Cerebral Palsy (CP) is defined as “a neurodevelopmental disorder characterized by movement and posture disorders causing activity limitations” (Gagliardi et al., 2018). The overall research was conducted in the Italian scientific institution called “IRCCS Eugenio Medea”. The main researcher on this study is Chiara Gagliardi, specifically working within the neurorehabilitation unit has performed numerous researches in order to improve a range of conditions linked with neuro disorders using advanced technology. Some of her previous work includes “A Different Brain: Anomalies of Functional and Structural Connections in Williams Syndrome” (Research Gate, 2018) and “Effects of dose and duration of Robot-Assisted Gait Training on the walking ability of children affected by cerebral Palsy” (Research Gate, 2017). Another researcher that has had a huge impact on this research is Emilia Biffi. Biffi has conducted numerous research papers using advanced technology and focusing on improving neuro diseases such as “A Virtual Design Process to Produce Scoliosis Braces by Additive Manufacturing” (Research Gate, 2019). Anna Carla Turconi is another valuable piece of research that has contributed immensely to the study of Cerebral Palsy using advanced biomechanical technology. This includes Turconi’s study into “An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries” (Research Gate, 2017). Cristina Maghini was also involved in the research of the rehabilitation of cerebral palsy. Maghini is a highly regarded professional where she works closely with cerebral palsy, gait movement, patient rehabilitation, and advanced technology such as robots and virtual reality. Alessia Marelli, Ambra Cesareo, Elenora Diella, and Daniele Panzeri are the other researchers involved in this case study contributing towards rehabilitation medicine, Orthopaedic surgery, Physiotherapy, and Neurology (Research Gate, 2018). Due to these professional attributions to the study and the strong understanding of neuro diseases and advanced technologies of biomechanics background of Gagliardi, Biffi and Turconi provide the research paper with reliable work that has been carried out appropriate, ethical and is deemed valid.
Cerebral Palsy is often described as “the most severe physical disability within the spectrum of developmental delay” (Gagliardi et al., 2018). Therefore, the main purpose of this study was to improve walking gait patterns of those affected by Cerebral Palsy using advanced kinematic and kinetic paraments of Immersive Virtuality Reality treatment. From the data collected the researchers came to a conclusion that there was in fact a various amount of effective forms of Cerebral Palsy treatment.
The research was conducted at the Scientific Institute E. Medea, Bosisio Parini, Italy, where 16 children (10 males, 6 females) between the ages of 7 and 16 years with bilateral Cerebral Palsy were recruited. In other cases, this sample size would usually be considered a low sample size, however, because only bilateral cases of Cerebral Palsy were examined it is classified as “concise”. From this, the research has a doubt in the repeatability due to the small number of participants and whether or not improvements will occur in all types of Cerebral Palsy as differences in joint kinetics, degrees of mobility are all limitations that need to be accounted for. The tests were performed on the Gait Real-time Analysis Interactive Lab (GRAIL), this system monitored the children’s walking patterns through one daily session for 30 minutes a day, 5 days a week which accumulated to 18 sessions over the course of 4 weeks. Although 4 weeks is enough time to accumulate results, if the tests were conducted over a longer period of time, the data could conduct more reliable results to determine whether or not these tests help with a child’s development of Cerebral Palsy. Motor functional abilities were conducted throughout the tests, this was assessed by the Gross Motor Function Measure (GMFM), energy expenditure was recorded by using a “3 axis accelerometer, heat flux sensor, galvanic skin response sensor (GSR), skin temperature sensor and a near body ambient temperature sensor” (Gagliardi et al., 2018) and parents or caregivers were given a Functional Assessment Questionnaire (FAQ) to rate the walking ability of their children, these techniques were all used to increase the reliability of the research. The children were able to work at their own pace and exercised performed were ones that mirrored real-life situations that these individuals may have not been able to e.g. skiing, hitting as many elves as possible while squatting, kick balls at targets, walking in a forest as fast as possible, etc… These fun interactive activities for the kids to enjoy, kept the kids motivated, positive and entertained as opposed to traditional approaches where repetition is key. A questionnaire set up for the children would have been a good approach to allow the researchers to develop valuable feedback and the effectiveness of Immersive Virtual Reality activities.
The data shown throughout the study is clear and concise and sums up that the GRAIL system is a key factor in the improvements of motor function of bilateral Cerebral Palsy. All participants except one had successfully completed all 18 sessions and results have shown that throughout the 4 weeks, bilateral stride length, walking speed, running and jumping capacity, ankle and hip power, and ankle and pelvis ROM in stance and swing had all increased, whilst excessive knee flexion, step width and stance time had all reduced (Gagliardi et al., 2018), which indicates a positive result of using Immersive Virtual Reality to help improve bilateral Cerebral Palsy. The children compared to healthy adults in table 3, show the improvement in the efficiency of their walking gait. The results of the caregivers showed that there was very little visual improvement, however, the statistical evidence shows that there in fact has been a positive improvement. Instead of the results being shown in decimals it would have been more effective if they were shown in percentages in order to interpret them better and understand the degree of improvement indicated. The children participants were only selected if they have had no previous treatment such as botulinum toxin-A treatment 16 weeks prior to the testing or orthopedic surgery, intrathecal baclofen treatment, or selective dorsal rhizotomy within the last 12 months prior to the rehabilitation (Gagliardi et al., 2018). Due to the exclusion of these children, it is unknown whether or not these factors would have changed the outcome of the results and raises questions as to why those children were unable to participate in the test, ultimately making the test unreliable for those with previous treatment. The data of the children were compared to 10 healthy adults; however, these adults were predominately female giving a 9:1 ratio (Gagliardi et al., 2018). This indicates that the male children with Cerebral Palsy were most likely compared to female adults which are unreliable as males, and females share different characteristics. This can be proven by the study of Bruening and Frimenko in 2015 that proved there are greater pelvic rotation, range of motion, and stride length in females (Bruening et al., 2015).