title: Does intervention using virtual reality improve upper limb function in children with neurological impairment: a systematic review of the evidence.
abstract: BACKGROUND
  Virtual reality (VR) is an emerging area of paediatric clinical and research practice, however the majority of research to date has focused on outcomes for adults following stroke. This paper appraises and describes current evidence for use of virtual reality interventions to improve upper limb function of children with neurological impairment.
  
  
  METHODS
  A comprehensive database search was undertaken to explore literature on the use of VR systems for rehabilitation of upper limb skills of children with neurological impairment. Studies investigating the use of robotics or other mechanical devices were excluded. Five studies were found and were critiqued using the Downs and Black scale for measuring study quality.
  
  
  RESULTS
  One randomized control trial and four case studies were found. No study scored over 50% on the Downs and Black scale, indicating methodological limitations that limit generalizability.
  
  
  CONCLUSIONS
  Current evidence for the use of VR to improve hand and arm skills is at an emerging stage. Small sample sizes and inconsistencies in outcome measurement limit the ability to generalize findings. Further studies are required to investigate the ability to maintain gains made in VR over time and to determine whether gains transfer from the VR to real life tasks and activities.
authors.affiliation: Victorian Paediatric Rehabilitation Service, The Royal Children's Hospital, Flemington Road, Parkville, VIC 3052, Australia. jane.galvin@rch.org.au
authors.forename: Jane
authors.initials: J
authors.lastname: Galvin
authors.forename: Rachael
authors.initials: R
authors.lastname: McDonald
authors.forename: Cathy
authors.initials: C
authors.lastname: Catroppa
authors.forename: Vicki
authors.initials: V
authors.lastname: Anderson
mesh_terms: D001930:Brain Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities / Q000295:instrumentation; D020127:Recovery of Function / Q000502:physiology*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*; D014584:User-Computer Interface