RESNA Annual Conference - 2019

Development And Application Of Virtual Reality-Based Cognitive Therapy In Children With Brain Lesions: A Pilot Study

Hyun Kyung Kim, M.D.1, Hyosun Kweon2, Hyun Jong Lee2, Soo Bin Yoo2, Sang Wook Oh, M.D.3, So Ra Park2, Seul Gi Kim2, Kuem Ju Lee2

1National Rehabilitation Center and Hospital, 2Department of Rehabilitation & Assistive Technology,

3Department Rehabilitation Medicine


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.


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.

Figure 1. PUI and software image of VR-based program
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.


Diagnosed with cerebral palsy, spastic bilateral type

Age : 6 to 13

Sex : Male


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.


Figure 2. VR-based cognitive therapy
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).


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





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


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.


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