Effects of combined virtual reality assisted gait training and proprioceptive neuromuscular facilitation on motor function in children with spastic cerebral palsy: a randomized controlled trial.

BACKGROUND

Spastic cerebral palsy (CP) is characterized by impaired motor function, particularly in the lower limbs. Although both virtual reality (VR)-assisted gait training and proprioceptive neuromuscular facilitation (PNF) have demonstrated beneficial effects, evidence regarding their combined application remains limited.

OBJECTIVE

This exploratory study aimed to explore the effects of combined VR-assisted gait training and PNF on lower-limb motor function in children with spastic CP.

METHODS

Thirty children with spastic CP were randomly assigned to a conventional rehabilitation group (CG), a VR training group, or a combined VR and PNF group (PNF + VR), with 10 participants in each group. All participants underwent a 12-week intervention program. The primary outcomes were Gross Motor Function Measure-88 (GMFM-88) dimensions D (GMFM-88D) and E (GMFM-88E); secondary outcomes included the Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), lower-limb Fugl-Meyer Assessment (FMA), range of motion (ROM), and bone mineral density (BMD). A two-way mixed analysis of variance (ANOVA) was used to evaluate group-by-time interactions, with post hoc comparisons of change scores used as supportive analyses.

RESULTS

All groups showed improvements in functional outcomes after the intervention. Significant group × time interaction effects were observed for GMFM-88D, MAS, FMA, and ROM (p < 0.05), with the PNF + VR group demonstrating the greatest improvements. Although GMFM-88E improved significantly in the PNF + VR group, as indicated by change-score comparisons, the interaction effect was not statistically significant. No significant interaction effects were found for BBS or BMD (p > 0.05).

CONCLUSION

The combination of VR-assisted gait training and PNF may provide additional benefits in improving lower-limb motor function in children with spastic CP compared with conventional rehabilitation or VR training alone.