Full-Immersive Virtual Reality for Lower Limb Strength and Balance in Children With Hemiplegic Cerebral Palsy

[Model: 01163, Lafayette Instrument Company, USA] was used for objective measurement of isometric muscle strength of the hip, knee muscle groups. The HHD was calibrated by the manufacturer before assessment. Hip flexors and knee extensors were assessed in a sitting position; hip abductors were assessed in a supine posture; and hip extensors and knee flexors were assessed in a prone position. The child was assessed in three distinct positions: supine, prone, and sitting. The child was asked to perform two warm-up trials at sub maximal effort without the transducer being placed on the limb. Transducer was subsequently placed on the limb, and the child performed three maximal attempts lasting 5 seconds each, with a 30-second rest interval between trials. The child was instructed and verbally prompted to exert maximal force during the test, while the examiner resisted the child's maximal voluntary contraction, representing the maximal isometric force. Peak isometric presented in Newtons.

FTSST is a reliable evaluative test used to assess lower-limb functional strength and has demonstrated correlations with functional balance ability assessments among children with CP. Test tools include a height-adjustable chair without an arm rest and a stopwatch. A stopwatch was used to measure how long it takes to perform five successive sit-to-stand-to-sit cycles as fast as possible.

PBS was used to evaluate the participants' functional balance, which is a valid and reliable scale. The scale comprises the following equipment: height-adjustable bench, chair with lumbar support and armrests, stopwatch or watch with a second hand, one-inch-wide masking tape, step stool six inches in height, chalkboard eraser, ruler or yardstick, and small level. It consists of 14 items. Every item has a score between 0 and 4, where higher scores correspond to better balance.

Modified Ashworth' Scale for selecting children (MAS) was used to evaluate spasticity, which is manifested by an increased resistance of joints to passive movement. It is administered easily and in a short-time, and includes grades from (0 to 4) to determine spasticity . Children with grades of 1 or 1+ (mild spasticity) in the affected limb were considered eligible for inclusion

Gross Motor Function Classification System (GNFCS) is a practical system that can be used in the clinics and rehabilitation team. The GMFCS is a reliable, valid and standard method for classifying gross motor function into five levels with emphasis on transfer, sitting and mobility. A five-level scale from Level I (very independent) to Level V (very limited) to categorize the degree to which children with CP can perform gross motor skills. The child was observed performing age-appropriate functional activities without assistance, only children classified as Level I (independent ambulation) were included in the study.