Burton J. Tabaac, MD
This review examined the efficacy of virtual reality, compared with an alternative intervention or no intervention, on upper limb function and activity. The publication is an update of the authors’ review first published in 2011 and then revised in 2015. The initial review, published in 2011, identified only 19 studies. For this iteration, 11 databases and trial registries were searched, including randomized and quasi-randomized trials of virtual reality in adults after stroke. A total of 72 trials (with 2470 participants) were included in the review.
While most recovery after stroke is thought to be made in the first few weeks, patients may make improvements on functional tasks many months after having a stroke. Prior research has shown that repetitive task training is effective in some aspects of rehabilitation, such as improving walking distance and speed and improving upper limb function. Virtual reality is a relatively recent approach that may enable simulated practice of functional tasks at a higher dosage than traditional therapies. Virtual reality has been defined as the “use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real-world objects and events.”
In assessing the primary outcome for this review paper, virtual reality was compared with the same dose of conventional therapy, and the results were not statistically significant for upper limb function. However, when virtual reality was used to supplement usual care (providing participants in the intervention group with a higher dose of therapy), there was a statistically significant difference between groups. There was a trend suggesting that customized virtual reality programs were preferable to commercial game products; however, these findings were not statistically significant.
Evidence of neuroplasticity as a result of training in virtual reality is modest; however, neuroimaging findings are guiding the development of virtual reality. The authors are keen to note that one major advantage of virtual reality programs, which has been underutilized to date, is that they allow clinicians to be able to trial tasks that are unsafe to practice in the real world, such as crossing the street. In addition, some programs are designed to be used without supervision, meaning that increased dosage of therapy can be provided without increased staffing levels. It is important to continually evaluate the efficacy of virtual reality in order to guide future design and use.