The Untapped Potential of Virtual Reality in Rehabilitation of Balance and Gait in Neurological Disorders

Abstract

Dynamic systems theory transformed our understanding of motor control by recognizing the continual interaction between the organism and the environment. Movement could no longer be visualized simply as a response to a pattern of stimuli or as a demonstration of prior intent; movement is context dependent and is continuously reshaped by the ongoing dynamics of the world around us. Virtual reality is one methodological variable that allows us to control and manipulate that environmental context. A large body of literature exists to support the impact of visual flow, visual conditions, and visual perception on the planning and execution of movement. In rehabilitative practice, however, this technology has been employed mostly as a tool for motivation and enjoyment of physical exercise. The opportunity to modulate motor behavior through the parameters of the virtual world is often ignored in practice. In this article we present the results of experiments from our laboratories and from others demonstrating that presenting particular characteristics of the virtual world through different sensory modalities will modify balance and locomotor behavior. We will discuss how movement in the virtual world opens a window into the motor planning processes and informs us about the relative weighting of visual and somatosensory signals. Finally, we discuss how these findings should influence future treatment design.

Effect of immersive visualization technologies on cognitive load, motivation, usability, and embodiment

“…The use of more immersive VR in motor training settings has been encouraged by recent reviews (Keshner and Lamontagne 2021;Levac et al 2019;Mekbib et al 2020). In an IVR system with an avatar visualized from a first-person perspective, visuospatial transformations from the performed movement to its virtual representation are minimized and the natural eye-hand coordination is preserved.…”

Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury

“…There have been indications that rehabilitation focusing on postural training can improve postural control in adults with severe TBI (66)(67)(68) and that such an improvement is accompanied by alterations in cerebellar white matter (69). Nevertheless, more research employing higher quality methodological designs and challenging VR environments are clearly needed to better assess the efficacy of current acquired brain injury rehabilitation strategies (48,(70)(71)(72).…”

“…In this previous work, the most challenging situations, i.e., unstable support surface, absence or conflicting visual information ( 2 – 5 , 9 ), and added cognitive load ( 6 , 7 , 27 , 39 – 42 ) induced the most postural difficulties. In line with the relevance of using more challenging dynamic stimulation, VR technology has recently been proposed as a useful tool for postural assessment, rehabilitation and to detect subacute mTBI deficits ( 43 – 48 ). For example, a recent study demonstrated that specific postural tasks designed to assess visual-vestibular inputs in dynamic immersive VR environment were found to be the most sensitive tests for discriminating health status following mTBI while the BESS, King-Devick and Dynamic Visual Acuity tests did not detect any differences between mTBI and control groups ( 49 ).…”

A Review of the Potential of Virtual Walking Techniques for Gait Rehabilitation

“…More recent reviews by Canning et al ( 2020 ), Huygelier et al ( 2021 ), and Keshner and Lamontagne ( 2021 ) highlighted the concrete contributions of VR to rehabilitation of balance and gait; suggesting that the most promising effects of VR are the ability to multitask in a VE that can replicate the demands of a physical space. There is indeed already a promising body of evidence for effective virtual walking techniques in populations such as stroke (Mirelman et al, 2010 ; Cai et al, 2021 ), multiple sclerosis (Samaraweera et al, 2013 ; Winter et al, 2021 ), Parkinson's disease (Janeh et al, 2019a ; Quek et al, 2021 ), and Alzheimer's disease (White and Moussavi, 2016 ).…”