A Short Communication on Virtual Reality for Neurorehabilitation in Post Stroke Patients

Introduction

One of the leading causes of disability worldwide is stroke. As per the Global Burden of Diseases (GBD), India has the highest incidence of stroke with 68.6% of stroke cases, 70.9% of stroke deaths, and 77.7% of the disability-adjusted life years (DALYs) lost. Another alarming and critical finding of the GBD 2010 stroke project is that 5.2 million (31%) strokes were noted in children aged less than 20 years.¹ The stroke burden is greater in India and more so among younger and middle-aged individuals. Stroke survivors often face challenges in their recovery journey, including motor impairments, cognitive deficits and balance dysfunction. This frequently causes issues during routine tasks, including walking, driving, and working.

Practical solution with a focus on neurorehabilitation is vital. Immersion virtual reality (IVR) is one of the most advantageous treatments for reducing disability and balance dysfunction post-stroke. VR works by creating a simulated environment that engages multiple senses, such as sight and hearing. By immersing the user in this virtual world, it can help stimulate neural pathways, enhance motor learning, and promote neuroplasticity, which is the brain's ability to reorganize and form new connections. Thus VR- based rehabilitation will offer a unique accessible therapeutic approach to reduce impairment and improve dynamic function.

Stroke survivors

Stroke patients’ functional ability, personal autonomy, and social abilities are diminished due to motor and cognitive impairments, necessitating special care and rehabilitation. A pertinent central vestibular symptom in neurological illnesses such as stroke is postural instability or impaired balance. Over 83% of stroke survivors experience balance problems and to maintain the upright posture, the central nervous system needs proprioceptive, visual and vestibular information. Errors in the central integration of this postural data can therefore lead to gait problems and an elevated risk for falls. Furthermore, stroke survivors exhibit a variety of neurological problems such as diminished muscle strength, stiffness, sensory loss, and visual neglect. These conditions raise the risk of falls in post-stroke patients many folds compared to older persons without brain injury. Additional issues of falls in stroke patients include fractures, tissue injury, immobility, and psychological anxiety of falling. Prolonged hospital stays concomitant to injuries due to falls are also extremely detrimental to the healing process of the patient.²

Multiple therapeutic modalities have been suggested as neurorehabilitation methods for stroke patients in an effort to optimise brain plasticity. Over the past ten years, virtual reality (VR) has seen a sharp rise in application, and can be used as a useful tool in stroke recovery.

Perez-Marcos et al. (2018) studied use of VR for gait rehabilitation in stroke survivors. They discovered that VR-based training improved gait parameters, balance, and walking speed. The immersive nature of VR allows patients to practice walking and balance exercises in a fun and engaging way. He also revealed that VR training can induce brain reorganization and improve motor performance among stroke survivors.³

VR-based interventions for stroke rehabilitation

Traditional neurorehabilitation approaches have limitations in maximizing outcomes. However, the emergence of virtual reality (VR) technology offers a promising avenue for enhancing stroke recovery. Several studies have highlighted the potential benefits of VR in stroke rehabilitation. For instance, a study by Laver et al. (2017) demonstrated that VR interventions can improve upper limb function and activities of daily living among stroke survivors. He also suggested that VR-based rehabilitation programs can enhance upper limb motor recovery in stroke patients. They found that VR interventions were more effective than conventional therapy in improving motor function and activities of daily living by improving balance.⁴ VR provides an engaging and motivating platform that encourages active participation and repetitive practice, which are critical for neuroplasticity and functional recovery. Vourvopoulos and Bermúdezi Badia (2016) found that VR-based therapy can enhance motor recovery and cognitive abilities in stroke patients.⁵

By incorporating VR into stroke rehabilitation, therapists can create customized and engaging interventions that target specific impairments. However, it is important to note that VR should be used as a complement to traditional therapy, rather than a replacement. Combining VR with conventional rehabilitation approaches can maximize the benefits and outcomes for stroke patients.

Moreover, the immersive and interactive nature of VR has shown to promote neuroplasticity and motor learning. Through the use of an integrated virtual surroundings, users may operate in a simulated world where they can engage in real-time with a visual viewpoint depending on their head and body positions.

Studies have shown that VR-based interventions can have a positive impact on stroke patients by immersing stroke patients in a virtual environment. VR helps them practice movements and exercises in a safe and controlled setting. Virtual reality has a significant impact on the quality of life for stroke patients. It offers a range of benefits that can improve their overall well-being and daily functioning.

VR can address psychological challenges that stroke patients often face. In 2016, Saposnik et al. showed that VR therapy reduced symptoms of post-stroke depression and anxiety. The immersive and engaging nature of VR distracts patients from negative emotions and provides a positive and enjoyable experience.⁶ Furthermore, the application of virtual reality in stroke patients' rehabilitation positively affects their ability to learn visual and spatial abilities, which in turn boosts their enthusiasm and involvement.⁷

Studies have shown that immersive nature of VR creates a sense of presence and enjoyment, making therapy sessions more enjoyable and encouraging patients to actively participate in their recovery process. VR also provides opportunities for social interaction and emotional well-being. VR-based social activities positively impact stroke survivors’ social participation and reduces feelings of isolation. By connecting with others in virtual environments, patients can combat loneliness and improve their overall mood. When it comes to balance rehabilitation in stroke patients, this communication can serve as a valuable foundation.⁸

Conclusion

This study's strength is in understanding how immersive virtual reality can be used to address static and dynamic balance in a hospital setting. Thus, adopting immersive virtual reality systems that completely focus the user's attention on the task in various situations might be highly beneficial for deficit recovery. The user's attention span and treatment compliance will increase with increasing levels of immersion in the virtual environment and decreasing levels of interaction with the real world. This is significant because attention, concentration, visual processing, language, memory, reasoning, problem-solving, and higher executive functions are the most significant cognitive changes following a stroke, and these changes can negatively affect how well a subject is learned by those who have had a stroke.

Conflict of Interest

The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the manuscript and there is no financial interest to report.

Source of financial support

This Research received no specific grant from any Funding agency

Acknowledgements

Sardar Bhagwan Singh University, Department of Physiotherapy is allocating resources, recruiting participants and equipment assistance