Stroke is a leading cause of disability worldwide. According to the Stroke Foundation, 15 million people worldwide per year will have a stroke, and 50% will end up disabled with a lack of mobility and motor function and lower quality of life. More than 795,000 Americans will experience a stroke every year. So, every 40 seconds, a person will experience a stroke, and every 4 minutes, one person dies from stroke complications (SAF, 2023). Swift and effective post-stroke rehabilitation is critical to optimize long-term recovery.
As science continues to evolve, medical technologies evolve, too, leading to groundbreaking treatments and therapies, improved patient outcomes, and better quality of life. In this blog post, we will discuss virtual reality (VR) therapy, a promising and transformative treatment modality that can have the same and “significantly greater” patient improvements for post-stroke rehabilitation than “conventional therapy (CT) for stroke rehabilitation” (Bui, 2021). In this blog post, we discuss how VR therapy improves balance, gait, upper limb function, postural control, functionality, and more in stroke patients.
Recognizing the potential to transform patient recovery, Dr. Brown of Better Brain & Body added Virtualis Motion VR to her practice. Virtualis is a cutting-edge virtual reality therapy that can aid the rehabilitation and recovery of various neurological, musculoskeletal, and other conditions, including stroke.
The Promise of Virtual Reality Therapy
Virtual reality, once primarily associated with video games, has rapidly evolved into a versatile healthcare tool. Inspired by its success in enhancing athletic performance by improving motor function, VR therapy has demonstrated potential benefits for various conditions, including stroke, PTSD, chronic pain, neurodegenerative disease, and depression. While conventional therapies have shown moderate effectiveness in recovery from stroke, researchers are exploring VR as a complementary approach. Researchers suggest integrating both conventional and virtual reality therapy, as more research is necessary to determine if VR therapy is sufficient as a standalone treatment. At Better Brain & Body, patients may also undergo other treatments, like hyperbaric chamber therapy for stroke, to complement their recovery process.
Virtual reality therapy is based on “full immersion.” The photo shows that VR therapy
includes wearing a headset that fully immerses patients in a virtual world while their bodies are still in their physical space. What the eyes see directly impacts how the brain processes our life. While some worry that full immersion might cause dizziness, research indicates that VR therapy typically does not induce this symptom.
VR therapy offers a unique advantage: the ability to transport patients into tailored virtual worlds. By immersing themselves in these digital environments via headset, patients can engage in various activities, from virtual sports to everyday tasks like cooking and cleaning. Experience mirror therapy, a promising module on our Virtualis VR rehabilitation device,
helping improve arm movement post-stroke (see photo). This sense of presence, where the virtual world feels real, is crucial for effective therapy (Bui, 2021). The possibilities are limitless, and the potential benefits for patient recovery are profound.
Gamification of Virtual Reality Therapy
VR therapy’s interactive nature boosts patient motivation through engaging scenarios. Patsaki notes that increased interest improves focus, attention, and concentration (2022). VR offers diverse, immersive, and repetitive experiences, unlike conventional therapies, which can be monotonous. This diversity can enhance psychological stimulation, maximizing patient treatment outcomes (2022). VR therapy improves balance, gait, upper limb function, postural control, functionality, and more in stroke patients.
Limitations of Conventional Therapy (CT):
Various conventional therapy modalities currently exist for post-stroke rehabilitation, such as PNF, motor re-learning, and neurodevelopmental techniques (Physiopedia, 2023). Other conventional therapies include physical therapy and occupational therapy for stroke patients. CTs show significant improvements when used alongside VR therapy. Patients relying only on VR for stroke rehabilitation also show substantial progress. VR therapy also demonstrated the potential to provide better patient outcomes than CT in some instances due to its widespread capabilities and applications.
One common limitation of CT includes asking too much of what the patient can accomplish physically, mentally, and emotionally. VR therapy is unique because patients wear a headset that fully immerses them in a novel virtual world and promotes “gamification” of the treatment (Demeco, 2023). CT cannot replicate this and can be tedious for patients, decreasing patient motivation, adherence, and compliance to complete their required therapy, thus lowering expected patient results. Other limitations of CT include:
Insufficient therapy time.
Lack of intensity.
Lack of data-driven insights.
Limited individualized care approaches.
Access Stroke Rehabilitation Immediately
Immediate rehabilitation is vital after a stroke. Delaying treatment increases the risk of severe, long-term consequences, including brain damage. Five-year survival rates for ischemic and intracerebral hemorrhagic strokes are 49.4% and 37.8%, respectively (Sennfält, 2018). The Considerations section will explore how virtual reality therapy aids recovery for different stroke types.
Virtual Reality Therapy & Neuroplasticity
Neuroplasticity is the brain and nervous system’s ability to respond and adapt to its environment. It explains the brain’s ability to reorganize itself. This process, crucial after injuries like stroke or concussion, can enhance or hinder recovery. While VR therapy shows promise in harnessing neuroplasticity, particularly in the early stages of stroke, its long-term effectiveness for chronic stroke patients is less clear. VR therapy’s appeal lies in its capacity for intensive, repetitive practice focused on impaired functions.
Current findings suggest that VR therapy induces significantly greater neuroplasticity, creating better outcomes for stroke patients than conventional therapy alone (Bui, 2021). Also, upper limb mobility can be greatly improved in sub-acute stroke patients using VR therapy rather than conventional therapy on its own (Wang et al., 2017). Due to the immersive experience of VR therapy, there is greater activation of the brain area responsible for movement and the planning and execution of movement, which is critical for post-stroke rehabilitation of motor function (Wu et al., 2021).
Advantages of Virtual Reality Therapy
Virtual reality therapy for stroke patients offers several advantages:
Increased Motivation & Engagement:
Gamification: VR often incorporates game-like elements, making therapy more enjoyable and motivating.
Immersive Experience: VR's immersive nature can make patients feel more engaged and focused on the rehabilitation process, whether for stroke therapy or other conditions such as cerebral palsy.
Improved Motor Function & Coordination:
Repetitive Practice: VR allows for high-repetition activities and exercises in a controlled environment, crucial for motor and movement learning after a stroke.
Functional Training: Patients can practice real-world tasks and activities of daily living in VR therapy, whereas, with CT, these activities may not be accessible.
Task-Specific Training: VR therapy can be tailored to address specific impairments, such as balance, coordination, hand dexterity, memory loss, upper limb function, gait (walking), and even sensory loss, numbness, tingling, and pain.
Enhanced Cognitive Function:
Cognitive Stimulation: VR therapy incorporates cognitive challenges, helping improve memory, attention, focus, and problem-solving skills.
Personalized Therapy:
Adaptive Difficulty: CT programs do not have the widespread flexibility VR has to help patients improve over time. VR therapy adjusts the difficulty level based on the patient’s progress, ensuring ongoing improvement and motivation.
Individualized Approach: VR therapy can be tailored to a patient’s goals, preferences, and needs, creating a more personalized rehabilitation experience.
Safe Environments: Virtual reality allows patients to safely practice difficult tasks, encouraging greater effort and skill improvement compared to traditional settings.
Objective Measurement:
Data Collection & Real-Time Feedback: VR therapy devices can collect detailed information on patient performance, allowing for an objective assessment of progress. Similarly, it can provide patients with real-time feedback, helping improve their performance during therapy. Real-time data also gives the physician and staff a window into a patient’s progression.
Considerations
Types of Strokes: As of today, science suggests VR therapy can assist both ischemic and hemorrhagic strokes. Research into the types of stroke and VR therapy is ongoing.
Stroke Timeline: Chronic stroke patients can equally benefit from VR therapy and CT in various areas, including “hand dexterity, arm function, and independence in ADL” (Schuster-Amft et al. 2018). Similarly, there may be “significantly greater improvements” in sub-acute and chronic stroke patients who use VR and CT therapy together instead of CT alone (Bui, 2021). Research is studying how VR helps across various post-stroke timeframes.
Conclusion
Virtual reality therapy may sound like a simple video game your kids or grandkids play. However, it is much more than that. This transformative therapy shows the same and significantly greater effects and potential recovery outcomes than conventional stroke therapy modalities like physical or occupational therapy. Patients should consider integrating conventional and virtual reality therapies together to optimize their stroke recovery.
VR therapy is transforming stroke rehabilitation through immersive, personalized experiences. Its interactive nature makes it engaging and effective, often surpassing conventional methods. By gamifying therapy, we inspire patient motivation and adherence, accelerating recovery. It allows for more repetitions, aiding in brain-body rewiring through neuroplasticity. While research on chronic stroke is ongoing, VR has shown remarkable potential for patients across all stroke stages. At Better Brain & Body, we are committed to informing you of the latest science and the potential to transform your health.
If you or a loved one are interested in virtual reality therapy, schedule a complimentary phone consultation with Dr. Alicia Brown online or call us at 704-752-8100. You can discuss with Dr. Brown how our Virtualis VR rehabilitation device can help you or a loved one recover from a stroke. Our team will try to schedule you with Dr. Brown for a phone consult as soon as possible.
Sources:
Bui, Julie & Luaute, Jacques & Farnè, Alessandro. (2021). Enhancing Upper Limb Rehabilitation of Stroke Patients With Virtual Reality: A Mini Review. Frontiers in Virtual Reality. 2. 595771. 10.3389/frvir.2021.595771.
Demeco A, Zola L, Frizziero A, Martini C, Palumbo A, Foresti R, Buccino G, Costantino C. Immersive Virtual Reality in Post-Stroke Rehabilitation: A Systematic Review. Sensors. 2023; 23(3):1712. https://doi.org/10.3390/s23031712
Laver, K. E., Lange, B., George, S., Deutsch, J. E., Saposnik, G., & Crotty, M. (2017). Virtual reality for stroke rehabilitation. The Cochrane database of systematic reviews, 11(11), CD008349. https://doi.org/10.1002/14651858.CD008349.pub4
Patsaki, I., Dimitriadi, N., Despoti, A., Tzoumi, D., Leventakis, N., Roussou, G., Papathanasiou, A., Nanas, S., & Karatzanos, E. (2022). The effectiveness of immersive virtual reality in physical recovery of stroke patients: A systematic review. Frontiers in systems neuroscience, 16, 880447. https://doi.org/10.3389/fnsys.2022.880447
Schuster-Amft C, Eng K, Suica Z, Thaler I, Signer S, Lehmann I, et al. (2018) Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial. PLoS ONE 13(10): e0204455. https://doi.org/10.1371/journal.pone.0204455
Sennfält, S., Norrving, B., Petersson, J., & Ullberg, T. (2019). Long-term survival and function after stroke: a longitudinal observational study from the Swedish Stroke Register. Stroke, 50(1), 53-61. https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.022913
Virtual Reality for Individuals Affected by Stroke. (2023, November 13). Physiopedia, . Retrieved 18:28, July 26, 2024 from https://www.physio-pedia.com/index.php?title=Virtual_Reality_for_Individuals_Affected_by_Stroke&oldid=344523.
Wang, Zun-rong1; Wang, Ping2; Xing, Liang1; Mei, Li-ping1; Zhao, Jun1; Zhang, Tong M.D., Ph.D.1,*. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients. Neural Regeneration Research 12(11):p 1823-1831, November 2017. | DOI: 10.4103/1673-5374.219043
Wu, J., Zeng, A., Chen, Z., Wei, Y., Huang, K., Chen, J., & Ren, Z. (2021). Effects of Virtual Reality Training on Upper Limb Function and Balance in Stroke Patients: Systematic Review and Meta-Meta-Analysis. Journal of medical Internet research, 23(10), e31051. https://doi.org/10.2196/31051
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