Virtual Reality (VR) and Cervicalgia Rehabilitation: a marriage that seems more and more promising
The large number of publications shows the importance of neck pain in physiotherapy and the interest of this treatment.
Can Virtual Reality, VR, bring a plus to the physiotherapist with regard to the recommendations for the management of neck pain? [1] [2] [3] [4] [5].
Let us recall that the cervical rachis is cephalophoric, cephalogyre, flexible and dynamic and that it makes the link between the head and the scapular belt. To be relevant, rehabilitation must consider all these points and include techniques for pain relief, mobility gain, muscular skill gain (speed, strength and endurance and gestural precision), oculo-cervico-kinetic rehabilitation and proprioception. All these objectives are eligible for VR treatment.
The cervical evaluation is essential to propose a rehabilitation adapted to the patient's capacities and objectives [6]. The assessment must include at least an evaluation of the 6 degrees of mobility, an evaluation of the pain VAS (visual analog scale) or NDI (neck disability index) [7], and a cephalic repositioning test [6] in order to orientate the objectives and the means.
The VR, now allows in less than a minute to determine the 6 active joint amplitudes of the patient's cervical spine with the incrementation of the painful areas. This test is performed to the nearest tenth of a degree and is reproducible independently of the operator, guaranteeing its reliability. The contribution of the VR technology takes all its sense here both in terms of simplicity and reliability of measurements compared to the tape measure that we all know.
The relevance of the cephalic repositioning test has been widely demonstrated, but it has been little used because of the complexity of its practical implementation [8][9][10]. However, it provides a numerical evaluation of the proprioceptive competence of the cervical muscles. This test has also been developed in VR and, in less than a minute, gives numerical values that will be used to monitor the sessions.
The versatility of VR allows the brain to focus on certain sensory inputs, including sight and hearing. These two sources of stimulation, inherent to virtual reality, must be used in the functional rehabilitation of neck pain. From 15° of eye movement, there is a contraction of the cervical muscles [11]. It is therefore perfectly appropriate to stimulate vision to initiate cervical mobility and oculocephalogy functional work. Similarly, the practitioner can use auditory stimulation to initiate visual exploration of the visual environment inducing cervical mobilization. The speed of movement of the object, entirely configurable in VR, will determine the strategy of execution of this task by the patient: ocular or cervical.
By diverting the patient's attention from the cervical region there will be a strong impact on kinesiophobia. The patient will be focused on the task at hand and detached from the painful area. The practitioner will be able to determine the painless analytical amplitudes of the movements he wants the patient to perform. He will then be able to modulate them and associate simple analytical movements by increasing the amplitudes or by modifying the angular sector solicited to reproduce complex three-dimensional movements.
The tasks performed by the patients in the virtual environment will call upon the different dynamic or static muscular skills of the cervical spine: speed, precision, stability of movement or postural control, either in isolation or in combination. The controlled modification of these parameters guarantees a progressiveness in the rehabilitation while ensuring the adaptation to the real needs of the patient.
After reading publications and feedback from practitioners, virtual reality becomes a relevant complementary tool in the daily practice of physiotherapy. Joint amplitude assessment, fight against kinesiophobia, active analytical and functional mobilization, cervical reprogramming in the head and neck functional unit, postural adaptation and balancing reactions and real time evaluation of the patient's progress, are all tools now gathered in a unique solution available to physiotherapists.
Philippe Gilmer, Physiotherapist- Osteopath, Trainer-Consultant, Virtualis
1] Rehabilitation of cervical spine injuries without neurological lesions - 25/08/08
26-285-A-10] - doi : 10.1016/S1283-0887(08)43949-X
[2] https://www.has-sante.fr/upload/docs/application/pdf/2014-05/referentiel_uncam_traumatisme_rachis_cervical.pdf]
[3] https://www.has-sante.fr/upload/docs/application/pdf/2013-04/referentiel_cervicalgies_fev_2013-vdef_2013-04-19_10-28-54_48.pdf
[4]https://www.has-sante.fr/upload/docs/application/pdf/argumentaire_cervicalgie_mel_2006.pdf
[5]https://www.has-sante.fr/upload/docs/application/pdf/synthese_cervicalgies_mel_2006.pdf
[6] https://www.has-sante.fr/jcms/c_272491/fr/bilan-kinesitherapique-de-la-cervicalgie]
7] Neck Disability Index (NDI) pain assessment
Algo-functional scale for the cervical spine. J Vaillant. KS 2013,0544:43-44 - 10/06/2013
8]Cephalic repositioning test: a study of performance stability Cervicocephalic relocation test: a study of performance stability N. Pinsaulta,b, J. Vaillanta,b,*, G. Vironec , J.-L. Caillat-Mioussea , L. Lachensa , N. Vuillermec Annales de réadaptation et de médecine physique 49 (2006) 647-651
9] Revel M, André-Deshays C, Minguet M. Cervicocephalic kinesthesic sensibility in patient with cervical pain. Arch Phys Med Rehabil 1991; 72:288-91.
10] Gouilly, P., Petitdant, B., Braun, R., Royer, A., & Cordier, J.-P. (2009). Assessment of the cervical spine. EMC - Kinesitherapy - Physical Medicine - Rehabilitation, 5(3), 1-16.
11] Cervical kinesthetic sensitivity after an oculo-cervical rehabilitation program in cervicalgicogenic patients Randomized controlled study MEMORY J. VAILLANT (1), M. MINGUET (2), P. GERGOY (2), J.-L. MANUEL (3), M. REVEL (4) Ann. Kinesitherapy, 1995, t. 22, nO 6, pp. 241-248 © Masson, Paris, 1995 Evolution