Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.

Andreia Andrade,Sergi Bermúdez I Badia,Ana Lúcia Faria,Luísa Soares

doi:10.1186/s12984-016-0204-z

Andreia Andrade, Sergi Bermúdez I Badia + Show 2 more

Open Access

https://doi.org/10.1186/s12984-016-0204-z

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Abstract

BackgroundStroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation.MethodsThe VR-based intervention involved a virtual simulation of a city – Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes).ResultsA within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy.ConclusionsOur results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL’s, has more impact than conventional methods.Trial registrationThis trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.

Highlights

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently
In addition to motor disabilities, more than 40 % of stroke survivors are left with cognitive impairment after the event and almost two thirds are affected by mild cognitive impairment, and are at risk of developing dementia [5]
Concerning the neuropsychological assessment measures at baseline, data were normally distributed in both groups for Addenbrooke Cognitive Examination (ACE) (KSExperimental = .218, p = .200; KSControl = .185, p = .200) and only in the control group for the TMT A time (KSExperimental = .390, p < .001; KSControl = .169, p = .200) and the Picture Arrangement test (KSExperimental = .371, p = .001; KSControl = .240, p = .143)

Summary

Introduction

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL’s) simulations, there is still a need of more clinical trials for its validation. Cognition is important for overall recovery since its impairment reduces a person’s ability to plan and initiate self-directed activities, to solve problems, to sustain and divide attention, to memorize information and to understand task instructions. It has been shown that recovery of cognitive function of stroke patients in inpatient rehabilitation is directly related to their level of participation in rehabilitation activities [8]. Reducing the impact of post stroke cognitive impairment through appropriate rehabilitation programs is an essential goal

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