Nicola Stefanucci (Università degli Studi di Roma Tor Vergata – IRCCS Fondazione Santa Lucia), Roma, Italia
The purpose of the review is to frame the potential of Immersive Virtual Reality (VR), regarding the neurophysiological aspects and how they can improve the cognitive and motor aspect of the patient, including these neurological insights, until now fragmented, in an experimental review. A part of the review is dedicated to illustrating the novelties and the limits of VR, which usually consists of an immersive viewer, which can be connected with other items and a computerized interface. The project also proposes to investigate the validity of academic insights already published. This review can inspire future developments of virtual reality as it integrates the brain stimuli provided by virtual reality with numerous pathologies, including imaging technique studies, randomized controlled trials and experimental studies.
The scientific review was conducted between September 2020 and March 2021 across the databases MEDLINE/Pubmed, Google Scholar, PEDro, Cochrane library and literature search. The string search used was (“VR”) AND (“Rehabilitation”) adapting it to different search engines to the names of the pathologies. Studies were selected on the basis of typology with a preference for RCTs, the number of the population sample, the number of citations received and the number of authors who participated in the study. The studies selected are of a comparative nature for most of the pathologies described studies of this type with an unrepresentative population sample were excluded, although some of them are cited due to their experimental nature.
Virtual reality can help neural networks reorganize. A VR protocol with BCI and exoskeleton showed partial neurological recovery and subcortical plasticity in patients with lesions, it can divert attention from pain, reducing it, providing an alternative or implementation to anesthetics. VR can induce inflammatory changes by releasing anti-inflammatory cytokines, it can stimulate dopamine production, aiding early Parkinson’s stages, maintaining function, and can reducing L-dopa dependency and can be safe in case of neurological fatigue. VR can help prevent relapse and, in a safe environment, in injured athletes, increases activation in brain areas for visual processing, motor planning and pain. Cybersickness from VR immersion is linked to the vestibulo-autonomic system. VR also improves healthcare communication via medical avatars and is effective in obesity, autism, social isolation, and phobias. Ethical VR use is essential for positive cognitive, emotional, and behavioral changes.
Based on what could be found, VR stimulates modulation of damaged brain areas, the sense of presence and interactivity engage patients, however physical therapist supervision is necessary to ensures effectiveness, personalizing treatment based on the patient’s experiences and deficits, as well as an evaluation of technological know-how which to promote success and avoid cybersickness. The comfort of the viewers and items should be increased, more RCTs are needed to confirm VR’s effectiveness across conditions and establish therapeutic protocols. There are not enough studies to consider it superior to conventional therapy, but it needs a complementary approach. Ethical use is essential to avoid identity dysphoria and dissociation from reality, ensuring virtual experiences don’t create dangerous false senses of security in real life. It can be hypothesized the usefulness of a personality test before using VR in order to prevent this technique from exacerbating latent pathologies.
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