Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies

ABSTRACT Introduction: Over recent decades many researchers and clinicians have started to use Virtual Reality (VR) as a new technology for implementing innovative rehabilitation treatments in cognitive and motor domains. However, the expression ‘VR’ has often also been improperly used to refer to video games. Further, VR efficacy, often confused with that of video-game exercises, is still debated. Areas covered: In this review, we provide the scientific rationale for the advantages of using VR systems in rehabilitation and investigate whether the VR could really be a promising technique for the future of rehabilitation of patients, or if it is just an entertainment for scientists. In addition, we describe some of the most used devices in VR with their potential advantages for research and provide an overview of the recent evidence and meta-analyses in rehabilitation. Expert commentary: We highlight the efficacy and fallacies of VR in neurorehabilitation and discuss the important factors emerging from the use of VR, including the sense of presence and the embodiment over a virtual avatar, in developing future applications in cognitive and motor rehabilitation.

[1]  W. Poon,et al.  The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury , 2013, Brain injury.

[2]  Antonio Frisoli,et al.  A Fully Immersive Set-Up for Remote Interaction and Neurorehabilitation Based on Virtual Body Ownership , 2012, Front. Neur..

[3]  Donatella Mattia,et al.  The 3Ts of the new millennium neurorehabilitation gym: therapy, technology, translationality , 2016, Expert review of medical devices.

[4]  Mansueto Gomes Neto,et al.  Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients , 2015, Topics in stroke rehabilitation.

[5]  Wijnand A. IJsselsteijn,et al.  Effects of Stereoscopic Presentation, Image Motion, and Screen Size on Subjective and Objective Corroborative Measures of Presence , 2001, Presence: Teleoperators & Virtual Environments.

[6]  Pawel Kiper,et al.  A Decade of Progress Using Virtual Reality for Poststroke Lower Extremity Rehabilitation: Systematic Review of the Intervention Methods , 2015, BioMed research international.

[7]  Albert A. Rizzo,et al.  Is clinical virtual reality ready for primetime? , 2017, Neuropsychology.

[8]  Tatiana de Paula Oliveira,et al.  Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study. , 2012, Physiotherapy.

[9]  Philippe S. Archambault,et al.  Virtual reality treatment and assessments for post-stroke unilateral spatial neglect: A systematic literature review , 2017, Neuropsychological rehabilitation.

[10]  Lutz Jäncke,et al.  Feeling Present in Arousing Virtual Reality Worlds: Prefrontal Brain Regions Differentially Orchestrate Presence Experience in Adults and Children , 2008, Frontiers in human neuroscience.

[11]  Salvatore Maria Aglioti,et al.  Wronger than wrong: Graded mapping of the errors of an avatar in the performance monitoring system of the onlooker , 2018, NeuroImage.

[12]  Maria V. Sanchez-Vives,et al.  Virtual Hand Illusion Induced by Visuomotor Correlations , 2010, PloS one.

[13]  Justin Dunn,et al.  Virtual and augmented reality in the treatment of phantom limb pain: A literature review. , 2017, NeuroRehabilitation.

[14]  Sandeep K Subramanian,et al.  Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement? , 2017, 2017 International Conference on Virtual Rehabilitation (ICVR).

[15]  K. Newell,et al.  Modulation of cortical activity in 2D versus 3D virtual reality environments: an EEG study. , 2015, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[16]  Alessia Bramanti,et al.  Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? , 2016, Neurological Sciences.

[17]  Luciano Gamberini,et al.  Controlling Memory Impairment in Elderly Adults Using Virtual Reality Memory Training: A Randomized Controlled Pilot Study , 2010, Neurorehabilitation and neural repair.

[18]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[19]  Tai Sing Lee,et al.  Contextual Influences in Visual Processing , 2008 .

[20]  Martijn J. Schuemie,et al.  Research on Presence in Virtual Reality: A Survey , 2001, Cyberpsychology Behav. Soc. Netw..

[21]  Robert Teasell,et al.  The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis , 2017, Topics in stroke rehabilitation.

[22]  G. Burdea,et al.  BrightBrainer feasibility study in a medical adult day program , 2015, 2015 International Conference on Virtual Rehabilitation (ICVR).

[23]  Pinata H Sessoms,et al.  Improvements in gait speed and weight shift of persons with traumatic brain injury and vestibular dysfunction using a virtual reality computer-assisted rehabilitation environment. , 2015, Military medicine.

[24]  Michitaka Hirose,et al.  3D User Interfaces: New Directions and Perspectives , 2008, IEEE Computer Graphics and Applications.

[25]  M. Whitton,et al.  Review of Four Studies on the Use of Physiological Reaction as a Measure of Presence in StressfulVirtual Environments , 2005, Applied psychophysiology and biofeedback.

[26]  A. Mirelman,et al.  Effects of virtual reality training on gait biomechanics of individuals post-stroke. , 2010, Gait & posture.

[27]  Jörg Krüger,et al.  Application of head-mounted devices with eye-tracking in virtual reality therapy , 2017 .

[28]  Philippe Coiffet,et al.  Virtual Reality Technology , 2003, Presence: Teleoperators & Virtual Environments.

[29]  Tabitha C. Peck,et al.  A threat to a virtual hand elicits motor cortex activation , 2014, Experimental Brain Research.

[30]  Javier Andreu-Perez,et al.  A virtual reality and brain computer interface system for upper limb rehabilitation of post stroke patients , 2017, 2017 IEEE International Conference on Fuzzy Systems (FUZZ-IEEE).

[31]  C. Caltagirone,et al.  The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial , 2014, BioMed research international.

[32]  M. Molinari,et al.  Brain–computer interface boosts motor imagery practice during stroke recovery , 2015, Annals of neurology.

[33]  M. Tarr,et al.  Virtual reality in behavioral neuroscience and beyond , 2002, Nature Neuroscience.

[34]  Pablo Gagliardo,et al.  Virtual reality and cognitive rehabilitation: a review of current outcome research. , 2014, NeuroRehabilitation.

[35]  J. Deutsch,et al.  Virtual Reality for Stroke Rehabilitation , 2011, The Cochrane database of systematic reviews.

[36]  Maria V. Sanchez-Vives,et al.  What Color is My Arm? Changes in Skin Color of an Embodied Virtual Arm Modulates Pain Threshold , 2013, Front. Hum. Neurosci..

[37]  Fabio Babiloni,et al.  Electroencephalographic Correlates of Sensorimotor Integration and Embodiment during the Appreciation of Virtual Architectural Environments , 2015, Front. Psychol..

[38]  Caroline Knight,et al.  Development of a simplified version of the multiple errands test for use in hospital settings , 2002 .

[39]  M. Slater,et al.  Sliding perspectives: dissociating ownership from self-location during full body illusions in virtual reality , 2014, Front. Hum. Neurosci..

[40]  Antoni Rodríguez-Fornells,et al.  Violating body movement semantics: Neural signatures of self-generated and external-generated errors , 2016, NeuroImage.

[41]  Maria del Carmen Juan Lizandra,et al.  Comparison of the Levels of Presence and Anxiety in an Acrophobic Environment Viewed via HMD or CAVE , 2009, PRESENCE: Teleoperators and Virtual Environments.

[42]  Antonio Frisoli,et al.  A force-feedback exoskeleton for upper-limb rehabilitation in virtual reality , 2009 .

[43]  Matt C. Howard A meta-analysis and systematic literature review of virtual reality rehabilitation programs , 2017, Comput. Hum. Behav..

[44]  Susan Persky,et al.  Immersive Virtual Video Game Play and Presence: Influences on Aggressive Feelings and Behavior , 2008, PRESENCE: Teleoperators and Virtual Environments.

[45]  Gaetano Tieri,et al.  Visual appearance of a virtual upper limb modulates the temperature of the real hand: a thermal imaging study in Immersive Virtual Reality , 2017, The European journal of neuroscience.

[46]  Howard Rheingold,et al.  Virtual Reality: Exploring the Brave New Technologies , 1991 .

[47]  Giuseppe Riva,et al.  New Technologies for Relaxation: The Role of Presence , 2007 .

[48]  Y Kuniyoshi,et al.  Restoring movement representation and alleviating phantom limb pain through short‐term neurorehabilitation with a virtual reality system , 2017, European journal of pain.

[49]  Concepción Perpiñá,et al.  Body Image and Virtual Reality in Eating Disorders: Is Exposure to Virtual Reality More Effective than the Classical Body Image Treatment? , 1999, Cyberpsychology Behav. Soc. Netw..

[50]  Paul Richard,et al.  The potential of virtual reality-based training to enhance the functional autonomy of Alzheimer's disease patients in cooking activities: A single case study , 2018, Neuropsychological Rehabilitation.

[51]  Maria V. Sanchez-Vives,et al.  Towards a Digital Body: The Virtual Arm Illusion , 2008, Frontiers in human neuroscience.

[52]  C. S. Green,et al.  Learning, Attentional Control, and Action Video Games , 2012, Current Biology.

[53]  Tabitha C. Peck,et al.  Putting yourself in the skin of a black avatar reduces implicit racial bias , 2013, Consciousness and Cognition.

[54]  S. M. Aglioti,et al.  Mere observation of body discontinuity affects perceived ownership and vicarious agency over a virtual hand , 2015, Experimental Brain Research.

[55]  Gernot R. Müller-Putz,et al.  Self-Paced (Asynchronous) BCI Control of a Wheelchair in Virtual Environments: A Case Study with a Tetraplegic , 2007, Comput. Intell. Neurosci..

[56]  Maria V. Sanchez-Vives,et al.  From presence to consciousness through virtual reality , 2005, Nature Reviews Neuroscience.

[57]  Pier Luca Lanzi,et al.  Exergaming and rehabilitation: A methodology for the design of effective and safe therapeutic exergames , 2016, Entertain. Comput..

[58]  Rosa María Baños,et al.  Immersion and Emotion: Their Impact on the Sense of Presence , 2004, Cyberpsychology Behav. Soc. Netw..

[59]  U. Castiello,et al.  Improving left hemispatial neglect using virtual reality , 2004, Neurology.

[60]  S. Paolucci,et al.  Seven Capital Devices for the Future of Stroke Rehabilitation , 2012, Stroke research and treatment.

[61]  Salvatore Maria Aglioti,et al.  Embodying Others in Immersive Virtual Reality: Electro-Cortical Signatures of Monitoring the Errors in the Actions of an Avatar Seen from a First-Person Perspective , 2016, The Journal of Neuroscience.

[62]  C Shawn Green,et al.  The Brain-Boosting Power of Video Games. , 2016, Scientific American.

[63]  Adam Gazzaley,et al.  Recommendations for the Use of Serious Games in Neurodegenerative Disorders: 2016 Delphi Panel , 2017, Front. Psychol..

[64]  Vincenzo Maffei,et al.  Vestibular nuclei and cerebellum put visual gravitational motion in context. , 2008, Journal of neurophysiology.

[65]  Mel Slater,et al.  A Framework for Immersive Virtual Environments (FIVE): Speculations on the Role of Presence in Virtual Environments , 1997, Presence: Teleoperators & Virtual Environments.

[66]  Albert A. Rizzo,et al.  Virtual Reality in Brain Damage Rehabilitation: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[67]  J. Pompeu,et al.  Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review , 2017, Topics in stroke rehabilitation.

[68]  Toby Howard,et al.  Can immersive virtual reality reduce phantom limb pain? , 2006, Studies in health technology and informatics.

[69]  Mel Slater,et al.  Inducing a virtual hand ownership illusion through a brain–computer interface , 2009, Neuroreport.

[70]  M. Bergamasco,et al.  Arm rehabilitation with a robotic exoskeleleton in Virtual Reality , 2007, 2007 IEEE 10th International Conference on Rehabilitation Robotics.

[71]  R. Calabró,et al.  Does body shadow improve the efficacy of virtual reality-based training with BTS NIRVANA? , 2017, Medicine.

[72]  E. Gibson Principles of Perceptual Learning and Development , 1969 .

[73]  G J Verkerke,et al.  Exergames for unsupervised balance training at home: A pilot study in healthy older adults. , 2016, Gait & posture.

[74]  Massimo Bergamasco,et al.  I'm in VR!: using your own hands in a fully immersive MR system , 2014, VRST '14.

[75]  M. Molinari,et al.  Rehabilitation of gait after stroke: a review towards a top-down approach , 2011, Journal of NeuroEngineering and Rehabilitation.

[76]  Maria V. Sanchez-Vives,et al.  Extending Body Space in Immersive Virtual Reality: A Very Long Arm Illusion , 2012, PloS one.

[77]  R. Calabró,et al.  The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial , 2017, Journal of NeuroEngineering and Rehabilitation.

[78]  É. Sorita,et al.  Do patients with traumatic brain injury learn a route in the same way in real and virtual environments? , 2013, Disability and rehabilitation.

[79]  Giuseppe Riva,et al.  The Role of Immersion and Narrative in Mediated Presence: The Virtual Hospital Experience , 2011, Cyberpsychology Behav. Soc. Netw..

[80]  Jonathan D. Cohen,et al.  Rubber hands ‘feel’ touch that eyes see , 1998, Nature.

[81]  A. Cherubini,et al.  Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics , 2017, Neuropsychiatric disease and treatment.

[82]  Corey J. Bohil,et al.  Virtual reality in neuroscience research and therapy , 2011, Nature Reviews Neuroscience.

[83]  C. Adams,et al.  Virtual reality for treatment compliance for people with serious mental illness. , 2014, The Cochrane database of systematic reviews.

[84]  S. Paolucci,et al.  Impact of participation on rehabilitation results: a multivariate study. , 2012, European journal of physical and rehabilitation medicine.

[85]  Maria V. Sanchez-Vives,et al.  First Person Experience of Body Transfer in Virtual Reality , 2010, PloS one.

[86]  I. Danovitch,et al.  Virtual Reality and Medical Inpatients: A Systematic Review of Randomized, Controlled Trials. , 2017, Innovations in clinical neuroscience.

[87]  M. Bar Visual objects in context , 2004, Nature Reviews Neuroscience.

[88]  A. Mirelman,et al.  Virtual reality for rehabilitation in Parkinson's disease. , 2014, The Cochrane database of systematic reviews.

[89]  M. Slater,et al.  Multisensory Stimulation Can Induce an Illusion of Larger Belly Size in Immersive Virtual Reality , 2011, PloS one.

[90]  Alberto Leardini,et al.  Validation of the angular measurements of a new inertial-measurement-unit based rehabilitation system: comparison with state-of-the-art gait analysis , 2014, Journal of NeuroEngineering and Rehabilitation.

[91]  Carlotte Kiekens,et al.  Comparison of the Effect of Two Driving Retraining Programs on On-Road Performance After Stroke , 2009, Neurorehabilitation and neural repair.

[92]  R. Calabró,et al.  Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial , 2017, Journal of the Neurological Sciences.

[93]  P. Singhi,et al.  Effectiveness of virtual reality rehabilitation for children and adolescents with cerebral palsy: an updated evidence-based systematic review. , 2017, Physiotherapy.

[94]  Mel Slater,et al.  Measuring Presence: A Response to the Witmer and Singer Presence Questionnaire , 1999, Presence.

[95]  Salvatore Maria Aglioti,et al.  Body visual discontinuity affects feeling of ownership and skin conductance responses , 2015, Scientific Reports.

[96]  Salvatore Maria Aglioti,et al.  Seeing pain and pleasure on self and others: behavioral and psychophysiological reactivity in immersive virtual reality. , 2016, Journal of neurophysiology.

[97]  Andrea Cherubini,et al.  The Three Laws of Neurorobotics: A Review on What Neurorehabilitation Robots Should Do for Patients and Clinicians , 2016, Journal of medical and biological engineering.