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Does Virtual Reality Have a Place in Physical Therapy?

June 28, 2016

Physical therapy is probably best known for its 45-minute sessions of pain - or discomfort, for the tough people out there. However, PT experiences could quickly change for patients and therapists alike because of this little thing called virtual reality.

Danielle Levac- who has a Ph.D. in Rehabilitation Science and is an assistant professor at Northeastern - is the director of the Rehabilitation Games and Virtual Reality (ReGameVR) Laboratory at the university. Through the lab, Levac and student researchers are examining the potential applications VR may have throughout the physical therapy field - and whether the technology would be more beneficial or detrimental to treatment in the long-run.

The ReGameVR’s website lists says its research objectives are to:

Understand how VR systems can exploit key motor learning principles known to be critical for rehabilitation (such as motivation, task-oriented training and multisensory feedback) and create transfer-oriented practice conditions.
Evaluate motor learning research paradigms in virtual environments to explore how differing task practice conditions impact motor learning outcomes.
Develop and evaluate the effectiveness of VR systems and active video games that promote motor learning and functional recovery from neurological impairments.

Create knowledge translation resources for therapists interested in integrating VR and gaming systems into clinical practice.
Levac, who's focused primarily on PT among children with cerebral palsy in the past, will be taking a broader approach with the research coming out of the ReGameVR Lab. They'll be looking at a broad range of demographics undergoing PT for varying conditions to see if VR is a viable, perhaps preferred, treatment option moving forward. And let's just say she's on the fence.

"Rehab is a complex intervention," Levac told us. "We can’t take the therapist entirely out of it. [VR] is a tool like anything else... but it’s the therapist who is masterminding that tool, determining how much should be done, at what frequency, at which intensity."

The more sophisticated gaming systems have become, the more people have wanted to explore their potential use in PT. Levac remembers she was finishing her medical field work when the Nintendo Wii was released, at which point individuals expressed enthusiasm for somehow incorporating gaming tools requiring movement into treatment plans. Now that VR headsets are becoming more popular, people are also pointing to this technology and asking whether it can be applied in sessions, especially as a means to engage and motivate folks to complete their exercises.

But it's not as simple as firing up a console and letting PT patients have at it, Levac explained.

"I'm also really concerned and certain that it wouldn’t be right for every person," she said. "Games could encourage poor movements, which can be corrected in an in-person session with something as simple as a therapist saying, 'Move your elbow up'... As people repeat the wrong movements, they can hurt the joint and won't be optimally functional."

Patients could become sloppy playing VR games at home, Levac said, because their motivation could be channeled to the wrong objective. Games could encourage users to aim for the best score, which is not necessarily guaranteeing they're doing the correct motions. As a result, they could thwart their treatment, impede progress or cause injuries. Or, motivation could also be totally lacking among patients playing PT-centric VR games at home.

"We might be overestimating games as engaging," Levac stated. "It might be cool for patients the first three, four times, but then quickly become boring... Nothing beats motivation in-person with a therapist you've developed a relationship with."

Despite the possible cons that VR may bring to physical therapy, Levac and the ReGameVR Lab are also exploring positive influences these games may have on treatment plans. People living in rural areas without PT clinics, as well as individuals unable to shell out the steep copays that can come with sessions, could have greater access to affordable treatment options through VR.

At the same time, Levac emphasized that any VR tool used for PT would still include heavily influence from therapists. Games would be selected and tailored by therapists. Professionals would have access to real-time feedback from VR tools, so they can monitor whether patients are completing the exercises they should be doing and how well they're completing them. And the ReGameVR Lab is evaluating the best methods for therapists to pick the right games for each patient and adjust the treatment accordingly, as well determining the overall efficacy of VR in this field.



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