I have long been fascinated with the concept of utilizing technology to further enhance and support the physiotherapy process. Virtual Reality (VR) or exergaming, is an innovative tool that is used in neurological rehab which may have some promising benefits for people with MS. VR therapy is being studied not only with MS but also its role and benefit with people diagnosed with Parkinson’s, and Stroke.
Research is looking at VR and the impact on various impairments of MS such as higher level cognitive executive functions, memory, dual task processes, and self-reports on quality of life and fatigue. In addition, other research is studying the impact of VR on balance, gait, and upper extremity function.
VR may take the form of easily accessible Nintendo Wii, X-box Kinect, Leap Motion controller, and could even include a 360 immersive experience such as the Oculus 360. This type of enriched environment provides new, personalized experiences, with task repetition, and feedback. These feedback loops are important for motor learning or learning a new skill. VR may also help with exercise adherence and satisfaction. It could potentially create a more interactive and engaging platform which may allow for a more engaged home program.
Here is some food for thought. A recent systematic review by Cortes-Perez et al (2021), discusses the potential for VR to improve self-reports on Quality of life and fatigue versus conventional therapy (CT). The researchers determined that both therapies are effective as standalone therapies.
However VR based intervention reduces fatigue more than just traditional conventional therapy. This also demonstrated improvements in patient self-reports of quality of life. The researchers also found that when VR is combined with CT the effect is significantly greater than CT alone.
In another recent review article by Dalmazane et al (2021), VR and its impact on balance and gait function was studied in the MS population. The researchers noted that VR can be effective in improving balance and gait functions, however the results were more contrasting for mobility and falls.
They also noted that in light of our continued Covid-19, VR could also be considered a safe home based alternative for MS patients who are functioning at a higher level and have a low disability (EDSS score).
These are just a few of the many research project looking at MS and VR. My overall take home message was despite the limited research, VR could be considered an interesting addition to conventional physiotherapy. I don’t think it can replace regular physiotherapy but it may help fend off the boredom, keep you motived, and more engaged in your home exercise program. My advice would be to dust off that old X-box Kinect or even your Wii over the holiday season. Get your brain and body out of park, play and have fun.
By Michelle Tyler, Physiotherapist at Pillars of Wellness
Cortés-Pérez, I., Sánchez-Alcalá, M., Nieto-Escámez, F. A., Castellote-Caballero, Y., Obrero-Gaitán, E., & Osuna-Pérez, M. C. (2021). Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis. Sensors (Basel, Switzerland), 21(21), 7389. https://doi.org/10.3390/s21217389
Dalmazane, M., Gallou-Guyot, M., Compagnat, M., Magy, L., Montcuquet, A., Billot, M., Daviet, J.C., Perrochon, A. (2021). Effects on gait and balance of home-based active video game interventions in persons with multiple sclerosis: A systematic review. Multiple Sclerosis and Related Disorders. Volume 51.https://doi.org/10.1016/j.msard.2021.102928.
Other interesting articles:
Baroni A, Fregna G, Milani G, et al. (2021), Video game therapy on mobility and dual tasking in multiple sclerosis: study protocol for a randomized controlled trial. BMJ Open ;11:e052005. https://doi: 10.1136/bmjopen-2021-052005
Casuso-Holgado, M. J., Martín-Valero, R., Carazo, A. F., Medrano-Sánchez, E. M., Cortés-Vega, M. D., & Montero-Bancalero, F. J. (2018). Effectiveness of virtual reality training for balance and gait rehabilitation in people with multiple sclerosis: a systematic review and meta-analysis. Clinical rehabilitation, 32(9), 1220–1234. https://doi.org/10.1177/0269215518768084
Nasciemto, A.Santos. Fagundes, C. Viera., Agustodos Santos Mendes, F, Cerqueria Leal, J. (2021). Effectiveness of Virtual reality Rehabilitation in Persons with Multiple Sclerosis: A systematic Review and Meta-analysis of Randomized Controlled Trials. Multiple Sclerosis and Related Disorders. Vol 54, Sept. https://doi.org/10.1016/j.msard.2021.103128