Featured Review: Virtual reality for stroke rehabilitation

Many people after having a stroke have difficulty moving, thinking, and sensing. This often results in problems with everyday activities such as writing, walking, and driving. Virtual reality and interactive video gaming therapy involves using computer-based programs designed to simulate real-life objects and events. This may have some advantages over traditional therapy approaches as they can give people an opportunity to practice everyday activities that are not or cannot be practiced within the hospital environment and patients may spend more time in therapy as the activity might be more motivating.

A team of Cochrane authors based in Australia, Canada, and United States worked with Cochrane Stroke to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity and on gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. 72 studies involving 2470 people after stroke were included.

This Cochrane Review found that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function but may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.

“Virtual reality is a rising popular trend that extends into clinical settings, including stroke rehabilitation,” says Kate Laver from the Department of Rehabilitation, Aged and Extended Cae at the Flinders University in Australia and the lead author of the Cochrane Review. “We first published this Cochrane Review in 2011 and then updated it in 2015. This latest update adds 35 more studies to the evidence base, almost doubling the previously included number of studies. Clinicians who currently have access to virtual reality programs should be reassured that their use as part of a comprehensive rehabilitation program appears reasonable, taking into account the patient's goals, abilities, and preferences.”

Thursday, November 23, 2017