The Effects of Virtual Reality on Upper Extremity in Patients with Obstetric Brachial Plexus Injury

Abstract

The present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p < 0.05). There was no significant difference in the MSS values of either groups (p > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI.

Keywords

conventional physiotherapy - obstetric brachial plexus injury - range of motion - virtual reality - function

Ethical Approval

Parental consent forms were obtained after informing the pediatric subjects and their parents about the study. Approval for the study was obtained from the Istanbul Okan University Ethics Board for Scientific, Social and Noninterventional Health Sciences Trials (24.04.2019/107).

Authors' Contributions

Concept: E.A., H.E.K.; Design: E.A.; Supervision: E.A., G.A.; Resources and financial support: E.A., H.E.K.; Materials: E.A., H.E.K.; Data collection and/or processing: H.E.K.; Analysis and/or interpretation: GA, MD; Literature research: GA, HEK, MD; Writing manuscript: EA, HEK; Critical review: EA, GA.

Publication History

Received: 27 November 2020

Accepted: 16 January 2021

Article published online:
19 February 2021

• References

• 1 Andersen J, Watt J, Olson J, Aerde JV. Perinatal brachial plexus palsy. Paediatr Child Health 2006; 11 (02) 93-100
• 2 Hoeksma AF, ter Steeg AM, Nelissen RGHH, van Ouwerkerk WJR, Lankhorst GJ, de Jong BA. Neurological recovery in obstetric brachial plexus injuries: an historical cohort study. Dev Med Child Neurol 2004; 46 (02) 76-83
• 3 Kaplan T, Başar H. Obstetrik Brakial Pleksus Felci [Obstetric brachial plexus palsy]. Sakaryamj. 2014; 4 (02) 60-65
• 4 Santamato A, Panza F, Ranieri M, Fiore P. Effect of botulinum toxin type A and modified constraint-induced movement therapy on motor function of upper limb in children with obstetrical brachial plexus palsy. Childs Nerv Syst 2011; 27 (12) 2187-2192
• 5 Brady K, Garcia T. Constraint-induced movement therapy (CIMT): pediatric applications. Dev Disabil Res Rev 2009; 15 (01) 102-111
• 6 Dodds SD, Wolfe SW. Perinatal brachial plexus palsy. Curr Opin Pediatr 2000; 12 (01) 40-47
• 7 Taniguchi M, Van Heest A, Partington M. Birth brachial plexus injuries: an update on evaluation and treatment. Pediatr Perspect 2009;18(03):
• 8 Metin Ökmen B, Doğan Aslan M, Nakipoğlu Yüzer GF, Özgirgin N. Effect of virtual reality therapy on functional development in children with cerebral palsy: a single-blind, prospective, randomized-controlled study. Turk J Phys Med Rehabil 2019; 65 (04) 371-378
• 9 El-Shamy S, Alsharif R. Effect of virtual reality versus conventional physiotherapy on upper extremity function in children with obstetric brachial plexus injury. J Musculoskelet Neuronal Interact 2017; 17 (04) 319-326
• 10 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. Phys Ther 2008; 88 (10) 1196-1207
• 11 Tarakci D, Ersoz Huseyinsinoglu B, Tarakci E, Razak Ozdincler A. Effects of Nintendo Wii-Fit^® video games on balance in children with mild cerebral palsy. Pediatr Int (Roma) 2016; 58 (10) 1042-1050 [Internet]
• 12 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74 (04) 491-516
• 13 Smith BW, Chang KWC, Saake SJ, Yang LJS, Chung KC, Brown SH. Quantifying real-world upper-limb activity via patient-initiated movement after nerve reconstruction for upper brachial plexus injury. Neurosurgery 2019; 85 (03) 369-374
• 14 Basheer H, Zelic V, Rabia F. Functional scoring system for obstetric brachial plexus palsy. J Hand Surg [Br] 2000; 25 (01) 41-45
• 15 Shigematsu K, Yajima H, Kobata Y, Kawamura K, Maegawa N, Takakura Y. Oberlin partial ulnar nerve transfer for restoration in obstetric brachial plexus palsy of a newborn: case report Case presentation. J Brachial Plex Peripher Nerve Inj 2006; 5: 1-5
• 16 Howcroft J, Klejman S, Fehlings D. et al. Active video game play in children with cerebral palsy: potential for physical activity promotion and rehabilitation therapies. Arch Phys Med Rehabil 2012; 93 (08) 1448-1456
• 17 Tripette J, Murakami H, Ryan KR, Ohta Y, Miyachi M. The contribution of Nintendo Wii Fit series in the field of health: a systematic review and meta-analysis. PeerJ 2017; 5 (09) e3600
• 18 Duff SV, DeMatteo C. Clinical assessment of the infant and child following perinatal brachial plexus injury. J Hand Ther 2015; 28 (02) 126-133 , quiz 134
• 19 Sajan JE, John JA, Grace P, Sabu SS, Tharion G. Wii-based interactive video games as a supplement to conventional therapy for rehabilitation of children with cerebral palsy: a pilot, randomized controlled trial. Dev Neurorehabil 2017; 20 (06) 361-367