Abstract

Virtual reality therapy (VRT) is an interactive intervention that induces cortical activation. However, when this tool may aid in motor function recovery after stroke is not yet established. The aim of this study was to evaluate the effects of VRT on upper limb function after stroke. Neuroimaging features were also assessed to investigate a predictor of better response to this therapy. Patients with stroke were consecutively selected and underwent VRT. Clinical neurological characteristics, function of the upper limb, and quality of life were evaluated before and after VRT. Statistical analysis was performed using a general linear model (GLM) comparing pre- and post-intervention outcomes. Age, sex, and thrombolytic therapy were used as confounding factors. High-resolution computed tomography (CT) scans were obtained in the post-stroke phase. CT images were registered into standard space using a lesion mask protocol and flipped based on the side of the stroke. Voxel-based lesion symptom mapping (VLSM) was performed using GLM and searching for correlations between the clinical data and CT lesion. Eighteen patients were studied (8 women; mean age, 55.5 ± 13.9 years). Quality of life, functional independence, functional characteristics, and dexterity of the upper limb showed improvement after the intervention ( P < 0.001). The mean volume of lesions was 24,172 ± 17,302 mm 3 . VLSM analysis showed negative correlations mainly between the posterior portion of the internal capsule and functional recovery ( Fig. 1 ). VRT showed benefits for patients with stroke. Subcortical strokes with involvement of the internal capsule presented the worst response to therapy.

Highlights

  • Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity

  • The Scandinavian Stroke Scale evaluation showed a mean of 49.2 ± 4.7 and 54.1 ± 3.9 before and after the intervention, respectively, with a mean difference of 4.9 ± 4.1

  • All scales showed a significant difference between the pre- and post-intervention stages (p < 0.0001), and no interactions with sex, age, and treatment with cerebral reperfusion were observed

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Summary

Introduction

Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed

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