Clinical Bottom Line
“How could I apply this information?”
This study underscores the importance of thoroughly evaluating adolescents classified at GMFCS level I, as they are often underserved. Because this population is considered “functional,” weekly services are not typically recommended. The authors highlight the need to use outcome measures that are sensitive to higher functioning children. The GMFM does not currently address high-level balance activities and it has a ceiling effect. However, the baseline scores for the Community Balance and Mobility Scale showed that subjects had difficulties with higher-level balance and coordination tasks that are necessary to function in the community.
This virtual reality (VR) protocol included key components of motor learning: repetition- and task-specific activities within a multisensory environment that were engaging for the subjects. The ability of the computer to generate unpredictable patterns promoted generalization of learned skills. Thus, VR can be an efficient way of providing intervention. It is also very relevant to today's “digital” generation: video games successfully motivate children of all ages.
There was an immediate and short-term effect of this intense, episodic therapy intervention. From a clinical standpoint, more patients could be served in a shorter amount of time. From a patient perspective, episodes of intervention fit more readily into busy family and school schedules.
“What should I be mindful about when applying this information?”
Studies using a single-subject design can be highly relevant to specific patients. Because this intervention was tailored to the individual subject, we can see the “real world” outcome from specific treatment. This study used the very best aspects of single-subject design including sufficient baseline data and a rigorous visual as well as statistical analysis.
Although the costs of the Interactive Rehabilitation and Exercise System may prohibit its use in some clinics, this type of technology combines the best of motor learning principles with fun and it clearly engaged adolescents in a therapeutic challenge. A physical therapist assistant implementing the protocol could provide VR intervention in a cost-effective manner.
Stephanie Yu, PT, MSPT, PCS
California Children's Services
Long Beach, Los Angeles, California
Linda Fetters, PT, PhD, FAPTA
University of Southern California
Los Angeles, California