I think we can safely assume that we are only beginning to see the potential that VR has for transforming occupational therapy (as well as physical therapy and speech therapy.)

There are whole societies that OTs can join, focused on the use of virtual reality (VR) in rehabilitation (like the International Society for Virtual Rehabilitation). New VR technologies and applications seem to be emerging almost daily.

Whether you are interested in incorporating virtual reality into your therapy practice, are a self-proclaimed "techie" or are just interested in glimpsing the future, this article is for you.

The post features:

What the research says about VR and OT

Therapy focused VR that is currently on the market

Discussion of product development and VR research that is in the works

Technology as Occupation: Why VR?

Technology is not only a means for occupation, including how we work and relate to each other, but is also the target of our occupation now more than ever before. As a human race, technology consumes a great deal of our occupational behavior. Why? We are engaged, connected and rewarded through technology.

A number of studies over the last decade and a half have revealed that game playing triggers dopamine release in the brain, a finding that makes sense, given the instrumental role that dopamine plays in how the brain handles both reward and exploration. Virtual reality (VR) activities rooted in games or ADL tasks with a distinct aim, reinforce voluntary repetition, which is a key ingredient for motor recovery based on principles of neuroplasticity.

Another benefit of virtual reality therapies is that patients can be engaged in a high dose of therapy or repetition early on in their stroke recovery, taking advantage of the window where cortical reorganization is at its peak. For children with neuromuscular challenges like CP, since technology and gaming has become second nature for many in the youngest generation, children may not even recognize that they are participating in rehabilitation through virtual reality.

What the Research Says About VR and Therapy

The literature shows that engagement in graded, appropriately dosed and task-oriented practice are contributors to upper limb improvement and cortical reorganization (Timmermans et al, 2010).

In traditional occupational therapy sessions focused on upper limb improvement post-stroke, research shows that only 23 to 32 repetitions are completed in a standard session (Kimberly et al, 2010). This is far fewer than is necessary for motor improvement. In addition, during sub-acute stroke rehab, an average of 4 minutes are spent on task-specific upper limb training in a typical session (Hayward & Brauer, 2015). In comparison, virtual reality interventions can yield an average of 200-300 functional movements per one hour session (Brunner et al, 2016).

A randomized controlled trial using the Neofect Smart Glove, compared to a control group of “standard occupational therapy” along with use of the VR tool, demonstrated improvement for both the proximal and distal upper extremity on the Fugl-Meyer. The device is primarily focused on forearm, wrist and hand motion, yet prompted shoulder and upper arm improvement as well as hand, wrist and forearm (Shin et al, 2016).

This speaks to the engagement in upper extremity task-oriented practice as counteracting the “learned non-use” that many stroke survivors experience. All participants received a 4-week face to face intervention program that included use of the Smart Glove along with traditional occupational therapy (OT) interventions or traditional OT only. The dosage of therapy or this study was daily intervention for 30 minutes, five days per week for a total of 20 sessions. Patients using the Smart Glove also demonstrated improvement in health related quality of life utilizing the Stroke Impact Scale compared to those that did not use the VR intervention (Shin et al, 2016).

Saposnik and Levin (2011), in a review of twelve VR approaches, reported that eleven of the twelve virtual systems showed significant benefit in the selected outcome measure. In an assessment of the use of virtual environments for stroke rehab, Holden (2005) noted that improvement in motor function appears to translate to real life tasks. A comparative investigation of an intervention in a real-life environment versus in a virtual environment, yielded nearly equivalent improvements in motor function (Subramanian et al, 2013).

What VR is Currently Available for OTs?

Virtual reality technology is quickly evolving. Here is a short list of accessible Virtual Reality devices that can be used in your practice: