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What’s new on the use of virtual reality in rehabilitation?

By Natalia Masztalerz, Assistant Psychology (Outcome Measures)

virtual reality in rehabilitation

This month we have been looking at the recent additions to the evidence base on the use of virtual reality (VR) in rehabilitation.

This has shown that in recent years, researchers have taken significant strides in investigating the use of VR in therapeutic settings [1, 2]. VR technology provides a human-computer interface system that allows us to more accurately measure a person’s needs, identify goals, and tailor rehabilitation to those areas, improving outcomes.

VR to assess and rehabilitate executive function has been one of the key areas of growth [1, 3]. Executive function is an umbrella term related to a multitude of behavioural and cognitive processes that are imperative for independent daily living. Our ability to problem-solve, plan, and keep track of what we are doing are all examples of these abilities, which are key to our capacity to look after ourselves and our loved ones, including cooking meals, doing housework and using the phone.

Many individuals with dysexecutive syndrome report struggling with different aspects of daily living, however, score within an average range on traditional neuropsychological “pen-and-paper” tests. VR can provide a solution to this problem.

During a simulation, a vast range of different scenarios can be rendered based on the individual’s needs and abilities. A person can be placed in a supermarket, city, classroom, shopping centre, or in an office! The level of cognitive load can be manipulated, by adding or removing noise and other distractors, there is the possibility of adapting the environment to the person’s performance in real-time, providing feedback, and adding multiple players, which may increase motivation [2].

Most recent developments have focused on creating 360o environments for an even more immersive experience, and many environments provide a unique opportunity to detect different types of spatial neglect through measuring a person’s eye movements [1]. Information like this is vital to care planning and sometimes more informative than traditional neuropsychological tests in identifying the difficulties a person may face in their everyday life.

In a simulation, the person is presented with several tasks that could be expected in that scenario. This creates a fantastic opportunity for clinicians to evaluate the person’s ability to formulate, plan, and respond to environmental demands. Interestingly, VR-based instruments appear to be effective at picking up very early signs of executive dysfunction, even prior to the onset of symptoms. This means that areas that could be targeted for intervention can be identified earlier, and the negative impact on a person’s function reduced [2].

The volume of research in this field is now robust enough to enable some clinical recommendations. For example, INCOG, an expert panel of clinicians and researchers, suggests that “clinicians should consider the use of virtual reality programs, in addition to in-person visits to provide equitable access to care for people with a traumatic brain injury with executive dysfunction” (p. 56). However, other aspects, such as the type of virtual reality platform, equipment, and immersion level, need to be explored [4]. Other studies suggest that few tests are ready for clinical use in neuropsychological assessment [1].

It is also important to consider possible adverse effects, such as cybersickness and headaches. At present we do not fully understand how common these effects are in people with brain injury. Furthermore, the familiarity of VR users with technology is critical when contemplating the use of this tool. Devos and colleagues [5] provide a practical summary of these and other considerations.

On balance, it would seem that we may have nothing to lose, and a lot to gain by incorporating VR technology in clinical practice. Like with many innovations, proceed with caution, but proceed!

References

  • [1] Pieri, L., Tosi, G., & Romano, D. (2023). Virtual reality technology in neuropsychological testing: A systematic review. Journal of Neuropsychology, 00, 1–18. https://doi.org/10.1111/JNP.12304
  • [2] Borgnis, F., Baglio, F., Pedroli, E., Rossetto, F., Uccellatore, L., Oliveira, J. A. G., Riva, G., & Cipresso, P. (2022). Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Frontiers in Psychology, 13, 1666. https://doi.org/10.3389/FPSYG.2022.833136/BIBTEX
  • [3] Voinescu, A., Sui, J., & Stanton Fraser, D. (2021). Virtual reality in neurorehabilitation: An umbrella review of meta-analyses. Journal of Clinical Medicine, 10(7), 1478.
  • [4] Jeffay, E., Ponsford, J., Harnett, A., Janzen, S., Patsakos, E., Douglas, J., … & Green, R. (2023). INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part III: Executive Functions. The Journal of Head Trauma Rehabilitation, 38(1), 52-64.
  • [5] Devos, H., Christi, N., Santos, F. H., Sood, P., Hu, X., Zanwar, P., Ogawa, E., & Heyn, P. C. (2022). Virtual Reality for Cognitive Rehabilitation: A Beginner’s Guide for Clinicians. Archives of Physical Medicine and Rehabilitation
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