Abstract
In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a treatment for motor and cognitive dysfunction is to improve neuroplasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic intervention for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders, and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation and its complimentary use with neuroimaging (e.g., fNIRS and EEG) and neuromodulation (e.g., tDCS and rTMS), more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.
Highlights
In the last two decades, the application of virtual reality (VR) training has become increasingly popular, as a means to enhance gaming experiences, and in the education and healthcare settings to improve learning and rehabilitation outcomes
While the results showed no statistical differences in stroke-specific clinical measures (i.e., Fugl-Meyer assessment, Wolf motor assessment, and modified Ashworth scale) of upper arm function between patients receiving real transcranial direct current stimulation (tDCS) compared to sham, it is important to note that more than 50% of participants receiving anodal tDCS and VR therapy had clinically significant improvements in wrist spasticity following treatment
The current evidence suggest that a combination of VR and conventional therapies are safe and likely to be more efficacious compared to just traditional or VR therapy alone
Summary
In the last two decades, the application of VR training has become increasingly popular, as a means to enhance gaming experiences, and in the education and healthcare settings to improve learning and rehabilitation outcomes. Patients practice and refine fine motor control of muscles controlling the hands and wrists through manipulating a virtual object that allows the same kind of natural interaction with objects that patients would engage in the real world Another important aspect of VR therapy is the ability to provide augmented feedback to its users. Observation of goal-oriented movements or processes provides sensory feedback about the movement, behavior or emotional state, which contributes to learning (Oouchida et al, 2013; Williams and Carnahan, 2014) These observations preferentially activate parts of the brain that are involved with the physical performance itself allowing a motor program to be developed based upon the observed movements (Burke et al, 2010). Training in a VE may facilitate observational learning in four different ways; (1) VR applications can provide an accurate visual representation of the user’s body and limb position using motion capture technology; (2) VR applications commonly use an avatar to mimic the movement of users, or the user could mimic the movements of the avatar; (3) accurate guides or a correct movement pattern can be produced for which users can follow; (4) VR applications can facilitate mental imagery by inducing optimal mood states and instructions for mental imagery
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