Table of Contents

    Topic review

    Virtual Reality for Rehabilitation

    Subjects: Others
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    Submitted by: Elvira Maranesi

    Abstract

    Virtual reality (VR) is a trending, widely accessible, contemporary technology of increasing utility to biomedical and health applications. VR is the technological experience that allows for a full immersion in virtual spaces with which you can interact via specific wearable or using only your hand. A key feature of all VR applications is interaction.

    VR ranges from non-immersive to fully immersive, depending on the degree to which the user is isolated from the physical surroundings when interacting with the virtual environment. Non-immersive virtual reality allows for interacting with the environment through mouse or joystick; immersive virtual reality, instead, uses tools that are connected to the human body in order to perform the same motor task.

    Despite the growing evidence of the positive effects of VR in rehabilitation of functional and cognitive abilities, some systems still raised concerns regarding their acceptability with complex clinical populations, as, for example, the older people. In particular, during trials with immersive systems, few adverse events have been described by participants, including headache and dizziness. Finally, little is known about the perceived effect of the exposure at multisensory input during a complex activity, such as treadmill walking with VR in patients during post-stroke rehabilitation to improve balance and gait ability.

    1. Definition

    Virtual reality (VR) is a trending, widely accessible, contemporary technology of increasing utility to biomedical and health applications[1]. VR is the technological experience that allows for a full immersion in virtual spaces with which you can interact via specific wearable or using only your hand. A key feature of all VR applications is interaction. Virtual environments (VE) are created and allow for the user to interact with not only the VE, but also with virtual objects within the environment. In some systems, the interaction might be achieved via a pointer operated by a mouse or joystick button. In other systems, a representation of the user’s hand (or other body part) might be created within the environment where the virtual hand movement is generated[2].

    2. Introduction

    VR ranges from non-immersive to fully immersive, depending on the degree to which the user is isolated from the physical surroundings when interacting with the virtual environment. Non-immersive virtual reality allows for interacting with the environment through mouse or joystick; immersive virtual reality, instead, uses tools that are connected to the human body in order to perform the same motor task[3][4]. Non-immersive VR systems have been studied as a therapeutic tool for improving symptoms in neurological disorders and have shown potential to promote cognitive and motor improvements even in advanced stages of different neurological diseases (e.g., stroke, Alzheimer and Parkinson disease (AD, PD), multiple sclerosis (MS), and traumatic brain injury) because of these characteristics[5][6][7][8][9].

    3. Application in Rehabilitation

    The use of VR technology in rehabilitation derives from research in computational neuroscience involving motor learning mechanisms[10]. VR provides real-time visual feedback for movements, thereby increasing engagement in enjoyable rehabilitation tasks[11].

    VR provides alternative rehabilitation programs with new and effective therapeutic tools that can improve the functional abilities in a wide variety of rehabilitation patients in a neurological setting, offering several features, such as goal-oriented tasks and repetition. The use of VR environments for virtual augmented exercise has recently been proposed as having the potential to increase exercise behavior in older adults[12] and it also has the potential to influence cognitive abilities in this population segment[13]. Therefore, VR represents a real opportunity for the cognitive rehabilitation of neurological patients with different neuropsychological symptoms, especially in attention, memory, problem-solving and executive dysfunction, and in behavioral impairments[7][8][9].

    Moreover, VR training has been mostly described for the upper limb[14][15], but also for the lower limb[16], balance and walking[17][18], as well as for perceptual/cognitive skills[19].

    To our knowledge, systematic reviews or meta-analyses have been undertaken to review the utility of VR technologies in a single arm of rehabilitation (i.e., motor or cognitive rehabilitation, upper or lower limb rehabilitation), focusing on a specific pathology (stroke, PD, AD, MS)[6][7][9].

    Despite the growing evidence of the positive effects of VR in rehabilitation of functional and cognitive abilities, some systems still raised concerns regarding their acceptability with complex clinical populations, as, for example, the older people. In particular, during trials with immersive systems, few adverse events have been described by participants, including headache and dizziness[20]. Finally, little is known about the perceived effect of the exposure at multisensory input during a complex activity, such as treadmill walking with VR in patients during post-stroke rehabilitation to improve balance and gait ability[6][21].

    References

    1. Jordi Torner; Stavros Skouras; Jose L. Molinuevo; Juan D. Gispert; Francisco Alpiste; Josi L. Molinuevo; Multipurpose Virtual Reality Environment for Biomedical and Health Applications.. IEEE Transactions on Neural Systems and Rehabilitation Engineering 2019, 27, 1511-1520, 10.1109/TNSRE.2019.2926786.
    2. Heidi Sveistrup; Motor rehabilitation using virtual reality. Journal of NeuroEngineering and Rehabilitation 2004, 1, 10-10, 10.1186/1743-0003-1-10.
    3. Amy Henderson; Nicol Korner-Bitensky; Mindy Levin; Virtual Reality in Stroke Rehabilitation: A Systematic Review of its Effectiveness for Upper Limb Motor Recovery. Topics in Stroke Rehabilitation 2007, 14, 52-61, 10.1310/tsr1402-52.
    4. Lamberto Piron; Andrea Turolla; Michela Agostini; Carla Silvana Zucconi; Laura Ventura; Paolo Tonin; Mauro Dam; Motor Learning Principles for Rehabilitation: A Pilot Randomized Controlled Study in Poststroke Patients. Neurorehabilitation and Neural Repair 2010, 24, 501-508, 10.1177/1545968310362672.
    5. Anaick Perrochon; Benoit Borel; Dan Istrate; Maxence Compagnat; Jean-Christophe Daviet; Exercise-based games interventions at home in individuals with a neurological disease: A systematic review and meta-analysis.. Annals of Physical and Rehabilitation Medicine 2019, 62, 366-378, 10.1016/j.rehab.2019.04.004.
    6. Roghayeh Mohammadi; Alireza Vaezpour Semnani; Majid Mirmohammadkhani; Namrata Grampurohit; Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis.. Journal of Stroke and Cerebrovascular Diseases 2019, 28, 1787-1798, 10.1016/j.jstrokecerebrovasdis.2019.03.054.
    7. Maria Grazia Maggio; Maria Cristina De Cola; Desirèe Latella; Giuseppa Maresca; Chiara Finocchiaro; Gianluca La Rosa; Vincenzo Cimino; Chiara Sorbera; Placido Bramanti; Rosaria De Luca; et al. What About the Role of Virtual Reality in Parkinson Disease’s Cognitive Rehabilitation? Preliminary Findings From a Randomized Clinical Trial. Journal of Geriatric Psychiatry and Neurology 2018, 31, 312-318, 10.1177/0891988718807973.
    8. Anas R. Alashram; Giuseppe Annino; Elvira Padua; Cristian Romagnoli; Nicola Biagio Mercuri; Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology.. Journal of Clinical Neuroscience 2019, 66, 209-219, 10.1016/j.jocn.2019.04.026.
    9. Maria Grazia Maggio; Margherita Russo; Marilena Foti Cuzzola; Massimo Destro; Gianluca La Rosa; Francesco Molonia; Placido Bramanti; Giuseppe Lombardo; Rosaria De Luca; Rocco Salvatore Calabrò; et al. Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes.. Journal of Clinical Neuroscience 2019, 65, 106-111, 10.1016/j.jocn.2019.03.017.
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    11. Sinae Ahn; Sujin Hwang; Virtual rehabilitation of upper extremity function and independence for stoke: a meta-analysis.. Journal of Exercise Rehabilitation 2019, 15, 358-369, 10.12965/jer.1938174.087.
    12. Paul Van Schaik; Jonathan Blake; Fred Pernet; Iain Spears; Clive Fencott; Virtual Augmented Exercise Gaming for Older Adults. CyberPsychology & Behavior 2008, 11, 103-106, 10.1089/cpb.2007.9925.
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    15. Seung Hak Lee; Hae-Yoon Jung; Seo Jung Yun; Byung-Mo Oh; Han Gil Seo; Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games With a Head Mount Display: A Feasibility Study.. PM&R 2019, NA, NA, 10.1002/pmrj.12206.
    16. Luara Ferreira Dos Santos; Oliver Christ; Kedar Mate; Henning Schmidt; Jörg Krüger; Christian Dohle; Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review. BioMedical Engineering OnLine 2016, 15, 144-88, 10.1186/s12938-016-0289-4.
    17. Jeonghun Ku; Yeun Joon Kim; SangWoo Cho; Teo Lim; Hye Sun Lee; Youn Joo Kang; Three-Dimensional Augmented Reality System for Balance and Mobility Rehabilitation in the Elderly: A Randomized Controlled Trial. Cyberpsychology, Behavior, and Social Networking 2019, 22, 132-141, 10.1089/cyber.2018.0261.
    18. Sarah Vogt; Nina Skjæret-Maroni; Dorothee Neuhaus; Jochen Baumeister; Virtual reality interventions for balance prevention and rehabilitation after musculoskeletal lower limb impairments in young up to middle-aged adults: A comprehensive review on used technology, balance outcome measures and observed effects.. International Journal of Medical Informatics 2019, 126, 46-58, 10.1016/j.ijmedinf.2019.03.009.
    19. Karin Törnbom; Anna Danielsson; Experiences of treadmill walking with non-immersive virtual reality after stroke or acquired brain injury – A qualitative study. PLOS ONE 2018, 13, e0209214, 10.1371/journal.pone.0209214.
    20. Chang-Man An; Young-Hyun Park; The effects of semi-immersive virtual reality therapy on standing balance and upright mobility function in individuals with chronic incomplete spinal cord injury: A preliminary study. The Journal of Spinal Cord Medicine 2017, 41, 223-229, 10.1080/10790268.2017.1369217.
    21. Anuja Darekar; Bradford J McFadyen; Anouk Lamontagne; Joyce Fung; Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review.. Journal of NeuroEngineering and Rehabilitation 2015, 12, 46, 10.1186/s12984-015-0035-3.
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