# Virtual Reality and Exergames in Rehabilitation of Neurological Patients - Savonia AMK

> In 20 – 25.2.2023, Blended Intensive program in Neurological rehabilitation ran.

## Overview
From February 20–25, 2023, a Blended Intensive Program in Neurological Rehabilitation was held, involving over 30 physiotherapy students and teachers from Savonia University of Applied Sciences (Finland), the Third Faculty of Medicine at Charles University (Czech Republic), and the University of Thessaly (Greece). Students collaborated on articles covering stroke, multiple sclerosis, Parkinson’s disease, children with neurological disorders, spinal cord injury, and the use of virtual reality (VR) and exergames in rehabilitation.

## Definitions
*   **Virtual Reality (VR):** A technology that allows a user to simulate a situation or experience using a VR headset within an interactive, computer-generated environment.
*   **Exergaming:** Technology-driven physical activities, such as video game play, that require participants to be physically active or exercise to play.

## Advantages and Challenges of VR
The primary advantages of VR include the optimization of motor learning in a safe environment with performance feedback. It encourages repetitive movement and endurance practice by keeping patients motivated. VR has shown beneficial results for strength, dynamic postural control, balance, and sensory-gross motor function, and can assist with daily living tasks and pain management by distracting the patient.

Conversely, VR systems can be expensive and inaccessible. Potential side effects include headaches, dizziness, and the risk of epileptic seizures. Furthermore, some patients may prefer conventional rehabilitation over modern technology.

## Clinical Applications
Research, including systematic reviews and meta-analyses, indicates that VR is effective in the rehabilitation of stroke, Parkinson’s disease, multiple sclerosis, chronic pain, Down syndrome, and cerebral palsy.

*   **Parkinson’s Disease:** VR helps improve balance, gait, and mobility while reducing falls. Studies show that VR-based exercise programs can yield improvements in gait and balance comparable to traditional therapy.
*   **Multiple Sclerosis:** VR-based telerehabilitation serves as an effective alternative for patients with mobility or geographical constraints, showing improvements in general balance similar to conventional physical therapy.
*   **Cerebral Palsy:** Research on treadmill training with VR for children with spastic cerebral palsy showed significant improvements in knee extension strength, 2-minute walk tests, and standing ability compared to treadmill training alone.
*   **Stroke:** VR rehabilitation has shown promise in improving balance and upper limb function, though further research is needed regarding its impact on grip strength and gait speed.
*   **Chronic Pain:** Meta-analyses suggest that VR therapy can reduce pain intensity and kinesiophobia in patients with chronic low back pain.

## Conclusion
While scientific evidence supports the use of VR and exergames as beneficial tools for various neurological conditions, they should be utilized as a complementary intervention rather than an exclusive treatment method.

## Authors
*   **Johanna Hyvärinen**, Physiotherapy student, Savonia University of Applied Sciences
*   **Jenni Pentti**, Physiotherapy student, Savonia University of Applied Sciences
*   **Alena Marsalkova**, Physiotherapy student, Third Faculty of Medicine, Charles University
*   **Sara Hukaufova**, Physiotherapy student, Third Faculty of Medicine, Charles University
*   **Julie Soukenikova**, Physiotherapy student, Third Faculty of Medicine, Charles University
*   **Eleni Maria Kalligeri**, Physiotherapy student, Department School of Health Sciences, University of Thessaly
*   **Dr. Marja Äijö**, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences
*   **Dr. Kamila Řasová**, Ph.D., Associative professor of Physiotherapy, Third Faculty of Medicine, Charles University
*   **Dr. Thomas Besios**, Assistant Professor, Department School of Health Sciences, University of Thessaly

## References
*   Afzal MW, et al. (2022). Effects of virtual reality exercises and routine physical therapy on pain intensity and functional disability in patients with chronic low back pain. *J Pak Med Assoc.*
*   Brea-Gómez B, et al. (2021). Virtual Reality in the Treatment of Adults with Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. *Int J Environ Res Public Health.*
*   Cho C, et al. (2016). Treadmill Training with Virtual Reality Improves Gait, Balance, and Muscle Strength in Children with Cerebral Palsy. *Tohoku J Exp Med.*
*   Dockx K, et al. (2016). Virtual reality for rehabilitation in Parkinson’s disease. *Cochrane Database Syst Rev.*
*   Feng H, et al. (2019). Virtual Reality Rehabilitation Versus Conventional Physical Therapy for Improving Balance and Gait in Parkinson’s Disease Patients: A Randomized Controlled Trial. *Med Sci Monit.*
*   Healthysd.gov (2023). What is Exergaming?
*   Liji T. (2021). Applications of Virtual Reality in Medicine.
*   Lopes JBP, et al. (2020). Virtual reality in the rehabilitation process for individuals with cerebral palsy and Down syndrome: A systematic review. *J Bodyw Mov Ther.*
*   Ortiz-Gutiérrez R, et al. (2013). A telerehabilitation program improves postural control in multiple sclerosis patients: a Spanish preliminary study. *Int J Environ Res Public Health.*
*   Truijen S, et al. (2022). Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson disease, multiple sclerosis, and stroke: a systematic review and meta-analysis. *Neurol Sci.*
*   Wu J, et al. (2021). Effects of Virtual Reality Training on Upper Limb Function and Balance in Stroke Patients: Systematic Review and Meta-Meta-Analysis. *J Med Internet Res.*
*   Äijö M, Řasová K & Besios T. (2022). Neurological rehabilitation, Blended Intensive program has started. *Savonia Article.*