Telerehabilitation and Face-to-Face Exergame Delivery Modalities to Improve Postural Control in Children with Cerebral Palsy: A Randomised Controlled Trial

Background: Low-cost virtual reality exergames may help maintain and improve postural control in children with spastic hemiplegia cerebral palsy (CP). This study aimed to evaluate the comparative effectiveness of the same six-week, low-cost exergame programme delivered via telerehabilitation (TR) and face-to-face (FF) in CP children. Methods: In this randomised controlled trial, 15 CP patients completed 18 sessions over 6 weeks. The TR group received remotely delivered sessions, whereas the FF control group completed in-person sessions with a physiotherapist. Outcomes were assessed at baseline; weeks 2, 4, and 6; and follow-ups at weeks 8 and 10. Postural control (centre-of-pressure sway area; CoPsway) was measured during eyes open (EO), eyes closed (EC), voluntary mediolateral sway to a 30 bpm auditory cue (EO/EC), and during exergames targeting mediolateral (ML-WS) and anteroposterior (AP-WS) weight-shifting. Timed Up and Go (TUG) and Modified Modified Ashworth Scale (MMAS) were also assessed. Results: At week 6, both TR and FF significantly reduced CoPsway (TR: p = 0.001, EC; FF: p = 0.01, EO). TR also improved dynamic postural control (p < 0.05) and TUG scores (p = 0.03), with functional gains sustained until week 10. Between-group comparisons revealed that TR achieved significantly greater reductions in AP weight-shifting (SDML, p = 0.001; VML, p = 0.004) and TUG (p = 0.009) than FF, with these advantages persisting throughout follow-up as revealed by post hoc analysis. Conversely, only FF significantly reduced ankle muscle tone (MMAS, p = 0.05). TR demonstrated broader improvements in secondary CoP metrics and superior long-term retention of functional mobility gains. Conclusions: Both six-week exergame interventions led to improvements in postural control. This trial demonstrated that telerehabilitation is a viable, comparable alternative to face-to-face delivery. Long-term retention suggests both modalities are complementary, offering flexible solutions to enhance routine physiotherapy service pathways. These findings provide a basis for validating these models across larger clinical cohorts.