Virtual reality therapy for cognition, mood needs more study: Review

Rehabilitation approaches involving virtual reality (VR) may have beneficial effects on cognitive function and anxiety in people with multiple sclerosis (MS), but more research is needed to better understand its effects, according to a recent meta-analysis of 10 clinical trials.

Small gains in certain aspects of cognition, including immediate and delayed information recall, were observed, but whether the observations would be clinically relevant wasn’t clear. Other aspects, like processing speed, attention, and depression were not overall altered with VR therapy.

Given the variability in the design of the studies — and in their findings — questions remain as to which type of VR might be best, how long the benefits would be sustained, and how safe it is.

“Despite the benefits of VR on cognitive function and mood in [people with MS], certain uncertainties persist, necessitating further research,” researchers wrote.

The study, “Effects of virtual reality-based rehabilitation on cognitive function and mood in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials,” was published in Multiple Sclerosis and Related Disorders.

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Cognitive dysfunction, mood problems in MS can affect quality of life

Cognitive dysfunction and mood problems such as depression and anxiety are common symptoms of MS. While they may be overlooked relative to the more well-recognized movement problems that characterize the neurodegenerative disease, these symptoms can also substantially disrupt daily functioning and lower quality of life.

Studies have indicated the possible benefits of VR-based rehabilitation strategies on mood and cognition across a number of neurodegenerative diseases.

VR therapy refers to computer-generated environments that a person can interact with while performing their rehabilitation activities. This can range from completely non-immersive — where a person uses a screen to engage with a virtual environment, but can still see their real environment (e.g. the Nintendo Wii) — to completely immersive, where they experience a virtual world using special equipment such as 3D near-eye displays and clothes with movement sensors.

When used in rehabilitation, a VR-based approach is thought to be more motivating for participants, and to better engage brain networks compared with standard rehabilitation approaches alone.

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Previous studies found VR therapy boosts adherence to training

Studies in MS patients have found that VR therapy makes patients more likely to adhere to training, and is associated with improved balance and limb function. However, the effects of VR therapy on cognitive and mood problems in MS have not been fully explored.

As such, the scientists conducted a review and meta-analysis of published data from 10 previous randomized controlled clinical trials that explored the use of VR approaches on these outcomes. A meta-analysis is a statistical approach used to pool data from separate studies and analyze them together, which has greater statistical power than any of the studies alone.

A total of 461 adults with MS were involved across the 10 studies, with average ages ranging from around 25 to 65 years. Different types of VR were used alone or in combination with other types of training, and compared to control groups involving training without VR or no training.

The duration and intensity of the intervention programs also varied, ranging from six weeks to six months, with two to five weekly sessions lasting 40-90 minutes.

In measures of cognitive processing speed, attention, and working memory — where small amounts of information are retained to be used for immediate tasks and decision-making — VR-based interventions were generally not found to have any significant benefit.

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VR therapy associated with overall benefit in some cognitive measures

On the other hand, VR therapy was associated with an overall significant benefit in terms of global cognitive measures, visuospatial processing, immediate information recall, and delayed information recall.

In measures of mood, VR therapy was also associated with significant benefits in measures of anxiety, but not depression.

Even though some benefits were observed, the findings between studies were variable and generally had a low effect size, a quantitative way in scientific studies of saying that the strength of the observations was weak.

As such, the researchers emphasized the findings “may lack clinical relevance” and therefore “need to be treated with caution.”

Due to the small number of studies and high variability between them, it couldn’t be determined whether a specific type of VR (e.g. immersive, non-immersive) was most beneficial, and most studies also lacked long-term follow-up to see if the benefits were sustained. Safety and adverse events were also not analyzed.

“To determine the efficacy of different VRs for the treatment of MS and ideal VR treatment parameters, more extensive multicenter [randomized controlled clinical trials] and longer follow-up periods are needed,” the team concluded.