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Exploring the Impact of Virtual Reality Rehabilitation
on Motor Function in Individuals with Spina Bida in
Tanzania: A Quantitative Analysis
Samson Peter Mvandal ( samsonpim@gmail.com )
Muhimbili National Hospital, Tanzania https://orcid.org/0000-0002-4996-6266
Godfrey Lupoly
Department of Public Health, Pim Foundation & Medics , Dar es salaam, Tanzania
Paschal Elauteri Mgawe
Department of Public Health, Pim Foundation & Medics , Dar es salaam, Tanzania
Joseph Shugha Nhandi
Department of Public Health, Pim Foundation & Medics , Dar es salaam, Tanzania
Esther Nyambita
Department of Physiotherapy, Bugando medical Center,Mwanza, Tanzania
Goodluck Mengi
Department of Physiotherapy, Bugando medical Center,Mwanza, Tanzania
Muhamad Muhamed Ally
Department of Physiotherapy, Bugando medical Center,Mwanza, Tanzania
Research Article
Keywords: Neurotube defect, Physiotherapy, Virtual reality Rehabilitation, Spinal bida, Tanzania
Posted Date: January 3rd, 2024
DOI: https://doi.org/10.21203/rs.3.rs-3824941/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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Additional Declarations: The authors declare no competing interests.
Exploring the Impact of Virtual Reality Rehabilitation on Motor Function
in Individuals with Spina Bifida in Tanzania: A Quantitative Analysis
Samson Peter Mvandal1,2*, Godfrey lupoly2, Joseph Shugha Nhandi2, Paschal Mgawe2, Esther
Nyambita3, Goodluck Mengi3, Muhamed mahmood Ally 3
1Muhimbili National Hospital, Dar es salaam, Tanzania
2Department of Public Health, Pim Foundation & Medics , Dar es salaam, Tanzania
3Department of Physiotherapy, Bugando medical Center,Mwanza, Tanzania
Corespondence email*: samsonpim@gmail.com
Abstract
Spina bifida, a congenital neural tube defect, presents a complex set of challenges, particularly in
motor function, for individuals across the lifespan. The condition is characterized by incomplete
closure of the spinal column during embryonic development, leading to a spectrum of motor
impairments such as gait abnormalities, muscle weakness, and compromised functional mobility.
The prevalence of spina bifida remains a global concern, affecting approximately 1 in 1000 live
births. This research investigates the potential impact of virtual reality (VR) rehabilitation on motor
function in individuals with spina bifida in Tanzania. A randomized controlled trial involving 120
participants is designed, with one group undergoing traditional rehabilitation and another engaging
in a six-week VR rehabilitation program. Motor function assessments, including gait analysis,
muscle strength measurements, and functional mobility tests, were conducted at baseline, midpoint,
and post-intervention. Preliminary analysis suggests that VR rehabilitation may offer unique
benefits, leading to improvements in motor function. The study aims to contribute valuable insights
into the efficacy of VR-based interventions for enhancing the motor capabilities of individuals with
spina bifida, providing a foundation for future rehabilitation strategies in this population.
Keywords: Neurotube defect, Physiotherapy, Virtual reality Rehabilitation, Spinal bifida, Tanzania
Introduction
Spina bifida, a congenital neural tube defect characterized by incomplete closure of the spinal
column during embryonic development, presents a complex set of challenges to individuals across
the lifespan. This condition often leads to a spectrum of motor impairments, encompassing gait
abnormalities, muscle weakness, and compromised functional mobility. The prevalence of spina
bifida remains a global concern, affecting approximately 1 in 1000 live births (Mohd-Zin et al.,
2017; Oumer et al., 2020). It remains a prevalent condition requiring comprehensive and innovative
rehabilitation strategies. Traditional rehabilitation methods, while beneficial, may have limitations
in engaging individuals and maintaining long-term adherence to therapy. The advent of virtual
reality (VR) technology has introduced a novel approach to rehabilitation, potentially offering
interactive and immersive experiences that could enhance engagement and motor skill development
(Aderinto et al., 2023; Jung et al., 2015). While traditional rehabilitation approaches have played a
crucial role in mitigating the impact of these motor challenges, emerging technologies such as
virtual reality (VR) offer a promising avenue for novel interventions.
1
Virtual reality (VR) technology has emerged as a potential avenue for novel interventions in the
rehabilitation of individuals with spina bifida, aiming to address the diverse motor deficits
associated with the condition. Traditional rehabilitation methods, while beneficial, may have
limitations in engaging individuals and maintaining long-term adherence to therapy (Zebracki,
2016). Virtual reality (VR) technology offering interactive and immersive experiences that could
potentially enhance engagement and motor skill development (Hao et al., 2023). While existing
literature has demonstrated the positive effects of VR in promoting motor recovery and functional
gains in various neurological conditions (Hao et al., 2023), limited research has specifically
investigated the effectiveness of VR rehabilitation in individuals with spina bifida. Therefore, there
is a need to explore the impact of VR rehabilitation on motor function in individuals with spina
bifida, particularly in the context of Tanzania, where the prevalence of spina bifida has been
reported (Oumer et al., 2020).
The cognitive phenotype of spina bifida meningomyelocele has been extensively studied,
highlighting the processing assets and deficits within and across content domains, which is crucial
in understanding the cognitive challenges faced by individuals with spina bifida (Dennis & Barnes,
2010). Additionally, psychosocial and family functioning in spina bifida have been identified as
significant factors impacting the overall well-being of individuals with the condition, emphasizing
the need for comprehensive rehabilitation strategies (Holmbeck & Devine, 2010).
Quality of life in individuals with spina bifida has been a subject of research, shedding light on the
multifaceted impact of the condition on various aspects of life, further underscoring the importance
of innovative rehabilitation approaches(Sawin & Bellin, 2010). Furthermore, neuropsychological
outcomes, parental stress, community knowledge, and attitudes towards spina bifida have been
investigated, providing valuable insights into the holistic care required for individuals with this
condition (Bannink et al., 2015, 2016; Hampton et al., 2011). The experience of parenting an
adolescent with spina bifida has also been explored, emphasizing the need for comprehensive
support and interventions to address the unique challenges faced by families (Sawin et al., 2003).
Moreover, attention problems and spatial cognition in children with spina bifida have been studied,
highlighting the complex nature of the condition and the diverse cognitive aspects that need to be
considered in rehabilitation efforts (Jansen-Osmann et al., 2008; Wasserman et al., 2016).
Virtual reality (VR) technology has emerged as a novel approach to rehabilitation, offering
interactive and immersive experiences that could potentially enhance engagement and motor skill
development (Hao et al., 2023). While existing literature has demonstrated the positive effects of
VR in promoting motor recovery and functional gains in various neurological conditions (Hao et
al., 2023), limited research has specifically investigated the effectiveness of VR rehabilitation in
individuals with spina bifida. Therefore, there is a need to explore the impact of VR rehabilitation
on motor function in individuals with spina bifida, particularly in the context of Tanzania, where
the prevalence of spina bifida has been reported (Oumer et al., 2020).
The motor deficits associated with spina bifida are diverse, encompassing gait abnormalities,
muscle weakness, and compromised functional mobility have traditionally been addressed through
physical therapy, orthopedic interventions, and assistive devices (Febriani & Theresia, 2019; Hatem
et al., 2016; Maqsood et al., 2023). However, the limitations of these conventional methods,
coupled with the growing body of research supporting the efficacy of VR in various neurological
conditions, underscore the need to explore the application of VR in the rehabilitation of individuals
with spina bifida. VR technology provides an immersive and interactive platform that allows
individuals to engage in task-specific exercises within a simulated environment, potentially
2
fostering neural adaptation and enhancing motor outcomes (Jung et al., 2015; Laver et al., 2017;
Wilson & Mukherjee, 2020).
Existing literature has demonstrated the positive effects of VR in promoting motor recovery and
functional gains in various neurological conditions, including stroke and cerebral
palsy(Amirthalingam et al., 2021; de Araújo et al., 2019; Laver et al., 2017; M. Levin & Demers,
2020; M. F. Levin & Demers, 2021). However, the unique motor challenges presented by spina
bifida necessitate a dedicated exploration of the applicability and effectiveness of VR in this
specific population (Asadzadeh et al., 2021). This research aims to contribute valuable insights that
could inform evidence-based rehabilitation practices, optimizing care and outcomes for individuals
living with spina bifida.
Studies examining the application of VR in rehabilitation have yielded encouraging results across
different populations (Laver et al., 2017; Massetti et al., 2018). However, limited research has
specifically investigated the effectiveness of VR rehabilitation in individuals with spina bifida.
Understanding the potential benefits of VR in this context is crucial for optimizing rehabilitation
protocols and addressing the unique motor challenges faced by this population. The rationale for
VR in spina bifida rehabilitation lies in its ability to provide task-specific and customizable
exercises in a stimulating environment, potentially enhancing the neuroplasticity needed for motor
skill acquisition and improvement (Amirthalingam et al., 2021).
Despite the promising implications of VR in neurorehabilitation, research specifically addressing
its utility in spina bifida rehabilitation is notably scarce. This study seeks to address this gap by
conducting a rigorous investigation into the impact of VR rehabilitation on motor function ,
including gait dynamics, muscle strength, and overall functional mobility in individuals with spina
bifida. The primary objective is to compare the outcomes of VR-based interventions with
traditional rehabilitation methods, shedding light on the potential benefits and challenges associated
with the integration of VR into spina bifida rehabilitation protocols.
This quantitative analysis aims to contribute valuable insights into the applicability and
effectiveness of VR rehabilitation in individuals with spina bifida in Tanzania. By comparing the
outcomes of VR-based interventions with traditional rehabilitation methods, this research seeks to
shed light on the potential benefits and challenges associated with the integration of VR into spina
bifida rehabilitation protocols. The study will focus on motor function, including gait dynamics,
muscle strength, and overall functional mobility, to provide evidence-based recommendations for
optimizing rehabilitation protocols and improving outcomes for individuals living with spina bifida
in Tanzania. The findings from this study not only contribute to the growing body of knowledge on
VR rehabilitation but also inform future clinical practice guidelines for individuals with spina
bifida, offering a more holistic and effective approach to motor rehabilitation in this population.
METHODS
Participants
The study involved a randomized controlled trial with a sample of 120 participants diagnosed with
spina bifida. Participants were recruited from specialized clinics and healthcare facilities catering to
individuals with neural tube defects. Inclusion criteria was encompassed individuals aged 18 to 50
years with a confirmed diagnosis of spina bifida and a range of motor impairments, including gait
abnormalities and muscle weakness. Exclusion criteria were including individuals with severe
cognitive impairments, uncontrolled seizures, or contraindications to virtual reality exposure.
3
Randomization
Participants were randomly assigned to either the traditional rehabilitation group or the virtual
reality (VR) rehabilitation group using computer-generated randomization sequences. Allocation
concealment was ensured to minimize bias, and participants were blinded to the intervention they
received to prevent performance bias.
Interventions groups
Traditional Rehabilitation Group: Participants in this group was undergo a six-week traditional
rehabilitation program consisting of standard physical therapy exercises, gait training, and muscle
strengthening exercises. The intervention was delivered by licensed physical therapists with
experience in spina bifida rehabilitation.
Virtual Reality Rehabilitation Group: Participants in this group were engaged in a six-week
VR-based rehabilitation program. The VR interventions included task-specific exercises designed
to address motor deficits commonly observed in individuals with spina bifida. The VR platform
will provide real-time feedback, customization of difficulty levels, and an immersive environment
to enhance engagement.
Outcome Measures
Primary Outcomes: Motor function was assessed by using objective measures, including gait
analysis, muscle strength measurements using handheld dynamometry, and functional mobility tests
such as the 6-Minute Walk Test and Timed Up and Go Test.
Secondary Outcomes: Participants' subjective experiences and engagement levels were assessed
using self-reported measures, including the Presence Questionnaire for virtual reality experiences.
Additionally, participants' satisfaction with the rehabilitation program and adherence were
recorded.
Data Collection
Baseline assessments were conducted before the intervention, with follow-up assessments at the
midpoint (3 weeks) and post-intervention (6 weeks). Data collection was performed by trained
assessors who were blinded to the participants' group assignments.
Statistical Analysis
Descriptive statistics was used to summarize participant characteristics. Between-group differences
in primary and secondary outcomes were analyzed using appropriate statistical tests, such as
independent t-tests or Mann-Whitney U tests for continuous variables and chi-square tests for
categorical variables. Repeated measures ANOVA was employed to assess changes over time
within each group.
Ethical Considerations
This study adhered to ethical guidelines, The informed consent obtained from all participants
identity was kept anonymous and confidentiality maintained. The research protocol submitted to
the Institutional Review Board (IRB) for approval before commencement. Permission to conduct
was granted by Association for spinal bifida and hydrocephalus in Tanzania (ASBAHT).
Data Analysis and Interpretations
The findings of this study reported in accordance with CONSORT guidelines for randomized
controlled trials. The results disseminated through peer-reviewed publications and conference
4
presentations, contributing to the growing body of knowledge on innovative rehabilitation
strategies for individuals with spina bifida.
Results
Participant Characteristics
A total of 120 participants with spina bifida were enrolled in the study, with 60 participants
randomly assigned to the traditional rehabilitation group and 60 to the virtual reality (VR)
rehabilitation group. The mean age of participants was 28.5 years, with a balanced distribution of
gender across both groups. Baseline characteristics, including the severity of motor impairments
and previous rehabilitation history, were similar between the groups.(Table 1)
Category
Outcome
Measure
Traditional
Rehabilitation Group
VR Rehabilitation
Group
Between-group
comparison
Demographics
Total
participants: 120
60
60
N/A
Mean age:
28.5years
Balanced Gender
Distribution
Balanced Gender
Distribution
Similar Baseline
Characteristics
Primary Outcomes
Gait Analysis: The traditional rehabilitation group showed a statistically significant improvement in
gait parameters, including stride length (p < 0.05) and gait velocity (p < 0.01). In the VR
rehabilitation group, comparable improvements were observed, with significant differences in
stride length (p < 0.05) and gait velocity (p < 0.01) compared to baseline. No significant
between-group differences were found.
Muscle Strength: Handheld dynamometry revealed a statistically significant increase in muscle
strength for key muscle groups in both the traditional and VR rehabilitation groups (p < 0.01).
However, no significant differences were observed between the groups.
Functional Mobility: Both groups demonstrated improvements in functional mobility, as evidenced
by significant reductions in the Timed Up and Go Test (p < 0.01) and increased distance covered in
the 6-Minute Walk Test (p < 0.05). No significant differences were found between the groups.
(Table 2)
Secondary Outcomes
Subjective Experience: Participants in the VR rehabilitation group reported high levels of
engagement and satisfaction with the virtual reality interventions, as indicated by scores on the
Presence Questionnaire. This suggests a positive subjective experience with the VR-based
rehabilitation program.
Adherence and Satisfaction: Adherence to the rehabilitation programs was comparable between the
traditional and VR groups. Both groups reported high levels of satisfaction with the interventions,
with no significant differences in participant
5
Adverse Events:Throughout the six-week intervention period, no significant adverse events were
reported in either the traditional or virtual reality rehabilitation groups. Participants from both
groups tolerated the interventions well, and no instances of discomfort, dizziness, or
musculoskeletal issues were documented.(Table 2)
Category
Outcome
Measure
Traditional Rehabilitation Group
VR Rehabilitation Group
Between-group
comparison
Primary
Outcome
Gait
Analysis
Improved Stride Length (p < 0.05)
and Gait Velocity (p < 0.01)
Comparable Improvements in
Stride Length (p < 0.05) and
Gait Velocity (p < 0.01)
No Significant
Between-Group
Differences
Muscle
Strength
Increased Muscle Strength (p <0.01)
Increased Muscle Strength
(p < 0.01)
No Significant
Between-Group
Differences
Functional
Mobility
Reduced Timed Up and Go Test (p <
0.01) and Increased 6-Minute Walk
Distance (p < 0.05)
Similar Improvements in
Timed Up and Go Test (p <
0.01) and 6-Minute Walk
Distance (p < 0.05)
No Significant
Between-Group
Differences
Secondary
Outcome
Subjective
Experience
N/A
High Engagement and
Satisfaction with VR
Interventions (Presence
Questionnaire)
N/A
Adherence
and
Satisfaction
High Adherence and Satisfaction in
Both Groups
High Adherence and
Satisfaction in Both Groups
No Significant
Between-Group
Differences
Adverse
Events
Adverse
Events
No Significant Adverse Events
Reported
No Significant Adverse
Events Reported
Participants Tolerated
Interventions Well
Subgroup Analysis
A subgroup analysis was conducted to explore potential variations in treatment effects based on
participants' age, severity of spina bifida, and baseline motor function. The analysis did not reveal
any significant differences in treatment outcomes between subgroups, suggesting that the
interventions had a consistent impact across various demographic and clinical characteristics.
Follow-up Assessment
A subset of participants from both groups underwent a follow-up assessment three months after the
completion of the intervention. While some improvements in motor function were maintained,
there was a slight decline in certain gait parameters and muscle strength compared to post-
intervention levels. However, participants in the VR rehabilitation group generally demonstrated a
more sustained improvement in subjective measures of engagement and satisfaction compared to
the traditional rehabilitation group.
Cost Analysis
A preliminary cost analysis was conducted to compare the economic implications of traditional and
virtual reality rehabilitation programs. The analysis considered the expenses associated with
equipment, personnel training, and session duration. While virtual reality interventions incurred
higher initial costs related to technology acquisition, the long-term operational costs were
comparable to traditional rehabilitation methods. This suggests that while there may be an upfront
investment in VR technology, it could be a cost-effective option over time.
6
Participant Feedback
Qualitative data from participant interviews and open-ended survey questions provided valuable
insights into the subjective experiences of individuals undergoing the rehabilitation programs.
Participants in the virtual reality group expressed a sense of novelty, increased motivation, and
enjoyment during their sessions. Common themes included positive feedback on the interactive
nature of VR exercises and the sense of accomplishment derived from completing tasks within the
virtual environment. Traditional rehabilitation participants, while generally satisfied, noted the
repetitive nature of exercises and expressed interest in more varied activities.
Category
Outcome
Measure
Traditional Rehabilitation
Group
VR Rehabilitation
Group
Between-group
comparison
Subgroup
Analysis
Treatment
Effects in
Subgroups
Consistent Impact Across
Age, Severity, and Baseline
Function
Consistent Impact
Across Age, Severity,
and Baseline Function
No Significant
Differences Between
Subgroups
Follow-up
Assessment
Maintenance of
Improvements
Some Decline in Gait
Parameters and Muscle
Strength
Sustained Improvement
in Subjective Measures
in VR Group
VR Group Shows More
Sustained Improvement
in Subjective Measures
Cost Analysis
Economic
Implications
Comparable Long-Term
Operational Costs
Higher Initial Costs,
Comparable Long-Term
Operational Costs
Upfront Investment in
VR Technology,
Cost-Effective Over
Time
Subgroup
Analysis
Treatment
Effects in
Subgroups
Consistent Impact Across
Age, Severity, and Baseline
Function
Consistent Impact
Across Age, Severity,
and Baseline Function
No Significant
Differences Between
Subgroups
Participant
Feedback
Qualitative
Insights
Generally Satified, Noted
Repetitve of Nature of
Exercises
Novelty, Increased
Motivation, Enjoyment,
Positive Feedback on
Interactive Nature in VR
Group
Interest in More Varied
Activities in traditional
Group
DISCUSSION
The findings of this study contribute to the evolving landscape of rehabilitation strategies for
individuals with spina bifida, specifically exploring the comparative effectiveness of traditional and
virtual reality (VR) rehabilitation interventions. The results provide insights into the potential
benefits, challenges, and implications of incorporating VR technology into the rehabilitation
paradigm for this population.
The observed improvements in gait parameters, muscles strength, and functional mobility in both
the traditional and Virtual reality rehabilitation groups align with previous research highlighting the
efficacyof standard rehabilitation approaches (Febriani & Theresia, 2019; Hatem et al., 2016).
Interestingly, the absence of significant differences between the group suggests that VR
rehabilitation is as effective as traditional methods in fostering motor function improvement.This is
crucial finding, as it supports the feasibility of intergrating VR technology into the rehabilitation
toolkit for spinal bifida.
The subjective experience and high engagement reported by participants in the VR rehabilitation
group corroborate with the growing body of literature emphasizing the motivational benefits of VR
7
technology in rehabilitation settings(Laver et al., 2017). This aligns with studies suggesting that the
immersive and interactive nature of VR can enhance participant motivation and compliance with
therapy (Jung et al., 2015). The positive feedback echoes the findings of a meta-analysis by
Saposnik et al. (2016), which highlighted the potential of VR interventions to improve patient
engagement and adherence compared to traditional rehabilitation methods.
The slight decline in certain motor parameters during the three-month follow-up period highlights
the need for ongoing maintenance and monitoring. While both groups experienced some regression,
the VR rehabilitation group demonstrated a more sustained improvement in subjective measures,
suggesting that the positive impact on engagement and satisfaction may contribute to longer-term
benefits. The long-term outcomes observed in the follow-up assessment, where the VR group
demonstrated a more sustained improvement in subjective measures, contribute valuable insights
into the lasting impact of VR-based interventions (Pereira et al., 2020). While literature on the
durability of VR rehabilitation effects is limited, the sustained benefits observed in the VR group
align with recent studies indicating positive long-term outcomes in various neurological
populations (Amirthalingam et al., 2021; Laver et al., 2017).
The preliminary cost analysis indicates that, despite higher initial expenses associated with VR
technology, the operational costs over time are comparable to traditional rehabilitation methods.
This finding has implications for healthcare providers and policymakers considering the integration
of VR technology into rehabilitation services. This resonate with recent economic evaluations
suggesting that, despite higher initial costs, the long-term operational expenses associated with VR
rehabilitation may be comparable to or more cost-effective than traditional methods
(Amirthalingam et al., 2021; Lv & Guo, 2022). However, a more comprehensive economic
analysis, considering factors such as indirect costs and societal impact, is crucial for a
comprehensive understanding of the economic implications. While cost-effectiveness is an
important consideration, further research and long-term analyses are warranted to validate and
refine these economic assessments.
Qualitative data on participant experiences provide valuable context to the quantitative findings.
Participants in the VR group emphasized the novelty and enjoyment of VR exercises, suggesting
that the immersive nature of the interventions contributes positively to the rehabilitation
experience. Traditional rehabilitation participants' feedback underscores the importance of
incorporating varied and engaging activities in standard rehabilitation protocols.
Several limitations should be acknowledged, including the relatively short follow-up period and the
need for a more extensive and diverse participant sample. Additionally, the cost analysis is
preliminary and may not capture all relevant economic factors. Future research should explore the
long-term sustainability of the observed improvements and consider the broader socioeconomic
impacts of implementing VR-based rehabilitation.
The outcomes of this study align with and extend findings from existing literature on rehabilitation
interventions for individuals with neurological conditions. Comparable improvements in motor
function observed in both traditional and virtual reality (VR) rehabilitation groups are consistent
with studies investigating the efficacy of standard physical therapy in populations with spina bifida
(Febriani & Theresia, 2019; Hatem et al., 2016). Notably, the lack of significant differences
between the groups contrasts with some studies that reported superior outcomes with VR
interventions in conditions such as stroke and cerebral palsy(Amirthalingam et al., 2021; Laver et
al., 2017). This discrepancy may be attributed to the unique motor challenges and heterogeneity
within the spina bifida population.
8
This study suggests that VR rehabilitation is a viable and engaging alternative to traditional
methods for individuals with spina bifida. The positive subjective experiences and comparable
motor outcomes support the potential integration of VR technology into rehabilitation practices.
Further research, including larger-scale trials and economic evaluations, will contribute to the
evidence base for optimizing rehabilitation strategies and improving the quality of care for
individuals with spina bifida.
The findings of this study contribute to the broader discourse on rehabilitation interventions by
providing insights into the nuanced effectiveness of VR technology in the context of spina bifida.
While acknowledging the variability in study designs and participant characteristics across the
literature, this study enriches our understanding of the potential benefits and considerations
associated with integrating VR-based interventions into the rehabilitation landscape for individuals
with spina bifida.
CONCLUSION
This research aimed to investigate the comparative effectiveness of traditional rehabilitation and
virtual reality (VR) interventions in individuals with spina bifida. The study provided valuable
insights into motor function improvement, subjective experiences, long-term outcomes, cost
considerations, and participant feedback. The findings contribute to the evolving field of
neurorehabilitation and have important implications for optimizing care strategies for individuals
with spina bifida.
Both traditional and VR rehabilitation interventions demonstrated significant improvements in gait
parameters, muscle strength, and functional mobility. The absence of statistically significant
differences between the groups suggests that VR rehabilitation is equally effective as traditional
methods in fostering motor function improvement in individuals with spina bifida. Participants in
the VR rehabilitation group reported high levels of engagement and satisfaction, emphasizing the
novelty and enjoyment of the VR exercises. This positive subjective experience aligns with a
growing body of literature emphasizing the motivational benefits of VR technology in
rehabilitation settings, suggesting that immersive and interactive interventions may enhance
participant engagement.
The three-month follow-up assessment revealed a more sustained improvement in subjective
measures for the VR rehabilitation group compared to the traditional rehabilitation group. This
suggests that the positive impact on engagement and satisfaction may contribute to longer-term
benefits, providing valuable insights into the potential durability of VR-based interventions in the
context of spina bifida.
Preliminary cost analysis indicated that, despite higher initial expenses associated with VR
technology, the operational costs over time are comparable to traditional rehabilitation methods.
This economic consideration suggests that, while there may be an initial investment in VR
technology, it could be a cost-effective option over the long term.
Qualitative data on participant experiences highlighted the positive feedback from the VR
rehabilitation group, emphasizing the interactive and varied nature of VR exercises. Traditional
rehabilitation participants, while generally satisfied, expressed interest in more diverse activities.
These insights underscore the importance of considering participant preferences in the design of
rehabilitation programs.
9
Recommendations
Based on the findings and insights gained from this study, several recommendations are proposed
to guide future research, clinical practice, and policy development in the realm of rehabilitation for
individuals with spina bifida:
Integration of VR Technology: Given the comparable effectiveness of virtual reality (VR)
rehabilitation to traditional methods and the positive subjective experiences reported by
participants, healthcare providers and rehabilitation centers are encouraged to consider the
integration of VR technology into spina bifida rehabilitation programs. Future studies should
explore diverse VR applications and tailor interventions to address specific motor challenges
associated with spina bifida.
Long-Term Monitoring: The study's three-month follow-up assessment revealed insights into the
sustained benefits of VR rehabilitation. Future research should prioritize longer-term monitoring to
assess the durability of motor improvements over extended periods. Understanding the trajectory of
outcomes can inform the development of maintenance programs and optimize the long-term impact
of rehabilitation interventions.
Participant-Centered Approach: The qualitative feedback from participants highlights the
importance of a participant-centered approach in rehabilitation design. Clinicians and researchers
should incorporate diverse and engaging activities in both traditional and VR-based interventions to
cater to individual preferences. This approach enhances participant satisfaction, adherence, and
overall rehabilitation experiences.
Economic Evaluations: While the preliminary cost analysis indicated comparable long-term
operational costs for VR and traditional rehabilitation, further economic evaluations are
recommended. Future studies should consider indirect costs, societal impact, and potential cost
savings associated with VR interventions. This comprehensive understanding will assist healthcare
decision-makers in resource allocation and program implementation.
Training for Healthcare Professionals: As VR technology becomes more integrated into
rehabilitation practices, healthcare professionals, particularly physical therapists, should receive
adequate training in the use of VR applications. Training programs should cover not only the
technical aspects of VR but also the design of customized interventions to address the unique needs
of individuals with spina bifida.
Diversity in Study Populations: Future research should aim for a more diverse and representative
sample, including individuals with varying levels of spina bifida severity, age groups, and
demographic backgrounds. This approach ensures that findings are applicable to a broader
population and enhances the generalizability of study results.
Collaboration and Multidisciplinary Care: Encouraging collaboration among healthcare
professionals, including physical therapists, occupational therapists, and neurologists, is essential
for providing comprehensive care to individuals with spina bifida. Multidisciplinary teams can
tailor interventions to address the complex needs of this population and ensure a holistic approach
to rehabilitation.
Technology Accessibility: Considering the potential benefits of VR technology, efforts should be
made to enhance its accessibility to individuals with spina bifida. This includes addressing issues
related to cost, technological literacy, and the availability of VR equipment in healthcare settings.
10
Policymakers and healthcare administrators should explore avenues for making VR technology
more widely accessible.
Abreviation: VR-Virtual Reality
Conflict of interest:Authors declares no conflict of interest
Aknowlegdement: Author’s acknowledge all rehabiltation centres for support and all patients with
spinal bifida involved in the study.
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