Current evidence on virtual reality and its potential usefulness in post-stroke neurorehabilitation
Correspondencia: Dr. Moisés Leén Ruiz. Servicio de Neurologfa. Clinica San Vicente. Avda, Ventisquero de la Condesa, 46. E-28035 Madrid.
E-mail: pistolpete271285@hotmail.com
Introduction: Virtual reality therapy (VRT) constitutes a powerful and motivating tool for stroke patients to actively participate in the process of neurorehabilitation, providing augmented performance feedback, with the aim of achieving better therapeutic results owing to the enhancing of neuroplasticity mechanisms. Aim: To report the most relevant data about the applications of VRT in the post-stroke neurorehabilitation. Development: We conducted a PubMed search for articles, latest books, leading clinical practice guidelines, and scientific societies, regarding such applications. Conclusions: Different performed randomized clinical trials (RCT) show that VRT safely facilitates in a statistically significant way motor and functional recovery of upper limb, gait, balance, quality of life related to health, and activities of daily living, together with conventional therapy, but have no clearly demonstrated overall superiority to conventional therapy. In this regard, underlying specific mechanisms remain elusive at this stage. Future RCT should define the good responder stroke patient profile based on the VRT used in conjunction with conventional therapy, allowing the generation of neurorehabilitation approaches that combine a customized immersive VRT with the clinical experience of the therapists, to maximize the results. It is necessary to carry out well-designed RCT, including larger samples of appropriately selected stroke subjects, to draft a consensus document that allows recommending, with a greater level of evidence and on a widespread basis, the implementation of VRT as add-on therapy in post-stroke neurorehabilitation. As well as to determine if the beneficial effects are maintained in the long term and to clarify the most suitable treatment schedule.
Objetivo Exponer los datos más relevantes sobre las aplicaciones de la TRV en la neurorrehabilitación postictus.
Desarrollo Búsqueda de artículos en PubMed, últimos libros y principales guías de práctica clínica y sociedades científicas publicados con respecto a dichas aplicaciones.
Conclusiones Los diferentes ensayos clínicos aleatorizados (ECA) realizados demuestran que la TRV facilita, de forma segura y estadísticamente significativa, la recuperación motora y funcional del miembro superior, la marcha, el equilibrio, la calidad de vida relacionada con la salud y las actividades de la vida diaria, junto con la terapia convencional, sin ser globalmente superior a la terapia convencional. Aún no se conocen los mecanismos específicos subyacentes. Los ECA futuros deberán definir el perfil de paciente respondedor según la TRV empleada, permitiendo generar enfoques de neurorrehabilitación que conjuguen una TRV personalizada inmersiva y la experiencia clínica de los terapeutas para maximizar los resultados. Son precisos ECA bien diseñados, incluyendo muestras amplias de pacientes adecuadamente seleccionados, para redactar un documento de consenso que permita recomendar, con un mayor nivel de evidencia y de forma generalizada, la implementación de la TRV como terapia complementaria en la neurorrehabilitación postictus, determinar si los efectos beneficiosos se mantienen a largo plazo y clarificar qué esquema de tratamiento es el más apropiado.
