Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses

Abstract

Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.

Improving Care for Veterans with Traumatic Brain Injury Across the Lifespan

“…Eight studies assessed the effectiveness of virtual care in the general adult population. Five of the reviews demonstrated positive effects (Alashram et al, 2019;Betts et al, 2018;Bogdanova et al, 2016;Leopold et al, 2015;Voinescu, Sui, and Fraser, 2021), one found mixed effects (Manivannan et al, 2019), and two drew uncertain conclusions (Brassel et al, 2021;Buhagiar et al, 2020). Physical exercise was tested for cognitive effects in four systematic reviews.…”

“…Virtual care was tested in seven systematic reviews that assessed functional outcomes, all in the general adult population. Two demonstrated effectiveness (Leopold et al, 2015;Voinescu, Sui, and Fraser, 2021), one did not (Alashram et al, 2020), two had mixed findings (Ownsworth et al, 2018;Sigmundsdottir, Longley, and Tate, 2016), and two drew uncertain conclusions (Brassel et al, 2021;Postol et al, 2019). Physical exercise was assessed for its effect on functional outcomes in two systematic reviews examining the general adult population.…”

Intensive Training with Virtual Reality on Mobility in Adolescents with Cerebral Palsy—Single Subject Design

“…Different possibilities for the use of VR have shown positive results, and the use of available non-immersive virtual reality video game consoles to provide “exergames” (i.e., a mixture of physical activity presented within the structure and flow of a game, which can function as a form of physical exercise) have been considered interesting [ 11 , 12 ]. According to Voinescu et al, in individuals with CP, the use of VR is a positive rehabilitation technique that provides movement, physical activity, and engagement [ 13 ]. Moreover, VR can provide improvement in lower limb strength, static and dynamic balance, mobility, increased gait speed, and improved gross motor function of the participants [ 6 , 7 , 8 , 9 , 10 , 14 , 15 , 16 , 17 , 18 ].…”

Development and Preliminary Testing of a System for the Multimodal Analysis of Gait Training in a Virtual Reality Environment

“…Nevertheless, the efficacy of VR therapies is still under debate. The existing literature reports mixed findings [2,11], with results often obtained from small groups and sometimes without an adequate control comparison. Thus, more research is needed to better understand the effects of VR-based rehabilitation on different clinical conditions.…”