Effects of virtual reality and robot-assisted therapy on rehabilitation outcomes in cerebral palsy: a systematic review and meta-analysis.

backgroundCerebral palsy (CP) is a leading cause of lifelong physical disability in children, necessitating long-term rehabilitation. Advanced technologies such as virtual reality (VR) and robot-assisted therapy are emerging as promising adjunctive interventions. However, existing research evidence remains fragmented, with most studies focusing on a single technology or lacking comprehensive subgroup analyses. This systematic review and meta-analysis aims to synthesize current evidence regarding the efficacy of VR and robot-assisted technologies versus conventional therapy for key outcomes including motor function, balance, spasticity, joint range of motion, and activities of daily living in children with CP.

methodsThis systematic review and meta-analysis was conducted in accordance with the Cochrane Handbook guidelines and the PRISMA statement, with a retrospective registration on PROSPERO. We searched electronic databases including PubMed, Embase, the Cochrane Library, Web of Science, and CINAHL, together with clinical trial registries and grey literature sources, to identify randomized controlled trials published from 2016 to 2025. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB-1 and RoB-2 tools. The GRADE approach was applied to assess the certainty of evidence. Meta-analyses were performed for primary outcomes including gross motor function, balance, spasticity, activities of daily living, and joint range of motion. Subgroup analyses were further conducted based on intervention type and CP subtype.

resultsOf the 1720 identified records, 17 randomized controlled trials were initially included. Pooled analyses of the 17 studies demonstrated that compared with conventional therapy, VR and robot-assisted therapies exerted positive effects on patients’ gross motor function (GMFM-88: SMD = 0.53, 95% CI = 0.32 to 0.75), balance ability (PBS: MD = 2.06, 95% CI = 1.17 to 2.95), and spasticity level (MAS: MD = -0.49, 95% CI = −0.82 to −0.15). A small yet statistically significant improvement was observed in the outcome of activities of daily living (PEDI-CAT Daily Activity: MD = 0.51, 95% CI = 0.27 to 0.74). No significant effect on joint range of motion was detected. Subgroup analyses suggested potential differences between VR and robot-assisted therapies. These findings were exploratory given the limited number of included studies. According to the GRADE approach, the certainty of evidence ranged from very low to moderate.

conclusionVR and robot-assisted therapies represent promising adjuncts to conventional rehabilitation for children with cerebral palsy, demonstrating benefits in gross motor function, balance, spasticity reduction, and activities of daily living. To facilitate the broader and optimal clinical application of these technologies, future research should prioritize high-quality, large-scale randomized controlled trials with long-term follow-up. These studies will help confirm these positive findings, establish optimal treatment protocols, and determine the efficacy of such therapies across different CP subtypes.