Virtual Reality- upper extremity
2. Are there different kinds of virtual reality?
3. Why use virtual reality after a stroke?
6. Who provides the treatment?
Authors*: Amy Henderson, PhD Student, Neuroscience; Dr. Nicol Korner-Bitensky PhD OT, Mindy Levin, PhD PT; Geoffroy Hubert BSc. Lic. K. ; Elissa Sitcoff BSc. B.A.
Expert: Francine Malouin PhD, PT
Additional support from undergraduate students, School of Physical and Occupational Therapy, McGill University: Kareim Aziz, Sara Jafri, James Moore, Sebastien Mubayed, Roshnie Shah, Samrah Sher, and Peter Yousef
Virtual Reality is an environment that is simulated by a computer. Most virtual reality environments are primarily visual experiences, displayed either on a computer screen or through special stereoscopic displays (see picture 1), and may also include auditory stimulation through speakers or headphones. Users can interact with the virtual environment through the use of devices such as a keyboard, a mouse, or a wired glove (see picture 2).
2. Are there different kinds of virtual reality?
Generally, there are two types of virtual reality: full immersion, and non-immersion.
Full immersive VR is when the environment is viewed through a device such as a head-mounted display to create the illusion that one is inside the environment.
Non-immersive, or partially immersive VR, is when the user views the scene on a computer screen and it appears as if he was watching TV.
3. Why use virtual reality after a stroke?
Loss of leg function, movement, and strength are common after a stroke, and can result in the impairment of walking and standing.
Virtual reality is becoming an increasingly popular intervention used to improve the use of one's leg after a stroke. It can be easily modified according to the needs of the individual, is perceived as being fun and motivating for patients, and allows researchers to include elements such as feedback that have been shown to maximize learning.
Researchers have studied how virtual reality can help stroke patients:
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Remapping of the brain: virtual reality has been shown useful in retraining of the brain in persons who have had a stroke.
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Walking: virtual reality was shown to be more useful than regular rehabilitation in improving walking speed, length of step, stamina, and strength in people who have had a stroke.
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Stepping over obstacles:evidence has shown that virtual reality does not lead to any more improvement in stepping over obstacles than regular rehabilitation therapy.
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Stair-climbing: There are no well-designed research studies that look at the effect of virtual reality on stair-climbing ability.
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Community living skills: There is some evidence that shows that virtual reality is more useful than regular rehabilitation in helping people who have had a stroke develop the community living skill of "cross the street" or walking. However, there is conflicting evidence as to whether virtual reality provides any further benefit compared to regular rehabilitation in developing the community living skill "taking the train" in people who have had a stroke.
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Perceived walking performance: There is evidence from one high quality study that virtual reality does not lead to any more improvement in how well patients view their ability to walk compared to regular rehabilitation therapy.
Use of devices such as a head-mounted display can cause nausea and vertigo.
No real risks have been reported because of the absence of external manipulation. All activities are self-paced and under individual control and perception of movement.
6. Who provides the treatment?
VR treatments are usually provided by a Physical Therapist or Occupational Therapist. Presently most rehabilitation centers and private clinics are not equipped with this technology other than for research purposes. But, given the promising early evidence for the value of using VR, this treatment is likely to be integrated as part of post-stroke therapy in the future.
Information on the amount and intensity of VR training needed is still not available. High quality studies need to be conducted before advice can be given regarding specific programs and content of treatment sessions.
There is concern that the use of VR in the clinic is not possible due to the cost of the required equipment. While certainly true when this technology was created, the cost of virtual reality hardware and software has decreased and should soon be reasonably affordable for clinical use.
There is clear evidence that there are benefits to using virtual reality in comparison to regular therapy or no therapy. These benefits include walking strength, how fast you can walk, length of step, stamina, the community living skill "crossing the street", and remapping of the brain. However, in terms of obstacle clearance, VR was not shown to be more effective than conventional therapy. More studies are needed to determine if VR is an effective intervention for stair-climbing and the community living skill "taking the train". So, overall, VR is an effective treatment you may want to consider after a stroke. If you are interested in learning more about VR, speak to your rehabilitation provider about the possibility of using this treatment.
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.