What is Spinal Cord Injury?

Spinal Cord Injury (SCI) refers to any injury that damages the spinal cord -the bundle of nerves and nerve fibres that sends and receives signals from the brain, often resulting in the loss of movement, sensation, and even autonomic functions below the level of injury. The spinal cord is a crucial part of the central nervous system, transmitting signals between the brain and the rest of the body. SCI can be caused by traumatic events, such as accidents, or non-traumatic conditions, like infections or tumours. The severity and consequences of SCI depend on the location and extent of the injury, and the impact can range from minor impairment to complete paralysis.

**Source:** Spinal Cord Injury: What the Patient Needs to Know, Aaron Cohen-Gadol, MD

Types of Spinal Cord Injury

SCI is classified into two primary types:

1. Complete SCI occurs when there is a total disruption in the spinal cord’s ability to transmit signals between the brain and the body. This results in complete paralysis and loss of sensation below the injury site. Complete SCI typically results in the inability to control motor functions or feel sensations in the affected areas.

2. Incomplete SCI, on the other hand, means that there is still some level of preserved function, either in sensation or motor control, below the level of injury. This type of injury allows for the potential for partial recovery, depending on the severity and type of damage sustained by the spinal cord.

Spinal Cord Injury Rehabilitation

Rehabilitation for SCI integrates physical therapy, skill development, and psychological support to enhance independence and quality of life.

Early rehabilitation focuses on rebuilding strength and communication skills, often using assistive devices to improve mobility. Therapy programs may include Physical Therapy, Occupational Therapy, Vocational Rehabilitation, Educational training, and Recreation Therapy.

Integrating Extended Reality into Spinal Cord Injury Rehabilitation

Individuals with SCI have experienced improvements in balance, pain management, and functional performance through Extended Reality (XR) technologies, including Virtual Reality (VR) and Augmented Reality (AR). XR solutions are transforming the SCI rehabilitation landscape by offering patients the opportunity to engage in therapeutic exercises that are both physically and cognitively stimulating, improving overall rehabilitation outcomes.

Psychological Benefits of XR in SCI Rehabilitation

Beyond physical health, psychological well-being is a crucial component of SCI rehabilitation, necessitating approaches that address both mental and emotional health. Research on VR interventions for SCI patients highlights various psychological benefits that contribute to enhanced rehabilitation outcomes [1].

Increased Enjoyment and Motivation: Participants describe VR experiences as novel, immersive, and enjoyable, which helps sustain motivation during rehabilitation [2, 3, 4].

Enhanced Relaxation and Well-Being: VR-based therapies promote relaxation, reduce stress, and support mindfulness, contributing to improved mental health [5, 6, 7].
Positive Distraction from Pain and Injury-Related Challenges: Immersive VR provides a temporary escape from discomfort, allowing patients to focus on recovery without constant awareness of their condition [2, 3, 6, 8].
Boosted Confidence and Independence: The ability to simulate real-world experiences in VR increases patients’ self-assurance and supports greater independence in daily activities [3, 6].
Reduction in Depression and Anxiety: Studies indicate significant improvements in depressive symptoms and anxiety, with some patients experiencing a shift from severe to normal psychological states after six weeks of VR intervention [5, 6 ,9, 10, 11, 12].
Improved Self-Esteem: VR therapy contributes to a positive self-perception, particularly in immersive environments designed for rehabilitation and engagement [2, 9].

Physical Benefits of XR in SCI Rehabilitation

The analysis of 11 studies covering 155 SCI patients found that VR-based therapies significantly contributed to motor function recovery, balance improvement, and engagement in rehabilitation [13].

Motor Function Enhancement: VR-based exercises promoted neuroplasticity, leading to improvements in upper and lower limb mobility [13].

Balance and Postural Control: Several studies reported enhanced static and dynamic balance through VR-assisted training [13].
Increased Repetition and Intensity: The interactive nature of VR encouraged more repetitions, optimizing rehabilitation outcomes [13].
Home-Based Rehabilitation Potential: Some studies suggested that VR could be integrated into at-home recovery programs, making therapy more accessible [13].

Overall, the analysis concluded that VR is an effective complement to conventional rehabilitation, improving both physical function and patient motivation [13].

References:

[1] Williamson, S.D., Aaby, A.O. & Ravn, S.L. Psychological outcomes of extended reality interventions in spinal cord injury rehabilitation: a systematic scoping review. Spinal Cord 63, 58–65 (2025). https://doi.org/10.1038/s41393-024-01057-7

[2] Tamplin J, Loveridge B, Clarke K, Li Y, Berlowitz DJ. Development and feasibility testing of an online virtual reality platform for delivering therapeutic group singing interventions for people living with spinal cord injury. J Telemed Telecare. 2020;26:365–75

[3] Nunnerley J, Gupta S, Snell D, King M. Training wheelchair navigation in immersive virtual environments for patients with spinal cord injury – end-user input to design an effective system. Disabil Rehabil Assist Technol. 2017;12:417–23.

[4] Pais-Vieira C, Gaspar P, Matos D, Alves LP, da Cruz BM, Azevedo MJ, et al. Embodiment comfort levels during motor imagery training combined with immersive virtual reality in a spinal cord injury patient. Front Hum Neurosci. 2022;16:909112.

[5] Pais-Vieira C, Figueiredo JG, Perrotta A, Matos D, Aguiar M, Ramos J, et al. Activation of a rhythmic lower limb movement pattern during the use of a multimodal brain-computer interface: a case study of a clinically complete spinal cord injury. Life. 2024;14:396.

[6] Riva G. Virtual reality in rehabilitation of spinal cord injuries: A case report. Rehabil Psychol. 2000;45:81–8.

[7] Flores A, Linehan MM, Todd SR, Hoffman HG. The use of virtual reality to facilitate mindfulness skills training in dialectical behavioral therapy for spinal cord injury: a case study. Front Psychol. 2018;9:531.

[8] Azurdia D, Acuña SM, Narasaki-Jara M, Furtado O, Jung T. Effects of virtual reality-based aerobic exercise on perceptions of pain and fatigue in individuals with spinal cord injury. Games Health J. 2022;11:236–41.

[9] Donati ARC, Shokur S, Morya E, Campos DSF, Moioli RC, Gitti CM, et al. Long-term training with a brain-machine interface-based gait protocol induces partial neurological recovery in paraplegic patients. Sci Rep. 2016;6:30383.

[10] Lakhani A, Martin K, Gray L, Mallison J, Grimbeek P, Hollins I, et al. What is the impact of engaging with natural environments delivered via virtual reality on the psycho-emotional health of people with spinal cord injury receiving rehabilitation in hospital? Findings from a pilot randomized controlled trial. Arch Phys Med Rehabil. 2020;101:1532–40.

[11] Trost Z, Anam M, Seward J, Shum C, Rumble D, Sturgeon J, et al. Immersive interactive virtual walking reduces neuropathic pain in spinal cord injury: findings from a preliminary investigation of feasibility and clinical efficacy. Pain. 2022;163:350–61.

[12] Chu X, Liu S, Zhao X, Liu T, Xing Z, Li Q, et al. Case report: Virtual reality-based arm and leg cycling combined with transcutaneous electrical spinal cord stimulation for early treatment of a cervical spinal cord injured patient. Front Neurosci. 2024;18:1380467.

[13] Wang, L., Zhang, H., Ai, H. et al. Effects of virtual reality rehabilitation after spinal cord injury: a systematic review and meta-analysis. J NeuroEngineering Rehabil 21, 191 (2024). https://doi.org/10.1186/s12984-024-01492-w

Enhancing Spinal Cord Injury Rehabilitation: The Role of Extended Reality Solutions