Additional Effects of Augmented Reality-Based Upper Extremity Training Combined with Bobath Therapy on Balance, Gross Motor Function, and Upper Extremity Function in Children with Spastic Hemiplegic Cerebral Palsy: A Pilot Randomized Controlled Trial

Background/Objectives: Children with spastic hemiplegic cerebral palsy commonly experience impaired upper extremity function, which limits daily activities and participation. Augmented reality (AR)-based rehabilitation has recently emerged as a promising adjunct to conventional therapy; however, evidence directly comparing AR with Bobath-based therapy remains limited. This pilot randomized controlled trial investigated the additional effects of AR-based upper extremity training combined with Bobath therapy on balance, motor development, and upper extremity function in children with spastic hemiplegic cerebral palsy. Methods: Twenty children with spastic hemiplegic cerebral palsy (GMFCS levels I–II) were randomly assigned to either an AR group (n = 10) or a Bobath group (n = 10). Both groups received conventional Bobath therapy for 40 minutes, three times weekly for four weeks. The AR group additionally received 15 minutes of AR-based upper extremity training during each session. Outcomes included the Korean Pediatric Balance Scale (K-PBS), Gross Motor Function Measure (GMFM-88), Quality of Upper Extremity Skills Test (QUEST), and Jebsen–Taylor Hand Function Test (JTHFT). Two-way mixed repeated-measures ANOVA and between-group comparisons of change scores were performed. Result: The AR group demonstrated significantly greater improvements in the QUEST total score than the Bobath group (mean change: 38.38 ± 18.72 vs. 9.59 ± 5.15, p < 0.001), with a significant time × group interaction (F = 21.99, p < 0.001, partial η² = 0.550). Significant between-group differences were also observed in all QUEST subdomains, including dissociated movement, grasp, weight-bearing, and protective extension (all p < 0.05). No significant group-by-time interactions were found for K-PBS, GMFM-88, or JTHFT outcomes (all p > 0.05), although both groups showed improvements in several functional measures over time. Conclusions: AR-based upper extremity training combined with Bobath therapy may provide additional benefits for improving the quality of upper extremity movement in children with spastic hemiplegic cerebral palsy. However, its effects on balance, gross motor function, and functional hand performance appear limited over a four-week intervention period. Larger randomized controlled trials with longer follow-up are warranted to confirm these preliminary findings.