Introduction:
The use of Virtual Reality (VR) offers promising opportunities for application in neurorehabilitation. However, concerns exist about its influence on the relationship between patient and therapist. This relationship, known as the therapeutic alliance, is crucial for successful rehabilitation and is based on agreement between patient and therapist regarding tasks, goals, and interpersonal connection.
Objective:
This study investigated the effects of immersive VR on the dynamics between patient and therapist during rehabilitation after acquired brain injury (such as stroke or traumatic brain injury). The aim was to derive design insights for rehabilitative VR systems. Specifically, key elements for VR systems in neurorehabilitation were to be identified and applicable design guidelines developed.
Methods:
Researchers used user observations combined with interviews with therapists and patients in a clinical environment. Patients were observed while wearing a VR headset and interacting in virtual worlds. Their field of view was limited exclusively to the virtual environment, preventing them from seeing therapists or the physical space. VR‑based rehabilitation was compared with traditional clinical rehabilitation settings. The focus was on differences in interaction between patients and therapists and on the dynamics of the therapeutic alliance. The collected data was analyzed using discourse analytic techniques, including conversation analysis.
Results:
Results indicate that immersive VR changes the interaction between therapists and patients. Despite visual barriers, therapists attempted to maintain communication using gestures and attempted eye contact. Informal conversations occurred less frequently, while shared laughter and improved verbal feedback from therapists were observed more often.
Summary:
Developers of VR applications for neurorehabilitation should incorporate the impacts of altered communication between patients and therapists into new system designs. In doing so, the potential of VR technology can be better utilized to strengthen the therapeutic alliance, potentially improving rehabilitation outcomes.