In an ideal world, many patients would be satisfied with just one consultation if we managed to eliminate their pain from the first session. Our role as therapist is to carry out an assessment with precise elements in order to explain to the patient the origin of their symptoms.

Without this, how can we make him aware that his pain is not proportional to the lesions but a warning signal announcing an underlying disorder? How can we justify a long-term therapeutic strategy whose management will be partially carried out by the physiotherapist, and partly by the patient himself?

Without this our know-how will not be worth more in their eyes than that of the experts from Google and Facebook and their numerous unsuitable online exercise programs.

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More engaging rehabilitation with Virtual Reality

With a multitude of different patients and pathologies, the practitioner must always respond to the same problem: how to get a patient who is in pain to move? How can we make him understand that his pain is a symptom like any other that must be assessed and monitored during the session but that it should not be the center of attention in the treatment?

However, it will be this symptom that the patient will take as a reference to judge the effectiveness of his treatment. The clinical approach to pain often stops at noting the moment or an angle of appearance but not its evolution in the face of a repetition of a specific movement. The patient's defense mechanisms can evolve with progressive exposure to stress, just like a person who finds the sea too cold but who will gradually get used to the temperature to finally manage to swim.

Thus, it is necessary to offer the patient a gesture repetition of progressive exposure to his pain and note if, with the repetition, its intensity decreases or if the amplitude of the movement progresses for the same intensity of pain. Virtual reality (VR) is a tool of choice for carrying out this type of evaluation. It allows the quantitative parameters of amplitude and speed of movement to be recorded so that the practitioner can concentrate exclusively on a qualitative assessment.

Data recording can be precisely compared over time using graphical exports or raw data. In addition, these assessments can be carried out in varied environments, conducive to diverting the patient's attention, significantly reducing possible Kinesiophobia.

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To this diagnostic aid, VR will add the possibility of carrying out spinal stabilization or mobility work exercises that can be segmented or integrated into functional gestures. The numerous universes and exercises available help to vary the rehabilitation sessions and above all to adapt the exercises in real time to the patient's abilities. Thus the practitioner helps to reduce the weariness that some patients feel when repeating exercises over time.

Once again, thanks to this tool monitoring the parameters of the sessions, the practitioner will have objective elements relating to the evolution of the treatment making it possible to adapt to the needs of the patient. The practitioner frees himself from part of the reassessment of the patient's abilities, this being done automatically in real time at the level of the software used. Virtual reality makes it possible to offer the patient various tasks and situations.

The practitioner offers the patient the possibility of resuming certain activities within a virtual world that they would not consider in their real world. These make it possible to integrate the spine in its role of stabilizer and control of the movement of the belts, making the functional link between the upper and lower limbs. Virtual reality rehabilitation thus gives another dimension to sessions carried out in a sometimes restricted space, echoing a now well-known expression: “good treatment is movement”.

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Bibliography :

[1] HAS. Prise en charge du patient présentant une lombalgie commune. Haute Autorité de Santé.2019.

[2] Virtual immersive gaming to optimize recovery (VIGOR) in low back pain: A phase II randomized controlled trial. Christopher R. France and James S. Thomas. Contemp Clin Trials. 2018 Jun; 69: 83–91. Published online 2018 May 3. doi:10.1016/j.cct.2018.05.001

[3] Is Virtual Reality Effective in Orthopedic Rehabilitation? A Systematic Review and Meta-Analysis. Phys Ther. 2019 Oct 28;99(10):1304-1325. doi: 10.1093/ptj/pzz093. Mohammed Gumaa 1, Aliaa Rehan Youssef 2 PMID: 31343702 DOI: 10.1093/ptj/pzz093

[4] Hoffman, H. G.,Richards, T. L., Coda, B., Bills, A. R., Blough, D., Richards, A. L., and Sharar, S. R. (2004). Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. Neuroreport, 15(8), 1245-1248.