Background: Many people after having a stroke have difficulty moving, thinking and sensing. This often results in problems with everyday activities such as writing, walking and driving. Virtual reality and interactive video gaming are new types of therapy being provided to people after having a stroke. The therapy involves using computer-based programs that are designed to simulate real life objects and events. Virtual reality and interactive video gaming may have some advantages over traditional therapy approaches as they can give people an opportunity to practise everyday activities that are not or cannot be practised within the hospital environment. Furthermore, there are several features of virtual reality that might mean that patients spend more time in therapy: for example, the activity might be more motivating.
Study characteristics: We identified 37 studies involving 1019 people after stroke. A wide range of virtual reality programs were used and most of the programs required the person using the program to be relatively active (as opposed to smaller movements associated with simply moving a joystick). The evidence is current to November 2013.
Key results: Twelve trials tested whether the use of virtual reality compared with conventional therapy resulted in improved ability to use one's arm and found that the use of virtual reality resulted in better arm function. Four trials tested whether the use of virtual reality compared with conventional therapy resulted in improved walking speed. There was no evidence that virtual reality was more effective in this case. Eight trials found that there was some evidence that virtual reality resulted in a slightly better ability to manage everyday activities such as showering and dressing. However, these positive effects were found soon after the end of the treatment and it is not clear whether the effects are long lasting. Results should be interpreted with caution as the studies involved small numbers of participants. Very few people using virtual reality reported pain, headaches or dizziness and no serious adverse events were reported.
Quality of the evidence: We classified the quality of the evidence as low for arm function. The quality of the evidence was very low for walking ability, global motor function and independence in performing daily activities. The quality of the evidence for each outcome was limited due to small numbers of study participants, inconsistent results across studies and poor reporting of study details.
Authors' conclusions:
We found evidence that the
use of virtual reality and interactive video gaming may be beneficial in
improving upper limb function and ADL function when used as an adjunct
to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy.
There was insufficient evidence to reach conclusions about the effect
of virtual reality and interactive video gaming on grip strength, gait
speed or global motor function. It is unclear at present which
characteristics of virtual reality are most important and it is unknown
whether effects are sustained in the longer term.