We approached several departments of acute and aftercare type and gerontopsychiatry departments with the offer of a new therapeutic activity “Using virtual rehabilitation”. After a brief presentation of the whole concept to the leading doctors and staff, we agreed on certain rules for its use in specific departments. For implementation across the entire hospital, variability in use is important for us – in gerontopsychiatry, we defined the goals of therapy as activation, familiarization with new technologies and enrichment of the existing program of the department. In acute and aftercare departments, we determined the direction of implementation as training of cognitive functions and executive functions and training focused on practicing gross and fine motor skills..

We visit individual departments at predetermined times and patients are indicated by a doctor. We have approximately 20 minutes reserved for each patient, and even more for the first therapy due to the initial familiarization with the overall virtual reality environment and its control. From our experience so far, a time allocation of around 20 minutes seems to us to be quite sufficient, even for the patients..

The use of virtual reality for patients with mental illness brings a number of advantages that can significantly contribute to the effectiveness of treatment. The patient trains the necessary skills in a safe and controlled environment, where the therapist flexibly responds to the patient's needs and escalates or adapts the situation. An interactive and modern form of therapy can be attractive to patients, thereby increasing their motivation and engagement. However, we were still concerned about possible risks and limitations, given our specific target group. We primarily asked ourselves whether the use of virtual reality in therapy would have a negative effect on anxious or paranoid patients, whether the environment is also suitable for patients undergoing addiction treatment, or whether the controls would be too complicated for our patients in gerontopsychiatry. So far, I can say that our fears have not come true and we have always managed to tailor the therapy to the patient and their functional level. This is probably also due to the fact that patients are referred for therapy by a doctor and everything is communicated with other medical personnel. Even before the first therapy, we know in which direction the therapy will probably be focused – whether on increasing the range of motion of the upper and lower limbs, cognitive and executive functions, or just passive use.

When first contacting the VR Vitalis program and operating the set, we generally prefer hand control over controllers – for most patients, this is easier to understand than working with controllers at first. Specifically, in gerontopsychiatry, we encountered the fact that patients had trouble perceiving the controllers as a “part” of their hands and then had difficulty controlling individual activities. When first contacting the environment, we initially choose simple activities that support and reassure the patient in control. We most often choose the “Free Painting” module, where we let patients explore the space around them and also explore movement options – we often supplement the activity with verbal instructions to increase the range of motion of the upper limbs and support patients in moving safely within the program boundaries. Sometimes patients who exercise while standing are shy about free movement and need to be reassured and supported that they can take a few steps under the supervision of a therapist..

Case report I.

Man, born 1963, Dg.: F067 - J.mental. disorder caused by brain damage, its dysfunction and somatic. diseases

Case report II.

Male, born 1986, Dg.: F200 Paranoid schizophrenia

Case report III.

Woman, born 1971, Dg.: F61 – Mixed and other personality disorders.

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