Studies and scientific research on virtual reality
Virtual reality has proven itself in the field of rehabilitation for over 20 years. Thanks to this innovative technology, patients can benefit from more immersive treatments to help them recover physical and cognitive abilities. Numerous studies have been conducted to evaluate the impact of VR on rehabilitation. The results are encouraging, particularly with regard to the cognitive and motor impact of virtual reality.
For us, the research of virtual reality in rehabilitation is a key topic in our developments
H'ability was developed based on clinical evidence found in the scientific literature, which shows the effectiveness of gamification, immersion and positive visual feedback in reducing pain and improving rehabilitation. These elements are important pillars of virtual reality as a therapeutic tool and have contributed to the development of our device.
Through immersive virtual environments, virtual reality can provide patients with a fun and effective rehabilitation experience, helping them focus on their recovery goal and improve their coordination, strength and flexibility. This technology allows patients to work on condition-specific tasks in a controlled virtual environment, which can promote better participation and increased motivation to achieve their rehabilitation goals .
- A patient's motivation plays an important role in their determination and outcome of his therapy.
"Factors influencing motivation for rehabilitation can only have positive effects on patient management." (1)
- The " serious games " (or serious games) increase patient engagement, which allows them to increase their exercise time.
"Prolonged endurance in training and greater improvement in some areas of motor function, as well as very high patient motivation and strong positive impressions of the treatment, suggest the positive effects of feedback therapy and its high level of patient acceptance." (2)
"The game-based mobile VR program effectively promotes upper extremity recovery in stroke patients. In addition, patients completed two weeks of treatment using the program without adverse effects and were generally satisfied with the program. This mobile game-based VR upper extremity rehabilitation program can replace parts of conventional therapy that are delivered individually by an occupational therapist." (3)
"The results of the study demonstrated that immersive 3D technology can provide an increased interest/fun score resulting in faster and more efficient functional performance." (4)
- Increasing the time of exercise allows for better and faster recovery.
"The experience of taking ownership of the rehabilitation process has made patients accountable, positively affected their activity level and a helped them cope with their challenges." (5)
The use of H'ability has a positive effect on the motivation of our patients!
84% of our patients feel they have successfully completed the exercises proposed by their therapist during the H'ability session
97% of patients want to use H'ability again
89% of healthcare professionals who have used the solution find that their patients go further than with conventional rehabilitation exercises
96% of healthcare professionals find their patients more motivated when using H'ability
Results of DM H'ability questionnaires as of 11/05/2023
- (1) Maclean, N., Pound, P., Wolfe, C., & Rudd, A. (2000). A critical review of the concept of patient motivation in the literature on physical rehabilitation. Soc Sci Med, 50(4), 495-506.
- (2) Popović, M. D., Kostić, M. D., Rodić, S. Z., & Konstantinović, L. M. (2014). Feedback-mediated upper extremities exercise: increasing patient motivation in poststroke rehabilitation. BioMed research international, 2014.
- (3) Choi, Y. H., & Paik, N. J. (2018). Game-based mobile virtual reality program for upper extremity stroke rehabilitation. Journal of visualized experiences: JoVE, (133), 56241.
- (4) Cikajlo, I., & Peterlin Potisk, K. (2019). Advantages of using 3D virtual reality based training in persons with Parkinson's disease: A parallel study. Journal of neuroengineering and rehabilitation, 16(1), 1-14.
- (5) Solbakken, L. M., Nordhaug, M., & Halvorsen, K. (2022). Patients' experiences of involvement, motivation and coping with physiotherapists during subacute stroke rehabilitation-a qualitative study. European Journal of Physiotherapy, 1-8.
Virtual reality is an innovative solution to combat kinesiophobia (the fear of injury or of suffering any consequence of these movements such as pain) in rehabilitation. Immersive virtual environments offer a stimulating way for patients to perform movements, receive immediate feedback and measure their progress. In addition, it can help motivate patients by customizing virtual environments to their needs and preferences.
- Pain management in the case of neck pain is essential and virtual reality improves its management.
« Par rapport au groupe témoin, le groupe de réalité virtuelle a montré des avantages significatifs (p < 0,05) dans le soulagement des maux de tête et une amplitude de mouvement cervicale active en flexion et en extension. Par rapport au groupe sensorimoteur, le groupe de réalité virtuelle a montré des améliorations significatives de l’extension cervicale. […] Conclusion : l’entraînement sensorimoteur basé sur la réalité virtuelle peut augmenter les effets d’un programme de rééducation standard pour les patients souffrant de cervicalgie chronique non traumatique, en particulier l’amplitude active des mouvements cervicaux en extension. » (1)
" Existing moderate evidence supports RV as a beneficial nonpharmacological approach to improving pain intensity in patients with neck pain, with benefits for multimodal intervention [...] " (2)
- VR also helps low back pain patients overcome their fear of pain.
"We found that participants [...] reported a greater reduction in fear of movement and a better overall impression of change compared to sham placebo and standard care after treatment." (3)
"VR can significantly reduce pain intensity and kinesiophobia in patients with chronic low back pain after surgery and at follow-up." (4)
- (1) Nusser, M., KRAMER, M., KNAPP, S., & Krischak, G. (2021). EFFECTS OF VIRTUAL REALITY-BASED NECK-SPECIFIC SENSORIMOTORTRAINING IN PATIENTS WITH CHRONIC NECK PAIN: A RANDOMIZED CONTROLLED PILOT TRIAL. Journal of rehabilitation medicine, 53(2).
- (2) Guo, Q., Zhang, L., Gui, C., Chen, G., Chen, Y., Tan, H., Su, W., Zhang, R., & Gao, Q. (2023). Virtual reality intervention for neck pain patients: a systematic review and meta-analysis of randomized controlled trials. Journal of medical Internet research, 25, e38256.
- (3) Eccleston, C., Fisher, E., Liikkanen, S., Sarapohja, T., Stenfors, C., Jääskeläinen, S. K., Rice, A. S. C., Mattila, L., Blom, T., & Bratty, J. R. (2022). A prospective, double-blind, pilot, randomized, controlled trial of an "embodied" virtual reality intervention for adults with low back pain. Pain, 163(9), 1700-1715.
- (4) Brea-Gómez, B., Torres-Sánchez, I., Ortiz-Rubio, A., Calvache-Mateo, A., Cabrera-Martos, I., López-López, L., & Valenza, M. C. (2021). Virtual reality in the treatment of adults with chronic low back pain: a systematic review and meta-analysis of randomized clinical trials. International journal of environmental research and public health, 18(22), 11806.
Virtual reality can help manage pain during care by providing distraction and relaxation to patients. It can be used to immerse the patient in a state of deep relaxation, educate them about their pain and treatment, and give them some control over themselves during care. VR should not replace traditional medical treatments, but can be used as an adjunct to enhance the patient experience.
- RV can reduce the amount of opioids prescribed.
" LRV significantly (39%) reduced the amount of opioids administered during painful procedures and appears to be a true distraction therapy for patients." (1)
- VR has an important role in reducing pain through distraction (use case: burn victims)
"Compared with standard analgesic treatment alone, the addition of VR distraction resulted in significant reductions in subjective pain ratings for worst pain intensity (20% reduction), pain unpleasantness (26% reduction), and time spent thinking about pain (37% reduction). Subjects' age, gender, ethnicity, initial burn size, or duration of therapy session did not affect the analgesic effects of VR distraction." (2)
"In the case of burned patients, administering care and distraction through VR reduces the pain perceived by patients. In some cases, patients need rehabilitation in addition to care and VR has an effect on pain reduction but also on range of motion post rehabilitation session." (3)
- Thanks to the use of 360° videos, the patient is distracted and relaxed, which reduces his fear of pain, his pain during the operation but also the fear of pain of the accompanying persons.
"Three-dimensional videos with virtual reality goggles and distraction maps including optical illusion images were effective in reducing pain associated with intramuscular injection of penicillin benzathine and increase patient satisfaction." (4)
- The pain reduction effect is maintained over several VR sessions.
"Results showed that on the first day of the study, subjects reported significant decreases (27-44%) in pain ratings during virtual reality. They also reported improved affect ("fun") during virtual reality. Improvements in analgesia and affect were maintained with repeated use of virtual reality over several therapy sessions. Maximum range of motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically significant and is maintained with repeated use." (5)
- (1) McSherry, T., Atterbury, M., Gartner, S., Helmold, E., Searles, D. M., & Schulman, C. (2018). Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults. Journal of Burn Care & Research, 39(2), 278-285.
- (2) Sharar, S. R., Carrougher, G. J., Nakamura, D., Hoffman, H. G., Blough, D. K., & Patterson, D. R. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of physical medicine and rehabilitation, 88(12), S43-S49.
- (3) Ali, R. R., Selim, A. O., Ghafar, M. A. A., Abdelraouf, O. R., & Ali, O. I. (2022). Virtual reality as a pain distractor during physical rehabilitation in pediatric burns. Burns, 48(2), 303-308.
- (4) Basak, T., Demirtas, A., & Yorubulut, S. M. (2021). Virtual reality and distraction cards to reduce pain during intramuscular benzathine penicillin injection procedure in adults: A randomized controlled trial. Journal of Advanced Nursing, 77(5), 2511-2518.
- (5) Schmitt, Y. S., Hoffman, H. G., Blough, D. K., Patterson, D. R., Jensen, M. P., Soltani, M., ... & Sharar, S. R. (2011). A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns, 37(1), 61-68.
Virtual reality is effective in helping patients with neurological diseases such as multiple sclerosis, Parkinson's disease, and neuropathic pain. It allows them to reduce their chronic pain. By distracting them from their pain and helping them to relax, VR can improve their quality of life and psychological well-being. Studies have shown that VR can reduce anxiety and pain in patients with neurological diseases, which can be used to complement traditional medical treatments.
The French National Authority for Health (HAS) recommends the use of virtual reality as a complement to conventional rehabilitation for the recovery of post-stroke motor functions.
- RV has an effect on quality of life and reduction of depressive states in the post-stroke population.
"The applied VR therapy significantly increased the sense of self-efficacy and the level of acceptance of the disease; however, this effect was similar to that obtained with the standard intervention. [...] The use of VR therapy combined with neurological rehabilitation had a positive effect on mood improvement and reduction of depressive symptoms in post-stroke patients." (1)
"The conventional rehabilitation approach combined with virtual reality appears to be more effective in improving perceived health-related quality of life in stroke survivors." (2)
"This meta-analysis showed that game-based rehabilitation [...] leads to better improvements, compared to conventional treatment [...]. Regardless of the technological device used, greater adherence to a consolidated set of neurorehabilitation principles improves the effectiveness of serious games. Future development of stroke-specific rehabilitation interventions should take greater account of the consolidated set of neurorehabilitation principles." (3)
- The use of VR is recommended for upper extremity motor rehabilitation in stroke patients.
"VR-supported upper extremity exercise therapy may be effective in improving motor rehabilitation outcomes. Our review showed that of the 12 rehabilitation outcome measures examined during VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion)" (4)
- Using virtual reality, multiple sclerosis patients have seen significant improvements in their fatigue, quality of life and balance.
"In general, functional mobility showed similar improvement between groups, while for fatigue, quality of life, and balance, VR promoted equal or greater improvement than conventional exercise. The meta-analysis confirmed that for functional mobility, RV did not promote significant improvement, whereas for fatigue, quality of life, and balance, RV promoted superior improvement." (5)
- The use of virtual reality is beneficial for improving balance in patients with Parkinson's disease.
"RV training resulted in significantly better performance compared to the conventional physical therapy group...12 weeks of RV rehabilitation resulted in greater improvement in balance and gait in people with Parkinson's disease compared to conventional physical therapy." (6)
- Haute Autorité de Santé - Rehabilitation in the chronic phase of adult stroke: Relevance, indications and modalities (has-sante.fr)
- (1) Kiper, P., Przysiężna, E., Cieślik, B., Broniec-Siekaniec, K., Kucińska, A., Szczygieł, J., ... & Szczepańska-Gieracha, J. (2022). Effects of Immersive Virtual Therapy as a Method Supporting Recovery of Depressive Symptoms in Post-Stroke Rehabilitation: Randomized Controlled Trial. Clinical Interventions in Aging, 1673-1685.
- (2) Rodríguez-Hernández, M., Criado-Álvarez, J. J., Corregidor-Sánchez, A. I., Martín-Conty, J. L., Mohedano-Moriano, A., & Polonio-López, B. (2021). Effects of virtual reality-based therapy on quality of life of patients with subacute stroke: A three-month follow-up randomized controlled trial. International journal of environmental research and public health, 18(6), 2810.
- (3) Doumas, I., Everard, G., Dehem, S., & Lejeune, T. (2021). Serious games for upper limb rehabilitation after stroke: a meta-analysis. Journal of neuroengineering and rehabilitation, 18(1), 100.
- (4) Chen, J., Or, C. K., & Chen, T. (2022). Effectiveness of using virtual reality-assisted exercise therapy for upper extremity motor rehabilitation in stroke patients: a systematic review and meta-analysis of randomized controlled trials. Journal of medical Internet research, 24(6), e24111.
- (5) Nascimento, A. S., Fagundes, C. V., Mendes, F. A. D. S., & Leal, J. C. (2021). Effectiveness of virtual reality rehabilitation in people with multiple sclerosis: systematic review and meta-analysis of randomized controlled trials. Multiple sclerosis and related disorders, 54, 103128.
- (6) Feng, H., Li, C., Liu, J., Wang, L., Ma, J., Li, G., Gan, L., Shang, X., & Wu, Z. (2019). Virtual reality rehabilitation versus conventional physical therapy to improve balance and gait in patients with Parkinson's disease: a randomized controlled trial. Medical science monitor: International Medical Journal of Experimental and Clinical Research, 25, 4186-4192.
The revival of virtual reality mirror therapy offers an innovative approach to rehabilitation. Using VR headsets, patients can have an immersive experience where they see their missing or affected limb as if it were present and functional. This approach promotes functional rehabilitation and pain reduction, offering new perspectives for mirror therapy.
- Mirror therapy can help activate the motor area of the brain on the affected side in stroke patients.
"Bilateral mirror therapy led to greater M1 neural activities than unilateral mirror therapy and bilateral mirrorless movements in stroke patients." (1)
- Mirror therapy is effective in improving upper extremity motor function, motor skills, activities of daily living and pain reduction.
"Virtual reality mirror therapy appears to have potential effects on restoring upper extremity motor function in chronic stroke patients." (2)
"Mirror therapy moderately improved movement of the affected upper and lower limb and the ability to perform daily activities for individuals during and beyond six months after stroke. Mirror therapy reduces pain after stroke, but especially in people with complex regional pain syndrome." (3)
- (1) Tai, R. Y., Zhu, J. D., Cheng, C. H., Tseng, Y. J., Chen, C. C., & Hsieh, Y. W. (2020). Cortical neural activity evoked by bilateral and unilateral mirror therapy after stroke. Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology, 131(10), 2333-2340.
- (2) Hsu, H. Y., Kuo, L. C., Lin, Y. C., Su, F. C., Yang, T. H., & Lin, C. W. (2022). Effects of a virtual reality-based mirror therapy program on improving hand sensorimotor function in chronic stroke patients: a randomized controlled trial. Neurorehabilitation and neural repair, 36(6), 335-345.
- (3) Thieme H, Morkisch N (2018). Mirror therapy for improving motor function after stroke.
The use of virtual reality therapy in rehabilitation is considered equivalent to or an effective complement to traditional approaches.