Virtual Reality (VR) is an innovative technology that aids the user to simulate experiences in worlds similar or different to our own. The technology was introduced in the 1970s as a means to aid in skills development for specific occupations in fields such as healthcare, aerospace, and military. VR has also recently gained popularity through commercial videogame adaptation. The use of VR in videogames also allows for its intersection in healthcare delivery, specifically as a novel approach for rehabilitation post-injury. This article will discuss the use of VR for rehabilitation and physical therapy delivery with a comparison against conventional treatment.
The most obvious practical application for VR therapy is in stroke rehabilitation. Stroke often confers impairments in movement, cognition, sensory function. These often manifest with handicaps in activities of daily living (ADLs) such as driving, writing, and shopping. Rehabilitation therapy is designed to engage in movements that simulate functional tasks. These therapies are usually repetitive movements with emphasis placed on sustained repetition, follow-through, and integration towards independence. Most functional recovery is made within a few weeks after injury via neuroplasticity. However, there is significant evidence to suggest gains are made even long after a stroke. Limitations to recovery include decreased patient participation, absence of individual functional training, and resource limitation (e.g., hospital without adequate rehabilitation equipment).
Because VR can simulate ADLs, it allows patients to practice everyday activities and improve functional recovery. Furthermore, VR-simulated environments and tasks are created with the patient’s goals in mind. VR software can provide visual feedback to the patient and therapist during specific activities, which allows treatment plans to be customized to the patient’s needs.
VR applications for rehabilitation therapy have been studied by several groups, and a recent Cochrane review organized these findings. Upon review of the current research, Cochrane determined that there is no substantial evidence to suggest that specific treatment for the upper extremity with VR is more beneficial than conventional treatments for stroke rehabilitation. There is also insufficient evidence to suggest that VR can improve gait speed, balance, participation, or motivation with therapy. Data suggests that VR is not preferable to conventional therapy; however, these studies did not look at customized therapy programs. The data does suggest that VR may be used as an adjunctive treatment. There is also evidence to suggest that higher durations of VR therapy and personalized computer programs lead to higher participation (however, it was not statistically significant). There is, overall, a paucity of evidence.
It should be noted that VR therapy is not cost-free. A sufficiently advanced computer is required to drive computer-based applications for simulation. Also, training must be given to staff and patients. Specific hardware and tracking systems are needed for treatments based on the patient’s preferred functional task simulation. There is also the potential for side effects with treatment including headache, nausea, vomiting, anxiety exacerbation, and visual discomfort. These costs and limitations may disrupt widespread adoption.
VR is a novel approach to rehabilitation therapy after injury. The application has the potential to aid functional recovery after stroke and augment traditional therapies. It can confer increased participation and satisfaction with rehabilitation therapy. There is a lack of evidence that VR treatment is superior to conventional therapy for stroke rehabilitation. Lastly, VR also comes with increased costs and these should be factored in before a practice or health system elects adoption of this novel technology.
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