Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness

Abstract

Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest “cibersikness” symptomatology. Data sources: a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years. Study selection: we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity. Data extraction: quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine. Data synthesis: VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy. Conclusions: as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.

Effectiveness of Virtual Reality Systems to Improve the Activities of Daily Life in Older People

“…Moreover, commercial exergames offer a virtual re-creation of environments and challenges that are highly immersive, appealing and enjoyable for the user, thus increasing commitment to the task. In line with other reviews [ 53 , 54 ], our results suggest that the use of commercial virtual reality consoles, such as the Nintendo Wii ® , PlayStation ® and Xbox Kinect ® , can be beneficial and feasible in improving the functional autonomy of older persons.…”

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

“…This technology lends the ability to create an environment in which the intensity of feedback and training can be systematically manipulated and improved to create the most appropriate paradigm of individualized motor learning. The use of VR also determines the development of motor skills and cognition, with a positive effect on the emotional state of patients with different types of neurological dysfunctions, increasing the compliance of the subjects with the treatment [40]. The patients move in front of a console and receive visual but also proprioceptive feedback about their movements through the sensor that projects on the screen the patient's hand.…”

Could Virtual Reality play a role in the rehabilitation after COVID-19 infection?

“…Their side-effects are reportedly limited. 8 9 These headsets allow VR becoming part of telemedicine: any type of healthcare delivery at a distance, employing technologies like telephone calls, videoconferencing and remote monitoring. 10 The articles referenced here analyse any type of VR.…”

“… 13 Reviews have also demonstrated VR’s efficacy in increasing joint mobility and motor function for patients with chronic musculoskeletal disorders, positive impacts on rehabilitation of individuals with geriatric syndromes and better balance among children with Cerebral Palsy. 8 9 14 Although these are different pathologies from COVID-19, the similarities in treatment goals and hurdles (eg, compliance, anxiety for movements and fatigue) suggest that VR is also beneficial in post-COVID-19.…”