Editorial: JRCRS. 2018; 7(2):39-41

1-Advances in Neurorehabilitation; Application of Virtual Reality in Geriatric Rehabilitation

Dr. Furqan Ahmed Siddiqui¹

¹Professor, Foundation University Institute of Rehabilitation Sciences
Foundation University Islamabad

Full-Text PDF

Virtual reality is the practice of interactive computer simulations presenting operators with opportunity to be involved in atmospheres that seem to be analogous to real world situations (1, 2). Virtual reality has recently became very popular in the field of rehabilitation and it is now used for physical therapy, cognitive rehabilitation and occupational therapy. As compared to conventional therapy,patients show greater compliance and engagement with virtual reality training because of its fun nature as it provides an immersive and illusionary environment to the patient, and the patient can interact with his or her virtual environment in the form of a game. With the use of virtual reality, telerehabilition has also become easier and more feasible, and patients can receive similar training in the comfort of their home and in the absence of a physical therapist. Literature has shown that existing amount of physical therapy is inadequate to result in significant plasticity and reorganization of the brain, following stroke (3). With the use of virtual reality training, additional amount of therapy can be offered to the patient in the absence of a physical therapist, in the form of home exercise program and telerehabilitation(2). Another benefit, of tele rehabilitation is that objective measurements can be included in the computer system and real time objective measurements can be recorded and analyzed for patient’s treatment progression and prognosis (1).

Advancement in Virtual Reality Systems

With the advancement in technology the virtual reality equipment and hardware are becoming more and more improved than before. In terms of visual feedback,visual display units (VDU) were used in systems like Wii fit by Nintendo and Kinect by Xbox etc, however, recently head mounted display (HMD) have been used in systems like Oculus, Vive and smartphones etc(2). In terms of sensor technology, both body tracking systems as well walking platforms (e.g. Virtuix) are now being used in virtual reality systems(3).Moreover, in terms of human computer interaction, advances in virtual reality technology provide more realistic atmosphere to the users, resulting in a very realistic spatial-temporal stimuli to facilitate learning(4). In fact, literature has also shown that visual stimuli in a virtual environment can possibly activate the mirror neuron system, and large scale cortical regions via several feedback mechanisms, following brain reorganization and neuroplasticity(4, 5).

Neuro-Rehabilitation using virtual reality training

Literature has shown virtual reality training to be effective in the management of different neurological conditions, including stroke(6, 7), Parkinson’s disease (8), multiple sclerosis(9, 10) and traumatic brain injury andalso in geriatric rehabilitation(11). In terms of outcomes, virtual reality training is found to be effective in terms of upper and lower extremity function, gait, balance, activity training and cognition (2). Moreover, in addition to neurological conditions, virtual reality training is also becoming increasingly popular in geriatric rehabilitation (11).

Effects of virtual reality training in geriatric rehabilitation

The most common equipment used for geriatric rehabilitation in literature has been shown to be Nintendo Wii, followed by computer games(11). Literature shows that virtual reality training exerts a positive motivation in the elderly to exercise, and participants report high level of enjoyment(11). Virtual reality training is found to be effective in the geriatric population in terms of improving physical functioning(12), mobility(13, 14), balance(12, 15-17), reaction time, muscular strength(18), fall risk(19, 20), cognition and executive functioning(21). However, it is imperative to point out that even though virtual reality training results in improvements in physical functioning, review of the literature shows that there is not sufficient and compelling evidence that virtual reality training is significantly more effective than conventional exercise training(11). Moreover, it is also imperative to point out that fall risk is a major problem in the aging population, and physical therapy interventions including virtual reality training have been focused at improving static and dynamic balance in the elderly. However, according to a recent study published in 2019 no significant correlation of Fall Risk Score (FRS) was observed with Berg Balance Scale (BBS), Timed Up and Go (TUG) and Forward reach Test (FRT), suggesting that balance is not the sole predictor of fall risk in the elderly, and attention should be paid to other factors including muscle performance, gait, and anthropometric parameters to reduce fall risk in the elderly (22).

References

1. Lam YS, Man DW, Tam SF, Weiss PL. Virtual reality training for stroke rehabilitation. NeuroRehabilitation. 2006;21(3):245-53.
2. Ku J, Kang YJ. Novel Virtual Reality Application in Field of Neurorehabilitation. Brain & Neurorehabilitation. 2018;11(1).
3. Lang CE, MacDonald JR, Reisman DS, Boyd L, Kimberley TJ, Schindler-Ivens SM, et al. Observation of amounts of movement practice provided during stroke rehabilitation. Archives of physical medicine and rehabilitation. 2009;90(10):1692-8.
4. Prochnow D, Bermúdez i Badia S, Schmidt J, Duff A, Brunheim S, Kleiser R, et al. A functional magnetic resonance imaging study of visuomotor processing in a virtual reality‐based paradigm: Rehabilitation Gaming System. European Journal of Neuroscience. 2013;37(9):1441-7.
5. Oujamaa L, Relave I, Froger J, Mottet D, Pelissier J-Y. Rehabilitation of arm function after stroke. Literature review. Annals of physical and rehabilitation medicine. 2009;52(3):269-93.
6. Lee HS, Park YJ, Park SW. The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. BioMed Research International. 2019;2019.
7. Henderson A, Korner-Bitensky N, Levin M. Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Topics in stroke rehabilitation. 2007;14(2):52-61.
8. Liao Y-Y, Yang Y-R, Cheng S-J, Wu Y-R, Fuh J-L, Wang R-Y. Virtual reality–based training to improve obstacle-crossing performance and dynamic balance in patients with Parkinson’s disease. Neurorehabilitation and neural repair. 2015;29(7):658-67.
9. Eftekharsadat B, Babaei-Ghazani A, Mohammadzadeh M, Talebi M, Eslamian F, Azari E. Effect of virtual reality-based balance training in multiple sclerosis. Neurological research. 2015;37(6):539-44.
10. Massetti T, Trevizan IL, Arab C, Favero FM, Ribeiro-Papa DC, de Mello Monteiro CB. Virtual reality in multiple sclerosis–a systematic review. Multiple sclerosis and related disorders. 2016;8:107-12.
11. Molina KI, Ricci NA, de Moraes SA, Perracini MR. Virtual reality using games for improving physical functioning in older adults: a systematic review. Journal of neuroengineering and rehabilitation. 2014;11(1):156.
12. Laufer Y, Dar G, Kodesh E. Does a Wii-based exercise program enhance balance control of independently functioning older adults? A systematic review. Clinical interventions in aging. 2014;9:1803.
13. Bisson E, Contant B, Sveistrup H, Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyberpsychology & behavior. 2007;10(1):16-23.
14. Maillot P, Perrot A, Hartley A. Effects of interactive physical-activity video-game training on physical and cognitive function in older adults. Psychology and aging. 2012;27(3):589.
15. Rendon AA, Lohman EB, Thorpe D, Johnson EG, Medina E, Bradley B. The effect of virtual reality gaming on dynamic balance in older adults. Age and ageing. 2012;41(4):549-52.
16. Bieryla KA, Dold NM. Feasibility of Wii Fit training to improve clinical measures of balance in older adults. Clinical interventions in aging. 2013;8:775.
17. Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs. Archives of physical medicine and rehabilitation. 2012;93(7):1138-46.
18. Jorgensen MG, Laessoe U, Hendriksen C, Nielsen OBF, Aagaard P. Efficacy of Nintendo Wii training on mechanical leg muscle function and postural balance in community-dwelling older adults: a randomized controlled trial. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences. 2012;68(7):845-52.
19. De Bruin E, Schoene D, Pichierri G, Smith ST. Use of virtual reality technique for the training of motor control in the elderly. Zeitschrift für Gerontologie und Geriatrie. 2010;43(4):229-34.
20. Schoene D, Lord SR, Delbaere K, Severino C, Davies TA, Smith ST. A randomized controlled pilot study of home-based step training in older people using videogame technology. PloS one. 2013;8(3):e57734.
21. Kayama H, Okamoto K, Nishiguchi S, Yamada M, Kuroda T, Aoyama T. Effect of a Kinect-based exercise game on improving executive cognitive performance in community-dwelling elderly: case control study. Journal of medical Internet research. 2014;16(2):e61.
22. Siddiqi FA, Masood T, Osama M, Azim ME, Babur MN. Common balance measures and fall risk scores among older adults in Pakistan: Normative values and correlation. JPMA. 2019.