Indonesian Journal of Physical Medicine and Rehabilitation

Indonesian Journal of Physical and Medical Rehabilitation Volume 14, First Edition

Rita Vivera Pane — 2025-06-17

Dear Readers,

With great gratitude, we present the first edition of the Indonesian Journal of Physical and Medical Rehabilitation Volume 14. This edition marks an important initial step in this academic year, while also being a manifestation of our consistency in presenting the latest research and thoughts in the field of physical and medical rehabilitation.

In this edition we proud to present fourteen articles that are well worth reading. Readers will find a variety of articles that reflect advances in science, clinical practice, and innovations in rehabilitation services. Among them is an interesting article examining the effectiveness of virtual reality-based exercise therapy for cerebral palsy patients, as well as research about effectiveness of dry needling on reducing pain, increasing range of motion of the neck in myofascial pain syndrome.

We also highlight a case report about abdominal wall pain after varicocele surgery. The patient has received various types of treatment for five months, including prolotherapy and radiofrequency ablation on the ilioinguinal nerve, but has not recovered. Re-evaluation has been conducted and it was found that the cause of abdominal wall pain is the entrapment of the anterior cutaneous nerve. Diagnosing based on patient complaints and directed anamnesis accompanied by accurate physical examination is key in laying the foundation for the treatment plan. Accurate therapy outcomes are preceded by a correct diagnosis. A proper treatment plan targets the correct cause of pain and the pathophysiology behind it.

We believe that the articles in this edition not only enrich the scientific knowledge but also provide practical guidelines for clinicians, researchers, and policymakers in improving the quality of rehabilitation services in Indonesia and the surrounding areas.

We extend our gratitude to all the authors, reviewers, and the editorial team who have worked hard to maintain the quality and scientific integrity of this journal. We invite readers to participate in the development of this journal through manuscript contributions, constructive criticism, and academic collaboration.

Respectful greetings,

Dr. dr. Rita Vivera Pane SpKFR., N.M (K)., FIPM., CIPS., FIPP

Editor-in-Chief

Indonesian Journal of Physical and Medical Rehabilitation

Factor Associated with Improvement of VO2 Max after Cardiac Rehabilitation in Patients with Coronary Artery Disease Post Revascularization

Arnengsih Nazir — 2025-06-17

Aims: This study aimed to assess the association of cardiovascular risk factors and the number of risk factors with improvement of VO2 Max in patients with coronary artery disease (CAD) post-revascularization by Coronary Artery Bypass Graft (CABG) and Percutaneous Coronary Intervention (PCI) after completing phase II cardiac rehabilitation (CR).

Methods: This was an analytic study with a cross-sectional design. Data were taken retrospectively using secondary data from medical records. The study population was post-revascularization CAD patients who underwent phase II CR at RSUP Dr. Hasan Sadikin Bandung in 2019-2020, and samples were taken by total sampling method. Data were processed with Microsoft Excel 2016 and Statistical Software R version 4.0.0, then presented analytically. The characteristics were described based on age, sex, body mass index, education, occupation, and the number of risk factors. Characteristic data were grouped based on the CABG and PCI interventions obtained. Correlation analysis was conducted to assess the association of age, family history, physical inactivity, smoking, obesity, hypertension, dyslipidemia, and diabetes mellitus risk factors and the number of risk factors with VO2 Max. Data were analyzed with appropriate statistical tests.

Results: The median (range) of improvement of VO2 Max was 6.00 (1.20, 17.73) (ml/kg/min). Smoking was significantly associated with an improvement of VO2 Max (p-value 0.0197), while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. Patients with a total of seven risk factors had the highest improvement of VO2 Max with 12.88 (3.15, 12.90) (ml/kg/minute), followed by patients with a total of six risk factors with 9.84 (1.80, 16.44) (ml/kg/minute). However, the number of risk factors had no significant association with the improvement of VO2 Max.

Conclusion: Smoking as a CVD risk factor was associated with improvement of VO2 Max, while age, family history, physical inactivity, obesity, hypertension, dyslipidemia, and diabetes mellitus were not. The number of risk factors had no significant association with the improvement of VO2 Max.

Effectiveness of Dry Needling on Reducing Pain, Increasing Range of Motion of the Neck, and Increasing Craniovertebral Angle in Obese Patients with Cervical Myofascial Pain Syndrome

Tirza Z Tamin — 2025-06-17

Introduction: Obese patients often experience neck pain due to cervical myofascial pain syndrome.Dry needling is one of method to treat myofascial pain syndrome.

Methods: This study was a single-blind randomized controlled trial. Participants aged 18- 59 year with neck pain > 3 months caused by myofascial pain syndrome in the neck region. Patients were randomized into the dry needling group (n=16 subjects) and the control group (n=16 subjects). The dry needling group received dry needling therapy once a week for 4 weeks and exercise therapy three times a week for 4 weeks. The control group received exercise therapy only three times a week for 4 weeks.

Results: Participants had an average age of 41.4±11.2 years. Both groups experienced significant improvement in NRS, cervical ROM, and CVA between the pre-treatment assessment and the fourth week evaluation (p<0.05). The dry needling group experienced more significant improvements in NRS, cervical extension ROM, and CVA compared to the control group at the fourth week evaluation (p<0.05).

Conclusion: Dry needling combined with exercise or exercise therapy alone is effective in improving NRS, cervical ROM, and CVA in obese patients with cervical myofascial pain syndrome. However, dry needling combine with exercise therapy is superior to exercise therapy alone.

Keywords : Dry Needling, Obesity, Pain, Range of Motion in the Joint, Craniovertebral Angle, Myofascial Neck Pain Syndrome

Ihsan Putra — 2025-06-17

Abstract

Background: Increasing incident of obesity was also in the population of intellectual disability (ID). Some of them are an athlete. The research aims to assess the relationship between level of physical activity and the degree of flatfoot on individual with intellectual disability and obesity. This research also provide data on the prevalence and degree of flatfoot.

Method: This research was using analytic observational method in cross-sectional studies in groups of athletes and non-athletes with a total of 68 subjects. The data collected between July 2021 to October 2022. The data included subject characteristics, daily activities that converted to metabolic equivalent (MET) score of physical activity level (PAL), BMI, and footprints using the Harris Mat. The clinical outcomes were analysed using Spearman, Man Whitney, and Fisher’s exact test.

Result: Flatfoot occurred in 97% of the samples based on Viladot criteria. All the non-athlete group had flatfoot and more severe degree of flatfoot, and there were 2 individuals with normal feet in the athlete group. There was relationship between the degree of flatfoot in special athlete - obesity groups and gender. No relationship between the degree of flatfoot in both groups with age, degree of intellectual disability, degree of obesity and PAL, type of sport or duration of active as an athlete.

Conclusion: There is no relationship between the degree of flatfoot and the PAL in the athlete and non-athlete groups of intellectual disability and obesity.

Keywords: flatfoot, physical activity level, intellectual disability, obesity, special athlete

The Effect of Intradialysis Resistance Training on Quality of Life and Physical Activity of End-Stage Chronic Renal Failure Patients Hemodialysis

Witri Septiani — 2025-06-17

Introduction: Patients with Chronic Kidney Failure have a decreased ability to excrete metabolic wastes. Metabolic wastes that accumulate in the musculoskeletal system are called uremic myopathy. Uremic myopathy is characterized by an increase in muscle protein catabolism which results in a decrease in contractility and muscle mass which causes the patient to tire easily and triggers sedentary behavior and reduces physical activity and quality of life.

Objective: The purpose of this study was to determine the effect of intradialysis resistance exercise on quality of life and level of physical activity in end-stage chronic kidney disease patients undergoing hemodialysis 2 times per week.

Methods: Thirty-nine subjects receive low-intensity resistance exercise for 2 sets of 15 repetitions. Progression of exercise is done by increasing the volume of exercise. Exercises are carried out twice a week for 24 training sessions under the supervision in the hospital. The examination was carried out before and after 24 training sessions including filling out the KDQOL (Kidney Disease and Quality of Life) and IPAQ (International Physical Activity Questionnaire) questionnaires. Statistical analysis using t-test and sign-test

Results: The results showed significant changes in all the variables studied, KDQOL score (p=0.00) and the level of physical activity (p=0.00). The average KDQOL scores before and after exercise were 166.67 and 243.16. Twenty-five research subjects has increased in physical activity level, and fourteen research subjects did not increase in physical activity level

Conclusion: Intradialysis resistance exercise improves quality of life and physical activity level of end-stage chronic kidney disease patients undergoing hemodialysis 2 times per week

Keywords: Chronic kidney disease, hemodialysis, physical activity, quality of life, resistance training

The "Exploring the Impact of Pain on Functional Capacity and Quality of Life in Elderly with Musculoskeletal Disorders"

Ika Rosdiana Rosdiana — 2025-06-17

ABSTRACT

Introduction: Pain is a common health issue among the elderly, with chronic pain significantly impacting functional capacity and quality of life. This study analyzes the relationship between pain, functional capacity, and quality of life in elderly individuals using the Barthel Index and WHOQOL-BREF.

Methods: This analytical observational study utilized a cross-sectional design involving 204 elderly individuals with musculoskeletal pain from 10 hospitals in Central Java. Pain levels were assessed using the Numerical Rating Scale (NRS), functional capacity was measured using the Barthel Index, and quality of life was evaluated using WHOQOL-BREF. Data were analyzed descriptively, and Spearman’s correlation test was used to determine relationships between variables.

Results: The descriptive analysis revealed knee pain as the most commonly reported location (33.33%), followed by lower back pain (30.4%). Functional capacity assessment showed high independence in daily activities, with 99.0% eating and 96.6% bathing independently. However, only 74.0% could navigate stairs without assistance. Spearman's correlation analysis showed a significant negative correlation between pain and the Barthel Index (r = -0.174, p = 0.013), WHOQOL-BREF Domain 1 (r = -0.319, p < 0.001), and Domain 2 (r = -0.185, p = 0.008). No significant relationships were observed for Domains 3 and 4.

Conclusion: Pain significantly impacts functional capacity and psychological well-being in elderly individuals, but its effect on social and environmental quality of life is less pronounced. Comprehensive pain assessment and targeted interventions are essential to improve their quality of life.

Abdominal Anterior Cutaneous Nerve Entrapment Syndrome: Case Report of An Overlooked Diagnosis

Theresia Chandra Tania Novy — 2025-06-17

Introduction: Abdominal Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a chronic abdominal pain condition caused by entrapment of thoracoabdominal nerve branches in the abdominal wall. It is often misdiagnosed due to nonspecific symptoms resembling gastrointestinal issues. Hydrodissection, a minimally invasive technique, involves injecting fluid to release entrapped nerves and alleviate pain. This case highlights successful pain relief in ACNES using ultrasound-guided hydrodissection. Methods: A case report of a 27-year-old male pilot presented with chronic lower abdominal pain for five months, worsened by sitting post varicocele operation. The patient reported having persistent abdominal pain with a Numeric Rating Scale (NRS) score of 5–6. Despite undergoing prolotherapy and radiofrequency targeting the left ilioinguinal nerve, the pain intensified to an NRS of 8–9. Examination revealed a positive Carnett’s sign, suggesting ACNES. Hydrodissection with lidocaine under ultrasound guidance was performed. Result: Post-hydrodissection, the patient reported significant pain relief, with his NRS score decreasing from 8–9 to 0–1. He experienced near-complete resolution of chronic abdominal pain without adverse effects, demonstrating hydrodissection's effectiveness. Conclusion: Recognizing ACNES as a potential cause of chronic abdominal pain is essential for targeted intervention.

Differences in Sensitivity and Specificity of the Time Up and Go Test and Berg Balance Scale in Assessing the Risk of Falls in Chronic Heart Failure Patients with Systolic Dysfunction

Made Suariastawa Putra — 2025-06-17

Introduction: Chronic heart failure (HF) patients face increased fall risks due to muscle dysfunction and balance impairment. The Time Up and Go (TUG) and the Berg Balance Scale (BBS) are the tests that have been developed to assess the risk of falls in general population, but research specifically investigating their sensitivity and specificity in chronic HF patients remains scarce.

Methods: This study was a cross-sectional study aimed at assessing the sensitivity and specificity of the TUG and BBS for risk of fall, performed using the Receiver Operating Characteristic (ROC) curve, involving patients from the Cardiology Department of Brawijaya University Hospital aged 21 to 60 years who were diagnosed with chronic HF with systolic dysfunction.

Results: Analysis of 32 participants with average age of 56 years showed TUG’s area under the curve (AUC) was 0.85 (95% CI 0.5 – 1), with cut-off at 11.22 seconds, with 75.00% sensitivity, and 96.43% specificity. Meanwhile, BBS had an AUC of 0.72 (95% CI 0.4 - 1), with 71.43% sensitivity, and 75.00% specificity respectively with cutoff at 56.

Conclusion: TUG demonstrated superior sensitivity and specificity compared to BBS, making it a preferred tool for identifying fall risk in chronic HF with systolic dysfunction.

Clinical Case Study on Functional Communication Program with Biomechanical and Rehabilitative Approach for Person with Guillain-Barre Syndrome

Gunawan Wicaksono — 2025-06-17

Backgrounds: Acute Inflammatory Demyelinating Polyradiculopathy (AIDP), also known as Guillain-Barre syndrome (GBS), is a condition that can affect anyone, causing muscle weakness, discomfort, and paralysis. Occupational therapy intervention aims to enhance communication abilities and overall quality of life for GBS patients.

Objective: This study aims to enhance functional communication in Guillain-Barre Syndrome patients through occupational therapy interventions

Methods: The participant in the study is a 45-year-old man with GBS who struggles with functional communication activities using tablets. Instruments used to measure progress include the Canadian Occupational Performance Measure (COPM), Range of Motion (ROM), and Manual Muscle Testing (MMT), as well as analysing Occupational Performances Area (OPA) and Occupational Performances Component (OPC) abilities.

Result: Occupational therapists developed interventions based on assessment results, which led to significant improvements in range of motion and muscle strength in the upper extremities. The participants' performance in using tablets also improved after the intervention, with an increase in both performance and satisfaction scores. The study showed a clear link between the importance of tablet use, patient performance, and satisfaction levels, with significant improvements seen after the occupational therapy intervention

Conclusion: The biomechanical frame of reference was effective in improving range of motion and muscle strength in GBS patients. This resulted in significant increases in ROM and muscle strength in both upper extremities. Additionally, the COPM examination showed improvements in patient performance and satisfaction, indicating the potential for increased independence in daily activities with the help of the rehabilitative frame of reference.

Risk Prediction using M-CHAT and Treatment with Speech and Occupational Therapy in Autism Spectrum Disorder

Alif Muhammad Sudarmanto — 2025-06-17

Introduction: Autism spectrum disorder (ASD) has been increasingly recognized, with the prevalence of ASD in 2017 in Indonesia was 0.36%. ASD is faced with challenges in detection and intervention, considering its new awareness initiated around 10-15 years ago.

Case Description: A 30-months-old male had a chief complaint of unable to form words. No other growth nor other pre-existing disorders were found. Denver II test found delay in speech and personal-social developments. M-CHAT found that the patient had a high risk of ASD. Behavioural Observational Therapy found no hearing disorders. The patient then received speech and occupational therapy, showing improvements in condition after 1 year of therapy.

Discussion: Diagnosing ASD must undergo several steps, which were development assessment, hearing assessment, ASD screening, and ASD diagnostic evaluation. Endorsed tools by the Ministry of Health of Indonesia for development screening were KPSP and Denver II test. Hearing assessment could be screened through TDD but should not undermine the need for equal distribution of hearing assessment tools, such as OAE and BERA. ASD screening was mainly done using M-CHAT, since other tools were less sensitive and specific. Diagnostic evaluation would be done according to DSM-5 criteria, which was more specific yet less sensitive than its predecessor. Other tests for development and ASD screening must be studied to provide alternatives. Regarding treatment, more studies were needed to provide deeper evidence for current therapies.

Conclusion: Further research in the screening, diagnosis, and treatment of ASD is needed.

Gait in Parkinson Disease: From Neurophysiology to Rehabilitation Overview

Farida Arisanti — 2025-06-17

Introduction: Parkinson's disease (PD) is a chronic and progressive neurodegenerative disorder, mostly happened in older adult, related to the degeneration of striatal dopaminergic neurons. Motor disorders in PD lead to gait disturbance, which worsen as the disease progresses. This literature review provides variety of gait disturbances possible in patients with PD. Understanding the mechanisms and factors associated with impaired walking activity of PD patients will form a solid foundation for selecting appropriate rehabilitation strategies, ultimately improving mobility, overcoming restriction of participation and life satisfaction for these patients.

Methods: Research was conducted using PubMed, Google Scholar, and the Cochrane Library to locate original articles, as well as systematic and narrative reviews, concerning the neurophysiology, pathophysiology, clinical features, and rehabilitation of gait in Parkinson disease

Result: PD Patients may experience a decrease in walking speed and stride length and increased axial rigidity. Early alterations in gait associated with PD include reduced arm swing amplitude, asymmetry between the extremities, and a decline in movement fluidity. In later stages, freezing of gait (FOG), festination, and turning en bloc can occur. These conditions will lead to increased dependency and affecting the patient's mobility and participation with further implication of immobility and isolation. Management of gait in Parkinson's disease (PD) consists of a combination of pharmacological and non-pharmacological treatment. A rehabilitation program designed for PD should cover the specific needs of each patient to optimize mobility and social participation.

Conclusion: Understanding the neurophysiology of walking and the neuropathology of PD, the effective rehabilitation strategies can be formulated to optimize mobility, efficiency and the independency in daily activities, especially related to gait and walking performance.

Effectiveness Of Muscle Strengthening Interventions In Patient With Grade 4 Osteoarthritis Following Total Knee Replacement Surgery : A Systematic Review And Meta-Analysis

Putu Krisna Maharani Purnama Dewi — 2025-06-17

ABSTRACT

Background: Osteoarthritis (OA) is the most prevalent kind of arthritis affects joints and one of the main causes of disability. Patients diagnosed with advanced OA in their knees typically undergo total knee arthroplasty (TKA). Strength training is tool for reducing muscle weakness, enhancing ability in functional ambulation after TKA, according to many systematic reviews and meta-analyses.

Objective: The aim is to investigate the importance of muscle-strengthening in individuals who had TKA surgery.

Methods: A systematic literature search of three online databases was performed for randomized controlled trials (RCT) evaluating effects of strength training on functional ambulation by six-minute walk test (6MWT)/ timed-up and go (TUG) test after TKA surgery. Data were pooled by random-effect meta-analyses and presented as standard mean difference (SMD). PRISMA criteria and Cochrane risk-of-bias approach was applied to each research determine the evidence quality.

Results: Eleven RCT were identified. A meta-analysis indicated that post operative 6MWT showed no significant difference between standard therapy and muscle-strengthening, but demonstrated that muscle-strengthening produced better outcomes in TUG test than standard therapy.

Conclusion: Based on existing studies, moderate-certainty evidence suggests that strength training could decrease time to complete TUG after TKA.

Keywords: Muscle strengthening, Osteoarthritis, Total Knee Replacement, Post operative, Effectiveness.

ABSTRAK

Latar Belakang: Osteoartritis (OA) adalah jenis artritis yang paling umum yang memengaruhi sendi dan merupakan salah satu penyebab utama kecacatan. Pasien yang didiagnosis dengan OA lanjut pada lutut mereka menjalani artroplasti total lutut (TKA). Latihan kekuatan merupakan alat untuk mengurangi kelemahan otot, meningkatkan kemampuan atletik dalam ambulasi fungsional setelah TKA, menurut tinjauan sistematis dan meta-analisis.

Tujuan: Tujuan literature ini adalah menyelidiki pentingnya penguatan otot pada individu yang telah menjalani operasi TKA.

Metode: Pencarian literatur sistematis pada tiga database online dilakukan untuk uji coba terkontrol secara acak (RCT) yang mengevaluasi efek latihan kekuatan pada ambulasi fungsional dengan uji jalan enam menit (6MWT)/ uji bangun-dan-jalan (TUG) setelah operasi TKA. Data dikumpulkan dengan meta-analisis efek acak& disajikan sebagai perbedaan rata-rata standar (SMD). Kriteria PRISMA dan pendekatan risiko bias Cochrane diterapkan pada setiap penelitian untuk menentukan kualitas bukti.

Hasil: Sebelas RCT diidentifikasi. Meta-analisis menunjukkan bahwa 6MWT pasca operasi tidak menunjukkan perbedaan signifikan antara terapi standar& penguatan otot, namun menunjukkan bahwa penguatan otot menghasilkan hasil yang lebih baik pada uji TUG dibandingkan terapi standar.

Kesimpulan: Berdasarkan studi, bukti dengan kepastian sedang menunjukkan bahwa latihan kekuatan dapat mengurangi waktu untuk menyelesaikan uji TUG setelah TKA.

Kata Kunci: Penguatan otot, Osteoartritis, Penggantian Lutut Total, Pasca operasi, Efektivitas.

Literature Review: 6PBRT and UULEX as an Unsupported Upper Limb test in People with Respiratory and Musculoskeletal disability

Peggy Sunarjo — 2025-06-17

Upper limb (UL) function is essential for daily activities, yet it is often overlooked in rehabilitation programs for individuals with respiratory and musculoskeletal disabilities. The six-minute pegboard and ring test (6PBRT) and the unsupported upper limb exercise test (UULEX) are two validated tools for assessing UL functional capacity. These tests simulate daily UL movements, measuring endurance, strength, and coordination, particularly in patients with chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, asthma, bronchiectasis, interstitial lung disease, and pulmonary hypertension. Research suggests that UL exercises improve dyspnea, endurance, and activities of daily living (ADLs), supporting their integration into rehabilitation programs. This review explores the methodology, clinical applications, and benefits of 6PBRT and UULEX, highlighting their role in comprehensive patient assessment and functional rehabilitation.

Keyword: upper extremity function, pulmonary rehabilitation, exercise rehabilitation, exercise test, chronic obstructive pulmonary disease, activities of daily living.

Utilization of Virtual Reality for Upper Limb Motoric Rehabilitation of Post-Stroke Patients: A Systematic Review

Johanes Prasetyo Harjanto — 2025-06-17

Background: Stroke is a neurological disorder which is classified as ischemic or hemorrhagic. The increasing incidence of stroke worldwide has increased the need for rehabilitation. Virtual Reality (VR) is a new technology that is still being developed for the rehabilitation of post-stroke patients. Several studies have shown that VR has good benefits to help the rehabilitation of post-stroke patients, especially in terms of patient motor skills.

Methods: A systematic review was conducted by searching the PubMed and Science Direct databases with all articles using English, randomized controlled trials and articles published in 2020-2024. The keywords used were "Virtual Reality", "VR", "Neurorehabilitation", "Rehabilitation", "Motor Function", "Stroke", "Recovery".

Results: A total of 870 studies were initially identified, 10 of those studies fulfilled the inclusion criteria for this systematic review. Total of 348 participants (178 VR groups and 170 control groups) were included in this systematic review and the results showed from most of the studies show a significant increase in the VR group in patient motor skills based on FMA-UE, ARAT, AROM, Grip Strength Test, DASH, JTT, WMFT and 9HPT assessments.

Conclusion: This systematic review shows that the use of VR for motor rehabilitation of post-stroke patients has better outcomes compared to patients who only receive conventional therapy.

Keywords: Stroke, Virtual Reality, Motoric Function, Upper Limb, Rehabilitation

FIT THROUGH FUN - Games in Upper Motor Rehab for Children with Cerebral Palsy, Navigating the Challenges and Benefit: a Scoping Review

Sheila Agustika Herliv — 2025-06-17

Background and Objective: Children with cerebral palsy (CP) experience significant limitations in daily activities, particularly due to motor impairments affecting upper limb function. While traditional physiotherapy is essential, its repetitive nature may reduce motivation and engagement. Emerging video game-based therapy (VGBT) offers potential to improve motor outcomes and adherence through interactive tasks. This review explores the role of video games in improving upper motor function in children with CP, focusing on their benefits, challenges, and accessibility. Method: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Literature was sourced from PubMed, ProQuest, and Scopus. Studies were appraised for quality using the McMaster Critical Review Form for quantitative studies. Results: Twenty-one articles were selected based on inclusion criteria, with an average McMaster score of 13.33. Video game-based therapies (VGBT), particularly exergames and virtual reality (VR), show promise in improving upper limb function in children with CP. Studies report improvements in hand function, coordination, and motor dexterity, alongside increased engagement and adherence. These interventions help address issues in traditional therapy, such as monotony and low participation. Adaptive feedback and biofeedback-enhanced games also offer potential for individualized therapy. However, challenges such as limited technology access, personalization, and long-term efficacy remain. Conclusion: This review demonstrates the effectiveness of VGBT in improving upper limb function and overcoming limitations of conventional therapies. Addressing barriers, such as technology access and the need for personalized interventions, is critical for maximizing VGBT's benefits. Further research into adaptable, accessible, and personalized interventions is essential to ensure equitable rehabilitation outcomes for all children with CP.