Middle-East Journal of Scientific Research 7 (1): 63-70, 2011

ISSN 1990-9233
IDOSI Publications, 2011

Virtual Reality Use in Motor Rehabilitation of

Neurological Disorders: A Systematic Review
1
Samia Abdel Rahman Abdel Rahman and 2Afaf A. Shaheen

1
Department of Physical Therapy for Disturbances of Growth and Development in
Children and its Surgery, Faculty of Physical therapy, Cairo University, Egypt
2
Department of Basic Sciences, Faculty of Physical therapy, Cairo University, Egypt

Abstract: Recent experimental evidence suggests that rapid advancement of virtual reality (VR) technologies
has great potential for the development of novel strategies for motor rehabilitation. Virtual reality is a computer
based, interactive, multi-sensory simulation environment that occurs in real time. The aim of this review was
to discuss the rationale, criteria of application, limits of the available procedures and the effects of VR in the
rehabilitation of patients with stroke and those with cerebral palsy (CP). Seventeen published articles from
1/1/2002 to 1/05/2010 were reviewed. Classification of the available virtual reality setups and comparison among
published studies, with focus on the criteria of motor impairment and recovery assessment, rehabilitation
procedures, and efficacy were reviewed. The studies completed to date support the application of VR in the
treatment of patients after stroke and CP patients. The duration of the rehabilitation effects after discontinuing
VR training is crucial and should be determined in controlled follow-up studies.

Key words: Virtual reality Wii Nentindo Video games Motor rehabilitation Neurological disorders

INTRODUCTION within environments that appear, to various extents,

Two major goals of rehabilitation are the
enhancement of functional ability and the realization of
greater participation in community life. These goals are
achieved by intensive intervention to improve sensory,
motor, cognitive and higher level-cognitive functions as
well as to practice in everyday activities and occupations
to increase participation [1,2]. Intervention is based
primarily on the performance of rote exercises and/or
different types of purposeful activities and occupations
[3,4]. For many injuries and disabilities, the rehabilitation
process is long and arduous and clinicians face the
challenge of identifying a variety of appealing, meaningful
and motivating intervention tasks that may be adapted
and graded to facilitate this process. Virtual reality-based
therapy, one of the most innovative and promising
recent developments in rehabilitation technology, appears
to provide an answer to this challenge [5].
Virtual reality is a computer based, interactive, multi-
sensory simulation environment that occurs in real time.
It presents users with opportunities to engage in activities
similar to real-world objects and events [6-8]. These
environments are usually three-dimensional and are
regarded as being immersive in that the user has a strong
sense of presence.[9].The concept of presence is the
illusion of going into the computer generated world and
depends on the convergence of multi-sensory input
(sight, sound and sometimes touch) in the virtual
environment. In general, there are two types of virtual
environments, immersive and non-immersive. Fully
immersive VR uses large screen projection (LSP),
headmounted display (HMD), or cave (BNAVE) systems,
where the environment is projected on a concave surface
to create the sense of immersion. Immersive systems may
also use environments such as video capture systems
(e.g. IREX, PHANToM; SensAble Technologies Inc.),
where the users view themselves or an avatar
(representation of the limb) in the scene on a computer
screen as if watching TV. In a non-immersive VR system,
users interact to different degrees with the environment
displayed on a computer screen, with or without interface
devices such as a computer mouse or haptic devices such

Corresponding Author: Samia Abdel Rahman Abdel Rahman, Department of Physical Therapy for Disturbances of Growth and
Development in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
Tel.: +966-01-2680442, Fax: +966-01-4355370, E-mail: yysamia@yahoo.com.
63
 Middle-East J. Sci. Res., 7 (1): 63-70, 2011
as Cybergloves/Cybergrasps, joysticks, or force sensors.
The achievement of different levels of virtual presence
is related to the degree of immersion in relation to the
meaning of the virtual task to the user [10].
Virtual reality systems have been developed
specifically for rehabilitation of the upper extremity,
lower-extremity training and gait retraining [11-14]. Most
of these systems are not commercially available and,
when available, are very expensive. Therefore, low-cost,
commercially available technologies, such as gaming
systems, are being trial tested for rehabilitation
applications [15].
The potentialities and actual advantages of this
learn and-transfer approach are a matter of debate [16].
There are indications of greater efficiency of VR training
compared with conventional rehabilitation in patients
with a neglect syndrome [17] or with walking disabilities
[18], but generalized evidence is still lacking. In this article
a brief overview of the rationale, criteria of application,
limits of the available procedures and the effects of VR
in the rehabilitation of patients with stroke and patients
with CP.
SUBJECTS AND METHODS
In order to gather the articles we carried out a
search on five databases: Medline (through Pubmed),
ISI (ISI Web of Knowledge), Scopus, IEEE Xplore and
ACM (Association for Computing Machinery). The query
used on Pubmed was schematically Virtual Reality,
Nintendo Wii and Video Games\ and Motor
Rehabilitation related terms (such as motor function,
Injury, Rehabilitation, Neurological disorders, Disability,
Brain Damage). On the other databases we used solely
Virtual Reality as to broaden our search and we applied
time scale restrictions (1/1/2002 to 1/05/2010) and also
excluded non-related subject areas (e.g. Psychology,
Chemistry, Sociology,).
This search yielded 860 articles. Duplicate articles
were excluded. After duplicate exclusion, we had a total
of 840 articles. These were subjected to a three stage
selection process. In the first stage two reviewers read the
title of the article and included or excluded it. In case of
disagreement the article was excluded. After this stage of
the selection process, we were left with 100 articles.
In the second stage, the same two reviewers read the
abstract of the article. If the abstract referred the use of
VR and/or VR-based therapy such as Nintendo Wii or
video games for patients with neurological disorders, the
article was included. In doubt or in case of disagreement,
64
the article was excluded. After the second stage, 40
articles were selected. In the third and final stage, the
article was subjected to a full text reading. To be included
it had to be an article (not a letter) and clearly related to
VR and its use for motor rehabilitation of patients with
stroke and those with CP.
After the final stage, 17 articles were selected. It is
important to refer that 9 articles were excluded because
they were letters, 8 were studies with only their abstract
published and 6 couldnt be obtained. Therefore, the
population of this study consists of 17 articles published
in English on Medline, Scopus, ISI and IEEE, from 1st
January 2002 to 1st May 2010. They clearly refer to the
impact of the use of VR for motor rehabilitation of patients
with stroke and those with CP.
After selecting the articles they were read and the
following variables were extracted; date of publication,
pathologic condition, sample size, study design, type of
VR, intervention procedures, outcome measures and
conclusions.
RESULTS
Comparison among studies is, to an extent, biased by
heterogeneities among studies and the small size of most
patients samples (Table 1). Several subject/VR interfacing
setups have been used, with substantial differences in the
degree of environmental immersion, display, supporting
hardware/software (from the commercial desktop to
professional video projectors) and interface devices (e.g.
haptic devices, electromagnetic sensors).
For stroke rehabilitation, some applied systems have
featured and enhanced VR setup with a virtual teacher for
upper limb tasks, desktop computer display and
electromagnetic motion tracking sensors [19-22] and more
recently wii gaming technology [23]. Immersive VR was
also used with video-projection onto a large screen and
cyber-gloves [24]. Others have provided a non-immersive
desktop display focusing on hand function and haptic
feedback using a glove [24-26]. While others have
favoured semi-immersive tele-rehabilitation VR using
rutger arm telerehabilitation system (VRRS.net) [27,28].
Semi-immersive VR was also provided by other researches
with a haptic feedback device [29].
The VR rehabilitative training began at least 6
months after stroke in most studies [23,26-28] while other
studies began the treatment after 1 year [22,24,26]; studies
in the acute stage (within 3 months after stroke) are
exceptional [19,20,29]. There was no consensus or
agreement in the selection criteria for pathophysiology
 Middle-East J. Sci. Res., 7 (1): 63-70, 2011

Table 1: Summary of the analyzed studies

No. Author (s), Pathology and Design Typeof Intervention Outcome
Year of Publication SampleSize of Study VR measures Conclusions
1.Boian et al. (2002) [25] 4 / Stroke Pre-post Non-immersive VR exercises to computerized A prehension task
reduce impairments measures, JTHF was performed 9-40%
in finger range of faster for three of the
motion, speed, patients after the
fractionation and strength. intervention
2. Merians et al. (2002) [24] 4 / Stroke Pre-post Non-immersive Dexterity tasks on JTHF Improvement of the
real objects and thumb and finger ROM,
VR exercises strength, velocity and
fractionation following
VR exercises
3. Kizony et al. (2004) [21] 13 / Stroke Pre-post Immersive Birds and Balls, SFQ, FM, Moderate relationships
Soccer and Snowboard Ashworth scale, between several cognitive
exercises FRT abilities and VR
performance. The motor
abilities and VR
performance were
inversely correlated
4. You et al. (2005) [22] 10 / Stroke Experimenter- Immersive Knee flexion- FAC, MMAS; Neuroplasticity and
Blind Randomized extension with 60 walking item associated locomotor
Study at frequency only, fMRI recovery after VR
of 0.5 Hz (15 seconds
of rest and 15 seconds
of stimulation)
5. Kuttuva et al. (2006) [27] 1/ Chronic Stroke Case study Semi-immersive Tele-rehabilitation Shoulder flexion/ Improvement in arm
for 16 sessions Extension,exercise motor control
time, wrist displacement,
Velocity, FM
6. Stewart et al. (2007) [20] 2 / ChronicStroke Pilot study Immersive 4 VR games (Reaching, Ball FM, FTHUE, BBT, SIS Successful improvement of
Shooting, Rotation ad Pinch) movement and rate
of performance
7. Heidi et al. (2007) [26] 15 / Stroke Pilot Study Non-immersive Training in reach-to-grasp of FM,, McMaster Hand Slight decrease in time to perform
virtual and actual objects Scale, WMFT,RLA some of functional tasks
8. Cameiro et al. (2008) [19] 14 / AcuteStroke Pre-post Immersive RGS including Hitting, FIM, BI, MI, FM, CAHAI Improvement with observed benefits
Grasping and Placing in performance of ADL
9 .Broeren et al. (2008) [29] 29 / Chronic Stroke Pre-post Semi- immersive Subjects movedthe Average velocity and HPR VR is promising in stroke
haptic stylus to different targets rehabilitation, with a wide range
in the virtual world of Applicability
10. Piron et al.(2009) [28] 36 / Chronic Stroke Randomized single- Semi-immersive Tele-rehabilitation Fugl-Meyer UE and the Better outcomes in motor
blind controlled trial ABILHAND scale, performance.
shworth cale
11. Saposnik et al. (2010) [2] 20 / Stroke Pilot randomized Immersive VR Wii versus recreational WMFT, BBT, SIS VR Wii gaming is feasible,safe
clinical trial therapy and efficient in stroke rehabilitation
12. Mirelman et al. (2010) [30] 18 / Hemiparetic Single blind rando Semi- immersive Six-degree of freedom force- Kinematic and kinetic Recovery of force and power of
Stroke mized control study feedback robot interfaced gait parameters LE with improved motor control
with VR stimulation at ankle
13.Brutsch et al. (2010) [35] 10 / Different Comparative study Semi- immersive Patients walked on the Lokomat Man-machine No difference between
neurological gait (VR versus non- in four different, interaction forces, VR and non-VR conditions
disorders and 8 / VR conditions) randomly-presented acceptance of the RAGT
Healthy controls conditions with VR was assessed using
a questionnaire
14.Bryanton et al. (2006) [33] 10 / Spastic CP Pre-post Immersive Ankle selective motor control ROM ,VAS VR improved exercise compliance
exercises (VR) exercise system and enhance exercise effectiveness
and conventional exercises
15. Chen et al. (2007) [31] 4 / Spastic CP Single-subject design Semi- immersive Individualized VR training 4 kinematic parameters, Improvement in the quality of
program with 2 VR systems PDMS-2 reaching, especially in children
with normal cognition and good
cooperation
16. Deutsch et al. (2008) [34] 1 / Spastic Case study Semi- immersive Wii sports games (Boxing, Visual-perceptual Positive outcomes at the impairment
diplegic CP Tennis, Bowling and Golf) processing, postural and functional levels
control and functional mo
bility tests
17. Qiu et al. (2009) [32] 2 / Spastic he Pre-post Semi- immersive Haptic Master, 6-degree of AROM and strength, The feasibility of integrating robotics
miplegic CP freedom, admittance Melbourne Assess and rich virtual environments to
controlled robot and a suite ment of forward address functional limitations
of rehabilitation simulations and lateral reaches , and decreased motor
time of hand to performance
mouth reach,
Kinematic measurements
JTHF: Jebsen Test of Hand Function, FM: Fugl-Meyer, FTHUE: Functional Test of Hemiparetic UE, BBT: Box and Block Test, SIS: Stroke Impact Scale, WMFT: Wolf Motor Function Test, RLA:
Rancho Los Amigos functional test of the hemiparetic UE, SFQ: Scenario Feedback Questionnaire, FRT: Functional Reach Test, FAC: Functional Ambulation Category, RGS: Rehabilitation Gaming
System. FIM: Functional Independence Measure, MMAS: Modified Motor Assessment Scale, VAS: Visual Analog Scale, BI: Barthel Index, MI: Motricity Index, CAHAI: Chedoke Arm and
Hand Activity Inventory, ADL: Activity of Daily Living, HPR: Hand-Path Ratio (the quotient between actual hand trajectory and the straight-line distance between two targets), RAGT: Robotic
Assisted Gait Training, PDMS-2: Fine Motor Domain of the Peabody Developmental Motor Scales-Second Edition, ROM: Active ROM.

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 Middle-East J. Sci. Res., 7 (1): 63-70, 2011
and localization of the brain lesion: ischaemic stroke was
a requisite in some studies [28], while patients with either
ischaemic or haemorrhagic stroke were admitted in others
[23,24]. On other researches, the main cause of stroke was
an infarct of posterior capsule, left corona radiata of the
posterior limb of the internal capsule and middle cerebral
artery. Other studies did not describe the criteria of
pathology [20,26,29].
Motor impairment was assessed in most cases by
means of the Fugl-Meyer (FM) scale, with required
moderate to severe or mild to moderate impairment
[19-21,27,28]. Scores lower than 45 on the Box and Block
Test functional scale (normality between 56 and 86) were
required for admission to two studies [20,23].
In most of the studies, the inclusion criteria were
active extension of the wrist above 20, metacarpophalanx
extension of fingers above 10 [24,26], or elbow extension
against gravity and Mini Mental Exam Score = 24.4) [20].
Fore rehabilitation of lower extremity (LE), the patient
must have the ability to extend the knee more than 60.
The exclusion criteria common to most studies were
severe cognitive or visuo-spatial impairment, neglect,
language impairment incompatible with communication at
the levels needed for VR rehabilitation [22,26,28], apraxia
[23], tremor, spasticity (modified Ashworth Scale score
more than 2) [22], other concomitant neurological
disorders and depression [20].
The individual training sessions in the VR setup
varied in duration from 20 minutes [19] to 1 hour [23], or 2-
2.5 hours [20,25] to a maximum 3.6 hours [24] and were run
3 times [19], 4 times [20] or 5 times per week [25], with a
full training programme lasting 2 weeks [23,24], 3 weeks
[20,25], 4 weeks [28] or 6 weeks [26,27] or with the
rehabilitation sessions distributed over a longer period of
approximately 11-13 weeks [19]. On the other hand, other
researches did not mention the details of treatment
protocol [22,29]. The efficiency of training in VR has been
assessed as reaching [20], speed, time needed to reach,
grasping, placing [19,24,26], hand-path ratio reflecting
superfluous movements or adjustment to movement [29],
finger speed, fractionation (ability to move each finger
independently), thumb and fingers range of motion
[19,24,25]. No other treatment was reportedly associated.
All study protocols had been approved by the
appropriate ethics committee and all subjects had signed
informed consent upon admission to the trial.
Mirelman et al [30] evaluated gait biomechanics after
training with a VR system (semi-immersive VR six degree
of freedom force feedback robot interfaced with VR
intervention) in 18 hemiparetic patients after stroke by
66
using kinematic and kinetic gait parameters. The training
was performed three times a week for 4 weeks for
approximately one hour each visit. Subjects in the VR
group demonstrated a significantly larger increase in ankle
power generation at push-off as a result of training. The
VR group had greater change in ankle ROM post-training
as compared to the non-VR group. Significant differences
were found in knee ROM on the affected side during
stance and swing, with greater change in the VR group.
No significant changes were observed in kinematics or
kinetics of the hip post-training.
Regarding the children with CP, Chen et al [31] used
VR system with sensor glove to provide auditory and
visual feedback for rehabilitation of upper extremity (UE).
Qiu et al [32] used New Jersey Institute of Technology
Robot-Assisted Virtual Rehabilitation (NJIT-RAVR)
system (haptic master) which consisted of adaptive
robotics with complex VR stimulation for rehabilitation of
UE. On the other hand, children with spastic CP
completed ankle selective motor control exercises using
VR exercise system and conventional exercises [33].
Other studies used VR (wii gaming system with haptic
feedback) for enhancement of visual perception, postural
control and functional mobility [34].
The age at which the VR rehabilitation program could
be applied with CP children varied in different studies. It
was 6.3 years [31], 7 to 10 years [32], 7 to 17 years [33] and
13 years [34]. Most of children were spastic hemiplegia
and spastic diplegia. Motor impairment was evaluated in
most of studies by 4 kinematic parameters (movement
time, path length, peak velocity and number of movement
units) for mail-delivery activities in 3 directions (neutral,
outward and inward) and Fine Motor Domain of the
Peabody Developmental Motor Scales-Second Edition
(PDMS-2) [31]. Upper extremity active range of motion
and strength, (MAUULF), Melbourne Assessment
including forward and lateral reaches, time of hand to
mouth reach [32], range of motion (ROM) of ankle joint
and Test of Visual Perceptual Skills, weight distribution,
sway measures and gait distance [33,34].
For UE rehabilitation the children were included if
they were able to follow verbal instructions in the
reaching task, reach forward for more than half of their arm
length and grasp a tennis ball with flexed fingers and if
they had normal or corrected-to normal vision and hearing
[31,32]. While for LE rehabilitation CP Children must have
Gross Motor Functional Classification System (GMFCS)
scores 7 of 1 or 2, indicating independent ambulation with
or without an assistive device [33,34]. The exclusion
criteria common to most studies were children received or
 Middle-East J. Sci. Res., 7 (1): 63-70, 2011
scheduled to receive surgery or botulinum toxin type A
injections in the training arm or leg within the preceding
4 to 6 months or during the planned study period or if
they had a severe attention deficit, as confirmed from their
medical records.
The individual training sessions in the VR setup
varied in duration from 60 minutes to 1.5 hours [32-34],
to a maximum of 2 hours and were run 1 time [31], 3 times
[32] or 5 times per week [20], with a full training
programme lasting 3 [32] and 4 [31] weeks. Other
researches did not mention the details of treatment
protocol [33].
Brutsch et al [35] compared the immediate effect of
different supportive conditions (VR versus non-VR
conditions) on motor output in patients and healthy
control children during training with the driven gait
orthosis Lokomat (semi-immersive VR system consisted
of robotic assisted treadmill training (RAGT) with
feedback devices). A total of 18 children (ten patients with
different neurological gait disorders and eight healthy
controls) took part in this study. They were instructed to
walk on the Lokomat in four different, randomly-presented
conditions: (1) walk normally without supporting
assistance, (2) with therapists instructions to promote
active participation, (3) with VR as a motivating tool to
walk actively and (4) with the VR tool combined with
therapists instructions. The authors concluded that
active participation in patients and control children
increased significantly when supported and motivated
either by therapists instructions or by a VR scenario
compared with the baseline measurement "normal
walking". They stated that the VR scenario used induces
an immediate effect on motor output to a similar degree as
the effect resulting from verbal instructions by the
therapists.
DISCUSSION
From the initial 860 articles retrieved by our search
only 17 were kept after selection (1.98%). This probably
means that our queries, especially in ACM were too
broad. However, they seemed to gather all the articles
available about the theme in the 5 databases. The
efficiency of our queries was different. The most efficient
one was the one we used on Pubmed (10 out of 410) and
the least efficient was ACM (0 out of 860). Searching in
ACM proved to be useless as no article was included in
the study from that database. Searching IEEE proved to
be unnecessary as the only final article found there was
also found in Scopus and ISI.
67
This study demonstrates that from 1/1/2002 to
1/05/2010, the first 2 complete studies about the uses of
VR in rehabilitation (article 1) was published only 2002.
Since then, many studies have been published, 1 study in
2004, 1 study in 2005, 2 studies in 2006, 3 studies in 2007,
3 studies in 2008, 2 studies in 2009 and 3 studies in 2010.
This probably reflects a growing interest in the potential
of VR in terms of its health effects.
Studies concerning the use of VR in stroke
rehabilitation are more organized, gathering groups and
demonstrating clearly that VR promotes greater motor
recovery than the traditional physical therapy program
(articles 1 to 12 in Table 1). However, only 1 study out of
13 studies (7.69%) reported that there is no significant
difference between VR and non-VR conditions (article 13
in Table 1). From all these 13 studies, 3 studies (23.08%)
used non-immersive VR, 5 studies (38.46%) used
semi-immersive VR and 5 studies (38.46%) used immersive
VR program.
Regarding the use of VR in the rehabilitation of CP
children, few studies were published. All the 4 reviewed
articles (articles 14 to 17 in Table 1) reported the
therapeutic effects of VR with such children in that VR
could be used effectively in their motor rehabilitation.
Three studies out of 4 studies (75%) used semi-immersive
VR and 1 study (25%) used immersive VR program.
The available evidence supports the applicability
of VR in the rehabilitation of the paretic arm and
hand. A comprehensive scientific rationale and a
pathophysiological understanding of the underlying
mechanisms nevertheless remain to be investigated. The
differences among studies in the criteria of evaluation of
the kinetic or clinical outcome limit direct comparison
among different VR setups and the training conditions to
be favored in clinical practice or in research therefore
remain unidentified.
The variety of available VR settings and subject-
machine interfaces allow different degrees of the subjects
immersion in the virtual environment. However, the
benefit-to-cost ratio of full immersive VR procedures has
never been estimated in detail, with proper evaluation of
the advantage of an artificial environment perceived as
real and the incidence of collateral disadvantages, such as
those defined as cybersickness (headache, nausea,
vomiting, dizziness and unsteadiness) [16].
The main rehabilitation benefits derived from the
reviewed articles included better hand performance,
improvements of UE, LE and cognitive functions,
recovery of the neuro-plasticity and locomotion,
improvement of ADL and improved exercise compliance.
 Middle-East J. Sci. Res., 7 (1): 63-70, 2011
Systematic neuro-imaging research is today mandatory
for the cortical functional re-arrangement to be correlated
in full detail with the clinical effects of neuro-
rehabilitation, irrespective of the applied rehabilitative
procedures; it would allow documentation of cortical
functional damage and efficacy of training. Rehabilitation
needs to be carried out intensively over long periods of
time and requires dedicated staff, resources and logistics.
The duration of the rehabilitation effects after
discontinuing VR training is crucial and should be
determined in controlled follow-up studies [12,36]. The
lack of the long-term efficacy of VR rehabilitation
procedures could challenge physicians and
physiotherapists.
Importantly, the loss of selective motor control may
interfere with overall level of functioning even when other
impairments are treated [37] since the underlying strength
and coordination may be limited. There are no specific
modalities to treat selective motor control but physical
and occupational therapy in conjunction with a home
program may improve selective motor control enough to
affect functioning. Thus repetitive activities guided by a
therapist or as in this case, a virtual environment and a
continuation of repetitive activities in daily functioning
may improve gross motor skills.
The degree of functional movement outcome
achieved by therapy is often suboptimal since intensive
therapy is limited by resource allocation and access. For
many individuals, such as traumatic brain injury
survivors, access to therapy is terminated once a level of
function is achieved even if residual deficits remain.
For other individuals, even when therapy is available such
as during in-patient neurological rehabilitation, low levels
of interaction between the patient and environment have
been reported [38,39]. For example, Tinson [39] reported
that individuals post stroke typically spent only 20-60
minutes per day in formal therapy. Common problems
influencing the degree of interaction include boredom,
fatigue, lack of motivation and lack of cooperation in
attending therapy [40]. Clinicians agree that such
problems are undesirable and restrict progress in
rehabilitation. Increasing interaction is seen as vital to
effective rehabilitation, a fact borne out by experimental
studies of recovery after brain damage [41]. Development
and incorporation of VR applications in rehabilitation may
increase the possibility of stimulation and interaction with
the world with potentially little or no increase on the
demands of staff time. Virtual reality may provide
interesting and engaging tasks that are more motivating
than formal repetitive therapy.
68
CONCLUSIONS
Functional re-organization of the motor system after
focal damage depends on substantial contributions from
the undamaged motor cortex [42], as well as on early and
intensive [43] motor training consistent with the subjects
potentialities [44]. Innovative technologies, such as VR
are being tested for applicability in neuro-rehabilitation
and their use in the treatment of the paretic UE, LE and
gait abnormalities appears promising [16]. It is feasible to
incorporate VR into rehabilitative hand training, even for
individuals with severe hand impairment following stroke.
Virtual reality may have contributed to positive
changes in neural organization and associated functional
ambulation. Clinically, VR may be used as augmented
chronic stroke rehabilitation.
The general experience of the VR application
approach suggests that this intervention seems to be a
promising tool in motor and cognitive rehabilitation, with
a wide range of applicability. It can provide a real-time
quantitative 3D task analysis and provides preliminary
evidence that interactive computer use with the right
training conditions may increase subjects motor and
cognitive skills for both stroke patients as well as CP
children.
Evidence from the literature has demonstrated the
feasibility, usability and flexibility of video-capture VR
and there is little doubt that this technology provides a
useful tool for rehabilitation intervention.
Much work remains to be done to identify which type
of patients will benefit from VR treatment, which system
features are critical and what types of training routines
will work best. However, a few findings appear to be
solidly emerging from the VR work to date, as they have
appeared repeatedly in multiple studies by different
research groups. These findings are that: (1) patients with
different disabilities appear capable of motor learning
within the virtual environments; (2) movements learned in
VR by patients with disabilities transfer to real word
equivalent motor tasks in most cases and in some cases
even generalize to other untrained tasks; and (3) when
motor learning in real versus virtual environments was
compared, some advantage for VR training has been
found.
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