Do patients with neurological disorders benefit from immersive virtual reality? A scoping review on the emerging use of the computer-assisted rehabilitation environment.

INTRODUCTION: Virtual reality (VR) is an advanced technology that creates simulated environments and conditions. By offering the possibility of combining motor, cognitive, and well-being in conjunction with the potential to manipulate multi-sensorial features in a safe environment, VR has emerged as a promising powerful rehabilitation tool. Among advanced VR systems, various authors have highlighted promising effects in the rehabilitation of the computer-assisted rehabilitation environment (CAREN - Motekforce Link; Amsterdam, The Netherlands). In our scoping review, we aimed to map the existing evidence on the use of CAREN in the rehabilitation of neurological patients. EVIDENCE ACQUISITION: This scoping review was conducted following the PRISMA guidelines. A search was carried out for all peer-reviewed articles published until June 30, 2023, using the following databases: PubMed, Embase, Cochrane Database, PeDro and Web of Science. The following terms have been used: ("Cognitive Rehabilitation" OR "Motor Rehabilitation" OR "CAREN" or "Computer-Assisted Rehabilitation Environment") AND ("Virtual Reality" OR "Rehab"). EVIDENCE SYNTHESIS: From the assessed studies, only seven met the inclusion criteria: 1) one study concerned cognitive rehabilitation in patients suffering from Parkinson's Disease (PD); 2) one was on the usability of CAREN in PD patients; 3) two studies related to the influence of emotional components to CAREN rehabilitation; 4) three studies were related to motor rehabilitation using CAREN, and involved individuals with PD, Multiple Sclerosis, TBI, respectively. Generally, the few assessed studies demonstrate that CAREN is a safe and potentially effective tool to treat different symptoms (including gait and vestibular disturbances, executive function, depressive mood, and anxiety) in patients with different neurological disorders. CONCLUSIONS: The reviewed literature indicated the potential use of CAREN in improving motor and cognitive skills with conflicting results on emotional aspects. However, since the data comes from few and small sample size studies, further research is needed to confirm the effectiveness of the tool in neurorehabilitation.

Personal computer-based cognitive training in Parkinson's disease: a case study.

Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. PD's main symptoms involve the motor system, but cognitive disorders can be very severe as well. The aim of this study was to evaluate the effects of the computerized rehabilitative tool Esercizi di Riabilitazione Cognitiva (ERICA) in the cognitive recovery of a patient with PD. The patient was a 65-year-old man affected by PD with motor complications and severe cognitive and behavioural alterations. He underwent two different types of intensive rehabilitation training: standard cognitive rehabilitation alone and in combination with specific personal computer (PC)-based cognitive training. We evaluated his neuropsychological profile before and after the two types of training by using a specific psychometric battery. Only at the end of the PC training did we observe improvement in cognitive function as well as mood stabilization. When used in addition to standard cognitive rehabilitation, PC-based cognitive training may be a valuable tool in improving cognitive skills, with regard to attention, memory process, and executive functions. PC-based cognitive training may be able to help optimize managing the symptoms of PD.