Virtual Reality- upper extremity

It is estimated that 55 to 75% of individuals who suffer a stroke experience persistent impairment of the affected upper limb (UL) up to 6 months post-stroke. There is a need to identify the best training strategies for regaining motor function of the UL. One intervention showing promise is virtual reality (VR) using immersive and non-immersive technology. Before recommending VR for use in clinical practice, it is important to understand the evidence regarding its effectiveness.

Virtual Reality is an environment that is simulated by a computer. It provides an interactive multi-sensory stimulation in real-time. VR provides users an opportunity to engage in activities within the environments that appear and feel similar to real world objects and events. Most virtual reality environments are primarily visual experiences, displayed either on a computer screen or through special stereoscopic displays, but some simulations include additional sensory information, such as sound through speakers or headphones. Users can interact with a virtual environment through the use of standard input devices such as a keyboard and mouse, or through multimodal devices such as a wired glove.

Generally, there are two types: immersive, and non-immersive.

Full immersive VR is when the environment is viewed through a device such as a head-mounted display (HMD) to create the illusion that one is inside the environment. But immersion can also be accomplished through Large Screen Projection (LSP) and by using a cave system (BNAVE). In more immersive systems various interface devices are used: a computer mouse and keyboard, Cyberglove/Cybergrasps, joysticks or force sensors.

Non-immersive, or partially immersive VR, is when the user views the scene on a computer screen and it appears as though the user is watching TV. The achievement of different levels of "virtual presence" is related to the degree of immersion in relation to the meaning of virtual tasks to the user.

VR is becoming increasingly popular as it can be easily modified according to the needs of individuals, it is perceived as being fun and motivating for patients, and allows researchers to incorporate elements such as feedback that have been shown to maximize motor learning. On the negative side, 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 is now reasonably affordable for clinical use. Prior to recommending the use of VR for widespread clinical practice for UL rehabilitation, it is important to understand the current evidence regarding its effectiveness.

Authors*:Amy Henderson, PhD Student, Neuroscience; Dr. Nicol Korner-Bitensky PhD OT, Mindy Levin, PhD PT; Geoffroy Hubert BSc. Lic. K. ; Elissa Sitcoff B.Sc, B.A.
Expert reviewer: Francine Malouin PhD, PT