Enhancing Upper Limb Rehabilitation of Stroke Patients With Virtual Reality: A Mini Review

Julie Bui,Jacques Luauté,Alessandro Farnè

doi:10.3389/frvir.2021.595771

Abstract

Upper limb motor impairment following stroke is a common condition that impacts significantly the independence and quality of life of stroke survivors. In recent years, scholars have massively turned to virtual reality (VR) to develop more effective rehabilitation approaches. VR systems are promising tools that can help patients engage in intensive, repetitive and task-oriented practice using new technologies to promote neuroplasticity and recovery. Multiple studies have found significant improvements in upper limb function for patients using VR in therapy, but the heterogeneity of methods and tools employed make the assessment of VR efficacy difficult. Here we aimed to assess the potential of VR as a therapy tool for upper limb motor impairment and to provide initial assessment of what is the added value of using VR to both patients and clinicians. Our mini-review focuses the work published since the Cochrane review (2017) and suggests that VR may be particularly effective when used in combination to conventional rehabilitation approaches. We also highlight key features integrated in VR systems that appear to influence rehabilitation and can help maximizing therapy outcomes, if exploited properly. We conclude that although promising results have already been gathered, more focused research is needed to determine the optimal conditions to implement VR in clinical settings in order to enhance therapy and to better define and leverage the true potential of VR. The rapid pace of technological development and increasing research interest toward VR-based therapy will help providing extensive knowledge and lead to rapid advancements in the near future.

Highlights

Stroke is the second leading cause of death and the third most common cause of disability worldwide (Feigin et al, 2017)
Four out of seven studies showing an additional effect of virtual reality (VR) concerned patients in the sub-acute phase (Ikbali Afsar et al, 2018; Lee et al, 2018; Rogers et al, 2019; Wang et al, 2017), two studies concerned chronic patients (Ain et al, 2021; Aşkın et al, 2018), and one concerned both subacute and chronic patients (Kiper et al, 2018). These results suggest that the likelihood to observe an additional gain provided by VR is increased at the sub-acute phase but a further improvement induced by VR therapy may occur at the chronic phase
The experimental VR group displayed larger improvement in the experimental group using the Wolf motor function test (WMFT), used to assess patients’ upper limb motor function. These findings suggest that repeated exercises with the affected limb and task-oriented practice in a virtual environment can facilitate neural reorganization to a larger extent compared to conventional therapy (CT) alone, promoting motor recovery of the affected upper limbs

Summary

Introduction

Stroke is the second leading cause of death and the third most common cause of disability worldwide (Feigin et al, 2017). Investigating a VR system designed for upper limb rehabilitation and VR as a stand-alone therapy, Schuster-Amft et al (2018) found that chronic stroke patients in both the experimental group and the control group improved their hand dexterity, arm function and independence in ADL after a 4-week treatment, with no between-group differences after the same amount of therapy.

Objectives

Results

Conclusion