Development of Cortical Plasticity Through Virtual Reality and Dual-Task Training in Children With Brachial Plexus Birth Injury: A Different Perspective in Paediatric Neurorehabilitation
试验速览
- 阶段
- 不适用
- 状态
- Enrolling By Invitation
- 发起方
- 入组人数
- 14
- 试验地点
- 1
- 主要终点
- Range of Motion (ROM)
研究概览
简要总结
Brachial plexus birth injury (BPBI) is a condition that occurs when the nerves controlling the arm are injured during birth, leading to weakness, limited movement, and sensory problems. These motor difficulties may also affect cognitive processes related to movement. BPBI requires long-term follow-up and rehabilitation.
This study will compare two treatment approaches in children with BPBI:
- virtual reality (VR)-based exercises, and
- motor-cognitive dual-task exercises. We will examine their effects on brain adaptation (cortical activation), muscle strength, joint motion, proprioception, and upper-limb function. Fourteen children aged 7-14 years will be randomly assigned to one of the two programs, each delivered for 12 weeks. Afterward, participants will continue a 9-month home program. Assessments will be conducted at baseline, after treatment, and at 12 months, including functional MRI (fMRI).
This study will be the first to evaluate long-term brain changes and functional outcomes after these two rehabilitation approaches in children with BPBI.
详细描述
Brachial plexus birth injury (BPBI) is characterized by unilateral or bilateral upper extremity motor and sensory impairment resulting from injury to the cervical (C4-C5 to T1-T2) nerve roots and their associated structures during birth. BPBI often leads to limited active movement, muscle weakness, impaired proprioception, and secondary musculoskeletal problems. Beyond these peripheral symptoms, decreased use of the affected limb and chronic motor impairment may influence cognitive processes related to motor planning and execution. Recent literature also highlights the role of central nervous system plasticity in functional recovery; however, evidence remains limited, and long-term cortical adaptation patterns in children with BPBI are not well understood.
This randomized controlled study aims to compare the effects of two rehabilitation approaches-virtual reality (VR)-based exercises and motor-cognitive dual-task exercises-on cortical adaptation, joint range of motion, muscle strength, proprioception, and upper extremity function in children with BPBI. A secondary aim is to examine the relationship between cortical activation and functional performance.
A total of 14 children aged 7-14 years with C5-C6 or C5-C7 involvement, who have not undergone neurosurgery and score ≥26 on the Modified Pediatric Mini Mental Scale, will be included. Participants will be randomly allocated into two groups:
- VR-based exercise + conventional physiotherapy (n = 7),
- Dual-task motor-cognitive exercise + conventional physiotherapy (n = 7).
Interventions will be delivered for 12 weeks, three sessions per week, with each session lasting 1 hour. After the supervised intervention period, participants will continue with a structured home program for 9 months. Evaluations will be conducted at baseline, post-intervention (12 weeks), and at 12 months. Cortical activation will be assessed using functional magnetic resonance imaging (fMRI). Additional outcome measures will include joint range of motion, muscle strength, proprioception, Modified Mallet Classification, and the Brachial Plexus Outcome Measure.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 7 Years 至 14 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Children aged 7-14 years
- •Diagnosed with unilateral DBPP
- •C5-C6 or C5-C7 involvement (Narakas I, IIa, IIb)
- •Modified Pediatric Mini-Mental Scale score ≥26
- •Child and parent willing to participate in the study
排除标准
- •Previous nerve surgery for DBPP
- •Surgery within the past year or Botulinum Toxin injection within the past 3 months
- •Any neurological condition other than DBPP
- •Vision or hearing impairments affecting participation
- •Contraindications for fMRI
- •Fixed contractures in shoulder, elbow, wrist, or finger joints
- •Participation in regular physiotherapy or other rehabilitation programs within the past 3 months
研究组 & 干预措施
Dual Task Group
Participants in the dual-task group will receive a motor-cognitive dual-task exercise program in addition to conventional physiotherapy. The program includes simultaneous motor activities (such as reaching, grasping, and upper-limb functional tasks) combined with cognitive challenges involving attention, memory, problem-solving, and decision-making. Each session lasts 60 minutes and is delivered three times per week for 12 weeks. The aim of the intervention is to enhance cortical activation, improve motor planning, and support upper-limb functional performance through combined motor and cognitive stimulation.
干预措施: Conventional Physiotherapy Program (Other)
Dual Task Group
Participants in the dual-task group will receive a motor-cognitive dual-task exercise program in addition to conventional physiotherapy. The program includes simultaneous motor activities (such as reaching, grasping, and upper-limb functional tasks) combined with cognitive challenges involving attention, memory, problem-solving, and decision-making. Each session lasts 60 minutes and is delivered three times per week for 12 weeks. The aim of the intervention is to enhance cortical activation, improve motor planning, and support upper-limb functional performance through combined motor and cognitive stimulation.
干预措施: Dual Task (Other)
Virtual reality (VR) Group
Participants in the virtual reality (VR) group will receive a VR-based exercise program in addition to conventional physiotherapy. The VR program includes interactive upper-limb activities designed to promote active movement, motor control, and engagement through immersive, game-based tasks. Exercises target reaching, grasping, coordination, and proprioceptive awareness in a visually enriched environment. Each session lasts 60 minutes and is conducted three times per week for 12 weeks. The intervention aims to stimulate cortical activation, support motor learning, and enhance upper-limb functional performance.
干预措施: Conventional Physiotherapy Program (Other)
Virtual reality (VR) Group
Participants in the virtual reality (VR) group will receive a VR-based exercise program in addition to conventional physiotherapy. The VR program includes interactive upper-limb activities designed to promote active movement, motor control, and engagement through immersive, game-based tasks. Exercises target reaching, grasping, coordination, and proprioceptive awareness in a visually enriched environment. Each session lasts 60 minutes and is conducted three times per week for 12 weeks. The intervention aims to stimulate cortical activation, support motor learning, and enhance upper-limb functional performance.
干预措施: Virtual Reality (Other)
结局指标
主要结局
Range of Motion (ROM)
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Active joint movement of the affected upper limb will be measured with an electronic goniometer in standardized positions for shoulder, elbow, and wrist.
Brachial Plexus Outcome Measure (BPOM)
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Functional performance of the upper limb in daily activities will be assessed using a validated scale, including shoulder, elbow, and hand tasks. The BPOM consists of three domains (shoulder, elbow, and hand) and includes 11 task-based activities, each scored on a 5-point scale (1-5). The total BPOM score ranges from 11 to 55, with higher scores indicating better upper limb functional performance.
Muscle Strength
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Upper limb muscle groups will be tested using a handheld dynamometer with standardized positions and the "make method."
Change in Motor Cortex Activation (BOLD Signal) Measured by fMRI
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9-month follow-up after baseline.
Motor cortex activation will be evaluated before treatment, after 12 weeks, and at 9-month follow-up using non-contrast BOLD fMRI during finger and elbow movements to assess cortical plasticity.
Range of Motion (ROM)
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Active joint movement of the affected upper limb will be measured with an electronic goniometer in standardized positions for shoulder, elbow, and wrist.
Brachial Plexus Outcome Measure (BPOM)
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Functional performance of the upper limb in daily activities will be assessed using a validated scale, including shoulder, elbow, and hand tasks. The BPOM consists of three domains (shoulder, elbow, and hand) and includes 11 task-based activities, each scored on a 5-point scale (1-5). The total BPOM score ranges from 11 to 55, with higher scores indicating better upper limb functional performance.
Muscle Strength
时间窗: From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.
Upper limb muscle groups will be tested using a handheld dynamometer with standardized positions and the "make method."
次要结局
- Modified Mallet Classification(From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline)
- Change in Joint Position Sense Error (Degrees) of the Upper Limb Measured(From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline.)
- Modified Mallet Classification(From baseline (pre-treatment) to 12 weeks of intervention and 9 months follow-up after baseline)
研究者
Barış CELBEK
Lecturer in Physiotherapy and Rehabilitation
Istanbul Aydın University