INTRODUCTION

In recent study, task-oriented cognitive therapy is more efficient than conventional cognitive therapy for children with brain lesions. However, existing cognitive therapy such as paper and pencil tasks and computerized cognitive training for children with brain lesions has limitation with the use of pencils, keyboards or unrealistic scenes. The purpose of this study was to develop and apply a virtual (VR)-based cognitive therapy with task-oriented, realistic scenes, simple operations and adequate difficulty level for children with brain lesions.

METHODS

VR-based system

Hardware: motion sensor (Kinect®) and physical user interface (PUI) to detect children behavior and provide sensory feedback based on the outcome and concentration of the training (Figure 1.) (Figure 2.).

Software: consists of three categories (visualization and reasoning, attention and memory, and activity of daily life) and 13 sub-items.

The level of difficulty in the program is from 1 to 5, which is divided by the changes in the number, characteristics, location of objects and time limit.

Subject

Diagnosed with cerebral palsy, spastic bilateral type

Age : 6 to 13

Sex : Male

Treatment

2 patients received conventional cognitive therapy using paper and pencil task (control group) and 2 patients received VR-based therapy (experimental group) (Table 1.).

The therapy consists of total 20 session, 1 session for 30 minutes and lasted 4 weeks in both groups.

Outcome

Motor-free visual perception test (MVPT) or developmental test of visual perception (DTVP), attention diagnostic system(ADS), pediatric volitional questionnaire (PVQ) and verbal cue frequency of the therapist (1,20 session of each treatment).

RESULTS

The VR based system was able to recognize the limb motion of the child and to provide the training program and feedback stimulation according to the children’s motion. In comparison with the control group, visual perception test score and participation of therapy in PVQ increased and verbal cue of the therapist decreased in the experimental  group (Table 2.). Results of inattention and impulsiveness in ADS were inconsistent between participants.

Table 1. Characteristics of patients

Patients	Age	Sex	Diagnosis	Training method
1	11	Male	CP	Conventional
2	13	Male	CP	Conventional
3	9	Male	CP	VR-based
4	6	Male	CP	VR-based

 

Table 2. Comparison of visual perception assessment and degree of the participation of before and after therapy

Training method	Patients		Visual perception	Inattention	Impulsiveness	PVQ	Verbal cue
Conventional	1	Before	29	246/132	78/100	17	70
		After	23	327/149	76/45	29	81
	2	Before	33	165/121	153/83	16	51
		After	22	232/110	99/105	22	55
VR-based	3	Before	32	294/87	39/75	38	21
		After	33	235/128	41/42	47	12
	4	Before	33	78/67	119/79	28	32
		After	40	254/74	40/72	42	25

CONCLUSION

The VR based system was feasible to cognitive therapy for children with brain lesion. VR-based cognitive therapy showed more improvements in the visual perception function and participation of the children than the conventional therapy. VR-based cognitive therapy will be helpful for children with brain lesions who have impaired hand function and decreased participation of therapy.