Why use a virtual world for rehabilitation?

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In April 2021, Drs. Chau and Humbert from the US Department of Veteran Affairs published an interesting systematic review of the literature on the use of Virtual Reality (VR), immersive or non-immersive, to rehabilitate patients with Parkinson’s disease.

Their conclusion was striking. Even though Virtual RealityReality is a promising approach, little clinical evidence was found of the benefit of the approach, especially for the non-immersive approach.

The use of VR proved beneficial in numerous diseases such as treating PTSD or acute and persistent pain management, even when in labor. In recent years, the improvement in technology and portability led to the development of virtual worlds for functional rehabilitation.

In the article, we will check on the benefits of such an approach, review the literature and explore if your next physical therapist will be an avatar or not?

Virtual RealityReality and post-stroke rehabilitation

Most stroke survivors will suffer some form of short-term or long-lasting disabilities. 

One of the benefits of Virtual Reality is that it will trigger the brain to create new functional connections via neuroplasticity. 

11 out of 12 studies analyzed in a meta-analysis conducted by Saposnik et al. showed functional benefits when using virtual therapy to improve recovery post-stroke. A 20% improvement in motor function was found either by using VR or video games training.

Virtual reality technology is not necessarily expensive, and the price point is a crucial element to support its expanding use in physical therapy protocols. 

Jintronix is a Canadian company specializing in developing affordable interactive rehabilitation technologies to be used at home or during occupational therapy sessions. All it needs is a TV screen and a Microsoft Kinect camera to track the movements. Patients will experience interactive games such as skiing, squatting, or catching a ball specifically designed to improve motor or balance and gait. To date, eight peer-reviewed studies proved the benefits of this cost-effective approach that makes the most of patient engagement.

Haptic gloves that allow mimicking the movements and provide feedback are also an avenue that carries many potentials. For example, in a recent clinical trial conducted in China to evaluate the benefits of haptic-virtual stimulation in post-stroke rehabilitation, all parameters improved significantly. In addition, the overall cost of the system was just $500, which makes it very affordable and cost-effective.

Virtual RealityReality and neurological diseases

The use of Virtual RealityReality gained tremendous momentum for neurological diseases physical therapy. Primarily due to the Covid-19 pandemics, we saw an acceleration in the use of telehealth services. Hospitals and private companies now offer access to virtual reality physical therapy sessions. But is this technology mature and clinically proven enough to be used in complete confidence?

Parkinson’s disease and virtual physical rehabilitation

Parkinson’s Disease affects 1% of the worldwide population over 60 years old and is considered the most common neurodegenerative disorder. 

In a meta-analysis of the use of VR technology on PD patients, virtual RealityReality was found to improve gait, balance, and stride length positively. However, the authors, Lu et al., somehow warned of the low methodological quality of many studies involving virtual reality physical therapy protocols.

In a clinical study involving 28 participants (14 control / 14 PD patients) assessed in the course of a 12 weeks physical therapy period (45 minutes per day, the use of VR proved significantly more effective for gait and balance improvement than traditional physical therapy

Multiple Sclerosis and VR training

Neurological rehabilitation and physical therapy exercises are routine for patients who have Multiple Sclerosis. 

Upper Limb dexterity issues are common in Multiple Sclerosis patients and can dramatically decrease their quality of life. 

While conventional physical therapy carries numerous benefits, a Spanish research team headed by Roberto Cano-de-la-Cuerda went one step further and published the results of their study. 

They developed a Serious Game based on the use of the Leap Motion Controller (LMC). Six games were specifically developed to improve manual dexterity and grip strength.

Over ten weeks of 2 weekly sessions (45 minutes conventional therapy + 15 LMC therapy.) The benefits of combining classic physical therapy sessions with virtual ones proved to improve patients’ motor skills significantly. 

On top of the motor improvement, patients were very satisfied and displayed a high level of compliance.

This study is just one of the many that prove that immersive virtual reality protocols and technologies are not needed to induce significant motor benefits.

Are there any drawbacks limiting the use of a virtual reality?

Despite its many benefits, some limitations exist for VR therapy.

Lack of RealityReality is one of them. The environments are limited and even though quality has dramatically improved in recent years, breaking the illusion is just a pixel away. 

For frail patients, wearing an immersive headset can quickly become disturbing and uncomfortable, resulting in a lack of motivation and commitment to engage in VR physical therapy.

Moreover, immersive environments will by definition disconnect the users from the real world, potentially leading to injuries or damages.

Commitment is a critical element to achieve success in conventional therapy and even more in VR. 

After the rehabilitation, patients may also experience fatigue, nausea, or disorientation. Galvanic vestibular stimulation may be a way to limit these side effects, but the technology is not fully and readily available yet to balance these side effects.

Virtual sickness is one of the critical drawbacks for virtual reality therapy to be widely accepted by both patients and therapists.

To wrap up

Virtual reality physical therapy is undoubtedly beneficial for patients suffering from neurological disorders or in post-stroke rehabilitation protocols.

Numerous studies revealed the significant benefits of such approaches that do not come without limitations, mainly linked to the frailness of the patients and the possibility to induce VR motion sickness that in turn can impair the therapeutic improvements.

No clear protocol or technology (non-immersive vs. immersive VR) has been defined yet, and guidelines still do not support the procedures.

With so much to offer, new large-scale clinical studies are needed to help provide a structure and framework to an approach that can dramatically improve the outcomes. 

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