Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review

Table 2

Methodological characteristics of included studies (n = 25).

Studies	Design	Sample/dropout (n/n)	Type of therapy	VR characteristics	N/T of sessions	Sessions per week	Follow-up time (weeks)	Outcome measurements
Villiger et al. [14]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	14/0	VR	VR-augmented therapy system (games)	16 or 20/45 min	4 or 5	12–16	Numeric Rating Scale, 10-Meter Walk Test, lower extremity motor score, Spinal Cord Independence Measure, Walking Index for Spinal Cord Injury II, Patients’ Global Impression of Change, Berg Balance Scale
Carlozzi et al. [15]	Prospective, controlled, randomized, nonblinded	54/2	VR	Virtual reality driving simulator	—	—	—	Simulator Sickness Questionnaire and software driving simulator variables
Dimbwadyo-Terrer et al. [10]	Prospective, controlled, randomized, nonblinded	15/6	VR + occupational therapy and physiotherapy	CyberGlove® + 3D objects (reach and release)	10/30 min	2	—	Muscle Balance, Barthel Index scale for functional capacity, Spinal Cord Independence Measure, Nine-Hole Peg Test, Jebsen–Taylor Hand Function
Dimbwadyo-Terrer et al. [27]	Prospective, controlled, double-blinded, randomized	31/0	VR + occupational therapy and physiotherapy	VR system Toyra (games)	15/30 min	3	12	Functional Independence Measure, Spinal Cord Injury Independence Measure, Motricity Index, Manual Muscle Test, Quebec User Evaluation of Satisfaction 2.0
Fizzotti et al. [30]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	15/0	VR + traditional neurologic exercises	Apple iPad 2 (games)	6–36/—	2 or 3	—	Scores in the games and Trunk Recovery Scale
Gaffurini et al. [21]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	10/0	VR	Wii Sports (games)	—/10 min	—	—	Oxygen consumption, pulmonary ventilation, heart rate, energy expenditure
Gil-Agudo et al. [21]	Prospective, controlled, randomized, nonblinded	10/0	VR + occupational therapy	Toyra system (games)	15/30 min	3	—	Variables of Toyra, Spinal Cord Injury Independence Measure, Nine-Hole Peg; Test, Jebsen–Taylor Hand Function Test, Manual Muscle Test
Jordan et al. [18]	Prospective, controlled, single-blinded, randomized	35/0	VR	Visual illusory walking	—/20 min	—	—	Numeric Rating Scale and Quantitative Sensory Test
O’connor et al. [26]	Prospective, before and after design, noncontrolled, nonrandomized	10/0	VR	GAME^Wheels (games)	<3/3–12 min	—	—	Submaximal oxygen consumption, heart rate.
Roosink et al. [17]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	9/0	VR	Visual illusory walking	2/90 min	NA	—	Motor imagery vividness, effort and speed, Basic Pain Data Set, Kinesthetic and Visual Imagery Questionnaire
Sayenko et al. [19]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	6/0	VR	Game-based exercises	12/5 min	3	—	Force plate analysis system “Stabilan-01”
Villiger et al. [31]	Prospective, controlled, nonrandomized, nonblinded	9/0	VR	VR games	16 or 20/45 min	4 or 5	12–16	Longitudinal magnetic resonance
Wall et al. [13]	Prospective, before and after design, noncontrolled, nonrandomized	6/1	VR	Nintendo™ Wii Fit (games)	14/—	2	4	Timed Up and Go Test, 10-Meter Walk Test, 6-Minute Walk Test, Walking Index for Spinal Cord Injury II, Berg Balance Scale, Forward Functional Reach Test, Lateral Functional Reach Test, RAND SF-36
Hasnan et al. [22]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	8/0	VR	Taxi Magic VR Trainer	—/32 or 48 min	2 or 3	—	Cardiorespiratory responses and power output
D’Addio et al. [20]	Prospective, controlled, randomized, nonblinded	30/0	VR + traditional physical therapy	Nintendo™ Wii Fit	36/—	3	—	Posturography (center of pressure data), Berg Balance Scale, Spinal Cord Independence Measure
Sung et al. [29]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	12/0	VR	Driving simulator	—	—	—	Simulator performance measure
Dimbwadyo-Terrer et al. [16]	Prospective, controlled, nonrandomized, nonblinded	20/2	VR + occupational therapy and physiotherapy	Toyra system	12/—	4	12	Kinematic variables, Motor Index, Muscle Balance, Functional Independence Measure, Spinal Cord Independence Measure II, Barthel Index
Kowalczewski et al. [39]	Prospective, controlled, single-blinded, randomized	21/8	VR + conventional exercise therapy	ReJoyce Workstation	—/60 min	—	30	Action Research Arm Test and ReJoyce Automated Hand Function Test
Chen et al. [7]	Prospective, controlled, nonblinded, randomized	30/0	VR	EON Studio 4.0	—/—	—	—	Endurance, Borg’s Rating-of-Perceived-Exertion Scale, Activation-Deactivation Adjective Check List, Simulator Sickness Questionnaire
An and Park [32]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	10/0	VR	Interactive Rehabilitation and Exercise (IREX; GestureTek, Toronto, Canada)	18/30 min	3	—	Limit of stability, Berg Balance Scale, Timed Up and Go Test, Activities-Specific Balance Confidence Scale, Walking Index for Spinal Cord Injury II
Khurana et al. [33]	Prospective, before and after design, controlled, randomized, double-blinded	36/6	VR + conventional physiotherapy	Sony PlayStation 2 and EyeToy (Sony Computer Entertainment Inc., Beijing, China)	20/45 min	4	—	Modified Functional Reach Test, t-shirt test, self-care components of the Spinal Cord Independence Measure III
Pozeg et al. [34]	Single-session, cross-sectional, controlled, randomized, nonblinded	40/0	VR + tactile stimulation (synchronous and asynchronous)	Virtual leg illusion and full-body illusion	1/1 min	1	—	Sense of leg ownership (questionnaires) and perceived neuropathic pain (visual analogue scale pain ratings)
Prasad et al. [35]	Prospective, pilot, controlled, single-blinded, randomized	22/2	VR + conventional hand therapy and strength training	Wii Sports Resort game (Table Tennis, Swordplay Speed Slice, Bowling, and Cycling)	12/60 min	3	6	Capabilities of Upper Extremity Questionnaire, Box and Block Test for gross motor dexterity, Spinal Cord Independence Measure-Self Report, World Health Organization Quality of Life-BREF
van Dijsseldonk et al. [36]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	17/2	VR	Gait Real-time Analysis Interactive Lab (GRAIL) training	12/60 min	2	20	Gait (spatiotemporal parameters and stability measures) and Activities-specific Balance Confidence (ABC) Scale
Villiger et al. [37]	Prospective, before and after design, noncontrolled, nonrandomized, nonblinded	12/1	VR	Mobile prototype of the YouKicker system (YouRehab AG, Schlieren, Switzerland) for the lower limbs	16–20/30–45 min	4-5	10–13	Muscle strength, balance, and mobility: lower extremity motor score, Berg Balance Scale, Timed Up and Go Test, 10-Meter Walk Test, 6-Minute Walk Test, Spinal Cord Independence Measure III, Walking Index for Spinal Cord Injury II, Motivational Scale and Global Impression of Change

Note. n or N, number; VR, virtual reality; T, time; NA, not applicable; —, information not available. The number is not specified (ranges from min. to max.).