Virtual feedback for motor and pain rehabilitation after spinal cord injury

Abstract

Study design: Interventions using virtual feedback (VF) impact on motor functions and pain and may be relevant for neurorehabilitation after spinal cord injury (SCI) in which motor dysfunctions and (concomitant) pain are frequently observed. Potential mechanisms underlying VF include a modulation of cortical sensorimotor integration, increased therapy engagement and distraction from effort and pain. Still, the optimal parameters for VF and their technical implementation are currently unknown. Objectives: To provide an overview of interventions that have used VF to improve motor functions or to reduce pain after SCI. Methods: Literature review. Results: A total number of 17 studies were identified. VF interventions commonly focused on improving motor functions (n = 12) or reducing pain (n = 4). Only one study assessed both motor functions and pain. Studies generally report beneficial effects. However, the evidence is of low-level quality and many practical as well as theoretical issues remain unclear. Remaining knowledge gaps include: (1) optimal VF system characteristics, (2) the impact of different VF modalities and tasks, (3) dose-response relationships and (4) the identification of patients that are likely to benefit from VF. Future work should start by closing these knowledge gaps using systematic and controlled multi-session interventions and by assessing the underlying mechanisms involved. Conclusion: These results provide an important incentive to further assess the potential of VF interventions to simultaneously improve motor functions and reduce pain after SCI, which could contribute to better neurorehabilitation outcomes after SCI.

Promoting Gait Recovery and Limiting Neuropathic Pain After Spinal Cord Injury

“…This supports the view that interactive virtual feedback interventions could potentially affect simultaneously on motor functions and pain. 66,67 …”

Utilização da realidade virtual na reabilitação de indivíduos com lesão da espinal medula: revisão sistemática

“…Desta forma é possível aproveitar ao máximo a dedicação do paciente, conseguindo-se os melhores resultados possíveis. (Roosink, Mercier, 2014) O principal objectivo da realidade virtual é criar a sensação de que o paciente está dentro do ambiente simulado, para que o seu comportamento durante a realização do jogo, ou seja, durante a sessão de terapia, seja o mais idêntico ao que ele teria no mundo real. (Trincado-Alonso et al, 2014) A utilização da realidade virtual tem sido amplamente utilizada na terapia de reabilitação para disfunção do equilíbrio.…”

Interactive virtual feedback improves gait motor imagery after spinal cord injury: An exploratory study

“…The simultaneous effects of motor imagery on motor function and pain make it a particularly relevant intervention for individuals with spinal cord injury (SCI) ( Roosink & Mercier, 2014 ; Villiger, Bohli, et al, 2013 ), in whom neuropathic pain is prevalent (ranging between 34% and 83%) and is considered particularly difficult to treat ( Siddall, McClelland, Rutkowski, & Cousins, 2003 ; Turner, Cardenas, Warms, & McClellan, 2001 ). Importantly, pain interferes with the rehabilitation process and with motor recovery.…”

“…Moreover, given that motor imagery has often been applied in combination with other therapeutic modalities, such as visual feedback (e.g. mirror therapy, virtual reality) ( Villiger, Bohli, et al, 2013 ) or physical exercise ( Sharp et al, 2014 ), the contribution of each modality to therapy efficacy remains largely unclear ( Roosink & Mercier, 2014 ). A particular therapeutic approach that has been studied in individuals with neuropathic pain after SCI has initially been called “virtual walking” ( Moseley, 2007 ).…”

“…Although the triggering of initial pain (i.e. within session) has not been shown to be detrimental to the long term effects of motor imagery or virtual feedback therapy ( Beaumont, Mercier, Michon, Malouin, & Jackson, 2011 ; Mercier & Sirigu, 2009 ), therapeutic efficacy might be improved by facilitating motor imagery ( Roosink & Mercier, 2014 ).…”