# Exercise as it relates to Disease/Use of virtual reality in balance rehabilitation following acquired brain injury

Acquired Brain Injury (ABI) refers to any form of brain injury post birth. It is one of the main causes of disabilities and deaths nationwide. Balance impairment is one of the most common issues in ABI patients. Poor balance results in the inability to perform activities of daily living (ADLs) and reduces independency through increasing falls risk and fear of falling. Other limiting factors of ABI include:
* Muscle weakness
* Limited movement
* Loss of coordination
* Poor postural control
* Loss of walking ability
Traditionally, professional health allies prescribe exercise programs to regain balance in ABI patients through therapeutic exercises. However, not all ABI patients are receiving the benefits of these programs. Low motivation and enjoyment levels towards these programs are reducing program adherence. These issues need to be addressed by perhaps, creating new methodologies to integrate with the traditional rehabilitation methods. As new technologies are emerging, new forms of technologies are being designed to assist with the development of different approaches to motor rehabilitation therapy. Research has found that Virtual Reality (VR) has had astounding benefits to regaining balance following ABI.

# What is Virtual Reality?

Virtual Reality (VR) is a computer stimulated environment which can stimulate the physical presence in any given setting or situation. The VR system requires the use of real-world body movements to stimulate feedback that can be obtained instantly from the computers. This feedback can be controlled to a level that is comfortable for the patient, making VR a very personalized system. VR has been used in a wide range of rehabilitation such as motor, physiological and cognitive. Users of all different impairements and abilites are catered for, including wheelchair patients who can participate in the stimulated games or environments sitting down. Two of the most commonly used forms of VR in balance rehab is the Nintendo Wii Balance Board ® and Xbox Kinect ®.

# What are the benefits of virtual reality in balance following ABI?

Studies have found improvements in static balance in both acute and chronic ABI patients. Balance impairment usually affects the control of weight distribution within these patients while performing ADLs. Measurements of the distributed weights for different standing (normal and tandem) and sitting positions are able to be measured from the VR system during performance of activities. This is useful in terms of providing measures of improvement as well as alerting areas of concern which can be controlled and rehabbed through changes of stimuli from the VR system. Therefore, with changes in stimuli, the targeted areas of poor balance control can be addressed to improve static balance in ABI patients.

## Additional Benefits

In addition to balance, other benefits of VR balance programs include:
* More compelling and interesting than traditional therapeutic exercises
* Higher levels of enjoyment and motivation compared with traditional therapeutic exercises
* Increased adherence to program
* Decreased fall rates
* Cost effective
* Beneficial for children’s balance with ABI as well as adults
* Can easily be integrated at home
* Can be personalised depending on patient's skill level and impairment

# Recommendations

As mentioned above, balance impairment can cause a cascading number of issues for ABI patients. As traditional forms of therapy for regaining balance is receiving low engagement levels, ABI patients should consider VR as an additional form of therapy to further improve their balance. The fun and competitive environments provided by the VR systems increases levels of motivation, enjoyment and adherence towards the patient's 'exercise' program. These increasing factors relate back to the maintenance of balance improvements, further resulting in a better quality of life. Although VR systems have the flexibility of being integrated into home environments, keeping in mind that VR is technology based, sufficient knowledge of computer system usage is required from the operator as well as the patient/s before integrating it into their home. All first time and computer illiterate patients are required to be monitored to ensure correct usage of the system that will promote regaining balance. Thirty mins to one hour sessions 2 to 5 times a week should be adequate amount of time to see balance improvements within ABI patients.
The use of VR is a relatively new form of therapy. Gradual integration of VR into traditional therapeutic programs should be considered for system adaptation, especially for patients who have lower understandings of technology. As the world is becoming more technology based, VR will sure to have a stronger place in rehabilitation within the near future.

# Further Reading/Information

* New Virtual Rehabilitation program that allows you so do your rehabilitation at home: Virtual Rehab Webpage
* Different uses for VR programs in rehabilitation, research and sports settings: Motek Medical Webpage

# References
## References

* 1 2 3 4 5 6 7 8 9 10 11 12 Albiol-Perez, S, Gil-Gomez, J-, Llorens, R, Alcaniz, M & Colomer Font, C 2014, 'The Role of Virtual Motor Rehabilitation: A Quantitative Analysis Between Acute and Chronic Patients With Acquired Brain Injury', review of ID: 1, IEEE Journal of Biomedical and Health Informatics, vol. 18, no. 1, pp. 391-398.
* 1 2 3 4 5 6 7 Gil-Gomez, JA, Llorens, R, Alcaniz, M & Colomer, C 2011, 'Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury', Journal of neuroengineering and rehabilitation, vol. 8.
* 1 2 3 4 5 6 7 8 9 Betker, AL, Desai, A, Nett, C, Kapadia, N & Szturm, T 2007, 'Game-based exercises for dynamic short-sitting balance rehabilitation of people with chronic spinal cord and traumatic brain injuries', Physical Therapy, vol. 87, no. 10, pp. 1389-1398.
* 1 2 3 4 5 6 7 8 9 10 González-Fernández, M, Gil-Gómez, J, Alcañiz, M, Noé, E & Colomer, C 2010, 'eBaViR, easy balance virtual rehabilitation system: a study with patients', Student Health Technology Information, vol. 154, pp. 61-66.
* 1 2 3 4 5 6 7 8 Rizzo, A & Kim, GJ 2005, 'A SWOT Analysis of the Field of Virtual Reality Rehabilitation and Therapy', Presence: Teleoperators & Virtual Environments, vol. 14, no. 2, pp. 119-146.
* 1 2 3 Cheung, J, Maron, M, Tatla, S & Jarus, T 2013, 'Virtual reality as balance rehabilitation for children with brain injury: A case study', Technology & Disability, vol. 25, no. 3, pp. 207-219.
* 1 2 3 Meldrum, D, Glennon, A, Herdman, S, Murray, D & McConn-Walsh, R 2012, 'Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii® Fit Plus', Disability and Rehabilitation: Assistive Technology, vol. 7, no. 3, pp. 205-210.