Abstract
BackgroundIndividuals with Down syndrome may struggle with anticipatory postural adjustments, and adapt slower to motor tasks and environmental changes, due to decreased motor proficiency.ObjectivesTo determine the effectiveness of virtual reality therapy (VRT), specifically Nintendo Wii, combined with physiotherapy or occupational therapy (OT) for improving motor proficiency in individuals with Down syndrome, compared to standard physiotherapy, OT or no intervention.MethodNine computerised databases were searched from inception to July 2020. Methodological quality of randomised controlled trials and quasi-experimental studies was appraised using the physiotherapy evidence database (PEDro) scale and the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.ResultsTwo randomised controlled trials and four quasi-experimental studies were included, with an average PEDro score of 7.3. One included case study scored 5. This review included 345 participants. Motor proficiency includes balance, coordination, strength and agility. Agility showed a significant improvement after 5 (p = 0.01) or 24 (p < 0.01) weeks. Strength showed a significant improvement after a 6- (p = 0.000) or 24-week intervention (p < 0.05). Balance showed inconclusive results for adults, and significant improvement in children after 6 (p = 0.000), 8 (p < 0.05) or 24 (p < 0.003) weeks. One study (n = 155) showed that upper limb and bilateral coordination improved significantly after 24 weeks (p < 0.003).ConclusionLevel II, III-1 and IV evidence suggested that VRT may be valuable to improve agility and strength in individuals with Down syndrome, and balance and coordination in children with Down syndrome.Clinical implicationsIt may be beneficial to use VRT in addition to standard physiotherapy or OT interventions for improving motor proficiency in individuals with Down syndrome.
Highlights
The final seven eligible articles that were used in this systematic review are two randomised controlled trials (RCTs) (Ghafar & Abdelraouf 2017; Lin & Wuang 2012), four quasi-experimental studies (Álvareza et al 2018; Rahman 2010; Silva et al 2017; Wuang et al 2011) and a case study (Berg et al 2012)
According to the National Health and Medical Research Council (NHMRC) Hierarchy of evidence (Merlin et al 2009), the articles are classified as level II evidence (Ghafar & Abdelraouf 2017; Lin & Wuang 2012), level III-1 evidence (Álvareza et al 2018; Rahman 2010; Silva et al 2017; Wuang et al 2011) and level IV evidence (Berg et al 2012)
To the authors’ knowledge, our study is the first systematic review conducted in English on the effectiveness of VRT, using Nintendo Wii, alone or combined with physiotherapy or occupational therapy, compared with standard physiotherapy or occupational therapy alone or no intervention, on motor proficiency in individuals with Down syndrome
Summary
Known as trisomy-21, is a genetic condition that is caused by an error in cell division occurring at conception, resulting in an additional copy of chromosome 21 (Batshaw, Roizen & Pellegrino 2019) It is the most common chromosomal disorder reported in humans according to the United States of America’s National Association for Down syndrome (Presson et al 2013). Common anomalies include diminished muscle strength, abnormal body composition and decreased physical fitness, including reduced aerobic capacity or cardiorespiratory fitness (Baynard et al 2008; Bertapelli et al 2016; González-Agüero et al 2010; Pitetti, Baynard & Agiovlasitis 2013) This may lead to low levels of resting energy expenditure and physical activity, which can result in a sedentary lifestyle (Bertapelli et al 2016). Individuals with Down syndrome display generalised muscle hypotonia, ligamentous laxity, articular hypermobility and http://www.sajp.co.za
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