Virtual Reality: We Are Virtually There

Virtual reality (VR) is a virtual environment system that applies different types of computer technologies that present artificially generated sensory information (“virtual”), thus enabling the user to perceive experiences that simulate real-life activities (Wilson, Foreman, & Stanton, 1997). A three-dimensional simulated environment of objects and activities is created and presented either on a computer monitor or projected on a large screen or within a helmet-mounted display. Specific input devices such as a dataglove allow the user to actively interact with the virtual environment, and enhance participation for individuals with functional limitations (Wilson et al., 1997).

In the rehabilitation setting, VR can be used as a modality either to evaluate level of performance within a simulated task or more commonly as a treatment approach. For the latter, VR can incorporate motor learning principles such as repeated practice and positive feedback, so that play-based training of everyday functional activities can occur. Precise laboratory measurements may be made to quantify performance over time. Furthermore, the task demands (e.g., speed, accuracy, complexity of the task) and the type and frequency of feedback can be manipulated and graded, so as to grade performance requirements (Akhutina et al., 2003). VR can be utilized for task training (e.g., electric wheelchair mobility), by initially simplifying the task and subsequently grading the complexity of the task demands. In addition, benefits of this novel, animated treatment approach include enhancement of play skills or play attitudes, creativity and pleasure, a greater degree of control, and increased mastery motivation (i.e., persistence with tasks) (Chen et al., 2007). VR provides users with the opportunity not only to sense and explore the virtual environment, but also to engage in play-based activities, relatively free of limitations imposed by their disability. Multiuser formats, which are becoming increasingly commercially available, can provide new social and recreational opportunities.

VR has been used primarily in research as a new treatment modality for children and youth with cerebral palsy. Motor learning concepts to include the use of feedback and practice are applied as facilitators of motor performance. Through virtual games, children engage in multiple trials of a specific task with ongoing feedback on performance success. The children see themselves on a screen within a virtual environment that responds to their movements (Sandlund, McDonough, & Häger-Roos, 2009; Snider, Majnemer, & Darsaklis, in press). Emerging research demonstrates that this modality is feasible, highly enjoyable, and nonthreatening (Reid, 2002, 2004).

However promising, there is a paucity of research studies to date and level of evidence for existing studies is limited to experimental and pilot studies with small samples. An important issue to consider is that VR is not an explicit, well-defined method, rather it can be used in many different ways with different purposes. Indeed, the interactions and potential benefits of VR are influenced by the characteristics of the VR platform as well as by the task being performed within the virtual environment (Weiss, Rand, Katz, & Kizony, 2004). Thus when considering the potential impact of VR in an intervention study, one needs to think about the platform being used in the VR intervention, the interaction device, and the specific outcomes being studied.

The VR platform may be in a 2D or 3D environment. For example, there are now low-cost commercially available gaming platforms such as the Nintendo Wii or Sony's EyeToy, or platforms that are especially designed for rehabilitation treatments such as the Interactive Virtual Reality Exercise System (IREX). The IREX virtual reality environment offers client-specific programs designed to enhance functional improvement in chosen parameters (e.g., range of motion, control of motion, and balance). Needless to say, these latter systems are costly and not widely available to every child or treatment center. Second, interactive devices need to be considered as they each provide diverse ways to interact with the virtual environment. For example, interaction using a joystick or glove can be quite different from video-capture interaction, when determining the therapeutic goals for the VR experience. Finally, the outcomes or expected effects of this novel treatment approach vary widely. There are few studies that have evaluated the effect of VR approaches at the level of activity and participation, as most studies have applied measures of body function (impairments). Standardized tools that are responsive to clinically meaningful changes and evaluate the spectrum of functioning that is expected to improve using VR approaches would need to be systematically applied in future studies (Sandlund et al., 2009; Snider et al., in press).

The literature in this area is now emerging (since 2002) and remains fairly preliminary; however, evidence to date suggests that VR may prove to be a useful therapeutic modality for children and youth with disabilities. Greater clarity is required with respect to which children and which treatment outcomes should be targeted. Randomized controlled trials on large samples are needed to ascertain whether this approach is preferable to traditional rehabilitation interventions (Akhutina et al., 2003; Chen et al., 2007; Snider et al., in press). A wide range of potential uses of VR are currently being proposed and tested by several investigators. Ongoing developments in technology, such as low-cost virtual environments that are age-appropriate and activity-based are enabling clinicians and researchers to examine the potential that VR has for rehabilitation (Weiss et al., 2004). This modality is highly motivating and engaging, therefore if widely available, the compliance and potential benefits of virtual reality are likely to be high. We are virtually there….

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.