ENHANCING COGNITIVE-MOTOR REHABILITATION WITH VIRTUAL REALITY: AN INTERACTIVE AND PROMISING APPROACH
Interest in the use of Virtual Reality in the scientific community has grown significantly in recent decades, not least thanks to its potential to assist in innovative cognitive-motor rehabilitation treatments.
VR uses the principle of user-computer interaction to generate stimuli in real time. This includes the perception or feeling of being present in a different location due to the immersive sense of presence and the response to virtual stimuli, encompassing physiological and neural stimuli (embodiment). VR can also simulate unusual or impossible actions, allowing people to experience uncommon situations and deal with every possible event in a safe and controlled environment.
The application of virtual reality in the neurorehabilitation sphere has proven to be beneficial as it can create a standardised, reproducible, and controllable therapeutic environment using rehabilitation methods that are more stimulating than conventional treatment. Placing the user (patient and/or therapist) in a multidimensional and immersive environment that is essentially virtual, is the key difference between the immersive and non-immersive VR systems used in rehabilitation.
There are a wide variety of VR devices on the market for customised rehabilitation treatments at home and in hospital. These devices range from non-immersive to fully immersive.
Non-immersive virtual reality uses a monitor or wall projection to create a 3D image. The external environment is not completely excluded from the experience and users interact in real time with representations of their bodies within a system, receiving sensory (often visual, auditory, etc.) and proprioceptive feedback.
VR systems are becoming increasingly complex and immersive. They create a sense of immersion by projecting 3D images onto the walls and floors of a room-sized cube. By wearing 3D glasses, several people can enter a space at the same time and move freely within it.
A head tracking system continuously adapts the projection according to the main viewer’s position. To calibrate the users’ movements with the virtual environment and virtual object, their positions and movements need to be tracked so that the virtual image can be updated in real time.
Virtual Reality (VR) technology provides a unique opportunity to design assessment and treatment environments that enable precise control of immersive and non-immersive dynamic stimuli. This allows for advanced interactions, behavioural monitoring, and performance recording. These factors, combined with virtual environments, allow therapists to customise rehabilitation programmes to a high degree.
While previous rehabilitation applications have mainly involved the use of auditory and visual sensory feedback and indirect proprioceptive and vestibular feedback (particularly in the case of immersive virtual reality), the use of haptic input is evolving as we speak.
Tactile interface devices such as gloves, joysticks, pens, and suits restore tactile sensation to users by allowing them to perceive different shapes and surfaces, corroborating several findings in scientific literature that attest to the usefulness of these devices in achieving specific treatment goals, such as increasing limb strength and mobility.
23 scientific articles were analysed as part of a recent literature review. The study revealed that virtual reality (VR) could be a useful tool in enhancing rehabilitation for individuals with multiple sclerosis and Parkinson’s disease, who suffer from neurodegenerative disorders that necessitate constant care and rehabilitation support. VR has the potential to make rehabilitation more interactive and stimulating. The same is also true for paediatric and geriatric rehabilitation cases, where cognitive involvement in virtual environments – using sensory feedback – is key to promoting neuromotor recovery. These studies have tested the feasibility of using VR at home and have had encouraging results. VR improves functional use and the movement quality of impaired hands compared to conventional home exercises.
According to the study, VR-based exercises are effective in rehabilitating upper limbs, but they are not yet advanced enough to aid with manual dexterity and walking in all conditions.