Virtual Reality Rehabilitation from Social Cognitive and Motor Learning Theoretical Perspectives in Stroke Population

Bita Imam,Tal Jarus

doi:10.1155/2014/594540

Abstract

Objectives. To identify the virtual reality (VR) interventions used for the lower extremity rehabilitation in stroke population and to explain their underlying training mechanisms using Social Cognitive (SCT) and Motor Learning (MLT) theoretical frameworks. Methods. Medline, Embase, Cinahl, and Cochrane databases were searched up to July 11, 2013. Randomized controlled trials that included a VR intervention for lower extremity rehabilitation in stroke population were included. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality of the included studies. The underlying training mechanisms involved in each VR intervention were explained according to the principles of SCT (vicarious learning, performance accomplishment, and verbal persuasion) and MLT (focus of attention, order and predictability of practice, augmented feedback, and feedback fading). Results. Eleven studies were included. PEDro scores varied from 3 to 7/10. All studies but one showed significant improvement in outcomes in favour of the VR group (P < 0.05). Ten VR interventions followed the principle of performance accomplishment. All the eleven VR interventions directed subject's attention externally, whereas nine provided training in an unpredictable and variable fashion. Conclusions. The results of this review suggest that VR applications used for lower extremity rehabilitation in stroke population predominantly mediate learning through providing a task-oriented and graduated learning under a variable and unpredictable practice.

Highlights

Stroke is a global, debilitating problem which is increasing both in prevalence and incidence [1, 2]
Feedback fading was provided in only two virtual reality (VR) interventions [29, 31]. This was the first systematic review undertaken to attempt to explain the underlying training mechanisms of VR interventions in stroke population based on the Social Cognitive (SCT) and Motor Learning Theory (MLT)
The SCT and MLT might explain the underlying training mechanisms of the VR interventions that resulted in enhanced learning and improvement in the outcomes

Summary

Introduction

Stroke is a global, debilitating problem which is increasing both in prevalence and incidence [1, 2]. It is reported that between 55 and 75% of stroke survivors suffer from motor impairments which substantially reduce the quality of their life [5, 6]. During rehabilitation, stroke survivors must learn or relearn voluntary control over the affected muscles. The current standard of care for stroke rehabilitation is comprised of physical therapy and occupational therapy that help motor skills learning or relearning after stroke. The standard rehabilitation for stroke is labourand resource-intensive, tedious and often results in modest and delayed effects in clients [7, 8]. Promising results have been reported by studies regarding the benefits of VR treatment for motor learning or relearning after stroke [10]

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