It is an exciting time in rehabilitation. In the past decade, there has been a proliferation of novel technologies designed to enhance rehabilitation outcomes. Virtual reality is one of those emerging technologies that has been applied to a variety of medical purposes including medical education and training, primary care, psychiatry, surgery, radiology, and more recently, rehabilitation. There is considerable excitement surrounding virtual reality across a multidisciplinary group of scientists and clinicians who are developing this new technology for physical, psychological, cognitive, and social rehabilitation purposes. Telehealth, the delivery of health-care services at a distance, has emerged as a significant component of the health-care delivery system with the advent of high-speed, high-bandwidth telecommunication networks. The combination of virtual reality with telerehabilitation holds great promise in increasing our ability to work with patients at a distance, offering greater access to care for rural patients. Although telerehabilitation incorporating virtual reality to train balance in patients following a stroke has been recently tested with good outcomes,1 there have been no studies to date that have validated the use of telerehabilitation for patients with vestibular disorders.
It is currently estimated that 90% of the world's population now has access to a mobile network. This access creates opportunities that did not previously exist for improving patient care. In addition, the use of smart phones, which have sophisticated built-in sensors (e.g., accelerometers, gyroscopes, global positioning systems, and compasses), may be used to provide feedback and deliver and track precise rehabilitation programs. More recently, applications (apps, as they are commonly known) have been developed that can be used on smart phones and tablets to record gait speed, demonstrate the labyrinth and how the vestibulo-ocular reflex (VOR) works, and even to employ a metronome for use during assessment (e.g., dynamic visual acuity) and treatment. Additional apps for eye movements and demonstration of vestibular treatments are in the process of being developed. With the use of YouTube, one can show patients how to perform vestibular exercises and even the canalith repositioning maneuvers. As with anything, one must always ensure the accuracy of what is being taught or demonstrated. In the future, part of our job may be to identify for our patients the appropriate technology to optimize education concerning their specific condition.
The goal of this chapter is to highlight new technologies, focusing on virtual reality but also including augmented sensory biofeedback and relevant apps that are currently being tested or newly available to clinicians. These apps may be a useful adjunct to vestibular rehabilitation for improving outcomes or for widening our reach to include patients with limited clinic access. This is a burgeoning area of research that is exponentially expanding as technology costs decrease and research capacity increases.
Key Concepts Related to Virtual Reality
One of the challenges facing therapists is identifying activities that are appealing, meaningful, and motivating so that patients will engage in these activities ...