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|Improve balance and gait
(Walker et al.2010; Loureiro et al.2012; Rajaratnam et al.2013; Vernadakis et al.2014; Corbetta et al. 2015 ; Franciulli et al.2016; da Fonseca et al.2017; Streicher et al.2018; Feng et al.2019; Pazzaglia et al. 2020 ; Gianola et al. 2020 )
|Increase motor skills and mobility
(Kim et al.2012; Rajaratnam et al.2013; Shin et al.2015; Corbetta et al. 2015 ; Tsuda et al.2016; Ashkin et al.2018; Jonsdottir et al.2019; Oh e altri.2019; Subramaniam e Bhatt2019; Norouzi-Gheidari et al.2020; Rutkowski et al.2020)
|Improve exercise performance
|Enhance motor functionality
(Howcroft et al.2012; Bonnechere et al.2014; Bower et al.2015; House et al.2016; Punto et al.2016; Matt Rosly et al.2017; Bonnechere et al.2018; Jonsdottir et al.2019; Arman et al.2019; Warland et al.2019; Lee et al.2020; Rutkowski et al.2020)
|Build upon pain management in rehabilitation
(Hoffmann et al.2001; Das et al.2005; Sharar et al.2007; Morris et al.2010; Schmitt et al.2011; Yohannan et al.2012; Shin e Song et al.2015; Karahan et al.2016; Collado-Mateo et al.2017; Ashkin et al.2018; Arrebola et al.2019)
|Improve the quality of life
|Improve cognitive aspects
|Provide better postural control
|Reduce the risk of fall
|Reduce anxiety and depression
Between 2000 and 2021, a total of 1617 papers on VR rehabilitation were published. Emerging trends in VR rehabilitation research–related studies are outlined in this figure. From 2000 onward, VR rehabilitation research rapidly accelerated. In this figure, the blue line denotes the increasing trend in the annual number of studies from 2000 to 2021, whereas the red broken line represents the publication index, which also increased. In the initial 2000 to 2006 research period, publication numbers per year were relatively stable and were <25, suggesting an initial period of exploratory VR rehabilitation research. However, the rise in rehabilitation demands and the increased development of supporting technologies, which are due to the increased interest in applying VR to medicine and rehabilitation and the increasing, widespread use of VR technology, have resulted in a proliferation of publications since then. The number of publications in last decade accounted for more than 80% of the total publications found.
This theme is related to the impact of VR on the patient’s rehabilitation. Improvement of balance, for example, often occurs before the time expected. Patients are able to notice positive results in daily actions, and they report it to the professional, sometimes before the completion of the estimated period of their total recovery (Streicher et al. 2018 ; Gianola et al. 2020 ). For instance, Loureiro et al. (2012, p.6) who used AVG in neurological patients, advocate that ‘virtual reality represents a potentially effective alternative to facilitate physical therapy that should emphasize the relationship between balance control improvements and external sensory stimuli.’
Positive results were also found in pain relief. The reduction or even complete management of the pain condition favors the level of renewed well-being reported by patients and improves their perception of the use of VR during the process of rehabilitation (Hoffman et al. 2001 ; Sharar et al. 2007 ; Ahn and Hwang 2019 ). As an illustration of this VR benefit, Arrebola and Oliveira (2019) conducted an exploratory study using active video games embedded into conventional therapy and found it to be effective in reducing pain and recovering ROM in children with upper limb fractures.
The use of VR is promising in rehabilitation and the results are positive, however its clinical adoption remains slow (Glegg and Levac 2018 ); in order to encourage the wider use of VR, García-Bravo et al. ( 2019 ) suggest that the use of virtual reality and videogames should be considered as complementary tools to the practice of physiotherapists. In terms of practical implications to physiotherapy, the literature indicates that there is still much to be researched on the use of VR in rehabilitation, but its use has been shown to be effective in many cases, especially from the point of view of the patient, the main beneficiary.
Motor development is related to the main objective to be achieved by the professional and is one of the most important components in physiotherapy; contributing to the improved performance of the patients’ movement, so they can have greater autonomy when performing activities of daily living (ADL) (e.g., walking, playing sports and driving) (Jorgensen 2000 ; Corbetta et al. 2015 ). It is not unusual for the patient to seek physiotherapy when there is some change or difficulty in movement. No matter the cause of these difficulties, it generates a chain of reactions for the patient, ranging from frustrations (Hills and Kitchen 2007 ) that may result in them abandoning treatment, to secondary physiological changes (Giemza et al. 2007 ; Freke et al. 2018 ). The use of VR has helped to ease this issue and increase the treatment adherence rates. Tsuda et al. (2016) carried out a pilot study in Japan with elderly patients who were receiving chemotherapy and found that virtual reality is efficient and increases the adherence of patients to the treatment. The use of VR in motor development can also be used to train both patients and caregivers and prevent accidents and increase the outcome of the treatment, as Assis et al. (2016, p.8) report: ‘Simulation of the exercises performed by the virtual arm can teach stroke subjects and their caregivers how to perform the motor rehabilitation exercises with different scenarios.’
With regards to the motor development benefit provided by VR applications, our study provides practical implications for physiotherapy, and together with the literature reports that the use of VR in the rehabilitation process has both contributed to accelerating the recovery and improving the development of movement (Corbetta et al. 2015 ; Park et al. 2017 ; Norouzi-Gheidari et al. 2020 ). Finally, our analysis reports that despite the slow adoption of VR, there is an increasing application in the practice of physiotherapy, demonstrating that rehabilitation has already sought to extract the benefits from this technology.
VR also contributes to the area of rehabilitation when it comes to promoting the patient's independence. When the patient has a limiting physical disability, the individual’s functional abilities are also affected (Münter et al. 2018 ). For instance, a patient who needs surgery for total knee arthroplasty will have limited knee movement, which might prevent the patient from performing his ADLs properly (Pua et al. 2019 ). Furthermore, skills linked to motor execution ability can cause secondary harm, such as depression, anxiety, and fear. Some empirical studies conducted with patients before surgery have shown that the use of VR in rehabilitation has an impact of reducing these symptoms (Meldrum et al. 2015 ; de Melo Cerqueira et al. 2020 ). A survey conducted by Chang et al. (2012) found that AVGs can distract a patient from the sensation of pain or anxiety, and increase their motivation to participate in the therapeutic program. Concurrently, Shin et al. (2015) observed that ‘Gaming is known to provide challenging and fun game play, which can encourage skill development and motivate further movement (Shin et al. 2015 , p. 12).’
This benefit found in the literature has a direct impact on the patient’s treatment, and it underscores implications for physiotherapy, showing that the use of VR has helped reduce the effects of mental health problems that patients undergoing physiotherapy often face. This is similar to what House et al., (2016) reported when he pointed out an improvement in the self-confidence of patients and a reduction in the symptoms of depression. Aiming to contribute to practice and support the wider use of VR, our study also highlights the main approaches for using VR in physiotherapy (Table 5 ) and provides information that can support rehabilitation clinicians to implement new protocols of rehabilitation according to their patient’s needs.
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