Virtual Reality and Neck Pain Rehabilitation: a marriage that seems more and more promising

Can Virtual Reality, VR, provide added value to the physiotherapist with regard to the recommendations for the management of neck pain? [1] [2] [3] [4] [5]. Remember that the cervical spine is cephalophore, cephalogyre, flexible and dynamic and that it forms the link between the head and the shoulder girdle.

Rehabilitation must, to be relevant, consider all these points and include techniques aimed at pain relief, increased mobility, increased muscular skills (speed, strength and endurance and gestural precision), eye rehabilitation and cervico-kinetics and proprioception.

All these objectives are eligible for VR treatment. Cervical assessment is essential to offer rehabilitation adapted to the patient's abilities and objectives [6]. The assessment must include at least an assessment of the 6 degrees of mobility, a VAS (visual analogue scale) or NDI (neck disability index) pain assessment [7], and a head repositioning test [6] in order to guide the objectives. and the means.

VR now makes it possible in less than a minute to determine the 6 active joint ranges of the patient's cervical spine with the increment of the painful areas. This test is carried out to the nearest tenth of a degree and is reproducible independently of the operator, guaranteeing its reliability. The contribution of VR technology takes on its full meaning here both in terms of simplicity and reliability of measurements compared to the tape measure that we all know.

The relevance of the cephalic repositioning test has largely been demonstrated, but it has been little used due to the complexity of its practical implementation [8][9][10]. However, it gives a numerical evaluation of the proprioceptive competence of the cervical muscles. This test was also developed in VR and, in less than a minute, gives numerical values ​​which will be used to monitor the sessions.

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The versatility of VR allows the brain to focus on certain sensory inputs, including sight and hearing. These two sources of stimulation, inherent to virtual reality, must be used in the physical therapy of neck pain. From 15° of eye movement, there is a contraction of the cervical muscles [11].

It is therefore perfectly indicated to stimulate vision to initiate cervical mobility work and oculo-cephalogyre functional work. Likewise, the practitioner can use auditory stimulation to initiate a visual exploration of the visual environment inducing cervical mobilization.

The speed of movement of the object, fully configurable in VR, will determine the strategy of execution of this task by the patient: ocular or cervical. By diverting the patient's attention from his cervical region there will be a strong impact on the level kinesiophobia. The patient will be focused on the task to be carried out and detached from the painful area. The practitioner will be able to determine the painless analytical amplitudes of the movements that he wishes to have his patient perform.

He will then be able to modulate them and associate simple analytical movements by increasing the amplitudes or modifying the angular sector requested to reproduce complex three-dimensional movements. The tasks carried out by patients in the virtual environment will call on the different dynamic or static muscular skills of the patient. cervical spine: speed, precision, stability of movement or postural control, either alone or in combination.

The controlled modification of these parameters guarantees progressiveness in rehabilitation while ensuring adaptation to the real needs of the patient. After reading the publications and feedback from practitioners, virtual reality becomes a relevant complementary tool in daily practice. physiotherapy. Assessment of joint amplitudes, fight against kinesiophobia, active analytical then functional mobilization, cervical reprogramming in the head and neck functional unit, postural adaptation and equilibration reactions and real-time evaluation of the patient's progress, are all tools now brought together in a single solution made available to physiotherapists.

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Bibliography :

_{[1] Rééducation des traumatismes du rachis cervical sans lésions neurologiques – 25/08/08
[26-285-A-10] – Doi : 10.1016/S1283-0887(08)43949-X
[2]https://www.has-sante.fr/upload/docs/application/pdf/2014-05/referentiel_uncam_traumatisme_rachis_cervical.pdf]
[3]https://www.has-sante.fr/upload/docs/application/pdf/2013-04/referentiel_cervicalgies_fev_2013-vdef_2013-04-19_10-28-54_48.pdf
[4]https://www.has-sante.fr/upload/docs/application/pdf/argumentaire_cervicalgie_mel_2006.pdf
[5]https://www.has-sante.fr/upload/docs/application/pdf/synthese_cervicalgies_mel_2006.pdf
[6]https://www.has-sante.fr/jcms/c_272491/fr/bilan-kinesitherapique-de-la-cervicalgie]
[7] Evaluation de la douleur par Neck Disability Index (NDI)
Echelle algo-fonctionnelle pour le rachis cervical. J Vaillant. KS2013,0544:43-44 – 10/06/2013
[8]Test de repositionnement céphalique : étude de la stabilité de performance Cervicocephalic relocation test: a study of performance stability N.Pinsaulta,b, J. Vaillanta,b,*, G. Vironec , J.-L. Caillat-Mioussea , L.Lachensa , N. Vuillermec Annales de réadaptation et de médecine physique 49(2006) 647–651
[9] Revel M, André-Deshays C, Minguet M. Cervicocephalic kinesthesic sensibility in patient with cervical pain. Arch Phys Med Rehabil 1991;72:288–91.
[10] Gouilly, P., Petit dant, B., Braun, R., Royer, A., & Cordier, J.-P.(2009). Bilan du rachis cervical. EMC – Kinésithérapie – Médecine Physique –Réadaptation, 5(3), 1–16.
[11] De la sensibilité kinesthésique cervicale après un programme de rééducation oculo-cervicale chez des patients cervicalgiques Étude randomisée contrôlée MÉMOIRE J. VAILLANT (1), M. MINGUET (2), P. GERGOY (2), J.-L. MANUEL(3), M. REVEL (4) Ann. Kinésithér., 1995, t. 22, nO 6, pp. 241-248 © Masson, Paris, 1995 Évolution}