Motor learning through Virtual Reality

Since the 1970s, Virtual Reality, VR, has been used for technical gesture learning in the military and space fields. The acquired knowledge can be transposed to real life [1] and the learning can be repeated endlessly with almost zero human and material risk and benefits that can be greater. [2]

How does VR help motor learning in pathological situations and which patients could benefit from it? Throughout life, the nervous system modifies its structure and functioning thanks to cerebral plasticity. Sensory stimulation induces the regeneration of synaptic connections and its effects on the body shape these interactions in order to optimize motor responses. Thus, the more beneficially tangible the experiences, the more the brain will integrate the motor responses [3].

It is this phenomenon which allows an amputee patient to integrate a prosthesis [4]. Reasoned practice in physiotherapy requires 3 phases to optimize motor learning [5]. Motor learning is built before, during and after an exercise.

Before offering an exercise to the patient, the practitioner must ensure that the conditions are met for the exercise to be carried out correctly: does the patient understand the instructions? Can he complete the task asked of him? Does this gesture mean anything to the patient and will performing it benefit them? An exercise responding negatively to one of its points will put the patient in a situation of failure without benefit for learning.

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VR makes it possible to tailor exercises to the patient's needs at any given moment.

We can infinitely modify the parameters in space, in duration and in its progression, and the use of computers allows us to record to the nearest millimeter and tenth of a degree. Any physical progress, even small, can thus be quantified and objectified.

Once the conditions for success have been established, the patient will be able to repeat the exact same exercise as many times as necessary, at different times, thus facilitating gesture learning. [3]

The practitioner establishes exercises based on the patient's abilities and will propose their adaptation in real time according to his reactions. The practitioner determines the quantity, complexity and schedule. The patient needs feedback on their efforts. The question: “Was it good?” » comes up often. This question may reflect the superiority of brain processing of motivation over kinesiophobia.

The patient's attention is diverted from the anticipation of pain, which leads to the inhibition of cholecystokinin secretion, particularly in chronic pain pathologies [6]. VR will provide an immediate answer to this question with a real-time scoring display.

At the end of the session, it allows you to quantify a success rate that can serve as motivation for future sessions.

Finally, the continuous recording of data from the sessions carried out will make it possible to quantify long-term developments and demonstrate to the patient, as well as to the prescriber, the progress made, even minute ones. Therapeutic VR is something other than a simple game with a sequence of exercises which replaces the practitioner. Current solutions allow exercise parameters to be adapted in real time to the patient's capabilities: fatigue and pain.

The practitioner retains his expertise and this tool promotes his practice both with the patient, who remains supported, and with the prescribers who will be able to have precise feedback on the patient's progress. Thus, whether in neurological, orthopedic or rheumatological pathologies , VR provides reproducibility of sessions over time and their instantaneous modulation to adapt to clinical observations aimed at optimal stimulation of brain plasticity. It is a tool that facilitates the care of the physiotherapist without being able to replace it.‍

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Bibliography :

_{[1] Training in virtual environments: Transfer to real world tasks and equivalence to real task training. F D Rose, E A Attree, B M Brooks, D M PArslow, P R Penn, N Ambihaipahan DOI: 10.1080/001401300184378
[2] Virtual Environments for Motor Rehabilitation: Review MAUREEN K. HOLDEN,Ph.D. CYBERPSYCHOLOGY & BEHAVIOR Volume 8, Number 3, 2005
[3] The effect of virtual reality-based balance training on motor learning and postural control in healthy adults: a randomized preliminary study. Prasertsakul, T., Kaimuk, P., Chinjenpradit, W. etal. BioMed Eng OnLine 17, 124 (2018). https://doi.org/10.1186/s12938-018-0550-0
[4] H. Head and G. Holmes. Sensory disturbances from cerebral lesion. Brain,34(2-3):102–254, 1911.
[5] Principles of motor learning in treatment of motor speech disorders. MaasE, Robin DA, Austermann Hula SN, et al. Am J Speech Lang Pathol.2008;17(3):277-298. DOI:10.1044/1058-0360(2008/025)
[6] Lombalgie chronique prise en charge par la réalité virtuelle et innovations technologiques. Stéphane FABRI Kinésithérapie Scientifique 2019 ;611 :11-19}