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BACKGROUND In neurorehabilitation, virtual reality (VR) applications cover a wide range of areas, including the rehabilitation of patients with various types of brain and spinal cord injuries. VR provides the subject multisensory feedback, enhancing neuronal plasticity within the sensorimotor cortex. OBJECTIVE The systematic review critically analyses the existing literature on VR applications related to motor problems and somatic representation to propose new tools and experiments. METHODS The Protocol was registered in the international database for systematic reviews PROSPERO (ID: 481092 - 22 November 2023). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. To implement the search string, a broad overview of previous literature reviews in the field was developed. The databases PubMed, Embase, Scopus, and Web of Science (7 December 2023) were explored, and data regarding study design, methodology, participant characteristics, specific devices and instruments used and tested, body representation, and virtual somatic embodiment were collected. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies; for case report studies, a dedicated scale was used. RESULTS The review included 26 studies, mainly clinical trials on neurological patients. Internationally, VR technologies in the period 2008-2023 have evolved significantly; the emergence of inexpensive devices such as Oculus Rift and HTC Vive has stimulated research in this area. The best results have been achieved for patients with sensorimotor deficits. In VR systems, users experience a first- or third-person view (where their avatar is present) of the synthetic world around them. All included studies used the first-person perspective, which was found to be most effective. Five studies incorporated EEG for recording brain responses during experiments, while two studies used transcranial stimulators to enhance the effect of the VR intervention. A couple of studies employed other kinds of devices, such as eye trackers. Regarding the 3D engine used, Unity 3D remains the preferred choice for the development of VR applications in research due to its ease of learning and seamless integration with devices. CONCLUSIONS The review of the selected studies shows that the use of VR devices enhances reinforcement learning, thereby improving motor and cognitive recovery. The emerging operational proposition supports the use of tailor-made techniques in the rehabilitation setting - aimed at improving and evaluating the outcomes of therapeutic interventions in the treatment of neurological patients. CLINICALTRIAL International database for systematic reviews PROSPERO, ID: 481092 - 22 November 2023.
BACKGROUND In neurorehabilitation, virtual reality (VR) applications cover a wide range of areas, including the rehabilitation of patients with various types of brain and spinal cord injuries. VR provides the subject multisensory feedback, enhancing neuronal plasticity within the sensorimotor cortex. OBJECTIVE The systematic review critically analyses the existing literature on VR applications related to motor problems and somatic representation to propose new tools and experiments. METHODS The Protocol was registered in the international database for systematic reviews PROSPERO (ID: 481092 - 22 November 2023). The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. To implement the search string, a broad overview of previous literature reviews in the field was developed. The databases PubMed, Embase, Scopus, and Web of Science (7 December 2023) were explored, and data regarding study design, methodology, participant characteristics, specific devices and instruments used and tested, body representation, and virtual somatic embodiment were collected. The Newcastle-Ottawa Scale was used to assess the methodological quality of the studies; for case report studies, a dedicated scale was used. RESULTS The review included 26 studies, mainly clinical trials on neurological patients. Internationally, VR technologies in the period 2008-2023 have evolved significantly; the emergence of inexpensive devices such as Oculus Rift and HTC Vive has stimulated research in this area. The best results have been achieved for patients with sensorimotor deficits. In VR systems, users experience a first- or third-person view (where their avatar is present) of the synthetic world around them. All included studies used the first-person perspective, which was found to be most effective. Five studies incorporated EEG for recording brain responses during experiments, while two studies used transcranial stimulators to enhance the effect of the VR intervention. A couple of studies employed other kinds of devices, such as eye trackers. Regarding the 3D engine used, Unity 3D remains the preferred choice for the development of VR applications in research due to its ease of learning and seamless integration with devices. CONCLUSIONS The review of the selected studies shows that the use of VR devices enhances reinforcement learning, thereby improving motor and cognitive recovery. The emerging operational proposition supports the use of tailor-made techniques in the rehabilitation setting - aimed at improving and evaluating the outcomes of therapeutic interventions in the treatment of neurological patients. CLINICALTRIAL International database for systematic reviews PROSPERO, ID: 481092 - 22 November 2023.
IntroductionBody awareness (BA) is the process of gaining sensory awareness based on the physiological states and actions of the body. It is influenced by an individual’s attitudes, perceptions, beliefs, and experiences within the social and cultural contexts. Following a stroke, impairments in BA are thought to be widespread and could have a significant impact on recovery results. Regaining body awareness, however, is often neglected in the neurorehabilitation field. This study aimed to assess body image perception in two stroke patients and the potential effect of motor and cognitive rehabilitative treatments on possible improvement of BA.MethodsPatients were evaluated through a multidimensional neuropsychological assessment before and after a 3-month motor and cognitive rehabilitative training. Sessions were scheduled 6 times per week with a total duration of 3 h per session.ResultsAfter the neurorehabilitative treatment, both patients showed an improvement in BA, cognition, mood, and motor skills. Differences emerged related to the progression and improvement of their respective performances.DiscussionThe causes of these differences could include the following: different brain areas affected, the ischemic or hemorrhagic nature of the stroke, age, and sex. Further research is needed to better understand the differences and similarities in the correlations between deficit and lesional sites. Structured and early multidisciplinary intervention can certainly guarantee a better functional recovery for patients after a stroke. However, in this study we show how complementary assessment methods (such as human figure drawing) may be highly informative in choosing treatment modalities and verifying rehabilitation outcomes.
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