The challenge of using virtual reality in telerehabilitation.

Continuing advances in virtual reality (VR) technology along with concomitant system cost reductions have supported the development of more useful and accessible VR systems that can uniquely target a wide range of physical, psychological, and cognitive rehabilitation concerns and research questions. VR offers the potential to deliver systematic human testing, training, and treatment environments that allow for the precise control of complex dynamic three-dimensional stimulus presentations, within which sophisticated interaction, behavioral tracking, and performance recording is possible. The next step in this evolution will allow for Internet accessibility to libraries of VR scenarios as a likely form of distribution and use. VR applications that are Internet deliverable could open up new possibilities for home-based therapy and rehabilitation. If executed thoughtfully, they could increase client involvement, enhance outcomes and reduce costs. However, before this vision can be achieved, a number of significant challenges will need to be addressed and solved. This article will first present three fictional case vignettes that illustrate the ways that VR telerehabilitation might be implemented with varying degrees of success in the future. We then describe a system that is currently being used to deliver virtual worlds over the Internet for training safety skills to children with learning disabilities. From these illustrative fictional and reality-based applications, we will then briefly discuss the technical, practical, and user-based challenges for implementing VR telerehabilitation, along with views regarding the future of this emerging clinical application.