Applications of Head-Mounted Displays for Virtual Reality in Adult Physical Rehabilitation: A Scoping Review

Abstract

Importance: Head-mounted displays for virtual reality (HMD–VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds. Objective: To explore how HMD–VR has been used in adult physical rehabilitation. Data Sources: A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review. Study Selection and Data Collection: This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD–VR in a physical rehabilitation context and within the scope of occupational therapy practice. Findings: HMD–VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson’s disease. Conclusions and Relevance: HMD–VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes. What This Article Adds: We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.

What Do We Know about The Use of Virtual Reality in the Rehabilitation Field? A Brief Overview

“…Concerning motor outcomes, no significant differences were observed between the VR and control groups with regard to functional balance in four studies [118,[126][127][128][129]; however, opposite results were reported by other studies [54,116,117], particularly regarding upper limb motor functions [130], although with some exceptions [131]. Particularly, the entrainment of a mirror neuron system using VR feedback with a walking human avatar when providing patients with robot-aided treadmill gait training may be central for the improvement of motor rehabilitation outcomes [54].…”

“…Particularly, the entrainment of a mirror neuron system using VR feedback with a walking human avatar when providing patients with robot-aided treadmill gait training may be central for the improvement of motor rehabilitation outcomes [54]. Similarly, superior effectiveness of VR-based treadmill gait training compared to non-VR training was found concerning in terms of the overall gait performance [123] but not walking speed [115,118,120,[126][127][128].…”

The Effects of Visual Backgrounds in the Virtual Environments on the Postural Stability of Standing

“…There are important impacts and potential applications of our study results. Growing evidence from clinical studies has disclosed positive results for VR-based rehabilitation in adult rehabilitation, including for patients with stroke, spinal cord injury, cerebral palsy and other neurological impairments [5]. The interactions between VE design and human postural control would be one of the key issues, since some authors have suggested that VR can be a useful tool to provide balance training that activates the cerebral cortex and improves the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function [39].…”

“…They can simulate and create realistic-looking worlds with the high variability observed in real-world scenarios and enable realtime interactions through immersive feelings. The high levels of embodiment and great flexibility in manipulating the visual environment helps to achieve the desired clinical or experimental effects [4,5].…”

Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability

“…VR implies the use of a computer-generated simulation of 3D environments, through which the users can experience a full or semi-immersive experience, as if they were in a real context dimension [58,61,62]. Innovative VR devices, including head mounted displays (HMDs) [57,[63][64][65], give the opportunity of taking advantage of a higher level of immersion (i.e., immersive virtual environments (IVEs)) [57], which is effective for enhancing motor and cognitive skills in healthy [63,65,66] and clinical populations [67][68][69]. Conversely, semiimmersive VR, due to the lack of HDMs, does not guarantee a full immersion but favors the interaction among participants, promoting group therapies [61].…”