Personal Goals Crucial in Virtual Reality Physical Training

Laura Arenschield

November 19, 2019

ATLANTA — Virtual reality can help patients with movement issues, but only if it is done correctly and tailored to individual patients, said Robert Ferguson, a neurorehabilitation clinical specialist who focuses on such therapy.

Clinicians "are reading the research and they are applying it wrong," he explained. "The evidence suggests that it's not about the virtual reality, it's about how you use the research. You need to know how the equipment and programs work so you know how to modify them for your individual patient."

A more methodological approach to virtual reality therapy is needed. "It shouldn't be that we just throw someone into a virtual reality environment," said Nancy Baker, ScD, an occupational therapist at Tufts University in Medford, Massachusetts. "If you want it to be therapeutic, it has to be thoughtfully applied."

Ferguson, who manages the stroke rehabilitation program at the University of Michigan Health System in Ann Arbor, presented a number of cases during his talk on virtual reality and occupational therapy here at the American College of Rheumatology 2019 Annual Meeting.

He described asking a stroke survivor who appeared to be unable to handle problems on the left side of her body to "climb" a virtual reality rock wall. Ferguson watched as the patient sat in a chair and moved her arms in a climbing motion in response to the computer-generated field in front of her.

At first, the woman only seemed to climb to her right. But as she learned the rules of the game, Ferguson manipulated the rock wall she was seeing, ultimately encouraging her to explore the wall to her left. By the end of the session, her brain — which until then had ignored problems on the left side of her body — had led her to "climb" the wall to her left.

It shouldn't be that we just throw someone into a virtual reality environment. If you want it to be therapeutic, it has to be thoughtfully applied.

Another patient, an avid bow hunter, was trying to regain balance after a leg amputation. Ferguson constructed a virtual reality game in which the patient had to defend a castle using a bow and arrows.

"He told me, 'it's the hardest therapy I've ever done, but it's also the most fun'," Ferguson said.

"The thing about immersive virtual reality environments is that we need to connect it to a goal," he told the audience. "The virtual reality is not the treatment; it's an adjunct treatment to what you're doing. You need to know what your goal is and how you are going to get the patient to that goal."

The body of scientific research on virtual reality is still relatively small, Ferguson pointed out.

More Rigorous Studies Needed

A recent review indicates that patients who use virtual reality as part of their therapy report significantly lower levels of pain and effort than those who do not, and individual therapy sessions are significantly longer.

And virtual reality was shown to help patients with rheumatoid arthritis learn to protect their joints. But that study was a small pilot, Ferguson cautioned, and although the findings are encouraging, they do not conclusively show that virtual reality can and will help all patients.

"When we use immersive virtual reality — the kind of virtual reality that makes people feel as though they are in the virtual world — meta-analyses and systemic reviews suggest that people are more engaged and more motivated," Ferguson told Medscape Medical News.

"We are seeing some immediate and longer-term improvements in both cognitive performance and motor function, but we are not sure how long-lasting those effects are," he added.

After the presentation, Baker, who focuses on musculoskeletal disorders and chronic pain, said she has been working to launch research programs looking at the effect virtual reality can have in therapy.

"The thing about chronic pain is that people lose the ability to do the things they love to do, and it can be hard to motivate them in occupational therapy," she said. "In a virtual reality environment, you can put them in a real-seeming space, so they can do the things they like to do."

Research to this point indicates that virtual reality is a reasonable addition to a comprehensive rehabilitation program, as long as therapists take into account a patient's goals, abilities, and preferences, said Ferguson.

"The problem is that significant heterogeneity and small study sizes limit the power of the conclusions," he added. "That's why we need more research."

American College of Rheumatology (ACR) 2019 Annual Meeting. Presented November 10, 2019.

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