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Life post-stroke: Using virtual reality to achieve real world improvements

The Bottom Line

  • Virtual reality refers to the use of computer technology to simulate the feeling of being in an artificial environment.
  • Virtual reality therapy may result in small improvements in overall arm function, motor impairment level, and activities of daily living in people who’ve had a stroke.
  • Speak with your health care team about if and how you can go about engaging in virtual reality therapy safely. 

Be it The Matrix, Tron, or Black Mirror, movies and television shows have long been familiarizing us with the idea of using computer technology to simulate the feeling of being in an artificial or augmented environment. To sci-fi buffs, this concept is known as ‘virtual reality’ (1;2). For those not as familiar with the ins and outs of virtual reality, here’s a crash course.


The core features of a virtual reality experience include the virtual world that has been created, the provision of sensory feedback (e.g., visual, touch, etc.), and interactivity (2;3). How immersive this experience is, meaning the degree to which you feel like you’re inside this virtual world, varies based on the technology used (2;4). For instance, virtual reality systems that include head-mounted video displays and avatars pull you deeper into the virtual environment than those that just use a large screen or multiple screens or those that rely on one standard computer or television screen. Lastly, virtual reality systems include both gaming systems that are commercially available, such as the popular Nintendo Wii, and systems that are specifically developed for rehabilitation purposes (2;5).


You heard that right…rehabilitation! Long gone are the days of merely using virtual reality as a plot device to entice the viewing audience or sprinkling it in conversations about what the future will look like. Because, as they say, “The future is now,” and virtual reality interventions may have a real role to play in improving the health of certain populations. One of these populations is stroke survivors. Let’s explore the possibilities further with a recent systematic review on the impacts of virtual reality therapy among those who have had a stroke and suffer with mild to severe arm weakness (2).


What the research tells us

The review found that virtual reality therapy may provide multiple benefits in people who’ve had a stroke, compared to conventional therapy or sham (aka fake) treatments. Here, virtual reality therapy included both the use of commercial gaming systems and systems developed specifically for rehabilitation (2). These systems engaged participants in games or activities that allowed them to practice moving (e.g., extending, flexing, rotating, etc.) their shoulders, elbows, forearms, wrists, fingers, or whole arm. Examples of some of these games or activities include, kung fu, smashing ice cubes or demolishing walls, rally ball, bowling, boxing, tennis, golf, imitating motions performed by an avatar, and reaching, grasping, and releasing exercises (2;6-10).


Ultimately, small improvements were seen for overall arm function and the level of motor impairment experienced. Similar positive results around people’s ability to perform daily self-care activities were documented. What’s more, those with moderate to severe arm weakness appeared to benefit most from virtual reality therapy. The review was also able to provide us with some guidance around what type of virtual reality therapy may be best. If you guessed virtual reality therapy that’s immersive, you’d be correct! While it’s important to highlight the positives, it’s also worth noting that virtual reality therapy didn’t appear to have an effect on specific task-related activities or participation in activities (2).


But before embarking on a virtual reality experience, be sure to consult with your health care team. Together, you can discuss if this strategy is appropriate based on the status of your health, whether commercial or specially designed systems are right for you, the need for supervision, and ways to reduce any risks while engaging in this activity.


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Author Details

References

  1. Government of Canada. Stroke in Canada: Highlights from the Canadian Chronic Disease Surveillance System. [Internet] 2019. [cited March 2022]. Available from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/stroke-canada-fact-sheet.html
  2. Jin M, Pei J, Bai Z, et al. Effects of virtual reality in improving upper extremity function after stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil. 2022; 36(5):573-596. doi: 10.1177/02692155211066534.
  3. Sherman WR, Craig AB. Understanding virtual reality: Interface, application, and design. San Francisco, CA: Morgan Kaufmann, 2018.
  4. Gaggioli A, Keshner EA, Weiss PLT. Advanced technologies in rehabilitation: Empowering cognitive, physical, social and communicative skills through virtual reality, robots, wearable systems and brain-computer interfaces. Amsterdam: IOS Press, 2009.
  5. Rose T, Nam CS, Chen KB. Immersion of virtual reality for rehabilitation-review. Appl Ergon. 2018; 69:153-161. doi: 10.1016/j.apergo.2018.01.009.
  6. Mekbib DB, Debeli DK, Zhang L, et coll. A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann N Y Acad Sci. 2021; 1493:75-89. doi: 10.1111/nyas.14554. 
  7. Shin JH, Park SB, Jang SH. Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study. Comput Biol. 2015; 63:92-98. doi: 10.1016/j.compbiomed.2015.03.011.
  8. Brunner I, Skouen JS, Hofstad H, et coll. Virtual reality training for upper extremity in subacute stroke (VIRTUES): A multicenter RCT. Neurology. 2017; 89:2413-2421. doi: 10.1212/WNL.0000000000004744.
  9. Kong KH, Loh YJ, Thia E, et coll. Efficacy of a virtual reality commercial gaming device in upper limb recovery after stroke: A randomized, controlled study. Top Stroke Rehabil. 2016; 23:333-340. doi: 10.1080/10749357.2016.1139796.
  10. Sin H, Lee G. Additional virtual reality training using Xbox kinect in stroke survivors with hemiplegia. Am J Phys Med Rehabil. 2013; 92:871-880. doi: 10.1097/PHM.0b013e3182a38e40.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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