Effect of Virtual Reality-Based Breathing Training on Trunk Control in Children With Spastic Diplegic Cerebral Palsy: A Randomised Controlled Trial

Abstract Background Children with spastic diplegic cerebral palsy commonly have impaired trunk control and respiratory dysfunction, which reduce functional performance and quality of life. Virtual reality-based breathing training is a promising adjunct to paediatric neurorehabilitation, but has not been compared directly with conventional diaphragmatic breathing exercises. This trial compared the two approaches, each delivered alongside conventional physiotherapy, on trunk control, respiratory function and quality of life. Methods In this two-arm, parallel-group, single-centre randomised controlled trial, 60 children aged 6–12 years with spastic diplegic cerebral palsy (Gross Motor Function Classification System levels I–III) were allocated 1:1 to virtual reality-based breathing training (n = 30) or diaphragmatic breathing exercises (n = 30). Both arms received 60-minute sessions comprising 30 minutes of conventional physiotherapy and a 30-minute breathing block, five days per week for eight weeks (40 sessions). The primary outcome was the Trunk Control Measurement Scale; secondary outcomes were maximum inspiratory pressure, maximum voluntary ventilation and the caregiver-reported Cerebral Palsy Quality of Life Questionnaire. A single assessor, blinded to allocation, performed the performance-based assessments. Between-group differences were analysed using independent t-tests. Results All 60 randomised participants completed the intervention and were analysed. Post-intervention scores were higher in the experimental group on all four outcomes: Trunk Control Measurement Scale (mean difference 5.86 points, 95% CI 2.87–8.85), maximum inspiratory pressure (8.20 cmH₂O, 95% CI 3.91–12.49), maximum voluntary ventilation (8.88 L/min, 95% CI 5.24–12.52) and quality of life (8.02 points, 95% CI 4.40–11.64), with large between-group effect sizes (Cohen’s d 0.99–1.26). Both groups improved significantly from baseline on all outcomes. No intervention-related adverse events were observed in either group. Conclusions Virtual reality-based breathing training combined with conventional physiotherapy produced greater short-term improvements in trunk control, respiratory function and caregiver-reported quality of life than diaphragmatic breathing exercises combined with conventional physiotherapy. Given the single-centre design, pragmatic sample size and absence of long-term follow-up, larger multicentre trials are required to confirm these findings. Trial registration Trial registration: this trial was not registered in a clinical trial registry.