Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness

Abstract

Combining the benefits of tele-rehabilitation and Virtual Realitybased balance training -a systematic review on feasibility and effectiveness.Purpose: A motivational surrounding is desirable in stroke rehabilitation considering the need to train repetitively to improve balance, even after discharge from rehabilitation facilities. This review aims to investigate if it is feasible to combine VR which allows exercising in game-like environments with tele-rehabilitation in a community-dwelling stroke population.Methods: Literature searches were conducted in five databases, e.g. PubMed and the Cochrane Library. Randomised and non-randomised controlled trials investigating feasibility and effectiveness of VR-based tele-rehabilitation were included. Based on the risk of bias and study design, methodological quality is ranked according to the GRADE guidelines.Results: Seven studies (n=120) were included, of which four are RCTs.Evidence regarding therapy adherence and perceived enjoyment of VR, as well as a cost-benefit of tele-rehabilitation emphasizes feasibility. Equal effects are reported comparing this approach to a therapist-supervised intervention in the clinical setting on balance and functional mobility. Conclusions:Tele-rehabilitation could be a promising tool to overcome burdens that restrict accessibility to rehabilitation in the future. VR can increase motivation allowing longer and more training sessions in communitydwelling stroke survivors. Therefore, combining the benefits of both approaches seems convenient. Although evidence is still sparse, functional improvements seem to be equal compared to a similar intervention with therapist-supervision in the clinic, suggesting that for cost-efficient rehabilitation parts of therapy can be transferred to the homes.

Effects of an Innovative Telerehabilitation Intervention for People With Parkinson's Disease on Quality of Life, Motor, and Non-motor Abilities

“…Whereas, a negative association was observed for the Mental Health Score of the SF-12 Health Survey in the UC group. This finding supports the direct effect of telerehabilitation with VR tools to provide a motivating environment, which promotes greater adherence to an intensive treatment over a long-term period ( 54 ).…”

Deep Cerebellar Transcranial Direct Current Stimulation of the Dentate Nucleus to Facilitate Standing Balance in Chronic Stroke Survivors—A Pilot Study

“…Furthermore, another systematic review and meta-analysis based on literature searches in databases including PubMed, Embase, MEDLINE, and Cochrane Library by de Rooij et al [71] showed that VR training is more effective than balance training without VR for improving balance ability in patients with stroke. Also, a systematic review on feasibility and effectiveness based on literature searches in five databases including PubMed and the Cochrane Library [72] showed that VR can increase motivation allowing longer and more training sessions in community-dwelling stroke survivors. Nevertheless, there exists very little evidence about interventions other than exercises, e.g., ctDCS, that can improve post-stroke standing balance function [73].…”

“…India is ripe for the assessment of the feasibility and usability of telemedicine approaches not only in acute stroke [84] but also in chronic stroke. Tele-rehabilitation is also justified since functional improvements have been found to be equal for telerehabilitation and virtual reality (VR)-based training when compared to a similar intervention with therapist-supervision in the clinic [72]. Therefore, we propose testing of the effectiveness of a low-cost neurotechnology platform [23] for remote (smartphone-based) patient care and monitoring through the hub and spoke model (HSM) of telemedicine that is not only necessary to create a large patient outcome dataset but is also crucial to meet the growing needs of stroke survivors in India [85,86].…”

Multi-Lateral Teleoperation Based on Multi-Agent Framework: Application to Simultaneous Training and Therapy in Telerehabilitation

“…TR typically lowers the costs of both healthcare services and patients compared to conventional inpatient or individual-to-person rehabilitation. Few studies have been conducted on the economic aspects of TR in which the cost of hospitalization in clinics is significantly reduced (Peretti et al, 2017;Schröder et al, 2019). TR is mainly applied to the physiotherapy process, and neural rehabilitation is used to monitor the rehabilitation process of stroke patients (Gal et al, 2015;Mani et al, 2017).…”

“…Therefore, the TR process can be performed in virtual reality, while the rehabilitation for neurological conditions is done using robots and gamification (Larson et al, 2014). Also, due to the presence of position and force sensors in the haptic-enabled devices, the progress of a patient's treatment can be shown numerically and on a graph (Schröder et al, 2019).…”