Systematic Reviews. Evidence on Virtual Reality in Neurorehabilitation

1. Laver, K., et al. "Cochrane review: virtual reality for stroke rehabilitation." European journal of physical and rehabilitation medicine 48.3 (2012): 523-530. A meta-analysis based on 37 clinical trials with a total of 1019 participants found -- VR mediated interventions significantly more effective than conventional therapy (no intervention or standard care) in improving upper limb function (Fugl-Meyer scores), hand function (grip strength & dexterity) and activities of daily living.

2. Gibbons, Emma Maureen, et al. "Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke–a systematic review with meta-analysis." Topics in stroke rehabilitation 23.6 (2016): 440-457. A meta-analysis based on 22 post-stroke studies with 552 participants that tested virtual reality mediated training of lower limb function showed significant improvement in functional balance gait velocity, cadence, stride length in chronic populations. Evidence also suggests that VR is just as effective as conventional therapy. Hence its' use in practice is determined by affordability, and patient/practitioner preferences.

3. Lohse, Keith R., et al. "Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy." PloS one 9.3 (2014): e93318. A meta-analysis based on 26 clinical trials with post-stroke patients show a significant benefit of VR based therapy compared to conventional therapy in a variety of ICF (International Classification of Function, Disability, and Health) domains such as body function and daily activities.

4. Corbetta, Davide, Federico Imeri, and Roberto Gatti. "Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review." Journal of Physiotherapy 61.3 (2015): 117-124. A meta-analysis based 15 trials involving 341 post-stroke participants that used virtual reality for lower limb functional training showed significant improvements in walking speed, balance, and mobility.

5. Massetti, Thais, et al. "Virtual reality in multiple sclerosis–A systematic review." Multiple sclerosis and related disorders 8 (2016): 107-112. A review based on 10 studies with multiple sclerosis (MS) patients, authors concluded that virtual reality represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. Also, such training could be an effective method for training patients with multiple cognitive and / or motor deficits.

6. Pietrzak, Eva, Stephen Pullman, and Annabel McGuire. "Using virtual reality and video games for traumatic brain injury rehabilitation: A structured literature review." GAMES FOR HEALTH: Research, Development, and Clinical Applications 3.4 (2014): 202-214. Through 18 clinical studies on patients with traumatic brain injury, conclusions were drawn on improvements in balance, upper extremity function, and cognitive function. Participants were also more positive to use VR intervention than traditional therapies. VR approach has the potential to provide an alternative, possibly more affordable and available rehabilitation therapy for traumatic brain injury in settings where geographical or financial constraints limit access to therapy.

7. Dockx, Kim, et al. "Virtual reality for rehabilitation in Parkinson's disease." The Cochrane Library (2013). A meta-analysis based on 8 clinical studies involving 263 parkinsonian patients shows VR mediated training showed greater improvements in step and stride length, gait, balance, and quality of life compared to physiotherapy.

8. Stanmore, Emma, et al. "The effect of active video games on cognitive functioning in clinical and non-clinical populations: a meta-analysis of randomized controlled trials." Neuroscience & Biobehavioral Reviews (2017). A study based on 7 randomized controlled trials with 926 participants in total, showed significant improvement in cognitive function in healthy older adults and clinical population with neurocognitive impairments, especially in executive function, attention, inhibitory control, and visuospatial skills.

9. Chen, Yu-ping, Shih-Yu Lee, and Ayanna M. Howard. "Effect of virtual reality on upper extremity function in children with cerebral palsy: a meta-analysis." Pediatric Physical Therapy 26.3 (2014): 289-300. A study based on 14 research articles, including 3 randomized controlled trials and 11 case series, totaling 122 cerebral palsy patients showed significant improvement upper limb function. Data for cross reference and plots Upperlimb function: d = 1.97, 95% confidence interval (CI) = [−0.26, 4.20]

10. Bellani, M., et al. "Virtual reality in autism: state of the art." Epidemiology and psychiatric sciences 20.3 (2011): 235-238. The article reviews 8 studies on autistic children and teenagers in the age range 7-18 years that investigated the feasibility of virtual reality mediated intervention. Authors conclude -- The use of VR tools for rehabilitation in autism is therefore very promising and may help caretakers and educators to enhance the daily life social behaviors of individuals with autism. Future research on VR interventions should investigate how newly acquired skills are transferred to the real world and whether VR may impact on neural network sustaining social abilities.

11. Harris, Dale M., et al. "Exergaming as a viable therapeutic tool to improve static and dynamic balance among older adults and people with idiopathic Parkinson’s disease: a systematic review and meta-analysis." Frontiers in aging neuroscience 7 (2015). A meta-analysis based on 11 trials that used VR for balance training in elderly (n=325) and idiopathic Parkinsonian patients (n=56) suggest that exergaming may be an appropriate therapeutic tool for improving balance and postural control.

12. Opriş, David, et al. "Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis." Depression and anxiety 29.2 (2012): 85-93. The authors identified 23 studies involving 608 participants with anxiety disorders, who were tested with Virtual Reality Exposure (VRE) therapy. Their meta-analysis showed overall treatment benefits of VRET better than the waitlist control; They also observed that VRET has a powerful real-life impact, similar to that of the classical evidence-based treatments; VRET has an excellent stability of results over time, akin to that of the classical evidence-based treatments.

13. Anguera, J. A., Boccanfuso, J., Rintoul, J. L., Al-Hashimi, O., Faraji, F., Janowich, J., ... & Gazzaley, A. (2013). Video game training enhances cognitive control in older adults. Nature, 501(7465), 97-101. Video game training enhances cognitive control in older adults. 16 older adults (60+ years) exhibited improvements in their multitasking performance after 12 hours of training over 3 weeks using a custom-designed video game. Therapy showed to have long-lasting efficacy, with gains persisting for six months. This study confirms that dedicated video games can be used to assess and train cognitive abilities across the lifespan, and serve as a powerful tool for cognitive enhancement.