this study will be conducted to evaluate the effect of dual task virtual reality training on hand function (bilateral hand use and upper limb coordination), attention (divided and sustained) and activity of daily life in children with hemiplegic cerebral palsy.
Their age will be ranged from 7-12 years.
Their degree of spasticity will be ranged from 1 to 1according to the Modified Ashworth Scale
They will be on level 1 or II on Gross Motor Function Classification System (GMFCS)
Their manual ability to handle objects in daily activities will be at level II according to Manual Ability Classification System (MACS)
Severe sensory ,visual, auditory and cognitive impairments.
Structural or fixed soft tissue deformities of the upper extremities.
Botulinum toxin injections within the last six months.
Unstable seizures.
Parallel
Dual Task Virtual Reality Training
Other interventionChildren in this group will receive 45\_60 minutes of dual task VR training. each session will consist of: Games will be in the form of a series of kinect adventure game,big league game, forza horizon, sports island freedom and Kinect sports game designed for Xbox 360 Kinect console which targeting bilateral hand use and attention. The games will be projected onto a 24-Inch screen monitor. Each session consisted of playing 1-2 trials in a row of each of 5 game.Time of each game will be 5-10 minutes. plus tradional therapy
traditional physical therapy
Other interventionChildren in this group will receive designed occupational therapy training for 45-60 minutes. each session will consist of:Ball activities: catching and throwing ball (large balls for 2 hand use) while following rules as pick only red balls,Transfer cubes from one hand to the other hand and counting out load while transferring, Clapping with both hands while increaseing speed, Opening and closing a jar while focusing on steps,Towering cubes while focusing to put large then small cubes, Turning cards and react only when target card appears,Transfer cubes from one colored container to another,Pick objects from a toy bag and to range them according to their colors, shapes (triangles, rectangle, circular), and size (small, medium, big) and naming each object with their color and shape.
bilateral hand use
The Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) will be used to assess bilateral hand use. It is a standardized norm-referenced measure for evaluating fine and gross motor skills in children and adolescents aged 4 to 21. It includes 8 subtests with 4 motor areas: fine manual control, manual coordination, body coordination, and strength and agility. The child's performance will be recorded and scored on each item, then later, each item will be converted from raw score to point score and from point score to scale score and at the end, from scale score to standard score
attention
RehaCom will be used to assess attention in this study.The testing procedures will be conducted in quiet environment free from any distraction which can affect children' performance.The child will seat comfortably on a chair with back support and feet flat on the floor, facing the computer screen at eye level. The test will be explained in simple, child-friendly language, ensuring the child understands that they should focus and respond as accurately and quickly as possible.In the current study, attention and concentration module will be selected in the RehaCom software. The test will begin at Level 1 and automatically will progress to higher levels of difficulty depending on the child's performance.The child will identify or react to target stimulus.Grey performance bar will appear on the left side of the screen to show how well the participant will perform in real-time
life disability
Functional independence measure for children (WeeFIM) consists of 3 domains with a total of 18 measurement items. The subsets are categorized as self-care domain which includes 8 items (eating, grooming, bathing, lower and upper body dressing, toileting, as well as bowel and bladder control). The mobility domain includes 5 items (chair, toilet, and tub transfers, walking or wheelchair management, and stairs). The cognitive domain includes 5 items (language comprehension and expression, social interaction, problem solving, and memory).The minimum total score is 18 (total dependence in all skills) and the maximum required score is 126 (complete independence in all skills)
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