{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:17:37Z","timestamp":1785323857771,"version":"3.55.0"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"\n Objective<\/jats:title>\n This cross-sectional study used functional near-infrared spectroscopy (fNIRS) to explore cerebral cortical activation and functional connectivity in children with Unilateral Cerebral Palsy (UCP) at resting state, during traditional non-virtual reality (non-VR) and single-session VR throwing motor tasks, aiming to clarify the differences in neural responses between VR and non-VR tasks, and provide preliminary neuroimaging evidence for VR application in pediatric cerebral palsy rehabilitation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A total of 35 children with UCP (18 males, 17 females, mean age 9.67\u2009\u00b1\u20092.4 years; 16 with left hemiplegia, 19 with right hemiplegia; 3 graded MACS Level \u2160, 13 Level \u2161, 19 Level \u2162) were enrolled, with the affected hemisphere standardized to the left. All participants completed fNIRS data acquisition in a randomized order under three conditions: 6-minute resting state (seated quietly with eyes closed), a single-session semi-immersive VR throwing task (8\u2005s per movement cycle, with real-time audio-visual reward feedback for successful hits on horizontally moving virtual targets via ToF 3D motion capture), and a traditional non-VR throwing task with matched movement rhythm but no targets or feedback. fNIRS was used to monitor oxygenated hemoglobin (HbO\u2082) concentration in 6 regions of interest (ROIs): bilateral prefrontal (LPFC\/RPFC), premotor (LPMC\/RPMC) and sensorimotor cortices (LSMC\/RSMC). One-way repeated measures ANOVA with FDR correction was applied for statistical analysis, which was verified by a professional biostatistician.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Cerebral functional connectivity strength analysis showed that after FDR correction, there were significant main effects of task condition on the FCS of LSMC-LPMC [F(2,68)\u2009=\u200916.956,\n p<\/jats:italic>\n \u2009&lt;\u20090.001,\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009=\u20090.333], LPMC-RPFC [F(2,68)\u2009=\u200916.256,\n p<\/jats:italic>\n \u2009&lt;\u20090.001,\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009=\u20090.323], and LPMC-LPFC [F(2,68)\u2009=\u200922.725,\n p<\/jats:italic>\n \u2009&lt;\u20090.001,\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009=\u20090.401], all with large effect sizes (\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009\u2265\u20090.14). The FCS of these ROI pairs showed a consistent trend: resting state &gt; single-session VR throwing motor task &gt; non-VR throwing motor task, with significant differences between any two conditions (P\n FDR<\/jats:sub>\n &lt; 0.05). No statistically significant differences were observed in FCS between other ROIs (P\n FDR<\/jats:sub>\n &gt; 0.05). Cerebral activation level analysis showed that after FDR correction, there were significant main effects of task condition on the activation levels of the affected-side LSMC [F(2,68)\u2009=\u200915.952,\n p<\/jats:italic>\n \u2009&lt;\u20090.001,\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009=\u20090.319] and affected-side LPFC [F(2,68)\u2009=\u200913.606,\n p<\/jats:italic>\n \u2009&lt;\u20090.001,\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009=\u20090.286], both with large effect sizes (\n \u03b7<\/jats:italic>\n \u209a\n 2<\/jats:sup>\n \u2009\u2265\u20090.14). Specifically, the activation level of LSMC followed the order: single-session VR throwing motor task &gt; non-VR throwing motor task &gt; resting state; the activation level of LPFC followed the order: single-session VR throwing motor task &gt; resting state &gt; non-VR throwing motor task, with significant differences between any two conditions (P\n FDR<\/jats:sub>\n &lt; 0.05). No statistically significant differences were detected in activation levels of other brain regions (P\n FDR<\/jats:sub>\n &gt; 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Based on functional near-infrared spectroscopy (fNIRS) technology, this cross-sectional study confirmed that children with unilateral cerebral palsy (UCP) exhibit distinct cerebral cortical neural activity patterns during a single-session VR throwing motor task, compared with the resting state and traditional non-VR throwing motor task. Specifically, the single-session VR motor task was associated with significantly higher activation levels in the left sensorimotor cortex (LSMC) and left lateral prefrontal cortex (LPFC) \u2014 the two regions in the affected hemisphere uniformly standardized to the left for all subjects \u2014 and modulated the functional connectivity between the premotor cortex and its functionally related brain regions. Compared with the traditional non-VR throwing motor task, the single-session VR throwing motor task elicited greater activation in the above-mentioned motor-related and higher-order cognitive brain regions, and induced a significantly different neural response pattern of the motor-cognitive network. The findings of this study reveal the cortical neural response characteristics of children with UCP during a single-session VR motor task, and provide preliminary neuroimaging evidence for subsequent studies exploring the neural mechanisms of VR-based rehabilitation in children with cerebral palsy.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fresc.2026.1817820","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:29:34Z","timestamp":1780374574000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerebral cortical activation and functional connectivity characteristics of children with unilateral cerebral palsy during a single-session virtual reality throwing motor task: a functional near-infrared spectroscopy study"],"prefix":"10.3389","volume":"7","author":[{"given":"Haiying","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Changzhou De'an Hospital","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Changzhou De'an Hospital","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jijiang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Changzhou De'an Hospital","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Changzhou De'an Hospital","place":["Changzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"S125","DOI":"10.21037\/tp.2020.01.01","article-title":"Cerebral palsy in children: a clinical overview","volume":"9","author":"Patel","year":"2020","journal-title":"Transl Pediatr"},{"key":"B2","first-page":"213","article-title":"Cerebral palsy: an overview","volume":"101","author":"Vitrikas","year":"2020","journal-title":"Am Fam Physician"},{"key":"B3","first-page":"31","article-title":"Application progress of virtual reality technology in the rehabilitation of children with cerebral palsy","volume":"28","author":"Huang","year":"2021","journal-title":"China Modern Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"jrm00195","DOI":"10.2340\/16501977-2841","article-title":"Increasing prevalence of cerebral palsy among children and adolescents in China 1988\u20132020: a systematic review and meta-analysis","volume":"53","author":"Yang","year":"2021","journal-title":"J Rehabil Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2622310","DOI":"10.1155\/2022\/2622310","article-title":"A review on recent advances of cerebral palsy","volume":"2022","author":"Paul","year":"2022","journal-title":"Oxid Med Cell Longev"},{"key":"B6","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1080\/09638288.2019.1623852","article-title":"Quality of life in children and adolescents with cerebral palsy: a systematic review with meta-analysis","volume":"43","author":"Makris","year":"2021","journal-title":"Disabil Rehabil"},{"key":"B7","doi-asserted-by":"publisher","first-page":"101673","DOI":"10.1016\/j.cppeds.2024.101673","article-title":"Cerebral palsy in children: a clinical practice review","volume":"54","author":"Patel","year":"2024","journal-title":"Curr Probl Pediatr Adolesc Health Care"},{"key":"B8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13287-019-1545-x","article-title":"Therapeutic evidence of umbilical cord-derived mesenchymal stem cell transplantation for cerebral palsy: a randomized, controlled trial","volume":"11","author":"Gu","year":"2020","journal-title":"Stem Cell Res Ther"},{"key":"B9","doi-asserted-by":"publisher","first-page":"617740","DOI":"10.3389\/fneur.2020.617740","article-title":"Surveillance of cerebral palsy in Europe (SCPE) collaboration. 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