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      Virtual Reality Intervention to Help Improve Motor Function in Patients Undergoing Rehabilitation for Cerebral Palsy, Parkinson’s Disease, or Stroke: A Systematic Review of Randomized Controlled Trials

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          Abstract

          There are many successful interventions in medicine, especially in neurology and rehabilitation. The neurosciences represent an area of medicine with tremendous recent research innovations, one of which is virtual reality. This paper aims to discover the powerful relationship between virtual reality and rehabilitation. We assessed the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation on motor function recovery of three patient groups: patients with a diagnosis of cerebral palsy, Parkinson's disease, or stroke. We conducted a systematic review using PubMed and included only articles that were randomized controlled trials that were published in the last five years. We used a general search in combination with a more focused Medical Subject Headings (MeSH) search. After thorough assessment and risk of bias evaluation using the Cochrane risk of bias tool, we included thirteen studies in this review. The majority of the clinical trials showed a statistically significant effect for improved motor function. More specifically, improvements in upper extremity motor function, gait, and balance in patients diagnosed with stroke were seen. Similarly, when evaluating patients with Parkinson's disease, improved gait and posture were also seen. When it came to cerebral palsy, however, there were no significant differences between the experimental group and the control. The level of improvement in motor function with a virtual reality intervention was striking, particularly since a few studies demonstrated sustained motor improvement a few months post-trial as well. Virtual reality-based rehabilitation has promising results for adult patients diagnosed with stroke or Parkinson's disease. For pediatric patients, on the other hand, a larger number of clinical trials would still need to be conducted to validate if virtual reality interventions have the capability of providing improved motor function recovery. 

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          Most cited references48

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          The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

          Matthew Page and co-authors describe PRISMA 2020, an updated reporting guideline for systematic reviews and meta-analyses.
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            Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.

            This paper reviews 10 principles of experience-dependent neural plasticity and considerations in applying them to the damaged brain. Neuroscience research using a variety of models of learning, neurological disease, and trauma are reviewed from the perspective of basic neuroscientists but in a manner intended to be useful for the development of more effective clinical rehabilitation interventions. Neural plasticity is believed to be the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation. Neuroscience research has made significant advances in understanding experience-dependent neural plasticity, and these findings are beginning to be integrated with research on the degenerative and regenerative effects of brain damage. The qualities and constraints of experience-dependent neural plasticity are likely to be of major relevance to rehabilitation efforts in humans with brain damage. However, some research topics need much more attention in order to enhance the translation of this area of neuroscience to clinical research and practice. The growing understanding of the nature of brain plasticity raises optimism that this knowledge can be capitalized upon to improve rehabilitation efforts and to optimize functional outcome.
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              Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments.

              Mel Slater (2009)
              In this paper, I address the question as to why participants tend to respond realistically to situations and events portrayed within an immersive virtual reality system. The idea is put forward, based on the experience of a large number of experimental studies, that there are two orthogonal components that contribute to this realistic response. The first is 'being there', often called 'presence', the qualia of having a sensation of being in a real place. We call this place illusion (PI). Second, plausibility illusion (Psi) refers to the illusion that the scenario being depicted is actually occurring. In the case of both PI and Psi the participant knows for sure that they are not 'there' and that the events are not occurring. PI is constrained by the sensorimotor contingencies afforded by the virtual reality system. Psi is determined by the extent to which the system can produce events that directly relate to the participant, the overall credibility of the scenario being depicted in comparison with expectations. We argue that when both PI and Psi occur, participants will respond realistically to the virtual reality.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                30 July 2021
                July 2021
                : 13
                : 7
                : e16763
                Affiliations
                [1 ] General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [2 ] Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [3 ] Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [4 ] Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                [5 ] General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                Author notes
                Jashvini Amirthalingam jashvini001@ 123456gmail.com
                Article
                10.7759/cureus.16763
                8343554
                34367835
                0a8ff0b6-2ed9-4bfb-8305-f096aa446366
                Copyright © 2021, Amirthalingam et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 6 June 2021
                : 30 July 2021
                Categories
                Neurology
                Pediatrics
                Physical Medicine & Rehabilitation

                cerebral palsy,stroke,parkinson's disease,rehabilitation,virtual reality,motor function,neural plasticity,visual feedback,gait,posture

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