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Virtual reality and post-oncology rehabilitation, a new way?

The contribution of virtual reality (VR) brings undeniable benefits in many areas of medicine.

In functional rehabilitation, we can mention the treatment of a number of pathologies such as strokes, Parkinson's disease and balance disorders... It would take too long to list here all the hospitals that use VR to soothe patients before or during an anxiety-provoking or painful operation.

In general, VR is used as an alternative to certain drug treatments, however some institutions are beginning to communicate on their use of VR in oncology. For example, the Oscar Lambret Centre (Lille) has recently been equipped with 6 VR devices. It should be noted that these devices are not limited to use in hospitals but are becoming more widespread in all types of structures, including private practice.

What can VR bring to the problems of private practice? Its use in private practice in cancer rehabilitation seems perfectly appropriate [1]. If we consider senology and breast cancer, the indications for VR are omnipresent. Breast cancer is the most frequent oncological disease in the world. It concerns about 60,000 new cases per year in France alone. Each patient treated for breast cancer is specific according to the type of treatment and the time of treatment: during or after radiotherapy, after curative or reconstructive surgery, in the immediate post-operative period or at a distance...

While some will insist on the psychological component during these treatments and the need for human contact, the use of instrumentalized techniques has proved its worth in the treatment of scar adhesions. According to a team in Montpellier [2], 93% of women who have used VR during anxiety-provoking or painful treatments ask for these immersive environments to be used again during subsequent treatments. We note the preference for immersions in a natural environment accompanied by music to help escape or relax. Once again, knowledge of the patient and her psychological state will enable this adapted technological aid to be proposed.

Recurrent symptoms include pain and kinesiophobia. VR gives the possibility to isolate the patient in a virtual world which can be a seaside, a forest: environments favourable to relaxation and to the reduction of anxieties. By isolating the patient from the physical world, the practitioner inhibits her anticipatory reactions to a potential pain triggered by a visual stimulus. Thus immersed, the manoeuvres of tissue liberation or passive mobilizations can be approached differently.

VR is a technological tool that offers answers to individualised problems. It is an additional tool offered to the practitioner for the management of joint amplitude limitations. The patient can be offered virtual rehabilitation with the performance of simple tasks that can be similar to everyday tasks, or playful environments, which can be set according to the capacities and objectives of the rehabilitation. The diversion of attention obtained will be at the heart of the rehabilitation and will have a positive effect on potential kinesiophobia.
This therapeutic advantage offered to the practitioner simplifies many treatments. Moreover, the computer system linked to VR will quantify the movements carried out, making it possible to monitor progress in terms of both amplitude and criteria that are difficult to quantify in current practice, such as the speed of the movement carried out, reaction time, and the precision of a gesture or movement.

In summary, VR is to be considered as a tool that should facilitate the practice of the physiotherapist by allowing to place a patient in the best possible conditions to accompany her rehabilitation while offering the practitioner a simple measurement tool to quantify the evolution of the treatment with precision.

Philippe Gilmer, Physiotherapist

[1] Virtual reality in elderly women followed for breast cancer: interests and expectations. Aude Michel, Emmanuelle Brigaud, Florence Cousson-Gélie, Julien Vidal, Nathalie Blanc.Geriatr Psychol Neuropsychiatre Vieil 2019; 17 (4): 415-22
[2] Draw me a more beautiful reality: virtual reality as seen by breast cancer patients. A. Michel1, J. Vidal, E. Brigaud, K. Sokratous and N. Blanc. Psycho-Oncol. Volume 13, p 69-78, Issue 1, March 2019. DOI https://doi.org/10.3166/pson-2019-0087

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