Effects of Augmented Reality Motor Training on Gait and Balance in Children with Cerebral Palsy: Randomized Controlled Trial

Abstract

Highlights What are the main findings? Adding four weeks of augmented reality motor training (ARMT) to conventional rehabilitation was associated with selective between-group differences in gait parameters, including bilateral stride cycle duration, right double-support variability, and propulsion index. However, no additional effects of ARMT were observed on overall balance, walking speed, stride length, gait quality, or gait symmetry. What are the implications of the main findings? The short-term ARMT did not demonstrate comprehensive additional benefits over conventional rehabilitation in children with spastic cerebral palsy. The observed effects of ARMT on specific gait parameters should be considered exploratory results that require next confirmation in larger trials with pre-specified primary outcomes. Abstract Background: The current evidence regarding the impact of augmented reality (AR) rehabilitation on motor function in children with cerebral palsy (CP) remains limited. Objectives: This study aimed to evaluate whether integrating AR motor training (ARMT) into conventional rehabilitation enhances gait and balance outcomes compared to conventional rehabilitation alone. Methods: Forty children aged 7 to 12 years with unilateral or bilateral spastic CP were randomly assigned to receive either ARMT integrated into a 4-week conventional rehabilitation program (n = 20) or conventional rehabilitation alone (n = 20). The ARMT replaced 20–30 min of standard motor therapy five days per week. Gait and balance were assessed pre- and post-intervention using an instrumented 10 m walk test with the G-Walk sensor, the MABC-2 one-leg balance task, and the Pediatric Balance Scale. Due to unavailability of data from five control-group participants, analyses were conducted on 35 children using available-case mixed-model approaches. Results: Nominally significant between-group differences in pre- to post-intervention changes were observed for left stride cycle duration (mean difference: −0.083 s; 95% confidence interval [CI]: [−0.166, −0.0002]; p = 0.049), right stride cycle duration (−0.095 s; 95% CI: [−0.185, −0.006]; p = 0.038), the coefficient of variation of the first double-support phase on the right side (−8.91 percentage points; 95% CI: [−17.39, −0.44]; p = 0.040), and the left propulsion index (2.42 m/s2; 95% CI: [0.39, 4.45]; p = 0.021). No statistically significant differences were detected between groups for balance measures, gait speed, stride length, gait quality, or symmetry. Conclusions: Incorporation of four weeks of ARMT into conventional rehabilitation did not yield substantial additional benefits for gait or balance in this cohort. The observed effects on gait timing, variability, and propulsion are exploratory and warrant validation in larger, adequately powered studies with pre-specified primary outcomes.