Virtual Reality: A Promising New Tool in Rehabilitation Medicine
By Kevin Pelletier, MD
Earlier this year I had the unique opportunity to explore an underwater shipwreck. As I made my way around the wooden deck I saw an assortment of sea creatures inhabiting parts of the ship clearly never intended for such purposes. To my amazement, I even stumbled upon what appeared to be an ornate chest — a treasure chest perhaps? — I will never know, because what I saw next commanded my undivided attention. An enormous blue whale emerged from the adjacent darkness and bellowed as it swam dangerously close — its fin almost clipping my head [1].
At this point you might be saying to yourself “this story cannot be real.” Well, technically you are right — but to me it almost was. What I have described was my first experience with immersive virtual reality (VR). After putting on a head-mounted display and earphones, I felt fully immersed in the 360-degree audio-visual environment. It truly gave me goosebumps at the time and does so even now when recalling the experience. Immediately I began imagining the different ways this technology could be applied.
The first thing that came to mind was that VR could transport patients with long hospital stays and life-altering prognoses to a tropical island, or flying through the sky like Super Man as a means of diversion. My next thought was how exciting it would be to use this cutting-edge technology as a tool for rehabilitation.
Vourvopoulus and Bermúdez I Badia published an article in the Journal of NeuroEngineering and Rehabilitation in August of this year on the use of VR as a means of stimulating sensory-motor networks in the brain. The participants wore a head-mounted display and earphones. They saw a virtual hand turning a crank which slowly opened a garage door. Meanwhile they heard sounds of a chain pulley system and the movement of a large metal door. Participants were then instructed to use mental imagery (i.e., to imagine they were performing the action without physically doing so) while experiencing the VR environment. The same participants were later asked to use mental imagery of the above motor task without using VR. EEGs were recorded throughout to measure electrical activity in the sensory and motor cortices.
They found that VR, in addition to mental imagery, produced brain patterns which more closely resemble those present during overt motor execution. Since motor imagery has been previously shown to help restore active movement through stimulation of sensory-motor networks [2], the results of the above study suggest that the addition of VR may be able to do so more effectively given that the combination was able to augment the electrical activity in the same regions of the brain [3]. Namely, repeated stimulation of the sensory-motor networks of the brain have the potential to induce neuroplastic changes such that a patient could regain function.
Medical applications of VR is a burgeoning area of research and development, yet our knowledge of how best to apply this groundbreaking technology is still in its infancy. Given promising research and its vast potential for entertainment, I believe VR will be a welcomed therapy modality for a wide variety of patients.
References
- Experience provided by HTC Vive’s VR hardware running ‘theBlu: Encounter’ demo.
- García Carrasco D, Aboitiz Cantalapiedra J. Effectiveness of motor imagery or mental practice in functional recovery after stroke: a systematic review. Neurologia. 2016 Jan-Feb;31(1):43–52. doi: 10.1016/j.nrl.2013.02.003. Epub 2013 Apr 17.
- Vourvopoulos A, Bermúdez I Badia S. Motor priming in virtual reality can augment motor-imagery training efficacy in restorative brain-computer interaction: a within-subject analysis. J Neuroeng Rehabil. 2016 Aug 9;13(1):69. doi: 10.1186/s12984–016–0173–2.
- Hyungjun Im, MD et al. Virtual Reality-Guided Motor Imagery Increases Corticomotor Excitability in Healthy Volunteers and Stroke Patients. Ann Rehabil Med. 2016 Jun; 40(3): 420–431. Published online 2016 Jun 29. doi: 10.5535/arm.2016.40.3.420.
- Ana R.C. Donati et al. Long-Term Training with a Brain-Machine Interface-Based Gait Protocol Induces Partial Neurological Recovery in Paraplegic Patients. Sci Rep. 2016; 6: 30383. Published online 2016 Aug 11. doi: 10.1038/srep30383.
- AppliedVR Brings Therapeutic Virtual Reality Content To Cedars-Sinai Medical Center. mHealthTimes.
Kevin Pelletier is a second-year resident physician in the Department of Rehabilitation Medicine at the University of California Irvine.
