Virtual Reality (VR) is an environment that is simulated by a computer. It provides an interactive multi-sensory stimulation in real-time. VR provides users with the opportunity to engage in activities within an environment that appears and feels similar to real world objects and events. 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. 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 it 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.
Note: In this module we did not differentiate between immersive and non-immersive VR. This categorization is determined mainly by the degree of ‘virtual presence’ the subject experienced during training, and this information was not made readily available in most of the studies reviewed.
Note: This review focuses on any type of therapy involving a virtual environment. For a specific review of commercial game systems used for physical rehabilitation (e.g. Sony Playstation EyeToy, Nintendo Wii), please see the Video Games module. Studies were excluded in instances where the intervention did not pertain to lower extremity/mobility rehabilitation (e.g. cognitive rehabilitation), no outcomes of interest pertained to lower extremity/mobility (e.g. gait parameters, balance, etc.), or where both groups received a form of VR-based rehabilitation.
To date 11 high quality RCTs, 7 fair quality RCTs, and 2 quasi-experimental design studies have investigated the effect of virtual-reality based training for the lower extremity/mobility rehabilitation in patients with stroke.
Overall, effects of virtual reality-based training on lower-extremity/mobility were examined predominantly among patients with chronic stroke and included the used of VR ankle, balance, postural control, stepping exercises and treadmill gait training. Improvements in outcomes such as balance, gait parameters, walking speed and endurance, and functional ambulation/mobility were found in patients receiving the VR-based training in comparison to those receiving conventional gait/balance training or conventional physical therapy or no additional VR training.
Authors*: Tatiana Ogourtsova, PhD(c) OT, Adam Kagan BSc, Dr. Nicol Korner-Bitensky PhD OT, Annabel McDermott OT
Expert reviewer: Francine Malouin PhD, PT
Evidence reviewed as of before 06-08-2017