Attention diversion and gesture rehabilitation with Virtual Reality

Mirror therapy and modulation of the visual perception of the size of a painful limb has an effect on the intensity of pain perceived by the patient. Sight is therefore part of the pain. What happens if we reduce the visual perception of the size of a painful limb to the point that it is no longer visible to the patient?

Visual suppression and pain management

Completely removing visualization of a limb in a virtual environment removes the patient's visual input on segmental positioning in space. Sight will no longer be able to serve as a positional reference in anticipatory reactions to the perception of pain during a movement. The patient will have to prioritize their deep or superficial somesthetic inputs over visual input. VR is thus an essential tool for initiating gestural rehabilitation in a context of kinesiophobia.

Carrying out a task by the patient without visual perception of the movements of a limb allows a reduction in the anticipated amplitude limitation to get closer to a real anatomical limitation. The practitioner makes the patient perform a gesture or movement in VR in a non-painful area. During its implementation, he will be able to modulate the task or the environment in real time to approach and then exceed the amplitude expected to be painful.‍

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Is this noticeable to the patient?

These changes may or may not be perceptible to the patient. When carrying out a task in the first person, the patient has his avatar carry out a virtual task on the same scale as that of his real gesture. Its sensations of amplitude can thus be superimposed on the gestures. In an environment with a third person realization the patient interacts with an object in an indirect way.

The practitioner can vary the sensitivity of the parameters requiring the patient to increase their gesture amplitude without being able to visually perceive a change in their environment, dissociating the view in order to promote gesture perception.[1]

The diversion of attention by VR also has its place in cases of muscular astonishment. The variations of parameters in the virtual environment refocus the patient's attention on a gesture and not on a local lesion focus. In doing so, the practitioner will be able to search for muscle contraction by chain diffusion or by direct contraction.

Virtual Reality is a multi-sensory stimulation tool which addresses many clinical symptoms and is constantly evolving to meet the needs of patients. The real-time adaptability of environments and tasks to be carried out by the patient is justified as an essential criterion by numerous publications.

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Bibliography:

_{[1] Du contrôle de la motricité à l’organisation du geste. J. Paillard et D. Beaubaton Paris, Masson, 1978, 225-260.}