Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review

Journal of Rehabilitation and Assistive Technologies Engineering, 2019 · DOI: 10.1177/2055668319863557 · Published: June 18, 2019

Assistive Technology Rehabilitation

Simple Explanation

Rehabilitation is crucial for enhancing independence and quality of life for individuals with neurological conditions. Current rehabilitation strategies have proven effective, yet many individuals still face residual disabilities affecting daily life. Novel rehabilitation technologies are being explored to complement conventional therapies, aiming to minimize neurological disability and improve overall function. Robotic technologies in rehabilitation encourage motor re-learning with the goal of reducing impairment, offering advantages like high-intensity repetitive training. Virtual reality (VR) uses interactive simulations to create real-world environments for independent practice, increasing training intensity and repetitions while reducing therapist time. Combining VR and robotic technology activates more neural circuits involved in motor learning, promoting neuroplasticity. While studies show mixed results, this combination may better address the multifactorial nature of disabilities associated with neurological conditions, such as motor and sensory impairments, cognitive problems, and psychological issues.

Study Duration

Not specified

Participants

Stroke survivors

Evidence Level

Review Article

Key Findings

1
Upper-limb robotic rehabilitation technologies demonstrably improve movement, strength, and activities of daily living. However, the evidence supporting robotic lower-limb rehabilitation is less conclusive.
2
Virtual reality technologies have been shown to enhance activities of daily living, suggesting their utility as an adjunct to conventional rehabilitation to increase therapy duration and intensity.
3
Combining robotic and virtual reality technologies may further improve rehabilitation outcomes by activating more neural circuits involved in motor learning, promoting neuroplasticity.

Research Summary

Upper-limb robotic technology is as effective as dose-controlled conventional therapy in improving ADLs, motor function, and strength. However, the evidence for robotic-enhanced lower-limb rehabilitation is less convincing. VR technologies show a small benefit in ADLs compared to dose-controlled conventional therapy but no significant difference for upper-limb function, gait speed, or balance. Both robotic and VR technologies can be beneficial as part of a broader rehabilitation program, improving the intensity and amount of rehabilitation delivered. Further research is needed on combined VR and robotic technologies.

Practical Implications

Increased Therapy Intensity

Robotic and VR technologies can help increase the intensity and amount of therapy delivered, addressing a major limitation of conventional rehabilitation programs.

Improved Patient Engagement

VR can help with patient engagement and motivation, which are important for successful rehabilitation, especially given the psychological problems common after stroke and SCI.

Cost-Effectiveness Analysis

A formal up-to-date cost-effectiveness analysis is needed to justify the funding of new rehabilitation technologies by healthcare commissioners.

Study Limitations

1
Failure to examine other forms of technologies with applications in rehabilitation.
2
The majority of the published literature concerns stroke survivors, which tends to be representative of the neurological rehabilitation literature as a whole; hence, generalisability to patients with other neurological conditions may be limited.
3
Great variability between studies in terms of participants’ characteristics, rehabilitation regime, therapy duration and intensity.

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