An investigation of the clinical utility of virtual reality technology to improve the upper limb function of children with traumatic brain injury
Chief Investigator: Ms Jane Galvin, Melinda Randall
Lead Organisation: Murdoch Childrens Research Institute
TAC Neurotrauma Funding: $162,388
Project Start Date: 5 May 2008
Background:
Virtual reality (VR) as an intervention for motor and cognitive rehabilitation is a relatively new area of practice. Studies with adults who have sustained strokes or traumatic brain injuries have suggested that practice within a virtual environment may lead to improvements in upper limb function.VR is a promising area for paediatric rehabilitation as it meets the intervention requirements of being motivating and engaging, while providing an opportunity for practice and repetition. Despite the potential benefits, there is currently a lack of information that specifically addresses children’s motor and functional outcomes following VR interventions in rehabilitation.
The use of new technologies, such as VR, in paediatric rehabilitation is frequently reported in the popular media as facilitating and promoting recovery of motor skills.
A clinical decision to incorporate the use of VR in mainstream practice requires empirical evidence of effectiveness that addresses the potential of the technology, but which scientifically evaluates whether it offers advantages in comparison to other therapies.
Aims:
This project aimed to determine whether VR is clinically useful for improving upper limb skills in children who have sustained a traumatic brain injury.
Objectives:
1.
To establish clinical practice guidelines for the use of VR-based therapy for children with TBI.
2.
To determine or identify appropriate outcome measures that are sensitive to detecting clinically significant change in children’s upper limb function following VR intervention
3.
To carry out a pilot study on the implementation and effectiveness of VR therapy in upper limb rehabilitation of children with TBI.
4.
To determine whether engagement in VR results in improved upper limb function.
Methods:
A comprehensive literature review and critique was carried out. This information provided a basis to develop clinical protocols that were implemented in a pilot intervention trial. The pilot intervention trial recruited children who had sustained traumatic brain injuries and who presented with motor impairments in one or both

upper limbs. Children were aged between 6 and 15 years and participated in VR based therapy two times per week for six weeks.
Results:
There is currently little research to support the use of VR for children with acquired neurological disabilities. This study has provided support for children’s ability to be engaged and motivated by VR and has shown the feasibility of VR within a rehabilitation setting. Children demonstrated improvement in upper limb function, and made gains in self-chosen goals.
Conclusions:
We believe that VR is a clinically applicable tool for rehabilitation based on children’s ability to access the system, engagement with the games and set up, and ability to remain engaged over the time of the intervention. Children showed changes in their ability to complete self care tasks, and in self identified goals. Further studies that compare the efficacy of VR to traditional therapies for improving upper limb function are warranted.
Publications:
DAVIS, GALVIN J, SOO. Reliability of the Assisting Hand Assessment (AHA) for children and youth with ABI. Brain Impairment. 2010:11(2): 113-124.
LEVAC, GALVIN. A comparative analysis of virtual reality systems within ABI motor rehabilitation:
Development of a treatment model. Brain Injury. 2010: 24(3): 160-161
GALVIN J, HEWISH S, RICE J, MACKAY MT. Functional outcome following paediatric stroke.
Developmental Neurorehabilitation. 2011;14(2):67-71.
GALVIN J, MCDONALD R, CATROPPA C, ANDERSON V. Does intervention using virtual reality improve upper limb function in children with neurological impairment: A systematic review of the evidence. Brain Injury. 2011;25(5):435-442.
LEVAC DE, GALVIN J. Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Application of a classification framework. Developmental
Neurorehabilitation. 2011;14(3):177-184.
GALVIN J, ANDERSON, MCDONALD, CATROPPA. Does intervention using virtual reality improve upper limb function in children with neurological impairment: A systematic review of the evidence. Australian Occupational Therapy Journal. 2011: 58(Supplement 1): 96-97.
GALVIN, ANDERSON, MCDONALD, CATROPPA. Preliminary results for a controlled trial of virtual reality in motor rehabilitation following paediatric TBI. Australian Occupational Therapy
Journal. 2011:58(Supplement 1): 98.
GALVIN, LEVAC. Describing and classifying virtual reality systems for use in paediatric motor rehabilitation. Australian Occupational Therapy Journal. 2011:58(Supplement 1):137.
GALVIN J, LEVAC DE. Facilitating clinical decision-making about the use of virtual reality within paediatric motor rehabilitation: Describing and classifying virtual reality systems. Developmental
Neurorehabilitation. 2011;14(2):112-122.
Presentations:
GALVIN J, RANDALL M. Virtual reality in upper limb rehabilitation following paediatric TBI. OT
Australia National Conference & Exhibition; 2008 September 11-13; Melbourne, Australia.

GALVIN J, ANDERSON V, MCDONALD R, CATROPPA C. Virtual Reality and Paediatric TBI:
Pilot and possibilities. 6th Satellite Symposium on Neuropsychological Rehabilitation; 2009 August 3-
4, Tallinn, Estonia.
LEVAC D, GALVIN J. A comparative analysis of virtual reality systems within motor rehabilitation for children and youth with acquired brain injury: Development of a treatment model. International
Brain Injury Association 8th World Conference; 2010 March 10-14, Washington, USA.
FRENCH S, GALVIN J, McDONALD R. A pilot study investigating the reliability and potential of virtual reality for use in therapy. Rehabilitation 2010: Mind and Body Conference; 2010 October 6-8,
Melbourne, Australia.
GALVIN J, LEVAC DE. Describing and classifying virtual reality systems for use in paediatric motor rehabilitation. Occupational Therapy Australia, National Conference; 2011 June 29-31, Gold Coast,
Australia.
GALVIN J, ANDERSON V, MCDONALD R, CATROPPA C. Does intervention using virtual reality improve upper limb function in children with neurological impairment: A systematic review of the evidence. Occupational Therapy Australia, National Conference; 2011 June 29-31, Gold Coast,
Australia.
GALVIN J, ANDERSON V, MCDONALD R, CATROPPA C. Preliminary results for a controlled trial of virtual reality in motor rehabilitation following paediatric TBI. Occupational Therapy Australia,
National Conference; 2011 June 29-31, Gold Coast, Australia.
GALVIN J. Virtual Reality in Paediatric Rehabilitation. Innovations in Paediatric Neuropsychology:
Paediatric Satellite Symposium, ASSBI Conference; 2011 July 5 Auckland, New Zealand.