ROLE OF VIRTUAL REALITY IN

NEUROLOGICAL REHABILITATION

PRESENTED BY:-
DR. NIDHI SHARMA (PT)
ASSOCIATE PROFESSOR
MMDU, MULLANA, AMBALA
 With the passage of time & technological progress made computer

technology, become ever present in the lives of majority of people.

VIRTUAL REALITY is one of them .

 A way for humans to visualize, interact and manipulate with
computers
 Advanced form of “human-computer”
interaction in naturalistic fashion
 Thomas A. Furness is grand father of VR.
 Virtual reality is a generated, interactive simulation that
maps the real environment by affecting human senses,
and shows all activity in real time & speed.

 Stimulates the patient’s senses to create an illusion of

reality.

 To achieve the goal of realism for the patient which

is an incorporation of perception & cognition.

 Emulates learning process in the real world, while

allowing the addition of extrinsic feedback & increasing
the frequency, duration & intensity of an exercise.
 Virtual experience (sense of presence) through use of
 head mounted display

 gesture sensing gloves

 earphones

 haptic feedback devices

 tracking systems
 VR AND BRAIN
 VR has value for studying processes such as neuronal connectivity,
developmental dynamics, neuromuscular output and perhaps even the
initiation of molecular cascades.

 Goal is to foster brain and behavioural responses in the virtual world that are
analogous to those that occur in the real world.

 VR systems are best at displaying visual and auditory information.

 VR systems may provide limited but compelling haptic (tactile) feedback that
simulates the feel of forces, surfaces and textures as users interact with
virtual objects.
 This kind of control is beneficial for

understanding sensorimotor interactions

between, for example, proprioception and visual

experience (that is, interactions between brain

regions responding simultaneously).

 VR also increases the role of motor activation

during simulated experience, as users can move

through and physically interact with virtual

objects.
 Virtual environments can present combinations of stimuli that are not
found in the natural world and researchers can execute changes in the
environment that would not be possible physically.

 VR might be used to decouple visual and vestibular sensation, revealing

the roles of separate brain systems that are usually enlisted
simultaneously (for example, postural responses may reflect input from
visual perception more than from motion perception, or vice versa).
 Therapeutic Applications
 Neuro-rehabilitation applications- balance disorders and their underlying multisensory
integration mechanisms, and recovery of function.

 VR simulations can be highly engaging, which provides crucial motivation for rehabilitative
applications that require consistent, repetitive practice.

 Furthermore, the tracking systems used in VR provide an excellent tool for recording and
following minute changes and improvements over time.

 Indeed, immersive multimodal VRs that link head, hand and body movement to changes in
visual and auditory stimuli have proven useful for the recovery of motor function and postural
stability
Therapeutic Applications contd…
 Pain remediation- Virtual environments provide perceptual

representations of one’s body and the world that can shift the

patient’s attention and slightly alter the perceived properties of

pain.

 Psychiatric disorders- VR treatment has been applied to a range of

disorders, including fear conditioning, anxiety disorders and brain

damage
Clinical Evidence of Virtual Reality
Cognitive aspects

Supports cognitive rehabilitation

(Rose et al. 1998)

Motivation

Increases self confidence and motivation

(Riva 1998)
 Learning
VR environments stimulates neuroplastic change and
enhances learning effects

(Rose et al. 1998)

Upper Extremity

Improves upper extremity function and motor

processing

(Kuttuva et al. 2006)

Lower Extremity

Improves walking speed and muscle strength,balance

therefore improving overall quality of life
(Sviestrup 2004)
 Therapist Role
STAY UP TO DATE! Virtual reality is drastically
changing and we must be able to properly incorporate
this technique into our patient’s exercise program

EDUCATE YOUR PATIENT! Slowly introduce your

patient to this specific technique. Fear can be
associated with the use of virtual reality, especially if
your patients aren’t use to being so mobile

INDIVIDUALIZE THE TREATMENT! Virtual reality

allows you to specify the parameters of the exercise
and change them to fit your patient’s needs. Be aware
of their abilities and their reaction to the program
CASE STUDY – UPPER LIMB PARESIS IN PATIENTS WITH
STROKE

The Use of Virtual Reality Technologies during Physiotherapy of the Paretic Upper Limb in Patients after Ischemic Stroke – Stryla W and
Banas -2015
VR training set-up

GlenM.Doniger et.al-2016
VR training tasks
Sustained attention selective attention

working memory convert rule deduction

Planning training task

GlenM.Doniger et.al-2016
Advantages of VR in assessment &
rehabilitation applications
 More naturalistic or “real life” environments
 Control of stimulus presentation and response measurement
 Safe assessment of hazardous situations
 Increased generalization of learning
 Increased standardization of rehabilitation protocols
 Increased user participation
 Provides an interactive, motivating atmosphere where intensity & positive feedback can be
controlled while retraining the movement

 Allows the patient to participate in experiences that are both pleasing and rewarding

 Patient and therapist are able to interact with a multisensory and dimensional environment that is
explored in real time.
THANK YOU