Athletes and Rehabilitation in Virtual Reality = Performance and Return to practice

Historically, the big players in Virtual Reality (VR) have been the military, the airline industry, space agencies and video game manufacturers. It is the video game sector which developed virtual reality for the general public and today makes its use accessible for therapeutic objectives [1]. It turns out that rehabilitation and athlete performance find in VR increasingly relevant applications. Indeed, one of the characteristic points in the rehabilitation of athletes is the installation of Kinesiophobia following an injury. VR is proving to be a formidable weapon to counter this phenomenon. In a study carried out in Seattle, it was shown that the use of Virtual Reality reduces the time spent thinking about pain by 44%, reduces the appearance emotional aspect of pain by 45%, and the sensory aspect of it by 30% (Figure 1). When pain decreases in intensity, it becomes less painful, and consequently patients tend to adopt avoidance strategies less [2]. The immersive dimension of VR would therefore help to combat Kinesiophobia. This allows, during the early stages of rehabilitation, to lead the athlete to perform movements of very low amplitude and, while diverting their attention from the pain, to reach normal ranges of movement more quickly.A review of eighteen studies on VR published in 2018 also highlighted that increasing immersion in VR makes it possible to improve navigation performance, precision and postural instability [3]. Still at the level of performance, a 2019 study carried out on karatekas demonstrated that integrating a new tool, namely virtual reality, into the daily practice of the athlete was useful to improve the recognition of the type of attack of the opponent, the athletes could thus anticipate and improve their response time and decision-making. Where other studies only assumed an increase in motivation, Petri et al. (2019) statistically proved this motivational increase. The craze came from the fact that fighters could try new movements and reactions in a safe environment [4].

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Regarding advanced stages of rehabilitation, Gokeler et al. (2016) explain that patients who had the green light to return to sport following an ACL reconstruction presented an alteration in their movement patterns at the operated knee, resulting in a risk of relapse or injury. on the contralateral limb.

Rehabilitation with VR improved these patterns, approaching those of healthy subjects. Immersive virtual reality can improve the assessment of return to sport criteria and motor learning rehabilitation to reduce the risk of relapse in post-ACL reconstruction patients [5]As physiotherapists we are well placed to know that the psychological component of athletes is also extremely important. In VR it is possible to recreate an environment close to the competition, very useful for stress management.

Visual perception, anticipation, reaction time, decision-making are also very important factors that can be simulated in VR.

A 2019 study on basketball players' decision-making highlights transferable and generalized gains through the use of VR [6]. Let's imagine a dodging maneuver from a flying object in Virtual Reality, this involves a trajectory reading, coordination between vision and body movement, proprioceptive and vestibular work to keep balance among others. Now let's transfer this to a situation in sport, a defensive action in boxing or a dodge in fencing for example.

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Of course, VR will not replace the real conditions of sports practice, however its potential, although still little explored, remains more than encouraging. It is a booming tool, making it possible to carry out early rehabilitation by fighting against Kinesiophobia and to go through to the advanced phases of the athlete's preparation. It is possible to work on various aspects such as joint range of motion, precision, transfer of support, balance, coordination, reaction time, decision-making, and even stress management. It is an effective, fun immersive device, with score monitoring to motivate our athletes, it allows us to simulate situations close to a sporting activity while remaining in a controlled, safe environment where the parameters can be modified. in real time.

BibliographY :

_{[1] Katz, L., Parker,J., Tyreman, H., Kopp, G., Levy, R., & Chang, E. (2006). Virtual reality insport and wellness: Promise and reality. International Journal of ComputerScience in Sport, 4(1), 4-16.
[2] Hoffman, Hunter G.; Richards, Todd L.; Coda, Barbara; Bills, Aric R.;Blough, David; Richards, Anne L.; Sharar, Sam R. (2004). Modulation ofthermal pain-related brain activity with virtual reality: evidence from fMRI.NeuroReport, 15(8), 1245–1248.
[3] Rose, T., Nam, C. S., & Chen, K. B. (2018). Immersion of virtualreality for rehabilitation-Review. Applied ergonomics, 69, 153-161.
[4]Petri, K., Masik, S., Danneberg, M., Emmermacher, P. & Witte, K.Possibilities to use a virtual opponent for enhancements of reactions andperception of young karate athletes. Int. J. Comput. Sci. Sport 18, 20–33(2019)
[5] Gokeler, Alli; Bisschop, Marsha; Myer, Gregory D.; Benjaminse, Anne;Dijkstra, Pieter U.; van Keeken, Helco G.; van Raay, Jos J. A. M.; Burgerhof,Johannes G. M.; Otten, Egbert (2016). Immersive virtual reality improvesmovement patterns in patients after ACL reconstruction: implications forenhanced criteria-based return-to-sport rehabilitation. Knee Surgery, SportsTraumatology, Arthroscopy, 24(7), 2280–2286. doi:10.1007/s00167-014-3374-x
[6] Pagé C, Bernier PM, Trempe M. Using video simulations and virtual realityto improve decision-making skills in basketball. J Sports Sci. 2019Nov;37(21):2403-2410. doi: 10.1080/02640414.2019.1638193. Epub 2019 Jul 6.PMID: 31280685.
Figure 1 Issue de: Hoffman, Hunter G.; Richards, Todd L.; Coda, Barbara; Bills,Aric R.; Blough, David; Richards, Anne L.; Sharar, Sam R.(2004). Modulation of thermal pain-related brain activity with virtualreality: evidence from fMRI. NeuroReport, 15(8), 1245–1248.}