Ride ‘em cowboy! The therapeutics of virtual reality technology and simulation

Abstract

Linked Comment: Yoo et al. Int J Clin Pract 2014; 68: 941–9. Chronic low back pain is ubiquitous. Although pharmacotherapy can provide symptomatic relief 1, fundamental changes in body composition and muscle strength may more durably address this problem. Physical activities like swimming, walking and cycling, practiced at moderate intensity can help to maintain fitness and control pain 2, 3. However, not all physical activities are easily accessible, or free of safety issues. An example would be horseback riding. In this issue of the International Journal of Clinical Practice, Yoo et al. 4 describe a horse simulator machine that provides real horse movement and is intended to stimulate a higher level of posture enhancement and improve motor function, strength and muscle size. An 8-week clinical trial was conducted with 47 men with chronic low back pain who were randomised to a horse simulator riding group or a control group. Pain, body composition and isokinetic trunk strength were measured. Horse simulator exercise significantly reduced pain scores and enhanced isokinetic torques of the trunk. There was also significantly increased muscle mass and decreased fat mass in the participants in the horse simulator riding group. During real horseback riding, responding to a changing environment encourages adaptive behaviours or movement strategies, reducing the displacement of the rider's centre of gravity and keeping themselves on the moving horse 4. Adjusting to the horse simulator's movements also involves the use of these same muscles and joints. Thus, as the authors have noted, a horse simulator provides the benefits of a real horse including rhythmical movement, except the warmth of the horse's body. However, the latter can also be simulated if desired. Remaining missing are the care and feeding (and cleaning up after) the real horse. Simulated horse riding is a form of ‘virtual reality’, a technology that has usually been associated with entertainment rather than therapeutics. Yoo et al. have reported on a rather sophisticated machine that only superficially resembles the amusement arcade machines that simulate skiing or other sports. The technology is reminiscent also of the Nintendo Wii Fit game with balance board (http://wiifit.com/). Repurposing entertainment technology for therapeutic use is anticipated to be more common as technology continues to advance. In development is a headset that delivers a three-dimensional immersive experience that is perhaps neurologically indistinguishable from the outside world 5. This may be a real game-changer, and although intended for actual games, may also have medical applications. No disclosures relevant to the subject of this editorial other than being married to a physiatrist and having a lifelong fascination with technology.