. Technology and Health Care. 2012; 20(6):531-40.

Nagano A, Komura T, Fukashiro S. Optimal coordination of maximal effort horizontal and vertical jump motions: A computer simulation study. BioMedical Engineering OnLine. 2007; 6(1):20. doi: 10.1186/1475-925x-6-20

Samozino P, Morin J-B, Hintzy F, Belli A. Jumping ability: A theoretical integrative approach. Journal of Theoretical Biology. 2010; 264(1):11–8. doi: 10.1016/j.jtbi.2010.01.021

Liao HF, Jeny SF, Lai JS, Cheng CK, Hu MH. The relation between standing balance and walking function in children with spastic diplegic cerebral palsy. Developmental Medicine & Child Neurology. 2008; 39(2):106–12. doi: 10.1111/j.1469-8749.1997.tb07392.x



  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.