This would probably help in some stroke cases also but since there is NO leadership and NO strategy nothing will be done to get this tested in stroke. Hope you like complete incompetence in the stroke medical world.
Virtual reality-based interventions for the rehabilitation of vestibular and balance impairments post-concussion: a scoping review
Journal of NeuroEngineering and Rehabilitation volume 20, Article number: 31 (2023)
Abstract
Background
Concussions and mild traumatic brain injuries are the most common causes of physical and cognitive disability worldwide. Concussion can result in post-injury vestibular and balance impairments that can present up to five years post initial concussion event, ultimately affecting many daily and functional activities. While current clinical treatment aims to reduce symptoms, the developing use of technology in everyday life has seen the emergence of virtual reality. Current literature has failed to identify substantial evidence regarding the use of virtual reality in rehabilitation. The primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of virtual reality for the rehabilitation of vestibular and balance impairments post-concussion. Additionally, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic.
Methods
A scoping review of six databases (PubMed, Embase, CINAHL, ProQuest, SportDiscus, Scopus) and a grey literature (Google Scholar) was conducted using three key concepts (virtual reality, vestibular symptoms, and post-concussion). Data was charted from studies and outcomes were categorised into one of three categories: (1) balance; (2) gait; or (3) functional outcome measures. Critical appraisal of each study was conducted using the Joanna Briggs Institute checklists. A critical appraisal of each outcome measure was also completed utilising a modified GRADE appraisal tool to summarise the quality of evidence. Effectiveness was assessed using calculations of change in performance and change per exposure time.
Results
Three randomised controlled trials, three quasi-experimental studies, three case studies, and one retrospective cohort study were ultimately included, using a thorough eligibility criteria. All studies were inclusive of different virtual reality interventions. The ten studies had a 10-year range and identified 19 different outcome measures.
Conclusion
The findings from this review suggests that virtual reality is an effective tool for the rehabilitation of vestibular and balance impairments post-concussion. Current literature shows sufficient but low level of evidence, and more research is necessary to develop a quantitative standard and to better understand appropriate dosage of virtual reality intervention.
Background
Concussions and mild traumatic brain injuries (mTBI) are the most prevalent cause of physical and cognitive disability worldwide, affecting approximately 450–600 in every 100,000 people each year [1]. Although the terms concussion and mTBI have traditionally been used interchangeably by most medical practitioners and within the scientific literature, there has been a recent emphasis in some medical specialties towards classifying concussion as a less severe form of mTBI [2]. However, currently there are no distinct symptom profiles, diagnostic criteria, or objective biomarkers that distinguish concussion from mTBI [2]. Therefore, for the purposes of this study, the two terms will be used interchangeably. Concussions can arise from various biomechanical means and events including a blow to the head, face, or neck, and may result in an immediate and transient loss of consciousness, accompanied by periods of amnesia [3]. Studies demonstrate 5% to 58% of individuals who sustain a concussion suffer from persistent symptoms and limitations that affect many daily and functional activities [4]. These symptoms vary widely, commonly including headaches, visual disturbances, decreased concentration, fatigue and vestibular impairment [1, 5, 6].
Concussion can result in a high degree of post-injury vestibular impairment, with dizziness reported in ~ 39–90% of concussion cases [7,8,9,10], and still present in up to 25–32.5% of cases after 1–5 years of the initial concussion event. [7, 9] It is no surprise that imbalance is also frequently reported post-concussion, with correlations to impaired gait and other functional activities [11]. Vestibular and balance impairment post-concussion significantly increase return to school and return to sport times compared to those with concussion and no vestibular symptoms [12], with subjective complaints lasting from days to years [4]. Current clinical rehabilitation and management of symptoms employed by health professionals aim to reduce such symptoms and ultimately optimise return to work, sport and activities of daily living. Traditional vestibular rehabilitation such as gaze stabilization exercises standing and dynamic balance exercises, and canalith repositioning manoeuvres, are utilised depending on the patient’s presenting symptoms post-concussion [7]. Given the developing use of technology in everyday life, recently there has been a noticeable increase in the use of technology, specifically virtual reality (VR), for the rehabilitation of vestibular impairments, in clinical rehabilitation settings [13,14,15,16,17,18].
VR is an emerging form of rehabilitation and has been shown to be effective in treating a variety of vestibular and balance impairments [19]. The control and customisation over the VR technology system allows for gradual exposure to environmental stimuli in a safe, controlled, and reproducible environment [20]. Current studies available in the literature suggest that VR rehabilitation has been shown to be more effective than traditional forms of therapy for patients with vestibular and balance impairments [20, 21]. Patients using the technology report increased enjoyment and motivation, less fatigue, better adherence, and an increased ability to tolerate greater cognitive load within VR environments [19,20,21,22,23]. Furthermore, VR technology can provide greater individualised rehabilitation training programs when compared with traditional rehabilitation training. [24, 25]
Prior research [26,27,28,29,30] has established VR as a common assessment tool for identifying vestibular and balance impairments post-concussion, however to date, there has been no research collating or synthesising the use and effectiveness of VR as a rehabilitation modality for these impairments. Moreover, current literature has failed to identify substantial evidence regarding the use of VR in rehabilitating patients’ post-concussion for vestibular and balance impairments [31, 32]. Therefore, the primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of VR for the rehabilitation of vestibular and balance impairments post-concussion. Secondly, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic.
More at link.
No comments:
Post a Comment