Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

Abstract

The present article reports the results of a systematic review on the potential benefits of the combined use of virtual reality (VR) and non-invasive brain stimulation (NIBS) as a novel approach for rehabilitation. VR and NIBS are two rehabilitation techniques that have been consistently explored by health professionals, and in recent years there is strong evidence of the therapeutic benefits of their combined use. In this work, we reviewed research articles that report the combined use of VR and two common NIBS techniques, namely transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). Relevant queries to six major bibliographic databases were performed to retrieve original research articles that reported the use of the combination VR-NIBS for rehabilitation applications. A total of 16 articles were identified and reviewed. The reviewed studies have significant differences in the goals, materials, methods, and outcomes. These differences are likely caused by the lack of guidelines and best practices on how to combine VR and NIBS techniques. Five therapeutic applications were identified: stroke, neuropathic pain, cerebral palsy, phobia and post-traumatic stress disorder, and multiple sclerosis rehabilitation. The majority of the reviewed studies reported positive effects of the use of VR-NIBS. However, further research is still needed to validate existing results on larger sample sizes and across different clinical conditions. For these reasons, in this review recommendations for future studies exploring the combined use of VR and NIBS are presented to facilitate the comparison among works.

A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke

“…3 Growing evidence has revealed that VR has the potential to generate effective rehabilitation environments, which are possibly individualized, safe, and multimodal simulations. 2,[4][5][6][7][8] Moreover, VR has the potential to provide the key elements of neuroplasticity (i.e., feedback, repetition, intensity, and taskspecific training), which are not usually possible in conventional physical therapies 9 but are helpful to speed up the recovery of UEs poststroke. [10][11][12] Basic neuroscience behind VR-based treatment Besides providing external stimulation, VR has additional potential to stimulate the internal sensorimotor system, possibly linked with better functional outcomes.…”

“…VR is an advanced form of a computer‐simulated environment that allows users to “interact” with the virtual objects and the environment within a rendered scenario 3 . Growing evidence has revealed that VR has the potential to generate effective rehabilitation environments, which are possibly individualized, safe, and multimodal simulations 2,4–8 . Moreover, VR has the potential to provide the key elements of neuroplasticity (i.e., feedback, repetition, intensity, and task‐specific training), which are not usually possible in conventional physical therapies 9 but are helpful to speed up the recovery of UEs poststroke 10–12 …”

Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety

“…For future research, an interesting possibility could be to adopt a mixed approach. Indeed, for motor recovery, different studies have already reported positive effects on the combined use of VR and tDCS [ 173 , 174 , 175 , 176 ] and VR with tele-practice [ 177 ]. In addition, as previously described ( Section 2.2 ), since the combined effect of d-amphetamine with tDCS and language therapy was already successfully investigated in post-stroke aphasia, it would also be interesting to further explore this new approach [ 61 ].…”

Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment

“…Furthermore, some studies have combined virtual walking with transcranial direct current stimulation (tDCS), indicating the combination of these two tools to strongly reduce NP suggesting a synergistic effect [ 44 , 54 , 55 ]. Findings indicate that VR is an effective analgesic intervention for the treatment of NP in people with SCIs, with some studies identifying its short, medium, and long-term effects, especially when it is used in combination with tDCS.…”