Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review

Abstract

Background: Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement.

Methods: This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments.

Results: Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs.

Conclusion: This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.

Keywords: Immersive virtual reality; Motor recovery; Neurological disorders; Novel rehabilitation strategies; Upper extremity rehabilitation.

Fig. 1

PRISMA flow diagram of scoping review results

Fig. 2

Studies taxonomy structured per pathologies and tasks

Fig. 3

World map of the geographical distribution of the studies, organized by pathology

Fig. 4

Immersive virtual reality setup. The percentage of studies that used different technologies, setups, audio feedback types, and controllers are reported

Fig. 5

Rehabilitation outcomes. The figure illustrates the main rehabilitation outcome of each study, showing the pre- and post-intervention values of each study’s primary outcome metric on average (± standard deviation) across participants. The metric was chosen as either the one suggested by the authors, if available, or as the most used metric among the other studies. Studies are organized by neurological disorders, and the type of task implemented (motor tasks, mirror therapy, or motor imagery) is specified for each study. The black arrow in the bottom-left corner of each bar plot indicates the direction of the desired variation of the outcome metric. FMA-UE Fugl-Meyer Assessment-Upper Extremity, ARAT Action Research Arm Test, SF-MPQ short-form McGill Pain Questionnaire, 9HPT 9-Hole Peg Test

Fig. 6

Barriers (A) and facilitators (B) word clouds. Keywords are characterized by font size and color: (i) larger font sizes indicate a higher frequency of a keyword’s appearance in the studies, (ii) the font color represents the thematic area to which a keyword refers