Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review

Abstract

Background Spinal cord injury (SCI) is often associated with long-term impairments related to functional limitations in the sensorimotor system. The use of virtual reality (VR) technology may lead to increased motivation and engagement, besides allowing a wide range of possible tasks/exercises to be implemented in rehabilitation programs. The present review aims to investigate the possible benefits and efficacy of VR-based rehabilitation in individuals with SCI. Methods An electronically systematic search was performed in multiple databases (PubMed, BVS, Web of Science, Cochrane Central, and Scielo) up to May 2019. MESH terms and keywords were combined in a search strategy. Two reviewers independently selected the studies in accordance with eligibility criteria. The PEDro scale was used to score the methodological quality and risk of bias of the selected studies. Results Twenty-five studies (including 482 participants, 47.6 ± 9.5 years, 73% male) were selected and discussed. Overall, the studies used VR devices in different rehabilitation protocols to improve motor function, driving skills, balance, aerobic function, and pain level, as well as psychological and motivational aspects. A large amount of heterogeneity was observed as to the study design, VR protocols, and outcome measures used. Only seven studies (28%) had an excellent/good quality of evidence. However, substantial evidence for significant positive effects associated with VR therapy was found in most of the studies (88%), with no adverse events (88%) being reported. Conclusion Although the current evidence is limited, the findings suggest that VR-based rehabilitation in subjects with SCI may lead to positive effects on aerobic function, balance, pain level, and motor function recovery besides improving psychological/motivational aspects. Further high-quality studies are needed to provide a guideline to clinical practice and to draw robust conclusions about the potential benefits of VR therapy for SCI patients. Protocol details are registered on PROSPERO (registration number: CRD42016052629).

Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis

“…The present findings are supported by the structured review carried out by Yeo et al [ 28 ], which analyzed the effectiveness of VR therapy for improvement of mobility and showed potential benefits on balance. Furthermore, our results match with those obtained by de Araújo et al [ 29 ] and Abou et al [ 30 ], who suggested that VR-based rehabilitation may lead to positive effects on balance in patients with SCI. Conversely, the present findings do not match with those obtained by our previous meta-analysis [ 3 ], performed to assess the effects of VR interventions on functional performance in patients with SCI.…”

“…They included seven case series and two randomized controlled trials and concluded that VR is effective to improve balance and posture. A systematic review conducted by Araújo et al [ 29 ], aiming to evaluate the benefits of VR in patients with SCI, included 25 studies; 12 of them used a pre-post design without a control group, 13 were controlled in a parallel or crossover design, and only 11 studies used randomization between groups. They suggested that VR interventions could provide benefits on balance and motor function recovery.…”

Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Moreover, the statistical analysis showed favorable results of CPT on the functional independence measured by the FIM scale. Our results match with the findings of de Araújo et al [ 27 ], who reported no solid conclusions about the efficacy of VR interventions on quality of life. The authors reported that this can be attributed to the lack of methodological quality and statistical power observed.…”

“…Different recent reviews analyzed the potential use of VR-based neurorehabilitation in patients with SCI. The systematic review conducted by de Araújo et al [ 27 ] concluded that VR therapy could be effective in improving aerobic function, balance, pain level and motor function, but the review was not restricted specifically to assess the quality of life through controlled trials. Villiger et al [ 28 ] suggested that VR interventions may be useful as a neurorehabilitation tool to improve motor function in subjects with a chronic SCI, but authors only analyzed the effects provided by home-based VR interventions.…”

Effects of Virtual Reality Therapy on Gait and Balance Among Individuals With Spinal Cord Injury: A Systematic Review and Meta-analysis

“…This hypothesis is supported by a recent study which highlighted the beneficial effects of VR therapy on psychological and motivational aspects of individuals with SCI. 37 By increasing the motivation and providing a safe environment, VR therapy may enhance the interest of individuals with SCI to exercise. Improving interest, participation levels, and confidence might lead to adherence to the therapy 10 and improvement in standing balance in this population.…”