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Varilo V1, Härkönen U2, Valtonen A2
1Hospital District of Helsinki and Uusimaa, Department of Internal Medicine and Rehabilitation, Helsinki, Finland, 2Metropolia University of Applied Sciences, Department of Human Movement and Functioning, Helsinki, Finland
Background: Neglect (hemiagnosia) is a common stroke related failure to pay attention to stimuli on one side. Neglect deteriorates patient's ability to cope and predicts poor recovery of functional independence. Virtual reality (VR) offers options for clinical assessment and rehabilitation of neglect which completes conventional rehabilitation. Additionally, VR enables simulated practice of functional tasks in variable and easily manageable environments. Real-time interactive practice in computerized environments improves motor skills by providing task-oriented learning scenarios with easily controllable variables.
Purpose: The objective of this narrative literature research was to identify existing VR-based treatment and assessment tools utilized for patients with post-stroke neglect, and to conclude the effects of VR rehabilitation for neglect treatment.
Methods: During the summer of 2017, we carried out literature search in the Pubmed and the Cinahl databases applying the systematic literature search methods. Overall, the search strategy identified 145 studies. A total of 14 studies - reaching from the year 2010 to 2017 - met the inclusion and avoided the exclusion criteria.
Results: Our dataset consists of 14 studies. Nine of them are related to VR-based assessment and five to VR-based treatment tools for post-stroke neglect. Based on the results, VR-based treatment and assessment enable intensive task-oriented practice in variable and easily controllable environments. Virtual environments provide multisensory stimulation and require dynamic response to stimuli, as in real environment. Patients can practice daily activities which provide visual, audio and haptic feedback of their performance. Furthermore, VR-based assessment tools are more engaging and consequently more effective than conventional methods. Based on one fair quality randomized controlled trial of left hemibody, VR training is more effective than traditional visual scanning training in improving unilateral spatial neglect symptoms in patients with acute and subacute stroke.
Conclusion(s): Virtual reality opens an avenue for the development of effective assessment and treatment for post-stroke neglect rehabilitation. The practice of daily activities in virtual environments enhances the recovery. Several studies utilized moving stimuli which may be crucial to modulate patients' visual attention contralateral to the brain lesion. However, this review clarifies that research is still insufficient. Furthermore, rehabilitation methods are often incomparable since equipment, assessment metrics, virtual environments and intensity of practice vary between distinct studies, and the repeatability of the results are yet to be proven. It is essential for future research to survey distinct neglect patients with divergent brain lesions in various stages to obtain the optimal next-generation virtual reality rehabilitation methods.
Implications: Virtual reality can be utilized as a part of clinical assessment and rehabilitation of post-stroke neglect and it offers clinical options for conventional rehabilitation methods.
Keywords: virtual reality, stroke, neglect
Funding acknowledgements: The work was unfunded.
Purpose: The objective of this narrative literature research was to identify existing VR-based treatment and assessment tools utilized for patients with post-stroke neglect, and to conclude the effects of VR rehabilitation for neglect treatment.
Methods: During the summer of 2017, we carried out literature search in the Pubmed and the Cinahl databases applying the systematic literature search methods. Overall, the search strategy identified 145 studies. A total of 14 studies - reaching from the year 2010 to 2017 - met the inclusion and avoided the exclusion criteria.
Results: Our dataset consists of 14 studies. Nine of them are related to VR-based assessment and five to VR-based treatment tools for post-stroke neglect. Based on the results, VR-based treatment and assessment enable intensive task-oriented practice in variable and easily controllable environments. Virtual environments provide multisensory stimulation and require dynamic response to stimuli, as in real environment. Patients can practice daily activities which provide visual, audio and haptic feedback of their performance. Furthermore, VR-based assessment tools are more engaging and consequently more effective than conventional methods. Based on one fair quality randomized controlled trial of left hemibody, VR training is more effective than traditional visual scanning training in improving unilateral spatial neglect symptoms in patients with acute and subacute stroke.
Conclusion(s): Virtual reality opens an avenue for the development of effective assessment and treatment for post-stroke neglect rehabilitation. The practice of daily activities in virtual environments enhances the recovery. Several studies utilized moving stimuli which may be crucial to modulate patients' visual attention contralateral to the brain lesion. However, this review clarifies that research is still insufficient. Furthermore, rehabilitation methods are often incomparable since equipment, assessment metrics, virtual environments and intensity of practice vary between distinct studies, and the repeatability of the results are yet to be proven. It is essential for future research to survey distinct neglect patients with divergent brain lesions in various stages to obtain the optimal next-generation virtual reality rehabilitation methods.
Implications: Virtual reality can be utilized as a part of clinical assessment and rehabilitation of post-stroke neglect and it offers clinical options for conventional rehabilitation methods.
Keywords: virtual reality, stroke, neglect
Funding acknowledgements: The work was unfunded.
Topic: Neurology: stroke
Ethics approval required: No
Institution: Metropolia University of Applied Sciences (MUAS)
Ethics committee: Ethics Committees approved the original studies. MUAS approved this study.
Reason not required: The approval of Metropolia University of Applied Sciences was sufficient for the narrative literature study.
All authors, affiliations and abstracts have been published as submitted.
