Virtual Reality and Post-Oncological Rehabilitation, a new path?

In functional rehabilitation we can cite the treatment of a number of pathologies such as strokes, Parkinson's disease and balance disorders... It would take too long to list here all the hospitals using VR to soothe patients before or during an anxiety-provoking or painful procedure.

In general, VR is used as an alternative to certain drug treatments, however certain establishments are starting to communicate about their use of VR in oncology. For example, we can cite the Oscar Lambret center (Lille) which was recently equipped with 6 VR devices. Note that these devices are not limited to use in hospitals but are becoming more widely available in all types of structures, including private ones.

What can VR bring to the issues of liberal care?

Its use in private practice in rehabilitation following cancer seems perfectly indicated [1]. If we consider senology and breast cancers, the indications for VR are omnipresent. This cancer is the most common oncological disease in the world. It concerns around 60,000 new cases per year in France alone. Each treatment for a patient treated for breast cancer is specific depending on the type of treatment and the time of treatment: during or after radiotherapy, after curative or reconstructive surgery, immediately post-operative or remotely, etc.

While some will emphasize the psychological component during these treatments and the need for human contact, the use of instrumental techniques has proven itself in the treatment of scar adhesions. According to a team from Montpellier [2], 93% of women who have used VR during anxiety-provoking or painful care request these immersive environments again for subsequent care.

We will note the preference for immersions in a natural environment accompanied by music to help escape or relax. Once again, knowledge of the patient and her psychological state will make it possible to offer this adapted technological aid.

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Recurrent symptoms include pain and kinesiophobia. VR makes it possible to isolate the patient in a virtual world that could be a seaside or a forest: environments conducive to relaxation and reducing anxiety. By isolating the patient from the physical world, the practitioner inhibits her anticipatory reactions to potential pain triggered by a visual stimulus. Thus immersed, tissue release maneuvers or passive mobilizations can be approached differently.

VR is a technological tool offering responses to individualized problems. It is an additional tool offered to the practitioner for the management of joint range of motion limitations. The patient may be offered virtual rehabilitation with the completion of simple tasks that can be similar to everyday tasks, or fun environments, which can be configured according to the capabilities and objectives of the rehabilitation.

The resulting diversion of attention will be at the heart of rehabilitation and will have a positive effect on potential kinesiophobia. This therapeutic advantage offered to the practitioner simplifies a number of treatments. In addition, the computer system linked to VR will quantify the movements made, making it possible to monitor progress both in amplitude but also with criteria that are difficult to quantify in everyday practice such as the speed of the movement made, the reaction time, the precision of a gesture or movement.

In summary, VR should be considered as a tool which should facilitate the practice of the physiotherapist by making it possible to place a patient in the best possible conditions to support her rehabilitation while offering the practitioner a simple measuring tool to quantify the evolution of care with precision.

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Bibliography :

_{[1] La réalité virtuelle chez les femmes âgées suivies pour un cancer du sein : intérêts et attentes. Aude Michel, Emmanuelle Brigaud, Florence Cousson-Gélie, JulienVidal, Nathalie Blanc. Geriatr Psychol Neuropsychiatre Vieil 2019 ; 17 (4) :415-22
[2] Dessine-moi une réalité plus belle : la réalité virtuelle vue par lespatientes atteintes d’un cancer du sein. A. Michel1, J. Vidal, E. Brigaud, K.Sokratous et N. Blanc. Psycho-Oncol. Volume 13, p 69-78, Numéro 1, Mars 2019.DOI https://doi.org/10.3166/pson-2019-0087}