Efficacy of Virtual Reality in Rehab: Leveraging Principles of Neuroplasticity

Written by: Arik Yates, PTA

Back in June, Neuro Rehab VR’s Veena Somareddy and Gorbel Rehab’s Ramiro Maldonado joined forces for a Facebook live event titled “Efficacy of Virtual Reality in Rehab”. If you missed the opportunity to watch it, I highly recommend it even if you are even the slightest bit interested in VR; check it out here.

One of the  topics of the webinar, and the topic I am focusing on today, is virtual reality and neuroplasticity’s relationship. As a refresher, neuroplasticity refers to the building of pathways through practice and repetitions in the brain. Within neurological PT/OT, neuroplasticity is believed to be the reason behind functional improvements. With that being said, does VR and neuroplasticity have a good relationship? To put it shortly, yes! And, there are 11 neuroplastic principles that virtual reality can directly employ. So, what are they? Well, Gorbel Rehabilitation’s Ramiro Maldonado PT, DPT identifies 11 neuroplastic principles that VR can directly employ below.

Massed Practice

Dosage

Structured Practice

Task-Specific Practice

Variable Practice

Multisensory Stimulation

Increasing Difficulty

Explicit Feedback

Implicit Feedback

Avatar Representation

Use of Affected Limb

Now that we know what they are, let’s break them down.

DURATION PRINCIPLES

Massed Practice, Dosage, and Structured Practice all have something in common; they have to do with the duration of the session. Massed practice refers solely to one long session the patient is put into with little break, while Structured Practice refers to breaks in between therapy sessions. Dosage is the amount of time a patient is partaking in therapy i.e 3x a week.

PRACTICE BASED PRINCIPLES

Use of Affected Limb, Task-Specific Practice, Variable Practice, and Increasing Difficulty are all principles based around the content of each therapy session. Use of Affected Limb and Increasing Difficulty principles are exactly what you would expect, ask yourself, during the session is the patient challenge being reasonably increased and are they using the affected limb/body part with the exercise? Task-Specific Practice and Variable Practice deal with how the objectives of the exercise are being presented. For example, the patient’s TASK is reaching towards a shelf to grab objects, and the object that is being reached VARIES in location.

STIMULATION AND FEEDBACK PRINCIPLES

Multisensory Stimulation, Explicit Feedback, Implicit Feedback, and Avatar Representation all deal with the feedback given to the patient either in real time or at the end of the session. Multisensory Stimulation and Avatar Representation refer to touch (haptic feedback from VR remotes), hearing, as well as their body/limbs being represented within the virtual space. Explicit Feedback can be restated simply as “knowledge of results” while Implicit Feedback is based upon the patients execution of movement which is given audibly/physically (video playback, noises in the virtual environment, therapist cues).

APPLYING THE PRINCIPLES

Now, on to the beautiful union of physical therapy and virtual reality. When integrating virtual reality into your therapy session, if you use 6 of the above principles, VR becomes MORE effective than conventional therapy alone. With my time utilizing Neuro Rehab VR’s XR Therapy System, applying these principles is simplified. Feedback is given both visually to the patient as well as audibly if any adjustments are required. For example within Retail Therapy, when a patient can’t reach an object they are tasked with grabbing, a “jingle” audio cue will begin to play. This cues the patient to extend further or hold their position until the object moves close enough to where it can be grabbed. Patient arms are also represented virtually within the VR environment, as well as haptic feedback through the controllers to simulate touching.

Regarding dosage and practice, with the simple set up of VR, a patient can get a session within a clinic, at home, one long session, or multiple sessions across the span of a week; there really is no limit! Last but not least, difficulty can also be easily changed in real time with the Neuro Rehab VR XR Therapy System solution. By utilizing the XR Therapy tablet app paired with the VR headset, therapists can control and customize the user experience to make sure they are getting the most effective and challenging exercise therapy session possible. Neuro Rehab VR also leverages artificial intelligence and machine learning technology within some its games/exercises to automatically adapt to the needs and ability of various patients.

It is such a beautiful relationship virtual reality and neuroplasticity have. Leveraging these principles of neuroplasticity through virtual reality technology is proven to be not only efficient, but highly effective. Especially when you employ at least 6 of the above principles, VR transforms from a “just a new modality” to a life changing therapeutic intervention that could expedite your patient’s function. I don’t know about you, but this excites me, does it excite you? Reach out to us for any questions you may have or future blog posts you would like to see!