Virtual Reality in Physical Therapy

If you have suffered an injury or illness that results in pain or loss of functional mobility, you may benefit from the skilled services of a physical therapist (PT) to help you recover. Your PT will likely use several different techniques to help you return to your normal level of activity. One relatively new tool that some therapists are incorporating into their practice is virtual reality (VR).

Virtual reality headsets are often seen as a toy; people use them to play video games by immersing themselves in a virtual world. But can virtual reality be used in a rehabilitation setting? If so, what conditions can VR be used to treat, and is VR use in rehab supported by scientific research?

What Is Virtual Reality?

A virtual reality headset is a device that is worn on your head at the level of your eyes. The headset contains a small screen, often a mobile phone, that allows the user to fully immerse themselves in a virtual world. Some VR headsets also have an accompanying earpiece that supplies auditory input to the user.

Virtual reality headsets block out the outside world; the wearer only sees what is on the screen right in front of their eyes. And as the VR user moves, the virtual world that they are seeing moves with them.

Although VR headsets have been in development for years, only recently has their use become commonplace. You may find people using VR headsets while enjoying video games at home or experiencing a new movie trailer at the mall. Virtual reality devices may be used to distract patients during dental procedures.

But can virtual reality devices be used in a rehab setting? Can full immersion in a virtual environment help improve rehab outcomes? How can they be used, are they safe, and does research support their use for various diagnoses?

VR Use in Physical Therapy

Why use VR versus other forms of physical therapy? Can using VR really help you achieve your rehab goals, or is it just a novelty?

Sometimes taking a novel and fun approach to care is a good way to stay engaged in your rehab program. You are more likely to be motivated during your rehab if it is fun and enjoyable. Virtual reality rehab may be just the thing to motivate you to participate in physical therapy.

There are several instances where virtual reality headsets and devices can be used in physical therapy. People with various diagnoses might be able to benefit from its use.

Neurological Conditions

People with neurological conditions may have impairments in the arms that make reaching difficult, and lower extremity impairments may make balance and walking challenging. Using VR may be an effective and engaging way to improve upper or lower extremity coordination and balance during physical therapy.

Neurological diagnoses that may benefit from the use of virtual reality in physical therapy may include:

• Parkinson's disease
• Multiple sclerosis
• Stroke
• Cervical myelopathy
• Spinal cord injury

Any neurological injury that causes difficulty with normal movement may benefit from the use of VR in physical therapy.

Vestibular Rehab

Your vestibular system works to coordinate your head movements and positions with your eye movements. Sometimes, an impairment in your vestibular system may cause vertigo and difficulty maintaining upright position. Often, gaze stabilization exercises are done to help your body relearn the proper head and eye movements that are required to maintain upright positions.

Virtual reality headsets may be used to create situations that challenge your visual system while your are in vestibular rehab. Videos of roller coasters, swooshing cars zipping by, or optokinetic shapes may be projected in front of your eyes while you are working to maintain upright balance.

This challenges your visual input and nerves that help you stay upright, working to strengthen the necessary bonds between your vestibular organs and eye movements.

Pediatric Conditions

Physical therapy is hard work, but for children, this work is often done through play. Finding novel ways to incorporate play activities into rehab may be key to getting proper functional movement. Using VR technology may be just the key to keeping a child engaged in the work of rehab while correcting movement impairments.

Conditions that may benefit from VR use in children may include:

• Cerebral palsy
• Autism
• Hypotonia
• Attention deficit disorder
• Developmental coordination disorder
• Developmental delay

If a child is experiencing impairments that limit functional mobility, then they may benefit from physical therapy. And if a novel and playful instrument is needed to fully engage that child in rehab, then VR may be just the tool.

Orthopedic Conditions

If you are having shoulder pain and have a difficulty time reaching, you may enjoy a physical therapy session with a virtual reality device. While wearing the VR headset, video may be displayed that requires you to reach overhead in various directions.

Or you may have balance problems after an ankle sprain or knee surgery. Using VR to create engaging and challenging situations may help you stay focused and engaged in your rehab, and it may help your PT find new ways to challenge your body in order for you to improve movement and strength.

Common orthopedic conditions that may benefit from the use of VR may include:

• Ankle sprains
• Shoulder pain and impingement
• After ankle, knee, or hip surgery
• Back pain, neck pain, and associated radiculopathies
• Chronic pain management

Any orthopedic injury that creates an impairment that limits your functional mobility may possibly benefit from the use of virtual reality during rehab.

Research

Since VR use in medical settings is relatively new, there is limited research examining its use and effectiveness. But it is important to study any proposed (or current) treatment approach in physical therapy to ensure that it is safe and effective for your condition.

One positive study for the use of VR in physical therapy was published in the Medical Science Monitor in June of 2019. The study compared the use of VR rehab versus standard physical therapy treatments to improve balance and gait in patients with Parkinson's disease.

The study examined 28 patients with Parkinson's disease who were randomized into one of two groups: one group received VR therapy for five days a week for 12 weeks, while the other group received conventional PT for the same time period.

Several outcome measures were used to assess the effectiveness of the treatments including the Timed Up and Go Test, the Berg Balance Scale, The Unified Parkinson's Disease Rating Scale, and the Functional Gait Assessment.

Both study groups showed improvement in balance and gait, and the VR rehab group exhibited significantly greater improvements, especially in the measures on the Unified Parkinson's Disease Rating Scale. No participant suffered any injury as a result of any intervention.

The use of VR in rehab may have boosted the functional mobility of patients with Parkinson's disease. Similar results were found in another study examining the effects of VR rehab to patients after stroke.

A 2015 meta analysis of the use of virtual reality headsets in vestibular rehabilitation found that it may be a useful adjunct to standard vestibular rehabilitation. The researchers analyzed seven studies, and they concluded that the use of VR may be a safe and effective way to improve symptoms of vertigo and balance loss that comes with vestibular hypofunction.

Interestingly, they concluded that the main variable in achieving significant results is the total time spent using the VR device. Patients who were subjected to over 150 hours of VR training over a period of several months seemed to have greater benefits.

The bottom line in regards to research is that more work needs to be done to ensure that VR rehab is safe and effective to use. Also, a dose-response relationship should be found for various conditions; how much VR should be used, how frequently should it be used, and can it be done independently for long term gains for people with certain diagnoses?

Is VR Safe in Physical Therapy?

Since VR is such a new type of treatment in the rehab world, there is limited evidence suggesting it is safe (or dangerous). Initial studies regarding its use show that there is very little risk to using VR in physical therapy applications.

One could imagine that falls risk may be increased when using VR; a limited visual field combined with altered reality and impairments with mobility may be a recipe for disaster. But, your PT is trained to protect you during treatment, and hopefully they can prevent you from sustaining any injury during VR therapy.

If you are feeling unsafe during VR rehab (or during any other part of your physical therapy program), you must tell your therapist. They can alter their treatment approach to ensure that your remain safe.

A Word From Verywell

Going through a course of rehab can be tough. Taking time from your day to visit your PT to work on range of motion, strength, and functional mobility can be challenging (and sometimes painful).

Using virtual reality headsets in physical therapy can be a novel way to stay engaged in your physical therapy treatments. Virtual reality in rehab may help you improve mobility to achieve your physical therapy goals.