Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation.
Judith E Deutsch, Sarah Westcott McCoy
PMID 28654475WHAT IT FOUND
Virtual reality and serious games improve balance and motor function in children and adults with neurological conditions, but evidence for participation and fitness gains is mixed.
Dose and system type matter, yet clinical adoption is hindered by lack of training and clear guidelines.
Key findings
01Systematic reviews indicate that while body structure and function outcomes often improve, activity outcomes are mixed, and the overall design quality of included studies is low.
02For adults post-stroke, virtual reality offers a small but consistent benefit for gait speed and balance, though these improvements often do not meet the minimal clinically important difference.
03Barriers to clinical implementation include a lack of clinician knowledge about the systems and time to integrate them, alongside concerns that game play may distract from therapeutic movement practice.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review highlights that the quality of evidence in the included systematic reviews is generally low (CEBM levels 2b through 5). There is significant heterogeneity in the types of virtual reality systems used (customized vs. off-the-shelf), making it difficult to compare results or prescribe specific doses. Participation outcomes are rarely measured, especially in stroke populations, leaving a gap in understanding whether improvements in the lab translate to real-world life. Neuroplasticity data is derived from very small samples and is limited by the difficulty of obtaining brain scans in clinical populations, particularly children.
The easy way to misread this
Do not assume that improvements in virtual reality balance scores translate directly to improved daily life participation or safety. The review notes that many studies show statistically significant changes that do not meet the minimal clinically important difference, and participation outcomes are frequently absent or mixed.