Stroke recovery...through virtual reality?

Virtual reality gaming (yes gaming) is leading the shift to telemedicine

“Again”

A pair of assessing eyes track your every muscle movement as you repeat the action. The sound of a pen scribbling on a sheet of paper, and then- “….Again”.

It feels like you’ve been stuck doing the same stretch a million times, and it makes you wonder if any of these exercises are actually doing anything. In the back of your brain you know that the road to recovering from a stroke is one that takes time and persistence, but in the moment, that isn’t very reassuring especially since you’ve been doing this twice a week for the past two months.

Again.

And again.

And again.

And just like every other session you hear this at the end, “Great work! Just remember to practice the exercises I gave you last week. I know it’s kind of repetitive, but it’s important that you focus and put in effort on every rep, okay?” So you go home and do your exercises, with your attention drifting from 100% focus every so often, not fully invested in the task you’re trying to complete.

Welcome to what is likely the routine of the average person during post-stroke rehabilitation. A process that requires careful direction, perseverance, and above all, countless hours of focused repetition. This current rehabilitation process requires you to:

  • Firstly, be lucky enough to live in an area with an available physiotherapist.
  • Secondly, requires a physiotherapist to give one-on-one assistance and supervise a patient, leading them to devote large chunks of time to one patient.
  • And thirdly, requires the patient to remain focused on the same repetitive task at hand, which is imperative because this focusing allows the brain to create new neural associations.

All of these factors compound upon one another to create a larger picture of the rehabilitation process that seems exhausting for all parties involved. So now that I’ve painted this frankly dismal picture of the process, what’s the solution?

Virtual reality (VR) of course. Because what better way to recover physically than transporting yourself to a computer generated environment that you aren’t physically present in?

But seriously, virtual reality is gearing up to have a major impact in rehabilitation. For the past few years researchers have been testing the effectiveness of virtual environments and customized games as an alternative or as a supplement to traditional physiotherapy, and here’s how the facts stack up.

(Disclaimer: Most studies involve patients recovering from/ or with one of three conditions: strokes, spinal cord injuries, and cerebral palsy. The majority of studies however, reference stroke recovery as it is rather common (1/500). So for the purpose of this article, most of my background information was centered around observations of patients recovering from strokes. )

VR and neuroplasticity, or the brain’s ability to form/reorganize connections between synapses after an injury or traumatic experience, work really well together because of the defining aspect virtual reality- presence.

Portrayal of synapses forming a new connection

Simply put presence, is the reason that if you’ve ever put on a VR headset, you feel as if you were inside of the environment despite knowing that you obviously weren’t. That suspension of belief VR provided, puts your brain into overdrive, where it experiences the new environment as if you were there for the first time, amplifying the effect of neuroplasticity. This creates vivid associations, and as a result strong impressions within your brain.

The use of virtual reality in rehabilitation usually focuses on improving motor control, balance, gait, and strength. During physiotherapy, one aspect of it is to repeat an action enough times that it becomes second nature, or at least your brain creates those associations and can quickly call upon them in a situation where pre-injury a patient would’ve reverted to a different action.

VR by being so immersive helps strengthen those neural connections and provide the patient with a more enjoyable rehabilitation process, while retaining their focus, therefore helping to reduce overall recovery time. One study found that in elderly patients with previous strokes, using VR as their primary therapy source, saw:

  • improvement in muscle/ spatial orientation
  • increase in motivation
  • decrease in depression symptoms

And in general, benefits of VR rehabilitation include: improved motor skills, improved muscle strength and coordination and boosted and continuous motivation.

VR treatments typically come in the form of games, which have been adapted from the commercial market to align with a patient’s treatment plan and individual needs in a medical capacity. The gaming aspect of it is enhanced by add-ons such as controllers, gloves for haptic feedback or a camera set up similar to Playstation VR or Xbox Kinect for better tracking.

An issue with simply adopting a game though is the difficulty levels of a game are relative to a recovered, healthy person- not one on the path to recovery. Additionally, those games may not be accessible for patients with neurological disorders.

Patient trying out one of Neuro Rehab VR’s environments

One company, however is approaching this problem different. Neuro Rehab VR is a company that designs VR environments specifically for therapy. Their software is crafted by neurologists and physiotherapists, and takes into account specific needs of a patient and their therapy plan. If VR rehabilitation is to become more common this is likely the route it will take, as re-purposing commercial games for each individual patient isn’t a long-term or practical solution.

Another implication of using VR however, would be promoting more access to communities through “telemedicine”. If you’re not familiar with it, telemedicine is essentially accessing medicine related services over the internet.

For people in, for example, rural communities traveling to the city for an appointment every couple of days isn’t feasible. In that case, perhaps loaning the patient a VR headset and other required hardware, and uploading their treatment game might be a good idea. That way the patient still has access to the material they need to recover.

Grip strength device

Additionally using VR technology would allow for physiotherapists to gain real time insights and quantifiable data of how a patient is progressing, for example using a controller device that has sensors testing grip strength. VR rehabilitation if implement on a wide scale could also be a much better allocation of time for physiotherapists as they can see more patients if they can simply monitor some of them virtually.

People love to say that video games are a waste of time, but I’m pleased to say they’re wrong. In fact they’re very wrong, because virtual reality environments and games is the future of therapy.

Key Takeaways:

  • Traditional rehabilitation needs optimization
  • Presence is one of the biggest reasons VR is a good solution to this problem
  • VR helps patients to create stronger neural connections and is shown to have many benefits
  • Neuro Rehab VR is a company pushing the envelope in VR therapy
  • VR rehabilitation would be another step forward in telemedicine

Hi, I’m Hana Samad, an 11th-grade student, and an Innovator at The Knowledge Society. I’m a VR and AR developer with a special interest in AR wearables.

If you’re interested in my progress or have any thoughts or comments about what I’ve written feel free to:

Check out more of my Medium stories here
Add me on LinkedIn!👉 www.linkedin.com/in/hana-samad14
Shoot me an email at: hanasamad14@gmail.com

12th grade student, Activator at The Knowledge Society and Co-Founder of EC Urban Acres. Currently redefining equitable resident focused community development.