[ARTICLE] Tracking the evolution of virtual reality applications to rehabilitation as a field of study – Full Text

Abstract

Background

Application of virtual reality (VR) to rehabilitation is relatively recent with clinical implementation very rapidly following technological advancement and scientific discovery. Implementation is often so rapid that demonstrating intervention efficacy and establishing research priorities is more reactive than proactive. This study used analytical tools from information science to examine whether application of VR to rehabilitation has evolved as a distinct field of research or is primarily a methodology in core disciplines such as biomedical engineering, medicine and psychology.

Methods

The analysis was performed in three-stages: 1) a bibliographic search in the ISI Web of Science database created an initial corpus of publications, 2) the corpus was refined through topic modeling, and 3) themes dominating the corpus from the refined search results were identified by topic modeling and network analytics. This was applied separately to each of three time periods: 1996 to 2005 (418 publications), 2006 to 2014 (1454 publications), and 2015 to mid-2018 (1269 publications).

Results

Publication rates have continuously increased across time periods with principal topics shifting from an emphasis on computer science and psychology to rehabilitation and public health. No terminology specific to the field of VR-based rehabilitation emerged; rather a range of central concepts including “virtual reality”, “virtual gaming”, “virtual environments”, “simulated environments” continue to be used. Communities engaged in research or clinical application of VR form assemblages distinguished by a focus on physical or psychological rehabilitation; these appear to be weakly linked through tele-rehabilitation.

Conclusions

Varying terms exemplify the main corpus of VR-based rehabilitation and terms are not consistent across the many scientific domains. Numerous distinguishable areas of research and clinical foci (e.g., Tele-rehabilitation, Gait & Balance, Cognitive Rehabilitation, Gaming) define the agenda. We conclude that VR-based rehabilitation consists of a network of scientific communities with a shared interest in the methodology rather than a directed and focused research field. An interlinked team approach is important to maintain scientific rigor and technological validity within this diverse group. Future studies should examine how these interdisciplinary communities individually define themselves with the goals of gathering knowledge and working collectively toward disseminating information essential to associated research communities.

Background

Virtual Reality (VR) in general, and the application of VR to rehabilitation in particular, is a relatively young, interdisciplinary field where clinical implementation very rapidly follows scientific discovery and technological advancement. Indeed, implementation is often so rapid that demonstration of intervention efficacy by investigators, and establishment of research and development priorities by funding bodies, tends to be more reactive than proactive.

Rapid growth in the number and type of applications of VR to rehabilitation has occurred over the past 15 years, suggesting that the research in this area may be demonstrative of a new scientific field. Reviews of the research in this area (see e.g., Rizzo and Kim [1], Sveistrup [2], and Levin et al. [3]), however, focus principally on applications of VR technology to specific disability or impairment. If VR-based rehabilitation is chiefly one more tool in the field of rehabilitation science, then cross-disciplinary communication could consist primarily of reporting methodological approaches. If, however, VR-based rehabilitation has emerged as a distinctive scientific domain, then it becomes the responsibility of the scientists and clinicians engaged in this work to disseminate both research insights and future directions across engaged disciplines. Our aim in the current study is to use tools of analysis from the domain of information science to examine whether application of VR to rehabilitation has evolved as a distinct field of research or is primarily a methodology in core disciplines such as biomedical engineering, medicine and psychology.

We initiated our search in 1996 because only one moderately relevant review article alluding to virtual reality being applied to medicine was found prior to that time [4]. Thus Period 1 (1996–2005) is defined as the period in which key technological developments emerged that influenced the use of VR technology for rehabilitation (Fig. 1). The most characteristic features of the early technologies in Period 1 were their large size, high cost and limited accuracy. These systems led to several pioneering motor rehabilitation applications [5, 6, 7, 8, 9] whose clinical relevance was still uncertain since their high cost, technical complexity, and encumbrance severely limited access to both hardware or software [10]. Although there was limited recognition of its growing clinical potential, no significant grassroots perception of the need for VR-based interventions took hold during this period.

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Fig. 1Key technological developments that influenced the use of VR technology in rehabilitation

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