VR-based Rehabilitation Research Articles

Effectiveness of non-immersive virtual reality exercises for balance and gait improvement in older adults: A meta-analysis.

Virtual reality (VR)-based physical exercise is an innovative and effective intervention strategy for healthcare in older adults. This meta-analysis aimed to clarify the effects of VR-based balance exercise programs on various balancing abilities of older adults. In addition, the effect size of each variable was computed by total exercise time, sensor type, avatar presence, and feedback type to determine influencing factors that lead to the success of VR-based rehabilitation programs. The databases searched were PubMed/Medline, CINAHL, NDSL, and Google Scholar. Inclusion criteria were: (1)independent older adults; (2) non-immersive VR exercise; (3) randomized controlled design; (4) both balance and gait data; and (5) written in English and Korean. The studies without information to compute effect sizes were excluded. Standardized mean difference was used to analyze the effect size (d). Twenty-five studies were finally included in this study. The main findings of this meta-analysis were as follows: (1)Non-immersive VR-based balance exercises are moderately and largely effective for improving overall balance function, (2) VR balance exercise was more effective for static balance than for gait, (3) VR exercise is more effective when avatars are presented and KP is provided as feedback. Total exercise time and mode of feedback are influencing factors that affect the effectiveness of VR-based balance exercises.

Role of Virtual Rehabilitation in Total Knee Arthroplasty: Functional Outcomes and Cost-Effectiveness

This review article aims to explore the role of virtual rehabilitation in total knee arthroplasty in terms of functional outcomes and cost-effectiveness. Total knee arthroplasty (TKA) is a widely performed surgery for end-stage knee osteoarthritis, requiring supervised rehabilitation for rapid recovery and pain relief. Virtual rehabilitation has been evolving as an alternative to the traditional rehabilitation program in the recent years especially during the predicament of COVID-19 pandemic. Virtual rehabilitation leverages virtual reality (VR) technology to provide innovative, engaging, and measurable rehabilitation services that can complement or replace traditional therapy approaches. Virtual reality and telerehabilitation represent evolving fields in TKA rehabilitation, offering advantages over traditional therapy in terms of cost-effectiveness, improved outcomes, enhanced exercise adherence, and reduced barriers to accessing postoperative therapy. Despite the need for more research and standardized protocols, VR-based rehabilitation holds significant potential for optimizing the recovery process for patients undergoing TKA. The research indicates that VR-based rehabilitation programs for TKA patients have utilized a variety of interactive virtual environments, gaming activities, and feedback mechanisms to supplement traditional physical therapy exercises. Virtual rehabilitation for TKA encourages clinician-patient interaction beyond the hospital setting and offers the advantages of cost savings, convenience, at-home monitoring, and coordination of care, improved functional outcomes, increased exercise adherence, better balance performance, and psychological benefits like reduced stress and anxiety, all of which are geared to improve adherence and overall patient satisfaction. This review article outlines the importance of virtual rehabilitation in TKA, emphasizing cost-effectiveness and improved balance and function while maintaining enhanced adherence and exercise performance. This article also delves into the mode of administration of VR-based rehabilitation and its delivery, safety concerns, advantages and disadvantages, as well as the most common VR-based rehabilitation protocols for TKA. Further, it discusses the implications of virtual rehabilitation in the healthcare system and future directions for virtual rehabilitation in TKA. In conclusion, the evidence indicates that virtual physical therapy (PT) with remote clinical oversight is a safe, effective, and more cost-effective alternative to traditional in-person PT for patients undergoing TKA. Keywords: Virtual rehabilitation, virtual physical therapy, telehealth, telerehabilitation, total knee arthroplasty.

Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study.

Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation.

Effectiveness of Virtual Reality-Based Interventions for Upper Limb Rehabilitation in Breast Cancer Patients: Systematic Review and Meta-Analysis.

Purpose: To investigate the effectiveness of virtual reality (VR)-based interventions for functional rehabilitation of the upper limb in breast cancer patients through a systematic review and meta-analysis. Methods: The PubMed, Cochrane, Web of Science, CINAHL, Scopus, CNKI, Wanfang, and VIP databases were systematically searched for relevant literature published from the establishment of the database to June 2023. Differences in the effectiveness of VR-based interventions and other intervention therapies were compared using random effects model meta-analysis and standard deviation (SMD). Results: Seven eligible articles were identified and included in the meta-analysis. The combined analysis found that VR-based interventions had a positive impact on patients' upper limb mobility in terms of flexion (SMD = 1.33, 95% confidence interval; CI [0.48-2.19], P = 0.002), abduction (SMD = 1.22, 95% CI [0.58-1.86], P = 0.0002), and external rotation (SMD = 0.94, 95% CI [0.48-1.40], P < 0.0001). In addition, VR-based interventions could significantly improve the postoperative pain of patients with breast cancer. However, in grip strength (SMD = 0.43, 95% CI [-3.05 to 3.92], P = 0.81), shoulder muscle strength in flexion strength (SMD = 0.05, 95% CI [-2.07 to 2.18], P = 0.96), abduction strength (SMD = -0.10, 95% CI [-1.32 to 1.12], P = 0.88), external rotation strength (SMD = 0.46, 95% CI [-1.96 to 2.88], P = 0.71), and lymphedema, VR was as effective as other intervention treatments. A subgroup analysis showed that patients younger than 55 years had more benefit with VR-based rehabilitation than with other interventions and showed improvements with the intervention within 2 weeks. The intervention effect of using auxiliary equipment such as robotic arms is better than VR exercise based solely on games. Conclusion: The results of meta-analysis show that the intervention measures based on VR have positive effects on the improvement of upper limb mobility and pain relief in breast cancer patients. However, considering the low quality of evidence and small sample size, more clinical studies should be conducted to improve the credibility of the results.

An NLP-based system for modulating virtual experiences using speech instructions

The application of virtual reality (VR) technology in rehabilitation is a research area that has been attracting remarkable attention recently, especially as an intervention with learning and developmental disorders such as dyslexia and autism. Multi-modal VR-based rehabilitative systems can provide a rich experience to patients by responding to various types of bio-signals. This paper proposes a framework for incorporating voice input in rehabilitative games. The proposed framework equips collaborative learning environments with voice based interaction which allows for a more dynamic flow of therapy sessions between physically impaired patients and specialists in a rehabilitative VR environment. The proposed framework’s pipeline begins with a speech recognition module to parse utterances into sentences. Next, comes the feature extraction module to identify the intent of the user and entities as well. Finally, we modulate the 3D environment in Unity. The framework was designed in a way that guarantees smooth integration with any game or 3D environment. Several technologies were tested in terms of accuracy and speed to increase the overall performance of the pipeline. To the best of our knowledge, this research is the first to do the following: 1) build a dataset of instructions, inspired by a product already used in the healthcare market, 2) based on which we could realize a multi-modal system, with voice as one of the modalities, for the context of VR-based rehabilitation. We evaluate every stage in the system pipeline, and we show that we can achieve considerable results on each of these stages including the speech recognition module, with a 5.64% word error rate, and on intent classification where the BiLSTM model outperforms BERT in the Named Entity Recognition by 11% in terms of the F1-score. We envisage the proposed system to lend itself well to emerging healthcare frameworks in the Metaverse.

Embracing virtual reality in rehabilitation of post-stroke aphasia.

About one-third of stroke survivors experience aphasia, i.e., language dysfunction caused by brain damage. Aphasia affects not only a person's ability to communicate, but it often leads to the inability to return to work, loss of close relationships, diminished quality of life, negative self-perception, and depression. Yet persons with aphasia are globally underserved due to limited access to resources, which limits their chance for recovery. Immersive virtual reality (VR) has the potential to solve this problem and deliver efficient, personalized treatments to millions of people worldwide who need access to rehabilitation services or more flexibility in treatment delivery. To reduce the global burden of stroke experts recommend taking bold, pragmatic actions across all four pillars of stroke quadrangle-surveillance, prevention, acute care, and rehabilitation. Embracing immersive VR-based rehabilitation of poststroke aphasia would be one step in that direction.

Effectiveness of virtual reality-based rehabilitation on the upper extremity motor function of stroke patients: A protocol for systematic review and meta-analysis.

Upper extremity deficits (UED) is a common and impactful complication among stroke survivors. Virtual reality (VR)-based rehabilitation holds potential for enhancing rehabilitation intensity and engagement by stimulating tasks. While several clinical studies have examined the effectiveness and safety of VR-based rehabilitation, there is a need for further research to improve consistency in outcomes. The study will incorporate randomized controlled trials (RCTs) concerning the effects of VR-based rehabilitation on upper extremity (UE) function in stroke survivors. A comprehensive search of databases including PubMed, Embase, Cochrane Library, Web of Science, Scopus, Cinahl, China National Knowledge Infrastructure (CNKI), Wan-fang, and Chinese Biology Medicine Database will be performed from inception to the start of the study. Primary outcomes will focus on upper limb motor function assessments such as the Fugl-Meyer Upper Extremity (FMUE), Box and Block Test (BBT), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT). Secondary outcomes related to activities of daily living will include the Barthel Index (BI) and Functional Independence Measure (FIM). Research selection, data extraction, and quality assessment will be independently conducted by two researchers. The recently revised Cochrane risk of bias tool will be employed to evaluate study quality. Meta-regression and subgroup analyses will be utilized to identify effective therapy delivery modes and patterns. The assessment, development, and evaluation of recommendations approach will be applied to achieve a robust conclusion. This study provides a rigorous synthesis to evaluate optimal parameters-specifically intensity and duration-for VR-based rehabilitation interventions aimed at enhancing UE function in stroke survivors. Our secondary objective is to assess the impact of these parameters on rehabilitation outcomes. We anticipate an accurate, transparent, and standardized review process that will yield evidence-based recommendations for integrating VR technology into treating upper extremity dysfunction in stroke patients, offering clinicians effective strategies to enhance upper limb function.

Effects of Virtual Reality Cognitive Training on Neuroplasticity: A Quasi-Randomized Clinical Trial in Patients with Stroke.

Cognitive Rehabilitation (CR) is a therapeutic approach designed to improve cognitive functioning after a brain injury, including stroke. Two major categories of techniques, namely traditional and advanced (including virtual reality-VR), are widely used in CR for patients with various neurological disorders. More objective outcome measures are needed to better investigate cognitive recovery after a stroke. In the last ten years, the application of electroencephalography (EEG) as a non-invasive and portable neuroimaging method has been explored to extract the hallmarks of neuroplasticity induced by VR rehabilitation approaches, particularly within the chronic stroke population. The aim of this study is to investigate the neurophysiological effects of CR conducted in a virtual environment using the VRRS device. Thirty patients with moderate-to-severe ischemic stroke in the chronic phase (at least 6 months after the event), with a mean age of 58.13 (±8.33) for the experimental group and 57.33 (±11.06) for the control group, were enrolled. They were divided into two groups: an experimental group and a control group, receiving neurocognitive stimulation using VR and the same amount of conventional neurorehabilitation, respectively. To study neuroplasticity changes after the training, we focused on the power band spectra of theta, alpha, and beta EEG rhythms in both groups. We observed that when VR technology was employed to amplify the effects of treatments on cognitive recovery, significant EEG-related neural improvements were detected in the primary motor circuit in terms of power spectral density and time-frequency domains. Indeed, EEG analysis suggested that VR resulted in a significant increase in both the alpha band power in the occipital areas and the beta band power in the frontal areas, while no significant variations were observed in the theta band power. Our data suggest the potential effectiveness of a VR-based rehabilitation approach in promoting neuroplastic changes even in the chronic phase of ischemic stroke.

Effectiveness of Virtual Reality-Based Rehabilitation Interventions in Improving Postoperative Outcomes for Orthopedic Surgery Patients.

The surge in orthopedic surgeries strains the US healthcare system, necessitating innovative rehabilitation solutions. This review examines the potential of virtual reality (VR)-based interventions for orthopedic rehabilitation. The effectiveness of VR-based interventions in orthopedic surgery patients is scrutinized. While some studies suggest better patient-reported outcomes and satisfaction, mixed results emerge from others, demonstrating comparable or varied results compared to traditional rehabilitation. The underlying mechanisms of VR-based rehabilitation are elucidated, showing its positive impact on proprioception, pain management, agency, and balance. Challenges of unfamiliarity, patient engagement, and drop-out rates are identified, emphasizing the need for tailored approaches. VR technology's immersive environments and multisensory experiences offer a novel approach to addressing functional deficits and pain post-surgery. The conclusion drawn is that VR-based rehabilitation complements rather than replaces conventional methods, potentially aiding in pain reduction and functional improvement. VR-based rehabilitation holds promise for enhancing orthopedic surgery outcomes, presenting a dynamic approach to recovery. Its potential to reshape healthcare delivery and reimbursement structures underscores its significance in modern healthcare. Overall, VR-based rehabilitation offers a promising avenue for optimizing postoperative recovery in orthopedic surgery patients.

Effects of immersive and non-immersive virtual reality-based rehabilitation training on cognition, motor function, and daily functioning in patients with mild cognitive impairment or dementia: A systematic review and meta-analysis

Objective To examine the effectiveness of virtual reality (VR)-based rehabilitation training in improving cognition, motor function, and daily functioning in patients with mild cognitive impairment and dementia. Data sources A systematic review of published literature was conducted using PubMed, Web of Science, Elsevier, Embase, Cochrane, CNKI, Networked Digital Library of Theses and Dissertations. Methods The search period was from inception to 7 October 2023. Eligible studies were randomized controlled trials evaluating the efficacy of VR-based rehabilitation training in patients with mild cognitive impairment or dementia versus control subjects. Methodologic quality was assessed with the Cochrane risk of bias tool, and outcomes were calculated as the standard mean difference between participant groups with 95% confidence interval. Results A total of 21 randomized controlled trials with 1138 patients were included. The meta-analysis showed that VR-based rehabilitation training had significant effects on Montreal Cognitive Assessment (SMD: 0.50; 95%CI: 0.05 to 0.95; P = 0.030), Trail-making test A (SMD: −0.38; 95%CI: −0.61 to −0.14; P = 0.002), and Berg Balance Scale scores (SMD: 0.79; 95%CI: 0.13 to 1.45; P = 0.020). A subgroup analysis revealed that the type of VR, and duration and frequency of interventions had statistically significant effects on cognition and motor function. Conclusion VR-based rehabilitation training is a beneficial nonpharmacologic approach for managing mild cognitive impairment or dementia. Immersive VR-based training had greater effects on cognition and motor function than non-immersive VR-based training, but non-immersive VR-based training was more convenient for patients with limitations imposed by their disease. Also, an intervention lasting 5–8 weeks and for >30 min at a frequency of ≥3 times/week achieved the best results. It indicated that a longer intervention cycle may not achieve the best intervention effect and training duration and schedule should be carefully considered when managing patients.

Graph analysis of cortical reorganization after virtual reality-based rehabilitation following stroke: a pilot randomized study.

Stroke is the leading cause of functional disability worldwide. With the increase of the global population, motor rehabilitation of stroke survivors is of ever-increasing importance. In the last decade, virtual reality (VR) technologies for rehabilitation have been extensively studied, to be used instead of or together with conventional treatments such as physiotherapy or occupational therapy. The aim of this work was to evaluate the GestureCollection VR-based rehabilitation tool in terms of the brain changes and clinical outcomes of the patients. Two groups of chronic patients underwent a rehabilitation treatment with (experimental) or without (control) complementation with GestureCollection. Functional magnetic resonance imaging exams and clinical assessments were performed before and after the treatment. A functional connectivity graph-based analysis was used to assess differences between the connections and in the network parameters strength and clustering coefficient. Patients in both groups showed improvement in clinical scales, but there were more increases in functional connectivity in the experimental group than in the control group. The experimental group presented changes in the connections between the frontoparietal and the somatomotor networks, associative cerebellum and basal ganglia, which are regions associated with reward-based motor learning. On the other hand, the control group also had results in the somatomotor network, in its ipsilateral connections with the thalamus and with the motor cerebellum, which are regions more related to a purely mechanical activity. Thus, the use of the GestureCollection system was successfully shown to promote neuroplasticity in several motor-related areas.

DESIGNING FOR REHABILITATION MOVEMENT RECOGNITION AND MEASUREMENT IN VIRTUAL REALITY

AbstractVirtual reality (VR)-based rehabilitation has been widely implemented to maintain and increase patient motivation during therapy sessions. Researchers nowadays design VR-based rehabilitation by leveraging off-the-shelf VR devices for easy access and application. However, researchers need to implement additional custom hardware or incorporate a specific algorithm to perform a real-time evaluation of each therapeutic movement. This study aims to design and develop a system with features for recognizing and measuring the upper limb rehabilitation movement in VR using off-the-shelf VR devices such as VR headsets, controllers, and trackers. This system is bundled and distributed as a single toolkit to accommodate other researchers in providing the evaluation feature for their VR-based rehabilitation system. The user experiment was conducted to verify the usability of this proposed design system. The experiment results show that the system can recognize 16 upper limb movements and provide several measurement data that researchers can use in providing the evaluation feature based on their design requirements.

Virtual reality-based gait rehabilitation intervention for stroke individuals: a scoping review.

Virtual reality (VR)-based rehabilitation is rapidly gaining interest and has been shown to be an intervention to facilitate motor learning in balance and gait rehabilitation. A review of the current literature is needed to provide an overview of the current state of knowledge of VR-based gait physiotherapy for stroke patients. A systematic literature search was performed in PubMed and Scopus. Search terms included: "virtual reality," "stroke," "gait," and "physical therapy." Articles published in a peer-reviewed journal between 2017 and 2021 were considered. The intervention was mainly related to the use of VR as a therapeutic modality, and the outcome was gait performance. The initial search identified 329 articles. After an eligibility review, 13 articles that met the inclusion criteria were included in the study. Most of participants were in a chronic stage and were between 14 and 85 years old. The VR-based gait training ranged from nonimmersive to immersive, was mostly performed on a treadmill, and was usually combined with conventional physiotherapy. The duration of the program varied from 10 to 60 min, and there were about 9 to 30 sessions. VR-based gait rehabilitation has a positive effect on gait ability. The existing literature suggests that VR-based rehabilitation combined with conventional physiotherapy could improve gait ability of people with stroke, especially in the chronic stage. However, the duration of VR-based programs should be customized to suit individuals to avoid stimulation sickness. Further research is needed to investigate the long-term effects of this approach.

Gamification of Upper Limb Rehabilitation in Mixed-Reality Environment

The advancements in mixed reality (MR) technology in recent years have provided us with excellent prospects for creating novel approaches to supplement conventional physiotherapy to maintain a sufficient quantity and quality of rehabilitation. The use of MR systems to facilitate patients’ participation in intensive, repetitive, and task-oriented practice using cutting-edge technologies to enhance functionality and facilitate recovery is very encouraging. Multiple studies have found that patients who undergo therapy using MR experience significant improvements in upper limb function; however, assessing the efficacy of MR is challenging due to the wide variety of methods and tools used. Because of these challenges, a novel approach, gamified MR-based solution for upper extremity rehabilitation, is proposed, which is an MR application for the Microsoft HoloLens 2, complete with game levels, and can measure the ranges of motion of the arm joints. The proposed rehabilitative system’s functionality and usability were evaluated with ten healthy adult participants with no prior arm-related injuries and two occupational therapists (OTs). The system successfully provided rehab exercises for upper limb injuries through interactive mixed-reality games. The system can mimic upper limb behavior without additional sensors during rehab sessions. Unlike previously researched technologically-based rehabilitation methods, this method can integrate arm–joint data within the application and are independent of one another. The results and comparisons show that this system is relevant, accurate, and superior to previous VR-based rehabilitation methods because the VR-based system is blind to the surroundings, whereas the proposed approach has spatial awareness of the environment.

Systematic Review and Meta-Analysis of the Application of Virtual Reality in Hearing Disorders.

Trendy technologies, such as artificial intelligence, virtual reality (VR), and augmented reality (AR) are being increasingly used for hearing loss, tinnitus, and vestibular disease. Thus, we conducted this systematic review and meta-analysis to identify the possible benefits of the use of VR and AR technologies in patients with hearing loss, tinnitus, and/or vestibular dysfunction, with the aim of suggesting potential applications of these technologies for both researchers and clinicians. Published articles from 1968 to 2022 were gathered from six electronic journal databases. Applying our specified inclusion and/or exclusion criteria, 23 studies were analyzed. As only one article on hearing loss and two articles on tinnitus were found, 20 studies on vestibular dysfunction were only finally included for the meta-analysis. Standardized mean differences (SMDs) were chosen as estimates to compare the studies. A funnel plot and Egger's regression analysis were used to identify any risk of bias. High heterogeneity (I2: 83%, τ2: 0.5431, p<0.01) was identified across the studies on vestibular dysfunction. VR-based rehabilitation was significantly effective for individuals with vestibular disease (SMDs: 0.03, 95% confidence interval [CI]: -0.08 to 0.15, p<0.05). A subgroup analysis revealed that only improvement in the subjective questionnaire was meaningful and statistically significant (SMDs: -0.66, 95% CI: -1.10 to -0.22). VR-based vestibular rehabilitation showed potential for subjective rating measures like Dizziness Handicap Index. The negative effect of aging on vestibular disease was indirectly confirmed. More clinical trials and an evidence-based approach are needed to confirm the implementation of state-of-the-art technology for hearing loss and tinnitus, representative diseases in neurotology.

Head-Mounted Display-Based Virtual Reality and Physiological Computing for Stroke Rehabilitation: A Systematic Review

Virtual reality (VR)-mediated rehabilitation is emerging as a useful tool for stroke survivors to recover motor function. Recent studies are showing that VR coupled with physiological computing (i.e., real-time measurement and analysis of different behavioral and psychophysiological signals) and feedback can lead to 1) more engaged and motivated patients, 2) reproducible treatments that can be performed at the comfort of the patient’s home, and 3) development of new proxies of intervention outcomes and success. While such systems have shown great potential for stroke rehabilitation, an extensive review of the literature is still lacking. Here, we aim to fill this gap and conduct a systematic review of the twelve studies that passed the inclusion criteria. A detailed analysis of the papers was conducted along with a quality assessment/risk of bias evaluation of each study. It was found that the quality of the majority of the studies ranked as either good or fair. Study outcomes also showed that VR-based rehabilitation protocols coupled with physiological computing can enhance patient adherence, improve motivation, overall experience, and ultimately, rehabilitation effectiveness and faster recovery times. Limitations of the examined studies are discussed, such as small sample sizes and unbalanced male/female participant ratios, which could limit the generalizability of the obtained findings. Finally, some recommendations for future studies are given.

Virtual reality rehabilitation following total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials

PurposeThe use of virtual reality (VR) based rehabilitation has increased substantially within orthopedic surgery, particularly in the field of total knee arthroplasty (TKA). The objective of this systematic review and meta-analysis was to compare patient-reported outcomes and cost analyses from randomized controlled trials (RCT) utilizing VR-based rehabilitation in patients following TKA.MethodsMEDLINE, EMBASE, and Cochrane databases were searched for RCTs involving VR-based rehabilitation following TKA. Quantitative synthesis was conducted for pain scores and functional outcomes. Narrative outcomes were reported for results not amenable to quantitative synthesis.ResultsA total of 9 RCTs with 835 patients were included with follow-up ranging from 10 days to 6 months postoperatively. No differences in pain scores were demonstrated between VR-based and traditional rehabilitation at 2 weeks and 3 months postoperatively. VR-based rehabilitation demonstrated improved functional outcomes at 12 weeks (n = 353) postoperatively [mean difference (MD) − 3.32, 95% confidence interval (CI) − 5.20 to − 1.45, moderate certainty evidence] and 6 months (n = 66) postoperatively [MD − 4.75, 95% CI − 6.69 to − 2.81, low certainty evidence], compared to traditional rehabilitation. One trial demonstrated significant cost savings with the use of VR-based rehabilitation.ConclusionsVR-based rehabilitation for patients undergoing TKA represents an evolving field that may have advantages over traditional therapy for some patients. The current review is limited by the low quality of evidence in the literature. This is a rapidly evolving field with more trials needed to determine the impact of VR-based rehabilitation on patients undergoing TKA.Level of evidenceLevel I; meta-analysis of randomized controlled trials.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00167-022-06910-x.

A Review of Virtual Reality Technology in Exercise Training for Older Adults

Regular physical activity has profoundly positive impact on an individual’s physical and mental wellbeing. Older adults are recommended to engage in moderate-intensity physical activity for at least 30 minutes per day, and for three or more days per week. However, older adults may encounter various barriers which may lead to poor exercise compliance. In recent years, virtual reality (VR) technology has become increasingly popular in healthcare settings, with the aim to improve physical function, cognitive abilities, and mood in older people with chronic diseases. VR-based exercise may improve self-motivation in performing exercise, increase social interaction, and reinforces older adults’ compliance to exercise training. The aim of this review is to evaluate the effectiveness of VR exercise and the potential advantages of incorporating VR-based rehabilitation for the aging population. Keywords: Exercise; Virtual reality; Older adults; Chronic diseases; Diabetes

Variable Admittance Control of a Hand Exoskeleton for Virtual Reality-Based Rehabilitation Tasks.

Robot-based rehabilitation is consolidated as a viable and efficient practice to speed up and improve the recovery of lost functions. Several studies highlight that patients are encouraged to undergo their therapies and feel more involved in the process when collaborating with a user-friendly robotic environment. Object manipulation is a crucial element of hand rehabilitation treatments; however, as a standalone process may result in being repetitive and unstimulating in the long run. In this view, robotic devices, like hand exoskeletons, do arise as an excellent tool to boost both therapy's outcome and patient participation, especially when paired with the advantages offered by interacting with virtual reality (VR). Indeed, virtual environments can simulate real-life manipulation tasks and real-time assign a score to the patient's performance, thus providing challenging exercises while promoting training with a reward-based system. Besides, they can be easily reconfigured to match the patient's needs by manipulating exercise intensity, e.g., Assistance-As-Needed (AAN) and the required tasks. Modern VR can also render interaction forces when paired to wearable devices to give the user some sort of proprioceptive force or tactile feedback. Motivated by these considerations, a Hand Exoskeleton System (HES) has been designed to be interfaced with a variable admittance control to achieve VR-based rehabilitation tasks. The exoskeleton assists the patient's movements according to force feedback and following a reference value calculated inside the VR. Whenever the patient grasps a virtual object, the HES provides the user with a force feedback sensation. In this paper, the virtual environment, developed within the Webots framework and rendering a HES digital-twin mapping and mimicking the actual HES motion, will be described in detail. Furthermore, the admittance control strategy, which continuously varies the control parameters to best render the force sensation and adapt to the user's motion intentions, will be investigated. The proposed approach has been tested on a single subject in the framework of a pilot study.

Virtual Reality Neurorehabilitation

The present work investigates the application of virtual reality (VR) technology to neurorehabilitation. By consulting a wealth of data, the advantages of VR in neurorehabilitation are introduced, followed by the application status of VR in the rehabilitation of stroke patients, Parkinson’s patients, mental and psychological diseases. Besides, many research experiments on the application of VR technology in rehabilitation medicine at the present stage are investigated. The results indicate that compared with traditional balance training, the VR-based neurological rehabilitation training method can more effectively ease the tilt degree and strengthen the trunk control ability and balance function of patients with post-stroke tilt syndrome. When the effect of traditional rehabilitation training on the gait and balance of Parkinson’s patients is not good enough, VR-based rehabilitation training can at least be used as an alternative therapy. Moreover, VR games have made great breakthroughs in promoting limb rehabilitation and brain injury rehabilitation, which is of incredible benefit to those with motor and activity disorders. It is also beneficial to the treatment and recovery of mental disorders of patients with nerve injury. Although VR still has limitations such as high cost and technical breakthrough bottleneck, it has great advantages in relieving pain, enhancing interest, and recovering patients’ mental health in neurological rehabilitation training.