In the last decade, virtual reality (VR) training has been used extensively in video games and military training to provide a sense of realism and environmental interaction to its users. More recently, VR training has been explored as a possible adjunct therapy for people with motor and mental health dysfunctions. The concept underlying VR therapy as a therapeutic treatment for motor and cognitive dysfunction is to improve plasticity of the brain by engaging users in multisensory training. In this review, we discuss the theoretical framework underlying the use of VR as a therapeutic treatment for neurorehabilitation and provide evidence for its use in treating motor and mental disorders such as cerebral palsy, Parkinson’s disease, stroke, schizophrenia, anxiety disorders and other related clinical areas. While this review provides some insights into the efficacy of VR in clinical rehabilitation, more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Further, there is a lack in robust evidence for the use of VR in clinical populations that is likely due to the inherent nature of the study design used in current research. Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations. While the current literature provides some evidence for the efficacy of VR as an adjunct therapy in clinical rehabilitation, more research is needed to understand how different clinical conditions are affected by VR therapies (e.g., stimulus presentation, interactivity, control and types of VR). Future studies should consider large, longitudinal randomized controlled trials to determine the true potential of VR therapies in various clinical populations.

Parkinson's disease (PD) is a neurodegenerative disorder affecting motor and cognitive abilities. There is no cure for PD, therefore identifying safe therapies to alleviate symptoms remains a priority. This meta-analysis quantified the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (TES) to improve motor and cognitive dysfunction in PD. PubMed, EMBASE, Web of Science, Google Scholar, Scopus, Library of Congress and Cochrane library were searched. 24 rTMS and 9 TES studies (n = 33) with a sham control group were included for analyses. The Physiotherapy Evidence Database and Cochrane Risk of Bias showed high quality (7.5/10) and low bias with included studies respectively. Our results showed an overall positive effect in favour of rTMS (SMD = 0.394, CI [0.106–0.683], p = 0.007) and TES (SMD = 0.611, CI [0.188–1.035], p = 0.005) compared with sham stimulation on motor function, with no significant differences detected between rTMS and TES (Q [1] = 0.69, p = 0.406). Neither rTMS nor TES improved cognition. No effects for stimulation parameters on motor or cognitive function were observed. To enhance the clinical utility of non-invasive brain stimulation (NBS), individual prescription of stimulation parameters based upon symptomology and resting excitability state should be a priority of future research.

Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.

The study investigated the effects of circadian rhythm of cortisol (C) and testosterone (T) on maximal force production (Fpeak) and power output (Ppeak). Twenty male university students (mean age = 23.8 ± 3.6 years, height = 177.5 ± 6.4 cm, weight = 78.9 ± 11.2 kg) performed 4 time-of-day testing sessions consisting of countermovement jumps (CMJs), squat jumps (SJ), isometric midthigh pulls (IMTPs), and a 1-repetition maximum (1RM) squat. Saliva samples were collected at 0800, 1200, 1600, and 2000 hours to assess T and C levels on each testing day. Session rate-of-perceived exertion (RPE) scores were collected after each session. The results showed that Fpeak and Ppeak presented a clear circadian rhythm in CMJ and IMTP but not in SJ. One repetition maximum squat did not display a clear circadian rhythm. Session RPE scores collected at 0800 and 2000 hours were significantly (p ≤ 0.05) higher than those obtained at 1200 and 1600 hours. Salivary T and C displayed a clear circadian rhythm with highest values at 0800 hours and lowest at 2000 hours; however, no significant correlation was found between T and C with Fpeak and Ppeak. A very strong correlation was found between Taural with Fpeak of CMJ and IMTP and Ppeak of CMJ (r = 0.86, r = 0.84 and r = 0.8, p ≤ 0.001). The study showed the existence of a circadian rhythm in Fpeak and Ppeak in CMJ and IMTP. The evidence suggests that strength and power training or testing should be scheduled later during the day. The use of Taural seemed to be a more effective indicator of physical performance than hormonal measures, and the use of session RPE should also be closely monitored because it may present a circadian rhythm.