The aim of this study is to investigate the effect of virtual reality training on cervical mobility, proprioceptive accuracy and hand strength in patients with cervical radiculopathy. Forty patients of both sexes diagnosed with cervical radiculopathy will participate in this study. The participants' ages will be varied from 35 to 50 years, with a body mass index less than 30 kg/m². Patients will be randomly allocated to virtual reality and control groups. Both groups will receive a conventional physical therapy program in the form of electrotherapy, manual therapy, and strengthening exercises. The virtual reality group will receive virtual reality training in addition to the same physical therapy program. All participants will be assessed before and after treatment using the Joint Position Error by laser pointer for proprioceptive accuracy assessment; cervical ROM (CROM) for cervical mobility assessment; and hand dynamometer for hand grip strength. The treatment will be conducted three sessions per week for six weeks.
None
Disorders of the temporomandibular joint.
Primary issues related to the shoulder or upper limb.
Neurological deficits, cognitive impairments (MOCA< 25), or a history of cervical spine surgery.
Neck discomfort accompanied by dizziness or referred pain in both upper limbs.
Parallel
Virtual reality training using Shinecon Virtual Reality 3D Glasses
Other interventionThe virtual reality training will be in the form of virtual activities including postural correction via chin in exercise from sitting, supine and prone positions; and strengthening exercises using virtual reality for 30 minutes per session, three sessions per week for 6 weeks.
Conventional physical therapy program
Other interventionThe conventional physical therapy program will be in the form of Transcutaneous Electrical Nerve Stimulation (TENS) (frequency of 50-100 Hz, a pulse duration between 50-200 µs, and an intensity adjusted to a comfortable, non-painful level), Ultrasound Therapy (frequency of 1 MHz, intensity of 0.5-1.0 W/cm², and a 50% duty cycle for pulsed ultrasound)., Manual Therapy ( Grade III and IV Cervical Mobilization, soft Tissue Manipulation in the form of Deep tissue massage and myofascial release techniques for the cervical and upper trapezius muscles, and Strengthening Exercises for cervical and upper limb muscles).
Active cervical ROM (CROM)
Cervical mobility will be assessed using an objective CROM goniometer. First, the patients will be asked to assume an upright sitting with the head in the neutral position. The CROM device will be placed firmly on the head and the the Velcro strap will be secured tightly and then calibrated. The sagittal, frontal, and horizontal gravity meters will be set to 0°. Then, each patient will be asked to perform active cervical ROM in the three planes as the following: flexion, extension, right and left rotation, and right and left side bending. The patients will be stabilized during all ROM assessments to prevent substitutions. All six ROMs will be recorded as degrees.
Joint Position Error for proprioceptive accuracy assessment
A laser pointer will be used for proprioception assessment through Joint Position Error (JPE). It will be placed on the patient's forehead. A2-sized chart with a reference point in the center will be positioned 90cm in front of patient. The patient will sit down 90 cm from the wall, and the reference point of the laser projection will be marked. All patients will be blindfolded and asked to move the head actively away from the reference position to full range and then attempt to reposition the head back to the reference point as accurately as possible. The patients will perform one familiarization trial with eyes open. Head movement will be in the form of cervical flexion, extension, right rotation, and left rotation. Each head movement will be repeated for six times. The JPE will be measured as the difference between the reference position and the returning point in the plane of movement in centimeters and will be converted to degrees. The average of the 6 trials will be used.
Hand grip strength
Hand grip strength will be assessed by Electronic Hand Dynamometer. The participants will be asked to assume an upright sitting position with their forearm in neutral position and rested on the chair, shoulder in 30° abduction, elbow in 90° and wrist in neutral position. Each patient will perform three trials of maximal isometric contraction of hand muscles by applying as much pressure as possible on the dynamometer for at least six seconds. The highest maximal isometric hand strength will be recorded as in Kilogram (Kg).
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