Abstract
Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration’s tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= −2.29; 95% confidence interval: −3.00 to −1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.
Highlights
Spinal cord injury (SCI) involves an alteration of the spinal cord that causes a disorder or loss of proprioception, mobility, or autonomous function [1,2]
It is important to remark that we considered as conventional physical therapy (CPT) any standardized exercise used into the physical therapy program aiming to enhance sitting or standing balance, as well as any exercise focused on strengthening and/or stretching musculature [30], as defined by the World Confederation of Physical Therapy (WCPT) [32]
It must be emphasized that all the studies reported significant effects on balance recovery for virtual reality (VR) interventions compared to CPT, so we can conclude that VR interventions provided potential benefits in addition to CPT to recover balance in patients with SCI
Summary
Spinal cord injury (SCI) involves an alteration of the spinal cord that causes a disorder or loss of proprioception, mobility, or autonomous function [1,2]. The neurological rehabilitation of patients with SCI is focused on recovering functional performance, mobility, and balance, among others [3]. One of the emerging rehabilitation tools in recent years is the application of virtual reality (VR)-based technologies [6]. VR is a therapeutic option for rehabilitation in neurological disorders and the use of this technology has increased in recent years. VR comprises two types of systems according to the immersion level: (i) semi-immersive or non-immersive systems, and (ii) immersive systems. Semi-immersive and non-immersive systems use a screen to display the environment with a low level of immersion. Immersive systems offer full integration of the user into the virtual environment and these systems can incorporate other devices (e.g. gloves, exoskeletons, etc.) to provide sensory inputs to the patient. VR caves, large-screen projections, and head-mounted displays are considered as immersive VR systems [7]
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