A recent study from New Zealand has demonstrated the potential benefits of using virtual reality (VR) to help paralyzed individuals improve their mobility. Published in Disability and Rehabilitation, the results are part of a growing body of evidence for using VR in rehabilitation.
Researchers created an immersive, VR environment for potentially training spinal cord injury (SCI) patients in electric wheelchair use. As part of the development, they sought feedback from both patients and providers and released the results of this as a publication. The process of training for power mobility use often involves several steps with one or more skilled therapists. The investigators wanted to see how feasible using VR would be for assisting with such training and what features would be most helpful to include. To do so, they recruited SCI patients who were experienced in wheelchair use, and healthcare professionals with SCI rehabilitation experience (physical therapists, occupational therapists, and a nurse), placed them in the VR environment for a 20-30 minute session and then conducted a thematic analysis of participant feedback. The VR setup consisted of an Oculus Rift headset coupled with a LiNX joystick to emulate wheelchair controls, set in a custom-built simulation environment of the aptly-named TransitioNZ SCI rehabilitation unit in Christchurch, New Zealand.
Results include finding 4 key themes amongst participant responses: realism, wheelchair training system use, overcoming resistance to technology, and working outside of the rehabilitation environment. Participants identified the realism of the VR system as a strong factor for further use and engagement. They noted the environment had multiple potential applications in electric mobility training for SCI. Concerns regarding the potential for resistance to its implementation were addressed, mostly with recommendations for clinicians to try the system first before using it on patients.
Additionally, concerns about how difficult the system would be to implement on a technological level were mentioned. Finally, users noted an advantage of the VR system was the ability to virtually challenge them in scenarios not found within the walls of the rehabilitation hospital, providing additional training and an escape from the “rehabilitation bubble.” The authors plan to continue developing the VR wheelchair training software, advancing it through studying more recent SCI while also examining the role of reducing potential intolerance to the VR environment. This is a fairly small study with low-quality evidence, yet it provides interesting feedback on both the potential of VR in rehabilitation and challenges to be overcome.
Using VR in the SCI population is not a new concept, but recently a number of studies have been published on this topic. Dimbwadyo-Terrer et al described the use of an immersive virtual environment coupled with a data glove, the CyberTouch, to teach activities of daily living. Pozeq et al in 2017 reported using an Oculus Rift headset to improve neuropathic pain and measure embodiment. Another 2017 publication, in Frontiers in Neurology, noted a home-based non-immersive VR gaming system improved strength, balance, and functional mobility in incomplete SCI. Finally, the Journal of Spinal Cord Medicine published a 2017 study using semi-immersive VR for balance training in incomplete SCI with positive results. This miniature explosion in recent publications on a relatively niche topic demonstrates the increasing availability and interest in VR medical technology, including in rehabilitation.