Virtual Reality Interventions' Effects for Children with Autism Spectrum Disorder
Autism spectrum disorder (ASD) is another complex neurodevelopmental disorder referred to as a persistent impairment, interfering in communication and social interactions (American Psychiatric Association 2013). One of the most pronounced characteristics of this disorder is related to patterns of behaviors repetitive actions or movements and restricted and specific interests (Campisi et al. 2018). The global prevalence of ASD is around 7.6 per 1,000 persons (Baxter et al. 2015), and the impact on daily life or academic activities is huge (Campisi et al. 2018). Since communication and social skills are necessary to function and have autonomy, children with ASD are at a great disadvantage compared to their peers, because communication and social skills are, in fact, remarkable in those children.
Given these features, the diagnostic process for ASD is complex and difficult. There is scarce evidence about the etiology of ASD, but genetic components are present in more than 20% of the cases (Ivanov et al. 2015). Therefore, the earlier the diagnosis is made, the better the prognosis will be. Early intervention should be done as soon as possible in order to avoid severe consequences in all aspects of the children's development (Zwaigenbaum et al. 2015). Since interaction and communication are elements involved in therapeutic approaches for children, these deficiencies along with restrictive interests may be a barrier during the rehabilitation process. In contrast, VR approaches may afford a suitable therapeutic environment with ideal dosages of sensorial, social, and motor stimuli.
Although there are other systematic reviews available, only one systematic review (Mesa-Gresa et al. 2018) about VR for children with ASD fulfilled the purpose of this chapter, since it focused exclusively on children with ASD and interventions based on VR. Unfortunately, this systematic review (Mesa-Gresa et al. 2018) did not synthesize either the VR tools used among studies during interventions or the wide information about the dosage of treatment with those children. The majority of studies were interested in social (45%) and emotional (21%) skills as outcomes. Despite the improvements observed in the majority of studies (30 out 31 studies) in at least one outcome assessed, only in ten studies were these improvements significant. Regarding the level of evidence attested to by this systematic review, the authors (Mesa-Gresa et al. 2018) found only a moderate effect of VR intervention for children with ASD. This implies that despite the improvements observed, moderate evidence is not sufficient to recommend rehabilitation treatment based on VR as a substitute for traditional treatments for this population.
Moreover, this systematic review (Mesa-Gresa et al. 2018) compiled useful and promising information that widens our possibilities for helping children with ASD achieve greater quality of life and functionality. However, stronger evidence is necessary to consider VR as a good choice to treat ASD symptomatology, particularly related to aspects of social and emotional skills. In addition, following the suggestions given by authors of this systematic review, more studies are necessary, and new rehabilitation techniques using VR should be encouraged and developed for children with ASD.
CONCLUSION
Considering all evidence from the seven systematic reviews retrieved here, VR interventions are promising approaches for the rehabilitation process of children with neurodevelopmental disorders, particularly CP. DCD, and autism spectrum disorder. VR has brought benefits for functional outcomes for these children, such as motor skills, motor performance, balance, walking, social skills, and emotional skills. However, these benefits are not superior to those achieved by traditional interventions, such as conventional physiotherapy. Despite that, better effects of VR interventions appear to be achieved when combined with traditional no-VR interventions, which w'ould increase functional benefits for children with neurodevelopmental disorders while simultaneously maintaining engagement with the therapeutic process. Thus, more investigations regarding VR interventions’ effects for children with neurodevelopmental disorders should be carried out, particularly taking into account the advantages of technology and the unique and complex characteristics and needs of these children.
REFERENCES
American Psychiatric Association. 2013. Diagnostic and Statistical Manual of Mental Disorders. DSM-5. 5th ed. Washington, DC: American Psychiatric Association.
Baxter. P.. 2015. For and against the term cerebral palsy. Developmental Medicine & Child Neurology. 57 (7), 592-592.
Baxter. A.J.. Brugha. T.S., Erskine. H.E., Scheurer. R.W.. Vos. T.. and Scott. J.G., 2015. The epidemiology and global burden of autism spectrum disorders. Psychological Medicine. 45 (3). 601-613.
Blank. R., Barnett. A.L.. Cairney. J.. Green, D., Kirby, A.. Polatajko. H., Rosenblum, S.. Smits-Engelsman, B., Sugden, D„ Wilson. P.. and Vinçon, S„ 2019. International clinical practice recommendations on the definition, diagnosis, assessment, intervention, and psychosocial aspects of developmental coordination disorder. Developmental Medicine & Child Neurology, 61 (3). 242-285.
Bonney, E., Ferguson. G.. and Smits-Engelsman, B.. 2017. The efficacy of two activity-based interventions in adolescents with developmental coordination disorder. Research in Developmental Disabilities, 71, 223-236.
Bonney, E.. Jelsma. L.D., Ferguson. G.D., and Smits-Engelsman, B.C.M.. 2017. Learning better by repetition or variation? Is transfer at odds with task specific training? PLOS One. 12 (3), e0174214.
Campisi, L., Imran. N.. Nazeer. A.. Skokauskas. N.. and Azeem. M.W., 2018. Autism spectrum disorder. British Medical Bulletin, 127. 91-100.
Cardoso. F.. 2014. Movement disorders in childhood. Parkinsonism and Related Disorders, 20 (Suppl. 1), S13-S16.
Cavalcante Neto. J.L.. de Oliveira, C.C., Greco. A.L., Zamunér. A.R., Moreira. R.C.. and Tudella. E„ 2019. Is virtual reality effective in improving the motor performance of children with developmental coordination disorder? A systematic review. European Journal of Physical and Rehabilitation Medicine. 55 (2), 291-300.
Cavalcante Neto. J.L.. Steenbergen, B., Wilson, P.. Zamunér, A.R., and Tudella. E., 2020. Is Wii-based motor training better than task-specific matched training for children with developmental coordination disorder? A randomized controlled trial. Disability and Rehabilitation. 42. 2611-2620.
Chen. Y.. Fanchiang, H.D.. and Howard, A.. 2018. Effectiveness of virtual reality in children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials. Physical Therapy. 98 (1), 63-77.
Deutsch, J.E., Borbely. M.. Filler, J.. Huhn, K.. and Guarrera-Bowlby, R. 2008. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Physical Therapy, 88 (10). 1196-1207.
Eijlers, R., Ùtens. E.M.W.J., Staals, L.M.. De Nijs, P.F.A.. Berghmans. J.M.. Wijnen, R.M.H., Hillegers. M.H.J.. Dierckx. B., and Legerstee, J.S.. 2019. Systematic review and meta-analysis of virtual reality in pediatrics: Effects on pain and anxiety. Anesthesia and Analgesia, 129 (5), 1344-1353.
Golden, G.S.. 1987. Common neuromotor disorders. In: Gottlieb. M.I. and Williams, J.E. (eds) Textbook of Developmental Pediatrics. Boston. MA: Springer US, 27-40.
Harris. K. and Reid, D.. 2005. The influence of virtual reality play on children’s motivation. Education. 72 (1). 21-29.
Hickman, R., Popescu. L., Manzanares, R., Morris, B.. Lee, S.-Р., and Dufek. J.S., 2017. Use of active video gaming in children with neuromotor dysfunction: A systematic review. Developmental Medicine & Child Neurology. 59 (9). 903-911.
Hillier. S.. 2007. Intervention for children with developmental coordination disorder: A systematic review. The Internet Journal of Allied Health Sciences and Practice, 5 (3), 1-11.
Hubbard, I.J.. Parsons. M.W.. Neilson. C.. and Carey. L.M.. 2009. Task-specific training: Evidence for and translation to clinical practice. Occupational Therapy International, 16 (3-4). 175-189.
Ivanov. H.Y.. Stoyanova, V.K.. Popov, N.T.. and Vachev, T.I.. 2015. Autism spectrum disorder - A complex genetic disorder. Folia Medica. 57 (1), 19-28.
Jack, D.. Boian. R.. Merians, A.S.. Tremaine. M.. Burdea. G.C.. Adamovich. S. V., Recce. M., and Poizner, H.. 2001. Virtual reality-enhanced stroke rehabilitation. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 9 (3), 308-318.
Jonsson, U„ Eek, M.N.. Sunnerhagen, K.S.. and Himmelmann. K.. 2019. Cerebral palsy prevalence, subtypes. and associated impairments: A population-based comparison study of adults and children. Developmental Medicine and Child Neurology, 61 (10). 1162-1167.
Li. W.H.. Chung. J.O.. and Но. E.K.. 2011. The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing. 20 (15-16), 2135-2143.
Lillard. A.S.. 1993. Pretend play skills and the child's theory of mind. Child Development. 64 (2), 348.
Mentiplay, B.F.. Fitzgerald. T.L.. Clark. R.A.. Bower, K.J.. Denehy. L.. and Spittle. A.J.. 2019. Do video game interventions improve motor outcomes in children with developmental coordination disorder? A systematic review using the ICF framework. BMC Pediatrics, 19 (1). 22.
Mesa-Gresa. R. Gil-Gómez. H.. Lozano-Quilis. J. A., and Gil-Gómez, J. A.. 2018. Effectiveness of virtual reality for children and adolescents with autism spectrum disorder: An evidence-based systematic review. Sensors (Switzerland), 18 (8), 2486.
Miyahara, M.. Hillier. S.L.. Pridham. L„ and Nakagawa. S.. 2017. Task-oriented interventions for children with developmental co-ordination disorder. Cochrane Database of Systematic Reviews, 7 (7), CD010914.
Mouatt. B.. Smith, A.. Mellow, M.. Parfitt. G.. Smith. R.. and Stanton, T, 2019. The use of virtual reality to influence engagement and enjoyment during exercise: A scoping review. Journal of Science and Medicine in Sport. 22. S98.
O'Brien. H.L. and Toms. E.G.. 2008. What is user engagement? A conceptual framework for defining user engagement with technology. Journal of the American Society for Information Science and Technology, 59 (6), 938-955.
O'Regan. J.K. and Noe. A.. 2001. A sensorimotor account of vision and visual consciousness. Behavioral and Brain Sciences. 24 (5). 939-973.
Page. Z.E.. Barrington, S.. Edwards. J., and Barnett, L.M.. 2017. Do active video games benefit the motor skill development of non-typically developing children and adolescents: A systematic review. Journal of Science and Medicine in Sport. 20 (12), 1087-1100.
Palacios-Navarro. G.. Albiol-Pérez. S„ and García-Magariflo Garcia. !.. 2016. Effects of sensory cueing in virtual motor rehabilitation. A review. Journal of Biomedical Informatics. 60, 49-57.
Palisano. R.. Rosenbaum, R, Bartlett, D.. Livingston, M., Walter. S.. Russell. D„ Wood. E.. and Galuppi. B.. 1997. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39 (4). 214-223.
Rathinam. C.. Mohan. V.. Peirson, J.. Skinner, J.. Nethaji. K.S.. and Kuhn, I., 2019. Effectiveness of virtual reality in the treatment of hand function in children with cerebral palsy: A systematic review. Journal of Hand Therapy, 32 (4), 426-434.el.
Ravi, D.K.. Kumar. N.. and Singhi. R, 2017. Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: An updated evidence-based systematic review. Physiotherapy (United Kingdom), 103 (3), 245-258.
Rizzo. A.A. and Galen Buckwaiter. J.. 1997. Virtual reality and cognitive assessment and rehabilitation: The state of the art. Studies in Health Technology and Informatics. 44. 123-145.
Schultheis. M.T. and Rizzo. A.A.. 2001. The application of virtual reality technology in rehabilitation. Rehabilitation Psychology, 46 (3), 296-311.
Smits-Engelsman, B.. Vinçon, S„ Blank. R.. Quadrado. V.H.. Polatajko, H.. and Wilson. P.H.. 2018. Evaluating the evidence for motor-based interventions in developmental coordination disorder: A systematic review and meta-analysis. Research in Developmental Disabilities, 74. 72-102.
Snider. L.. Majnemer. A., and Darsaklis. V.. 2010. Virtual reality as a therapeutic modality for children with cerebral palsy. Developmental Neurorehabilitation, 13 (2). 120-128.
Ventura, S„ Brivio, E.. Riva. G., and Banos. R.M.. 2019. Immersive versus non-immersive experience: Exploring the feasibility of memory assessment through 360° technology. Frontiers in Psychology, 10, 2509.
Wang. M. and Reid. D.. 2011. Virtual reality in pediatric neurorehabilitation: Attention deficit hyperactivity disorder, autism and cerebral palsy. Neuroepidemiology, 36 (1), 2-18.
Warnier, N.. Lambregts. S„ and Port. I. Van De. 2019. Effect of virtual reality therapy on balance and walking in children with cerebral palsy: A systematic review. Developmental Neurorehabilitation, 1-17.
World Health Organization (WHO). 2001. International Classification of Functioning, Disability and Health (ICF). Geneva: WHO.
Zwaigenbautn. L.. Bauman. M.L.. Choueiri, R., Kasari, C.. Carter, A.. Granpeesheh. D.. Mailloux, Z.. Roley, S.S., Wagner. S.. Fein. D.. Pierce, K.. Buie. T.. Davis. P.A.. Newschaffer, C.. Robins. D., Wetherby, A.. Stone, W.L., Yirmiya, N.. Estes. A.. Hansen, R.L.. McPartland, J.C., and Natowicz. M.R.. 2015. Early Intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. In: Pediatrics. Evanston: American Academy of Pediatrics, S60-S81.
Zwicker, J.G., Harris. S.R., and Klassen. A.F., 2013. Quality of life domains affected in children with developmental coordination disorder: A systematic review. Child: Care. Health and Development, 39 (4), 562-580.
