Effect of Virtual Reality on Postural and Balance Control in Patients with Stroke: A Systematic Literature Review

Table 1

Characteristics of included primary studies.

Citation year	Participants	Intervention	Frequency of stimulation	Outcome measure	Main results
Kim et al., 2009 [23]	Mean age: 52.0 years; time since stroke: 2.1 years	E: IREX VR games + PT; C: PT	16 sessions,; 30 minutes/day, 4 days/week,; 4 weeks.	BBS, BPM, 10 m walking test, MMAS, and sway angle during static standing and walking	BBS, MMAS, and postural sway angles during static standing and walking were higher in intervention group than in control group ().; Cadence, step time, step length, and stride length were higher in intervention group than in control group ().
Yang et al., 2011 [24]	Mean age: 61.0 years; time since stroke: 16.7 months	E: VR treadmill + PT OT; C: traditional treadmill training + PT OT	9 sessions,; 20 minutes/day, 3 days/week,; 3 weeks.	Postural sway excursion during standing, sit-to-stand, and level walking	Sway excursion in medial-lateral direction and sit-to-stand transfers in intervention group were significantly lower compared to control group ().
Cho et al., 2012 [25]	Mean age: 64.2 years; time since stroke: >6 months	E: Nintendo Wii Fit + PT OT; C: PT OT	18 sessions,; 30 minutes/day, 3 days/week,; 6 weeks.	BBS, TUG, and postural sway velocity during standing	BBS and TUG in intervention group were significantly higher in the intervention group than in control group (). Postural sway velocities were not statistically different between the two groups ().
Cho and Lee, 2013 [26]	Mean age: 64.9 years; time since stroke: 300.4 days	E: VR-based treadmill using real-world video recording; C: non-VR treadmill	18 sessions,; 30 minutes/day, 3 days/week,; 6 weeks.	BBS, TUG, and gait performance	Greater improvement in the BBS, TUG, velocity, and cadence in intervention group compared to control group ().
Fritz et al., 2013 [27]	Mean age: 66.1 years; time since stroke: 3.1 years	E: Nintendo Wii Sports and Wii Fit and PS games EyeToy: Play 2 and Kinetic; C: no intervention	20 sessions,; 50–60 minutes/day,; 4 days/week,; 5 weeks.	BBS, FMA, gait performance, 6-minute walk test, and 3-meter walk	No statistically significant differences between or within groups ().
Cho and Lee, 2014 [28]	Mean age: 64.7 years; time since stroke: 437.0 days	E: VR-based treadmill using real-world video recording + PT, OT, and FES; C: non-VR treadmill + PT, OT, and FES	18 sessions,; 30 minutes/day,; 3 days/week,; 6 weeks.	BBS, TUG, postural sway, and gait temporospatial parameters	Significant improvements were reported in BBS, postural sway during gait, and gait parameters in both groups (). Greater improvements were reported in intervention group compared to control group.; No difference was reported in postural sway during static standing ().
McEwen et al., 2014 [29]	Mean age: 64.1 years; time since stroke: 34.8 days	E: IREX VR games in standing; C: IREX VR games in sitting	10 to 12 sessions,; 20 minutes/day,; 3 weeks.	TUG, TMWT, and Chedoke-McMaster Stroke Assessment scale leg domain	Both groups had improvement in all outcome measures.; Chedoke-McMaster leg domain score was significantly higher in intervention group than in control group ().
Morone et al., 2014 [30]	Mean age: 60.2 years; time since stroke: 51.5 days	E: Wii Fit + PT; C: usual balance therapy + PT	12 sessions,; 20 minutes/day, 3 days/week,; 4 weeks.	BBS, BI, and 10 m walking test recorded at baseline, after intervention, and at one-month follow-up	BBS, BI, and 10 m walking test were significantly higher in intervention group than in control group (). The difference was maintained at one-month follow-up.
Lloréns et al., 2015 [31]	Mean age: 56.7 years; time since stroke: 497.6 days	E: VR step training with PT; C: PT	20 sessions,; 1 hour/day,; 5 days/week,; 4 weeks.	BBS, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, BBAC, and the 10 m walking test	Both groups have significant improvement in BBS and 10 m walking test (). Greater improvements were reported in intervention group compared to control group.

BBA: Brunel Balance Assessment Category; BBS: Berg Balance Scale; BI: Barthel Index; BPM: Balance Performance Monitor; C: control group; COP: center of pressure; E: experimental group; FAC: Functional Ambulation Categories; FES: functional electrical stimulation; FMA: Fugl-Meyer Assessment; IREX: Interactive Rehabilitation Exercise software; MMAS: Modified Motor Assessment Scale; OT: occupational therapy; PT: physical therapy; RCT: randomized controlled trial; TMWT: Two-Minute Walk Test; TUG: Timed Up and Go test; VR: virtual reality.