Virtual reality in stroke rehabilitation: still more virtual than real.
OBJECTIVE
To assess the utility of virtual reality (VR) in stroke rehabilitation.


METHODS
The Medline, Proquest, AMED, CINAHL, EMBASE and PsychInfo databases were electronically searched from inception/1980 to February 2005, using the keywords: Virtual reality, rehabilitation, stroke, physiotherapy/physical therapy and hemiplegia. Articles that met the study's inclusion criteria were required to: (i) be published in an English language peer reviewed journal, (ii) involve the use of VR in a stroke rehabilitation setting; and (iii) report impairment and/or activity oriented outcome measures. Two assessors independently assessed each study's quality using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) grading system.


RESULTS
Eleven papers met the inclusion criteria: Five addressed upper limb rehabilitation, three gait and balance, two cognitive interventions, and one both upper and lower limb rehabilitation. Three were judged to be AACPDM Level I/Weak, two Level III/Weak, three Level IV/Weak and three Level V quality of evidence. All articles involved before and after interventions; three randomized controlled trials obtained statistical significance, the remaining eight studies found VR-based therapy to be beneficial. None of the studies reported any significant adverse effects.


CONCLUSIONS
VR is a potentially exciting and safe tool for stroke rehabilitation but its evidence base is too limited by design and power issues to permit a definitive assessment of its value. Thus, while the findings of this review are generally positive, the level of evidence is still weak to moderate, in terms of research quality. Further study in the form of rigorous controlled studies is warranted.
Crosbie
J H
JH
Health and Rehabilitation Sciences Research Institute, Faculty of Life and Health Sciences, University of Ulster, Shore Road, Newtownabbey, County Antrim, Northern Ireland, UK.
Lennon
S
S
Basford
J R
JR
McDonough
S M
SM
D006429:Hemiplegia / Q000534:rehabilitation; D006801:Humans; D011597:Psychomotor Performance; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface; D018910:Video Games / Q000523:psychology