Virtual reality technology, consisting of computer simulations to artificially generate sensory information in the form of a virtual environment that is interactive and perceived as similar to the real world, is recognised as a novel intervention tool in stroke rehabilitation. This timely systematic review addressed the effectiveness of virtual reality training on gait and balance using commonly assessed clinical outcome measures. The meta-analyses conducted on these outcomes all favoured virtual reality training when the time-dose was matched between balance and gait training, with and without virtual reality. Virtual reality-based rehabilitation should thus be considered to be more than an adjunct to conventional gait training, which is recommended by a recent update on stroke rehabilitation best practice.1
While virtual reality offers the opportunity to create unique and customisable interventions that are unavailable or readily accomplished in the real world, its clinical implementation may be challenging. Diverse virtual reality tools exist; they range from computer games (eg, Wii, Kinect) to high-end, immersive, and costly systems.2 The realism and ecological validity of a virtual environment could enhance training efficiency in virtual reality-based rehabilitation. A useful framework3 to guide clinical decision-making consists of three essential phases: (1) interaction between the user and the virtual environment, taking into account the personal and environmental characteristics; (2) transfer of skills learned from the virtual environment to the real world; and (3) participation in the real world and its affordances as a result of rehabilitation. The transfer of virtual reality-based gait and balance training to actual community ambulation should thus be considered. It should be assessed with mobility outcomes recorded in the community and during negotiation of actual environmental challenges, such as slopes and obstacles. Outcomes of participation, motivation and adherence to training should also be evaluated.
Provenance: Invited. Not peer-reviewed.
© 2017 Published by Elsevier B.V. on behalf of Australian Physiotherapy Association.