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      The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review

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          Abstract

          Background:

          Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established.

          Method:

          We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.”

          Results:

          We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function.

          Conclusions:

          The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.

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          Most cited references74

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          Preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement and publication bias.

          Publication bias is a major problem in evidence based medicine. As well as positive outcome studies being preferentially published or followed by full text publication authors are also more likely to publish positive results in English-language journals. This unequal distribution of trials leads to a selection bias in evidence l level studies, like systematic reviews, meta-analysis or health technology assessments followed by a systematic failure of interpretation and in clinical decisions. Publication bias in a systematic review occurs mostly during the selection process and a transparent selection process is necessary to avoid such bias. For systematic reviews/meta-analysis the PRISMA-statement (formerly known as QUOROM) is recommended, as it gives the reader for a better understanding of the selection process. In the future the use of trial registration for minimizing publication bias, mechanisms to allow easier access to the scientific literature and improvement in the peer review process are recommended to overcome publication bias. The use of checklists like PRISMA is likely to improve the reporting quality of a systematic review and provides substantial transparency in the selection process of papers in a systematic review. Copyright © 2010 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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            Virtual reality in neuroscience research and therapy.

            Virtual reality (VR) environments are increasingly being used by neuroscientists to simulate natural events and social interactions. VR creates interactive, multimodal sensory stimuli that offer unique advantages over other approaches to neuroscientific research and applications. VR's compatibility with imaging technologies such as functional MRI allows researchers to present multimodal stimuli with a high degree of ecological validity and control while recording changes in brain activity. Therapists, too, stand to gain from progress in VR technology, which provides a high degree of control over the therapeutic experience. Here we review the latest advances in VR technology and its applications in neuroscience research.
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              A discussion of cybersickness in virtual environments

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                Author and article information

                Journal
                J Cent Nerv Syst Dis
                J Cent Nerv Syst Dis
                CNS
                spcns
                Journal of Central Nervous System Disease
                SAGE Publications (Sage UK: London, England )
                1179-5735
                27 November 2018
                2018
                : 10
                : 1179573518813541
                Affiliations
                [1 ]Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
                [2 ]School of Arts, Sciences and Humanities (EACH), University of São Paulo (USP), São Paulo, Brazil
                [3 ]Faculty of Medicine of ABC, Santo André, Brazil
                [4 ]Israelite Hospital Albert Einstein, São Paulo, Brazil
                [5 ]Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
                [6 ]The Cambridge Centre for Paediatric Neurorehabilitation, Cambridge, UK
                [7 ]Medical School, University of Exeter, Exeter, UK
                [8 ]Haven Clinical Psychology Practice, Cornwall, UK
                Author notes
                [*]Thais Massetti, Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, Rua Cipotânea, 51, São Paulo 05360-000, Brazil. Email: thaismassetti@ 123456gmail.com
                [*]

                T.D.d.S. is co-first author.

                Article
                10.1177_1179573518813541 CNS-18-0016.R2
                10.1177/1179573518813541
                6262495
                30515028
                5d91799b-169d-4f7e-88f1-deff9f1e5410
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 7 June 2018
                : 19 October 2018
                Funding
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico, FundRef https://doi.org/10.13039/501100003593;
                Award ID: 442456/2016-6
                Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico, FundRef https://doi.org/10.13039/501100003593;
                Award ID: 8887.091039/2014-01
                Categories
                Systematic Review
                Custom metadata
                January-December 2018

                devices,neurorehabilitation,virtual reality
                devices, neurorehabilitation, virtual reality

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