Virtual reality training improves balance function

Yurong Mao, Peiming Chen, Le Li, Dongfeng Huang, Yurong Mao, Peiming Chen, Le Li, Dongfeng Huang

Abstract

Virtual reality is a new technology that simulates a three-dimensional virtual world on a computer and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can activate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.

Keywords: NSFC grant; balance; balance dysfunction; brain injury; mechanism; nerve regeneration; neural plasticity; neural regeneration; proprioception; rehabilitation; reviews; sensorimotor function; somatosensory; spinal cord injury; stroke; vestibule; virtual reality; vision.

Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
A simplified representation of the human motion control loop. A desired body state directs the controller within the central nervous system generating motor commands that drive the muscles of the body. External sources like electric current (d) can stimulate the body (a). The actual state of the body is registered by (among other things) the vestibular apparatus and the visual system (b). The signals from these sensors are processed by the central nervous system (c) for comparison with the desired body state. Adapted from Bos et al. (2002).
Figure 2
Figure 2
Areas activated during an active foot movement task by a patient with stroke at the First Affiliated Hospital, Sun Yat-sen University, China. The two functional MRI images of preliminary experiments are supplied by the Motor Recovery Laboratory in the Department of Rehabilitation, showing active tasks of the right paretic foot before (A) and after (B) virtual reality training.
Figure 3
Figure 3
Virtual training with bilateral limb movement in the Motor Recovery Laboratory, Department of Rehabilitation, the First Affiliated Hospital, Sun Yat-sen University, China.

References

    1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009;169:938–944.
    1. Ayaz H, Shewokis PA, Curtin A, Izzetoglu M, Izzetoglu K, Onaral B. Using MazeSuite and functional near infrared spectroscopy to study learning in spatial navigation. Vis Exp. 2011:3443.
    1. Basso Moro S, Bisconti S, Muthalib M, Spezialetti M, Cutini S, Ferrari M, Placidi G, Quaresima V. A semi-immersive virtual reality incremental swing balance task activates prefrontal cortex: a functional near-infrared spectroscopy study. Neuroimage. 2014;85:451–460.
    1. Berra K. Virtual rehabilitation: dream or reality? Clin Invest Med. 2004;29:187–192.
    1. Bisson E, Contant B, Sveistrup H, Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyberpsychol Behav. 2007;10:16–23.
    1. Blennerhassett JM, Dite W, Ramage ER, Richmond ME. Changes in balance and walking from stroke rehabilitation to the community: a follow-up observational study. Arch Phys Med Rehabil. 2012;93:1782–1787.
    1. Bolton DA, Brown KE, McIlroy WE, Staines WR. Transient inhibition of the dorsolateral prefrontal cortex disrupts somatosensory modulation during standing balance as measured by electroencephalography. Neuroreport. 2012;23:369–372.
    1. Borlongan CV. Motor activity-mediated partial recovery in ischemic rats. Neuroreport. 2000;11:4063–4067.
    1. Bos EJ, Bles W, Hosman R. The cause of spatial disorientation RTO HFM symposium on “Spatial Disorientation in Military Vehicles: Causes, Consequences and Cures. La Coruna. Spain. 2002
    1. Bower KJ, Clark RA, McGinley JL, Martin CL, Miller KJ. Clinical feasibility of the Nintendo Wii™ for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting. Clin Rehabil. 2014;28:912–923.
    1. Bryanton C, Bossé J, Brien M, McLean J, McCormick A, Sveistrup H. Feasibility, motivation, and selective motor control virtual reality compared to conventional home exercise in children with cerebral palsy. Cyberpsychol Behav. 2006;9:123–128.
    1. Cho KH, Lee KJ, Song CH. Virtual-reality balance training with a video-game system improves dynamic balance in chronic stroke patients. J Exp Med. 2012;228:69–74.
    1. Cikajlo I, Rudolf M, Goljar N, Burger H, Matjačić Z. Telerehabilitation using virtual reality task can improve balance in patients with stroke. Disabil Rehabil. 2012;34:13–18.
    1. Colledge N, Lewis S, Mead G, Sellar R, Wardlaw J, Wilson J. Magnetic resonance brain imaging in people with dizziness: a comparison with non-dizzy people. J Neurol Neurosurg Psychiatry. 2002;72:587–589.
    1. Courjon JH, Jeannerod M, Ossuzio I, Schmid R. The role of vision in compensation of vestibule ocular reflex hemilabyrinthectomy in the cat. Exp Brain Res. 1977;28:235–248.
    1. Craig LE, Bernhardt J, Langhorne P, Wu O. Early mobilization after stroke: an example of an individual patient data meta-analysis of a complex intervention. Stroke. 2010;41:2632–2636.
    1. Dennis M, Mordi N, Graham C, Sandercock P CLOTS trials collaboration. The timing, extent, progression and regression of deep vein thrombosis in immobile stroke patients: observational data from the CLOTS multicenter randomized trials. J Thromb Haemost. 2011;9:2193–2200.
    1. Deutsch JE, Robbins D, Morrison J. Wii-based compared to standard of care balance and mobility rehabilitation for two individuals post-stroke. IEEE. 2009:117–120.
    1. Ding Q, Stevenson IH, Wang N. Motion games improve balance control in stroke survivors: A preliminary study based on the principle of constraint induced movement therapy. Displays. 2013;34:125–131.
    1. Drew T, Prentice S, Schepens B. Cortical and brainstem control of locomotion. Prog Brain Res. 2004;143:251–261.
    1. Dvorkin AY, Shahar M, Weiss PL. Reaching within video-capture virtual reality: using virtual reality as a motor control paradigm. Cyberpsychol Behav. 2006;9:133–136.
    1. Eser F, Yavuzer G, Karakus D, Karaoglan B. The effect of balance training on motor recovery and ambulation after stroke: a randomized controlled trial. Eur J Phys Rehabil Med. 2008;44:19–25.
    1. Fetter M, Zee DS. Recovery from unilateral labyrinrthectomy in Rhesus monkeys. J Neurophysiol. 1988;59:370–393.
    1. Flynn S, Palma P, Bender A. Feasibility of using the Sony PlayStation 2 gaming platform for an individual post-stroke: a case report. J Neurol Phys Ther. 2007;31:180–189.
    1. Guo HR, Li L. Effect of Early Rehabilitation Intervention on the Prognosis of Patients with Stroke. Jinlin Yixue. 2012;33:933–934.
    1. Horlings CG, Carpenter MG, Küng UM, Honegger F, Wiederhold B, Allum JH. Influence of virtual reality on postural stability during movements of quiet stance. Neurosci Lett. 2009;451:227–231.
    1. Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002;33:2626–2630.
    1. Johansson BB. Brain plasticity and stroke rehabilitation: the Willis lecture. Stroke. 2000;31:322–327.
    1. Johansson BB, Ohlsson AL. Environment, social interaction, and physical activity as determinants of functional outcome after cerebral infarction in the rat. Exp Neurol. 1996;139:322–327.
    1. Keenan MA, Perry J, Jordan C. Factors affecting balance and ambulation following stroke. Clin Orthop Relat Res. 1984;182:165–171.
    1. Kim JH, Jang SH, Kim CS, Jung JH, You JH. Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind randomized controlled study. Am J Phys Med Rehabil. 2009;88:693–701.
    1. Kizony R, Raz L, Katz N, Weingarden H, Weiss PL. Video-capture virtual reality system for patients with paraplegic spinal cord injury. J Rehabil Res Dev. 2005;42:595–608.
    1. Kober SE, Kurzmann J, Neuper C. Cortical correlate of spatial presence in 2D and 3D interactive virtual reality: an EEG study. Int J Psychophysiol. 2012;83:365–374.
    1. Lacour M, Roll JP, Appaix M. Modifications and development of spinal reflex in the alert baboon following a unilateral vestibular neurotomy. Brain Res. 1976;113:255–269.
    1. Langhorne P, Stott D, Knight A. Very early rehabilitation or intensive telemetry after stroke: a pilot randomised trial. Cerebrovasc Dis. 2010;29:352–360.
    1. Lewis JW, Van Essen DC. Corticocortical connections of visual, sensorimotor, and multimodal processing areas in the parietal lobe of the macaque monkey. J Comp Neurol. 2000;428:112–137.
    1. Lewis SJ, Slabosz A, Robbins TW, Barker RA, Owen AM. Dopaminergic basis for deficits in working memory but not attentional set-shifting in Parkinson's disease. Neuropsychologia. 2005;43:823–832.
    1. Li M. Application of early rehabilitation intervention on hemiplegic. Zhongguo Shiyong Shenjing Jibing Zazhi. 2011;14:71–72.
    1. Lo HC, Hsu YC, Hsueh YH, Yeh CY. Cycling exercise with functional electrical stimulation improves postural control in stroke patients. Gait Posture. 2012;35:506–510.
    1. Manor B, Hu K, Zhao P, Selim M, Alsop D, Novak P, Lipsitz L, Novak V. Altered control of postural sway following cerebral Infarction. Neurology. 2010;74:458–464.
    1. McEwen D, Taillon-Hobson A, Bilodeau M, Sveistrup H, Finestone H. Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial. Stroke. 2014;45:1853–1855.
    1. Michalski A, Glazebrook CM, Martin AJ, Wong WW, Kim AJ, Moody KD, Salbach NM, Steinnagel B, Andrysek J, Torres-Moreno R, Zabjek KF. Assessment of the postural control strategies used to play two Wii Fit video games. Gait Posture. 2012;36:449–453.
    1. Mihara M, Miyai I, Hatakenaka M, Kubota K, Sakoda S. Sustained prefrontal activation during ataxic gait: a compensatory mechanism for ataxic stroke. Neuroimage. 2007;37:1338–1345.
    1. Mihara M, Miyai I, Hatakenaka M, Kubota K, Sakoda S. Role of the prefrontal cortex in human balance control. Neuroimage. 2008;43:329–336.
    1. Mihara M, Miyai I, Hattori N, Hatakenaka M, Yagura H, Kawano T, Kubota K. Cortical control of postural balance in patients with hemiplegic stroke. Neuroreport. 2012;23:314–319.
    1. Miles FA, Eighmy BB. Long-term adaptive changes in primate vestibuloocular reflex: behavioral observations. J Neurophysiol. 1980;43:1406–1425.
    1. Miller EK, Cohen JD. An integrative theory of prefrontal cortex function. Annu Rev Neurosci. 2001;24:167–202.
    1. Nancy LC. The vestibular and proprioceptive systems to dysfunction in verticality perception posture and movement afterr stroke. J Physiother. 1980;26:5–16.
    1. Norre M, Beckers A. Vestibular habituation training: exercise treatment for vertigo based upon the habituation effect. Otolaryngnol Head Neck Surg. 1989;1989:14–19.
    1. Pan HP, Feng H, Li YJ, Jin HZ. Effects of load-controlled proprioceptive training on lower extremity motor and balance function of stroke patients. Zhongguo Kangfu Yixue Zazhi. 2011;26:1025–1028.
    1. Pavlou M, Lingerwaran A, Davies RA. Machine-based vs customized rehabilitation for the treatment of chronic vestibular disorders. ISPG Symposium. 2001
    1. Pluchino A, Lee SY, Asfour S, Roos BA, Signorile JF. Pilot study comparing changes in postural control after training using a video game balance board program and 2 standard activity-based balance intervention programs. Arch Phys Med Rehabil. 2012;93:1138–1146.
    1. Schwesig R, Goldich Y, Hahn A. Postural control in subjects with visual impairment. Eur J Ophthalmol. 2011;21:303–309.
    1. Singh DK, Rajaratnam BS, Palaniswamy V, Pearson H, Raman VP, Bong PS. Participating in a virtual reality balance exercise program can reduce risk and fear of falls. Maturitas. 2012;73:239–243.
    1. Slobounov S, Hallett M, Stanhope S, Shibasaki H. Role of cerebral cortex in human postural control: an EEG study. Clin Neurophysiol. 2005;116:315–323.
    1. Song YB, Chun MH, Kim W, Lee SJ, Yi JH, Park DH. The effect of virtual reality and tetra-ataxiometric posturography programs on stroke patients with impaired standing balance. Ann Rehabil Med. 2014;38:160–166.
    1. Srivastava A, Taly AB, Gupta A, Kumar S, Murali T. Post-stroke balance training: role of force platform with visual feedback technique. J Neurol Sci. 2009;287:89–93.
    1. Stepniewska I, Fang PC, Kaas JH. Microstimulation reveals specialized subregions for different complex movements in posterior parietal cortex of prosimian galagos. Proc Natl Acad Sci U S A. 2005;102:4878–4883.
    1. Suttanon P, Hill KD, Said CM, Logiudice D, Lautenschlager NT, Dodd KJ. Balance and mobility dysfunction and falls risk in older people with mild to moderate Alzheimer disease. Am J Phys Med Rehabil. 2012;91:12–23.
    1. Suzuki M, Miyai I, Ono T, Oda I, Konishi I, Kochiyama T, Kubota K. Prefrontal and premotor cortices are involved in adapting walking and running speed on the treadmill: an optical imaging study. Neuroimage. 2004;23:1020–1026.
    1. Tachibana A, Noah JA, Bronner S, Ono Y, Onozuka M. Parietal and temporal activity during amultimodal dance video game: an fNIRS study. Neurosci Lett. 2011;503:125–130.
    1. Tyedin K, Cumming TB, Bernhardt J. Quality of life: an important outcome measure in a trial of very early mobilization after stroke. Disabil Rehabil. 2010;32:875–884.
    1. Viau A, Feldman AG, McFadyen BJ, Levin MF. Reaching in reality and virtual reality: a comparison of movement kinematics in healthy subjects and in adults with hemiparesis. J Neuroeng Rehabil. 2004;1:11.
    1. Viirre E, Buskirk J. Utilization of virtual reality technology in the rehabilitation of balance disorder patients. Micromedical Technologies Vestibular Update. 2000;24:1–4.
    1. Virk S, McConville KM. Virtual reality applications in improving postural control and minimizing falls. Conf Proc IEEE Eng Med Biol Soc. 2006;1:2694–2697.
    1. Walker ML, Ringleb SI, Maihafer GC, Walker R, Crouch JR, Van Lunen B, Morrison S. Virtual reality-enhanced partial body weight-supported treadmill training post-stroke: feasibility and effectiveness in 6 subjects. Arch PhysMed Rehabil. 2010;91:115–122.
    1. Webster JS, McFarland PT, Rapport LJ, Morrill B, Roades LA, Abadee PS. Computer-assisted training for improving wheelchair mobility in unilateral neglect patients. Arch Phys Med Rehabil. 2001;82:769–775.
    1. Whitney S, Sparto PJ, Brown KE. The potential use of virtual reality in vestibular rehabilitation: preliminary findings with the BNAVE. J Neurol PhysTher Report. 2002;26:72–78.
    1. Yavuzer G, Eser F, Karakus D, Karaoglan B, Stam HJ. The effects of balance training on gait late after stroke: a randomized controlled trial. Clin Rehabil. 2006;20:960–969.

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