Innovations In Clinical Neuroscience

JAN-FEB 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 1 – 2 , J A N U A R Y – F E B R U A R Y 2 0 1 7 ] 20 postulates that "individuals develop a ttitudes by observing their own behavior and concluding what attitudes must have caused them." Observing an avatar's appearance as different from the actual self may shape and change the patients' o wn attitudes—a phenomenon known as the Proteus effect. 40 This strategy has been especially successful in the treatment of body dysmorphic disorder, binge eating, and anorexia. 7 As reviewed herein, use of virtual environments, plus low-calorie diets and exercise, led to significant improvements in body image concerns, weight loss, and body satisfaction while also reducing anxiety and emotional eating. 26 Additional longitudinal studies must be conducted in order to assess the long-term efficacy of VR interventions in preventing weight gain. Cognitive and motor rehabilitation. VR also presents a novel rehabilitation approach for patients with strokes, Parkinson's disease, and brain injuries. 7 VR training allows for high ecological validity in a safe and controlled environment, provides immediate visual and tactile feedback about the individual's specific performance, and may boost motivation. 33–35 Experimenter-manipulated environments allow for individualized training to enhance specific skills and neuroplasticity through repeated practice, as well as a means of helping patients overcome underutilization of limbs. 28 The intervention studies reviewed herein consisted of repeated safe practice of particular skills with the help of superimposed virtual limbs that train individuals in tasks specific to their medical condition. Inconsistent results suggest that further testing of VR in motor and cognitive rehabilitation is required. 22,23 Limitations. We only included 11 controlled trials in medical inpatient populations, and did not consider other successful case studies or efficacious outpatient interventions. Because of the heterogeneity of this small number of studies, we could not conduct a formal meta-analysis. Additional studies will need to be conducted to assess the efficacy of VR fully. Future research. Whereas early studies of VR utilized costly platforms precluding widespread use, more recent versions are available at price points that g reatly improve affordability and accessibility. 36 In the present review, two studies using low-cost off-the-shelf HMD visors did not report significant pain reductions. 18,19 Future research s hould further examine whether the quality of HMD technology is associated with improved efficacy. Future studies of VR in medical inpatients should utilize larger samples assessed over time to investigate long- term effects. 37 Although most VR studies are found within hospital settings, some clinicians predict VR will be used as home-based rehabilitation in the future. According to Sandlund, McDonough and Häger-Ross, interactive computer play and VR are especially helpful for physicallydisabled children who are often treated at home. 29 In the hospital setting, VR could be used by patients suffering from chronic pain syndromes (e.g., chronic pancreatitis, back pain, and/or refractory migraines) or used to reduce pain and anxiety in the emergency department (e.g., for reduction of dislocated joints, suturing of lacerations, cardioversion for arrhythmias, or casting of fractures). VR could also be used as a distraction for patients undergoing magnetic resonance imaging or computed tomography scanning, during interventional procedures or hemodialysis, or as part of chemotherapy infusion protocols. CONCLUSION Overall, a majority of studies from the past decade found VR to be efficacious, easy to use, safe, and contributing to high patient satisfaction. Studies varied in terms of quality, but we observed no relationship between study quality and key findings. In most cases, patients considered the VR experience to be fun, immersive, and enjoyable, and few patients were lost to attrition due to side effects. The use of VR in medical fields is relatively novel but also promising. 37 It is highly interactive, flexible, tailored to the individual, and applicable to people varying in age, sex, and medical disorders. As technology improves and costs are reduced, VR will undoubtedly shape the future of healthcare. REFERENCES 1. Ferrer-Garcia M, Gutiérrez-Maldonado J, Riva G. Virtual reality based treatments in eating disorders and obesity: a review. J Contemp Psychother. 2013;43:207–221. 2. Medling B. Virtual reality utilization in health care: it's virtually done. Biomed Instrum Technol. 2005;39:16–18. 3. Riener R, Harders M. Virtual Reality in Medicine. London: Springer; 2012:1– 2. 4. Riva G, Gaggioli A, Villani D, et al. NeuroVR: an open source virtual reality platform for clinical psychology and behavioral neurosciences. Stud Health Technol Inform. 2007;125:394– 399. 5. McCann RA, Armstrong CM, Skopp NA, et al. Virtual reality exposure therapy for the treatment of anxiety disorders: an evaluation of research quality. J Anxiety Disord. 2014;28:625–631. 6. Rothbaum BO, Hodges L, Smith S, et al. A controlled study of virtual reality exposure therapy for the fear of flying. J Consult Clin Psych. 2000;68:1020– 1026. 7. Wiederhold BK. The potential for virtual reality to improve health care. VRMC: The Virtual Reality Medical Center [website]. 2006. http://www.iactor.eu/downloads/WP% 20The%20Potential%20for%20VR%2 0to%20Improve%20Healthcare.pdf. Accessed May 3, 2016. 8. Mühlberger A, Wiedemann G, Pauli P. Efficacy of a one-session virtual reality exposure treatment for fear of flying. Psychother Res. 2003;13:323–336. 9. Cornick JE, Blascovich J. Are virtual environments the new frontier in obesity management? Soc Personal Psychol Compass. 2014;8:650–658. 10. Llobera J, González-Franco M, Perez- Marcos D, et al. Virtual reality for assessment of patients suffering chronic pain: a case study. Exper Brain Res. 2013;225:105–117. 11. Parsons TD, Rizzo AA, Rogers S, York P. Virtual reality in paediatric rehabilitation: a review. Dev Neurorehabil. 2009;12:224–238. 12. Wiederhold MD, Wiederhold BK. Virtual reality and interactive simulation for pain distraction. Pain

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