Effectiveness of Virtual Reality in Improving Upper Limb Function in Critically Ill Patients

Millions of people are hospitalized every year in Intensive Care Units (ICUs) with severe health conditions due to various causes and categories of diseases, such as stroke, Traumatic Brain Injuries (TBI), polytrauma, sepsis, and others. In recent years, there has been a remarkable increase in survival rates among patients from all diagnostic categories admitted to the ICU. However, the stay of critically ill patients in the ICU is associated with a significant reduction in physical activity, even in cases where patients can participate in an active, voluntary rehabilitation program. This prolonged immobility has been linked to the development of Intensive Care Unit-Acquired Weakness (ICU-AW) and a decline in health-related quality of life (HRQOL). During the performance of Activities of Daily Living (ADLs), eye-hand coordination plays a crucial role. It depends on the integration of multiple brain systems and is therefore often impaired in many pathological conditions. Moreover, in recent years, the use of exercises that simulate functional tasks and activities of daily living, has been continuously increasing in physiotherapy and occupational therapy programs. Additionally, the implementation of purposeful, repetitive activity in patients with central nervous system lesions (e.g., stroke, traumatic brain injury) can lead to significant neuroplastic changes in the brain that may help improve upper limb function. Nowadays, Virtual Reality (VR) applications are increasingly used in patient rehabilitation. However, the application of fully immersive virtual reality devices for purposeful activities aiming to improve upper limb function in critically ill patients is an innovative intervention that has not yet been sufficiently studied to inform the development of Clinical Guidelines. Furthermore, despite its clinical significance, eye-hand coordination is not routinely assessed , and there is a limited amount of data regarding its rehabilitation, especially through VR technology. The aim of this study, therefore, is to investigate the effect of fully immersive virtual reality on the rehabilitation of sensorimotor perception and visuomotor coordination skills, as well as on the improvement of upper limb function in critically ill patients.