Virtual Reality in Physiotherapy: For Whom? For what?

Virtual Reality has been used for several decades for training and learning, particularly through simulators, because the learning is transposable and sustainable in a physical world [1] [2].

What about the learning and gesture reconditioning of our patients?

Studies have demonstrated the superiority of VR over traditional training in certain complex gesture learning, and also when learning gesture adaptation or dual-task activities [3][4] [5]. Gesture repetition is more precise and reproducible thanks to tracking.

VR offers a wide variety of exercises in the 3 planes of space which can be analytical or complex. It allows the patient to have feedback via visual feedback on the gestures performed: he is notified when compensation takes place.

Thus, during a lateral spinal inflection exercise the patient will be warned if he adds flexion or extension to his movement. Likewise, for a shoulder abduction exercise, VR will indicate to the patient flexion compensation during abduction. Studies on the benefit of VR in post-stroke patients highlight a 30% reduction. of the Timed Up and Go test in patients who have benefited from rehabilitation with VR exercises compared to carrying out classic rehabilitation with the same exercises [6] [7] [8].

Moreover, the physiotherapist will be able to dissociate specifically a sensory input involved in equilibration reactions. In an athletic patient, the practitioner can rely on virtual reality to analyze whether a deficit in a balancing reaction is caused by a somesthetic, visual or vestibular deficit, or a deficit in muscular strength.

‍‍

Practical applications of VR in Physiotherapy

Kinesiophobia is also an excellent indication for working in virtual reality. The patient's attention is diverted from the task to be performed (perceived as potentially painful) to focus on the success of the “game”. Research into the acceptance of pain in patients suffering from phantom limb pain or CRPS also highlights the beneficial contribution of sensory isolation induced by VR. [9] [10]The practitioner can eliminate the patient's failures in rehabilitation exercises.

The more it is able to adapt the virtual environment in real time without interrupting the immersion experience, the more impact it will have on neural plasticity. The brain will learn more quickly if the gesture experience is positive.

VR is a complete tool that allows assessments but also rehabilitation exercises for numerous pathologies of the upper and lower limbs and also of the spine. We will also note the reduced space required by an installation allowing a patient to work seated and standing. It is also possible to move a patient in a larger space and even perform jumps. In conclusion, as in many areas, VR is establishing itself in Physical Therapy in a lasting manner and will quickly establish itself as an essential tool reinforcing the therapeutic arsenal of the Physiotherapist.

‍

Bibliography :

_{[1] Training in virtual environments: Transfer to real world tasks and equivalence to real task training. F D Rose, E A Attree, B M Brooks, D M PArslow, P R Penn, NAmbihaipahan DOI: 10.1080/001401300184378
[2] Virtual Environments for Motor Rehabilitation: Review MAUREEN K. HOLDEN, Ph.D. CYBERPSYCHOLOGY & BEHAVIOR Volume 8, Number 3, 2005
[3] Augmented FeedbackPresented in a virtual Environment Accelerates Learning of a Difficult MotorTask. E Todorov, R Shadmehr, E Bizzi. Journal of Motor Behaviour, 1997, Vol.29, N°2, 147-158
[4] Effects of physical randomness training on virtual and laboratory golf putting performance in novices. T C Pataky 1, P F Lamb 2 Sports Performance 8 oct 2017 DOI:10.1080/02640414.2017.1378493
[5]Learning andtransfer of complex motor skills in virtual reality: a perspective review.Danielle E Levac 1, Meghan E Huber 2, Dagmar Sternad .DOI:10.1186/s12984-019-0587-8
[6] Rehabilitationthat incorporates virtual reality is more effective than standardrehabilitationfor improving walking speed, balance and mobility after stroke a systematicreview Davide Corbetta 1, Federico Imeri 2, Roberto Gatti 3 j.jphys.2015.05.017.Epub 2015 Jun 18 DOI: 10.1016/j.jphys.2015.05.017
[7]Gait and balancetraining using virtual reality is more effective for improving gait and balanceability after stroke than conventional training without virtual reality.Journal of Physiotherapy 63 (2017) 114 doi.org/10.1016/j.jphys.2017.02.010doi.org/10.1016/j.jphys.2017.02.009
[8] Feasibility andEffectiveness of Virtual Reality Training on Balance and Gait Recovery Earlyafter Stroke: A Pilot Study. de Rooij et al., Int J Phys Med Rehabil 2017, 5:4DOI: 10.4172/2329-9096.1000418
[9] Immersive VirtualReality and Virtual Embodiment for Pain Relief Marta Matamala-Gomez1,2*, TonyDonegan3, Sara Bottiroli4,5, Giorgio Sandrini1,2, Maria V. Sanchez-Vives3,6,7†and Cristina Tassorelli1,2†Front. Hum. Neurosci., 21 August 2019 https://doi.org/10.3389/fnhum.2019.00279
[10] Faure C, LimballeA and Kerhervé H (2019) Fooling the Brain, Fooling the Pain: The Role of MirrorTherapy and Modern Uses in Virtual Reality. Front. Young Minds. 7:91. doi:10.3389/frym.2019.00091}