Virtual Reality Interventions’ Effects on Functional Outcomes for Children with Neurodevelopmental Disorders
Interventions based on virtual reality (VR) have greatly increased over the last decades, and these interventions employ key elements of this approach to enable gains in people’s health and functionality. VR is characterized as a technology resource that allows a dynamic form of human-machine interaction through several types of scenarios designed by a sophisticated computer apparatus, simulating, in most cases, a real-word context (Schultheis and Rizzo 2001).
VR resources are commonly characterized as immersive or non-immersive according to the level of immersion provided by the apparatus and the level of immersion is determined by how effectively the technology creates a perception of reality, supporting sensorimotor demands (O'Regan and Noe 2001). The differences between immersive and non-immersive VR resources can also be determined by characterizing the spatial presence of the user (Ventura et al. 2019). Finally, the closer the apparatus gets the user to the perception of real-life scenarios, the more immersive the technology is.
However, equipment based on immersive VR resources is very expensive, which might make it unfeasible for many intervention settings as well as the effectiveness of interventions based on VR is related more to the engagement than to the degree of immersion afforded by the VR apparatus (O’Brien and Toms 2008). Therefore, non-immersive VR seems to be a promising rehabilitation option for some patients, including pediatric ones (Deutsch et al. 2008). Rehabilitation using VR technology is built on distinctive advantages not observed in many traditional approaches (Palacios-Navarro et al. 2016), particularly with children (Snider et al. 2010).
Among the advantages observed with VR technology are the augmentative feedback of the action required (Wang and Reid 2011); the more controlled and safe environment provided; and the increased control of the duration, frequency, and intensity of the movements performed during the rehabilitation session (Jack et al. 2001). Taken together, all these factors enable more flexibility within rehabilitation sessions, which might optimize the possibilities of transferring the skills learned during intervention sessions to the real world (Rizzo and Galen Buckwaiter 1997).
Another distinctive advantage of VR is the huge capacity to promote fun (Mouatt et al. 2019), which might be crucial for helping children maintain their motivation throughout the rehabilitation sessions, consequently children can challenge themselves within an interactive relationship between them and the machine (Lillard 1993), the targeted functional outcomes can then be reached faster and better. Given this previous contextualization, the literature has highlighted the intervention effects of VR or synonymous terms (active video games, VR games, exergames) on health and functional outcomes for children with different conditions, such as cancer (Li et al. 2011), pain and anxiety (Eijlers et al. 2019), and neurodevelopmental disorders (Hickman etal. 2017). Among these conditions, evidence about VR interventions for children with neurodevelopmental disorders has been highlighted in recent systematic reviews (Hickman et al. 2017, Ravi et al. 2017, Mesa-Gresa et al. 2018, Cavalcante Neto, de Oliveira et al. 2019), particularly because such conditions and their corresponding treatments are complex, and updates about rehabilitation approaches for this group are provided frequently.
Neurodevelopmental disorders are characterized by delays related to the central or peripheral nervous system (Golden 1987) and compose a group of the most prevalent, complex, and disabling disorders during childhood (Cardoso 2014). Additionally, the impairments associated with these conditions interfere with children’s health, self-esteem, and quality of life (Cardoso 2014) and, consequently, in their functionality over adulthood. As examples among several types of neurodevelopmental disorders, cerebral palsy (CP), developmental coordination disorder (DCD), and autism spectrum disorder share the most challenges with respect to both diagnostic processes and rehabilitation strategies, which has aroused intriguing findings in the context of VR from the sources of evidence available. Therefore, the objective of this chapter is to present an overview of the effects of VR interventions/rehabilitation on functional outcomes for children with neurodevelopmental disorders, particularly CP, DCD, and autism spectrum disorder. In order to achieve this, the results of this chapter are divided into three topics, one for each condition.
In total, seven systematic reviews were selected to help and illustrate the use of VR for children with neurodevelopmental disorders. Table 6.1 presents the main characteristics about the systematic reviews included in this study.
Broadly, the outcomes targeted for the majority of studies were related to motor function or motor skills recovery, which emphasizes that VR’s use in the rehabilitation process for children with neurodevelopmental disorders is focused primarily on their body function. Studies regarding autism spectrum disorder are the exception, since the one review retrieved about this primarily focused on behavioral outcomes. However, it did not neglect the role of motor function for these children.