Virtual Reality = accurate measurements = increased efficiency
Modern medicine relies on ever more powerful technologies. More and more data is being compiled and used to improve the prognosis of patient care. Robotic surgery is a good example. It translates imaging information and a compilation of other data to help the surgeon perform the best possible procedure. However, the surgeon remains the decision-maker on the technique he will use. In physiotherapy, few technologies record data whose transcription allows the practitioner to offer a better quality of care to his patients. Virtual reality integrates this possibility. A lot of data is recorded: measurements of angle, distance, speed, precision... It remains to be seen how this can change the outcome of a rehabilitation?
Although not subject to the obligation of results, the physiotherapist is more and more subject to an activity control and an obligation of means. We are asked to do better with less sessions: a utopia some will say, not so sure others will say.
No rehabilitation is perfectly linear. Progress can be slow, in stages. The more data the practitioner is able to compile, the more he will be able to transcribe these evolutions. The VR records the data from the sessions, so the transcription of data is no longer the responsibility of the practitioner. He can devote himself to other tasks while having at his disposal objective and precise data. The quantification of the evolutions is no longer subjective.
A recent meta-analysis published on the Pedro database[1] highlights the value of virtual reality rehabilitation in several therapeutic areas. Immersive VR emerges as the most relevant technology. To boost results, it requires the customisation of environments. In other words, it is up to the VR to adapt to the patient, not the patient to adapt to the VR. But what does this mean in practice and what are the benefits for the patient and the practitioner?
The ability to use VR technology and the modification of environments allows the practitioner to systematically propose the most appropriate exercise for the patient's abilities. A patient who becomes fatigued during a session needs to have a revised goal so as not to expose them to failure which would hinder the positive impact on brain plasticity of successful exercise. The patient will carry out precise and targeted sessions. He will spend less time in a practice and this time will nevertheless be optimised.
Thus a patient treated for a shoulder pathology will be able to carry out active care in an articular sector with an accuracy of the order of a mm or a degree. From one session to the next, the practitioner will be able to offer extremely accurate care based on objective data that dissociates articular and muscular skills. At the same amplitude of flexion, does the patient gain in speed of execution of the movement? is the movement more stable? after how long does the movement become slower? when does the fatigue become preponderant? Is it the speed of execution of the movement that does not progress despite an increase in amplitude? Each criterion can be considered independently and adjusted in real time during the session, without the patient even realising that the practitioner has modified the objective of the session. The same will be true for conditions of the spine or lower limbs.
In addition to being a versatile tool for the physiotherapist, VR could become the ally of performance: more targeted, more precise sessions with better and faster results.
Philippe Gilmer, Physiotherapist, Osteopath
[1] Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses
Alexandra Voinescu, Jie Sui, Danaë Stanton Fraser. J Clin Med. 2021 Apr; 10(7): 1478. doi: 10.3390/jcm10071478