Realidad virtual en la rehabilitación de adultos mayores con accidente cerebrovascular. Una revisión de alcance
Resumen
Introducción. El accidente cerebrovascular es una de las principales causas de discapacidad en el adulto mayor, con alteraciones frecuentes del equilibrio. La realidad virtual puede favorecer la recuperación del equilibrio estático y dinámico, sin embargo, su evidencia en esta población aún es limitada. El objetivo de este estudio es analizar los efectos de la realidad virtual en el equilibrio de adultos mayores post accidente cerebrovascular. Metodología. Revisión de alcance siguiendo los lineamientos JBI Manual for Evidence Synthesis y PRISMA – CSR. Se revisaron las bases de datos: PubMed, Scopus y PEDro (Physiotherapy Evidence Database) para la identificación y selección de los estudios. Se utilizó la escala metodológica PEDro para evaluar la calidad de los ensayos clínicos controlados aleatorios en fisioterapia, para incluir los estudios. Resultados. Siete ensayos clínicos aleatorizados incluidos. Seis estudios utilizaron realidad virtual no inmersiva y uno semi-inmersiva. La realidad virtual, aplicada como complemento a la terapia convencional, mostró mejoras significativas en el equilibrio estático y dinámico, así como otros beneficios funcionales. Discusión. La realidad virtual muestra beneficios consistentes en el equilibrio post ACV, especialmente al integrarse a la terapia convencional. La modalidad y la dosificación influyen en los resultados, sugiriendo que un mayor grado de inmersión e intensidad terapéutica optimizan la recuperación, aunque persisten limitaciones metodológicas y de seguimiento a largo plazo. Conclusiones. La realidad virtual, integrada a la terapia convencional, mejora el equilibrio en adultos mayores post ACV en periodos cortos de intervención. Las modalidades de realidad virtual muestran beneficios diferenciados según la complejidad del movimiento, destacando su factibilidad y potencial para favorecer la adherencia terapéutica.
Citas
1. Burgaya-Subirana S, Macià-Rieradevall E, Cabral-Salvadores M, Ramos-Calvo AM. Ictus: un reto diagnóstico. Rev Pediatr Aten Primaria [Internet]. 2021;23(90):179-182. Recuperado a partir de: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1139-76322021000200012
2. Ustrell-Roig X, Serena-Leal J. Ictus. Diagnóstico y tratamiento de las enfermedades cerebrovasculares. Rev Esp Cardiol [Internet]. 2007;60(7):753-769. doi: https://doi.org/10.1157/13108281
3. García-Alfonso C, Martínez-Reyes AE, García V, Ricaurte-Fajardo A, Torres I, Coral-Casas J. Diagnosis and Treatment of Acute Ischemic Stroke: An Update. Univ Med [Internet]. 2019;60(3):1-17. doi: https://doi.org/10.11144/Javeriana.umed60-3.actu
4. Murie-Fernández M, Irimia P, Martínez-Vila E, Meyer MJ, Teasell R. Neurorrehabilitación tras el ictus. Neurología [Internet]. 2010;25(3):189-96. doi: https://doi.org/10.1016/S0213-4853(10)70008-6
5. Fernández-Vázquez D, Cano-de-la-Cuerda R, Navarro-López V. Haptic glove systems in combination with semi-immersive virtual reality for upper extremity motor rehabilitation after stroke: a systematic review and meta-analysis. Int J Environ Res Public Health [Internet]. 2022;19(16):10378. doi: https://doi.org/10.3390/ijerph191610378
6. Leong SC, Tang YM, Toh FM, Fong KNK. Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis. J NeuroEngineering Rehabil [Internet]. 2022;19(1):93. doi: https://doi.org/10.1186/s12984-022-01071-x
7. Rodríguez-García PL. Examen clínico del paciente con ictus. Rev Cubana Neurol Neurocir [Internet]. 2011;1(1):74-89. Recuperado a partir de: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=49297
8. Kashif M, Ahmad A, Bandpei MAM, Gilani SA, Hanif A, Iram H. Combined effects of virtual reality techniques and motor imagery on balance, motor function and activities of daily living in patients with Parkinson’s disease: a randomized controlled trial. BMC Geriatr [Internet]. 2022;22(1):381. doi: https://doi.org/10.1186/s12877-022-03035-1
9. Garay-Sánchez A, Suarez-Serrano C, Ferrando-Margelí M, Jimenez-Rejano JJ, Marcén-Román Y. Effects of immersive and non-immersive virtual reality on the static and dynamic balance of stroke patients: a systematic review and meta-analysis. J Clin Med [Internet]. 2021;10(19):4473. doi: https://doi.org/10.3390/jcm10194473
10. Domínguez-Téllez P, Moral-Muñoz JA, Salazar A, Casado-Fernández E, Lucena-Antón D. Game-based virtual reality interventions to improve upper limb motor function and quality of life after stroke: systematic review and meta-analysis. Games Health J [Internet]. 2020;9(1):1-10. doi: https://doi.org/10.1089/g4h.2019.0043
11. Bayona-Prieto J, Bayona E, Leon-Sarmiento FE. Neurorrehabilitación: de un pasado rígido a un futuro plástico. Gac Med Mex [Internet]. 2012;148(1):91-96. Recuperado a partir de: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=33341
12. Alashram AR, Annino G, Padua E, Romagnoli C, Mercuri NB. Cognitive rehabilitation post traumatic brain injury: a systematic review for emerging use of virtual reality technology. J Clin Neurosci [Internet]. 2019;66:209-19. doi: https://doi.org/10.1016/j.jocn.2019.04.026
13. Triegaardt J, Han TS, Sada C, Sharma S, Sharma P. The role of virtual reality on outcomes in rehabilitation of Parkinson’s disease: meta-analysis and systematic review in 1031 participants. Neurol Sci [Internet]. 2020;41(3):529-36. doi: https://doi.org/10.1007/s10072-019-04144-3
14. Ögün MN, Kurul R, Yaşar MF, Turkoglu SA, Avci Ş, Yildiz N. Effect of Leap Motion-based 3D immersive virtual reality usage on upper extremity function in ischemic stroke patients. Arq Neuro-Psiquiatr [Internet]. 2019;77(10):681-8. doi: https://doi.org/10.1590/0004-282x20190129
15. Boyd LA, Winstein CJ. Cerebellar stroke impairs temporal but not spatial accuracy during implicit motor learning. Neurorehabil Neural Repair [Internet]. 2004;18(3):134-43. doi: https://doi.org/10.1177/0888439004269072
16. Manivannan S, Al-Amri M, Postans M, Westacott LJ, Gray W, Zaben M. The effectiveness of virtual reality interventions for improvement of neurocognitive performance after traumatic brain injury: a systematic review. J Head Trauma Rehabil [Internet]. 2019;34(2):E52-65. doi: https://doi.org/10.1097/htr.0000000000000412
17. Schiza E, Matsangidou M, Neokleous K, Pattichis CS. Virtual reality applications for neurological disease: a review. Front Robot AI [Internet]. 2019;6:100. doi: https://doi.org/10.3389/frobt.2019.00100
18. Azuma R, Baillot Y, Behringer R, Feiner S, Julier S, MacIntyre B. Recent advances in augmented reality. IEEE Comput Graph Appl [Internet]. 2001;21(6):34-47. doi: http://dx.doi.org/10.1109/38.963459
19. Feng H, Li C, Liu J, Wang L, Ma J, Li G, et al. Virtual reality rehabilitation versus conventional physical therapy for improving balance and gait in Parkinson’s disease patients: a randomized controlled trial. Med Sci Monit [Internet]. 2019;25:4186-92. doi: https://doi.org/10.12659%2FMSM.916455
20. Wang B, Shen M, Wang YX, He ZW, Chi SQ, Yang ZH. Effect of virtual reality on balance and gait ability in patients with Parkinson’s disease: a systematic review and meta-analysis. Clin Rehabil [Internet]. 2019;33(7):1130-8. doi: https://doi.org/10.1177/0269215519843174
21. Anwar N, Karimi H, Ahmad A, Mumtaz N, Saqulain G, Gilani SA. A novel virtual reality training strategy for poststroke patients: a randomized clinical trial. J Healthc Eng [Internet]. 2021;1-6. doi: https://doi.org/10.1155/2021/6598726
22. You SH, Jang SH, Kim YH, Hallett M, Ahn SH, Kwon YH, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke [Internet]. 2005;36(6):1166-71. doi: https://doi.org/10.1161/01.str.0000162715.43417.91
23. Martino-Cinnera A, Bisirri A, Chioccia I, Leone E, Ciancarelli I, Iosa M, et al. Exploring the potential of immersive virtual reality in the treatment of unilateral spatial neglect due to stroke: a comprehensive systematic review. Brain Sci [Internet]. 2022;12(11):1589. doi: https://doi.org/10.3390%2Fbrainsci12111589
24. Scott H, Griffin C, Coggins W, Elberson B, Abdeldayem M, Virmani T, et al. Virtual reality in the neurosciences: current practice and future directions. Front Surg [Internet]. 2022;8:807195. doi: https://doi.org/10.3389/fsurg.2021.807195
25. Corbetta D, Imeri F, Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J Physiother [Internet]. 2015;61(3):117-24. doi: https://doi.org/10.1016/j.jphys.2015.05.017
26. Bai Y, Liu F, Zhang H. Artificial intelligence limb rehabilitation system on account of virtual reality technology on long-term health management of stroke patients in the context of the Internet. Comput Math Methods Med [Internet]. 2022;2022:1-7. doi: https://doi.org/10.1155/2022/2688003
27. De Araújo AVL, Neiva JFDO, Monteiro CBDM, Magalhães FH. Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review. BioMed Research International [Internet]. 2019;2019:1-15. doi: https://doi.org/10.1155/2019/7106951
28. Lei C, Sunzi K, Dai F, Liu X, Wang Y, Zhang B, et al. Effects of virtual reality rehabilitation training on gait and balance in patients with Parkinson’s disease: a systematic review. PLoS One [Internet]. 2019;14(11):e0224819. doi: https://doi.org/10.1371/journal.pone.0224819
29. Tixi-Guaraca J, Lozada-Ulloa A, Hernández-Amaguaya J. Virtual reality for patients with balance disorders due to traumatic spinal cord injury: scoping review. Medisur [Internet]. 2025;23(0). Recuperado a partir de: https://medisur.sld.cu/index.php/medisur/article/view/52922
30. Bower KJ, Clark RA, McGinley JL, Martin CL, Miller KJ. Clinical feasibility of the Nintendo WiiTM for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting. Clin Rehabil [Internet]. 2014;28(9):912-23. doi: https://doi.org/10.1177/0269215514527597
31. Demeco A, Zola L, Frizziero A, Martini C, Palumbo A, Foresti R, et al. Immersive virtual reality in post-stroke rehabilitation: a systematic review. Sensors [Internet]. 2023;23(3):1712. doi: https://doi.org/10.3390/s23031712
32. Chen J, Or CK, Chen T. Effectiveness of using virtual reality-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res [Internet]. 2022;24(6):e24111. doi: https://doi.org/10.2196/24111
33. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev [Internet]. 2017;11(11):CD008349. doi: https://doi.org/10.1002/14651858.cd008349.pub4
34. Peters MDJ, Godfrey C, Mclnerney P, Munn Z, Tricco AC, Khalil H. Chapter 11: Scoping reviews. En: Aromataris E, Munn Z (Editors). JBI Reviewer’s Manual [Internet]. 2020;408-452. Recuperado a partir de: https://jbi-global-wiki.refined.site/space/MANUAL/355863557/Previous+versions?attachment=/download/attachments/355863557/JBI_Reviewers_Manual_2020June.pdf&type=application/pdf&filename=JBI_Reviewers_Manual_2020June.pdf#page=406
35. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med [Internet]. 2018;169(7):467-73. doi: https://doi.org/10.7326/M18-0850
36. Pollock D, Davies EL, Peters MDJ, Tricco AC, Alexander L, McInerney P, et al. Undertaking a scoping review: a practical guide for nursing and midwifery students, clinicians, researchers, and academics. J Adv Nurs [Internet]. 2021;77(4):2102-13. doi: https://doi.org/10.1111/jan.14743
37. De Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother [Internet]. 2009;55(2):129-33. doi: https://doi.org/10.1016/S0004-9514(09)70043-1
38. Lee MM, Lee KJ, Song CH. Game-based virtual reality canoe paddling training to improve postural balance and upper extremity function: a preliminary randomized controlled study of 30 patients with subacute stroke. Med Sci Monit [Internet]. 2018;24:2590-8. doi: https://doi.org/10.12659/msm.906451
39. Cannell J, Jovic E, Rathjen A, Lane K, Tyson AM, Callisaya ML, et al. The efficacy of interactive, motion capture-based rehabilitation on functional outcomes in an inpatient stroke population: a randomized controlled trial. Clin Rehabil [Internet]. 2018;32(2):191-200. doi: https://doi.org/10.1177/0269215517720790
40. Utkan-Karasu A, Balevi-Batur E, Kaymak-Karataş G. Effectiveness of Wii-based rehabilitation in stroke: a randomized controlled study. J Rehabil Med [Internet]. 2018;50(5):406-12. doi: https://doi.org/10.2340/16501977-2331
41. Cano-Mañas MJ, Collado-Vázquez S, Rodríguez-Hernández J, Muñoz-Villena AJ, Cano-de-la-Cuerda R. Effects of video-game based therapy on balance, postural control, functionality, and quality of life of patients with subacute stroke: a randomized controlled trial. J Healthc Eng [Internet]. 2020;2020:1-11. doi: https://doi.org/10.1155/2020/5480315
42. De Rooij IJM, Van De Port IGL, Punt M, Abbink-van Moorsel PJM, Kortsmit M, Van Eijk RPA, et al. Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial. Physical Therapy [Internet]. 2021;101(5):pzab051. doi: https://doi.org/10.1093/ptj/pzab051
43. Marques-Sule E, Arnal-Gómez A, Buitrago-Jiménez G, Suso-Martí L, Cuenca-Martínez F, Espí-López GV. Effectiveness of Nintendo Wii and physical therapy in functionality, balance, and daily activities in chronic stroke patients. J Am Med Dir Assoc [Internet]. 2021;22(5):1073-80. doi: https://doi.org/10.1016/j.jamda.2021.01.076
44. Inoue S, Otaka Y, Kumagai M, Sugasawa M, Mori N, Kondo K. Effects of Balance Exercise Assist Robot training for patients with hemiparetic stroke: a randomized controlled trial. J NeuroEngineering Rehabil [Internet]. 2022;19:12. doi: https://doi.org/10.1186/s12984-022-00989-6
45. Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Fergusson D, Levac D, et al. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol [Internet]. 2016;16:42. doi: https://doi.org/10.1186/s12883-016-0563-x
46. Yasuda K, Muroi D, Ohira M, Iwata H. Validation of an immersive virtual reality system for training near and far space neglect in individuals with stroke: a pilot study. Top Stroke Rehabil [Internet]. 2017;24(7):533-8. doi: https://doi.org/10.1080/10749357.2017.1351069
47. Bluett B, Bayram E, Litvan I. The virtual reality of Parkinson’s disease freezing of gait: a systematic review. Parkinsonism Relat Disord [Internet]. 2019;61:26-33. doi: https://doi.org/10.1016/j.parkreldis.2018.11.013
48. Freitag F, Dozzi-Brucki SM, Ferreira-Barbosa A, Chen J, de Oliveira-Souza C, Francato-Valente D, et al. Is virtual reality beneficial for dual-task gait training in patients with Parkinson’s disease? A systematic review. Dement Neuropsychol [Internet]. 2019;13(3):259-67. doi: https://doi.org/10.1590/1980-57642018dn13-030002
Descargas
Derechos de autor 2026 MedUNAB
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
