Effects of combined virtual reality assisted gait training and proprioceptive neuromuscular facilitation on motor function in children with spastic cerebral palsy: a randomized controlled trial.

BACKGROUND: Spastic cerebral palsy (CP) is characterized by impaired motor function, particularly in the lower limbs. Although both virtual reality (VR)-assisted gait training and proprioceptive neuromuscular facilitation (PNF) have demonstrated beneficial effects, evidence regarding their combined application remains limited. OBJECTIVE: This exploratory study aimed to explore the effects of combined VR-assisted gait training and PNF on lower-limb motor function in children with spastic CP. METHODS: Thirty children with spastic CP were randomly assigned to a conventional rehabilitation group (CG), a VR training group, or a combined VR and PNF group (PNF + VR), with 10 participants in each group. All participants underwent a 12-week intervention program. The primary outcomes were Gross Motor Function Measure-88 (GMFM-88) dimensions D (GMFM-88D) and E (GMFM-88E); secondary outcomes included the Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), lower-limb Fugl-Meyer Assessment (FMA), range of motion (ROM), and bone mineral density (BMD). A two-way mixed analysis of variance (ANOVA) was used to evaluate group-by-time interactions, with post hoc comparisons of change scores used as supportive analyses. RESULTS: All groups showed improvements in functional outcomes after the intervention. Significant group × time interaction effects were observed for GMFM-88D, MAS, FMA, and ROM (p < 0.05), with the PNF + VR group demonstrating the greatest improvements. Although GMFM-88E improved significantly in the PNF + VR group, as indicated by change-score comparisons, the interaction effect was not statistically significant. No significant interaction effects were found for BBS or BMD (p > 0.05). CONCLUSION: The combination of VR-assisted gait training and PNF may provide additional benefits in improving lower-limb motor function in children with spastic CP compared with conventional rehabilitation or VR training alone.