PROMOTING PHYSICAL RECOVERY IN NEUROLOGICAL DISEASES THROUGH IMMERSIVE VIRTUAL REALITY: A SYSTEMATIC REVIEW

I. Patsaki¹, N. Dimitriadi², D. Tzoumi¹, A.-.A. Despoti³, N. Leventakis³, G. Roussou³, A. Papathanasiou⁴, S. Nanas³, L. Karatzanos³

Background: Neurological disorders affect a significant amount of people every year, limiting their functional ability and changing their daily living. Over the past few years technological innovations, such as virtual reality (VR) seem to have the potential for augmenting rehabilitation. Immersive VR has gained particular attention through its ability to deliver a customized training session, and increase the patients’ engagement through immersion into simulated environments.

Purpose: To investigate the effectiveness of fully immersive VR rehabilitation program using a Head Mounted Display in adult neurological disorders.

Methods: A systematic search was conducted in Pubmed and Pedro databases. Articles published until May 2020 were included. The key words used, in appropriate combinations were “immersive, virtual reality, neurorehabilitation, stroke, neurological disorders, head mounted display, safety, functional ability, physical functioning”. Additional, applicable articles were identified through screening reference lists of relevant articles.

Results: We indentified 11 RCT studies and 5 series of cases that used Head Mounted Display (HMD) for immersing the patient into the virtual word. Studies that were identified were conducted with stroke (Ν=9), multiple sclerosis (Ν=1) and Parkinson’s disease (Ν=4) patients. 241 neurological patients were recruited, while in some studies the control group involved healthy people of matching age to investigate safety and feasibility. The intervention group in some studies involved only rehabilitation through VR and in some a combination of VR with a more traditional program while the control received only the traditional one. HMD was combined with haptic devises/controllers in studies (N= 6) investigating hand recovery In order Apart from the feasibility of VR, a range of benefits were identified, especially in terms of functional ability as measured by FIM or Barthel, strength, gait (2/2 studies) and balance outcomes (2/2 studies). Upper arm functionality as measured by the  Action Research arm Test, Box and Block Test, Fugl-Meyer assessment of physical performance was improved in 4/5 studies. Physical endurance was investigated in 3 studies with positive effect favoring  VR.  Limitations identified involved a short intervention period, small number of participants  and the different outcomes used present a serious challenge to generalize the findings.  

Conclusion(s): The results from this review present a potential beneficial effect of VR in neurological patients, maximizing recovery in terms of hand rehabilitation and activities of daily living. Additionally, it was found to be a safe intervention even in patients with acute stage stroke.

Implications: The results support potential of VR as a therapeutic approach of neurological patients and provide  insights for future technology development in neurorehabilitation field. Further research is needed to investigate how VR could be applied to lower limb rehabilitation and to maximize the interface between the patient and the virtual environment, offering a multiple therapeutic approach combining both cognitive and physical rehabilitation.

Funding, acknowledgements: European Regional Development Fund and National resources thought the Operational Program Competitiveness, Entrepreneurship & Innovation

Keywords: immersive virtual reality, neurorehabilitation, functional ability

Topic: Disability & rehabilitation

Did this work require ethics approval? No

Institution: Athens Medical School, Kapodistrian University of Athens

Committee: Kapodistrian University of Athens

Reason: This study was a systematic review.