Virtual Reality In Stroke Rehabilitation Research Articles

Efficacy of Virtual Reality-Based Sword Fighting Exercises to Improve Upper Body Movements in Hemiplegic Patients

Background: Stroke is a leading cause of disability, with hemiplegia affecting the motor function of stroke survivors. Traditional rehabilitation methods often yield limited improvements. Virtual reality (VR) technology offers a novel approach to enhancing upper body movements through immersive, task-oriented exercises.Objective: To evaluate the efficacy of VR-based sword fighting exercises in improving upper body movements in hemiplegic patients.Methods: A randomized, controlled, single-blind trial was conducted with 62 hemiplegic patients at Hussain Memorial Hospital, Lahore. Participants were randomly assigned to either the VR-based sword fighting group or the conventional physical therapy (CT) group. Both groups received 12 sessions over three weeks. Outcomes were measured using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Functional Independence Measure (FIM). Data were analyzed using SPSS version 25, with a p-value of <0.05 considered significant.Results: The VR group showed significantly greater improvements compared to the CT group in post-treatment scores for FIM (115.32 ± 6.665 vs. 79.71 ± 10.681, p = 0.000), FMA, and ARAT (z = -6.778, p = 0.000).Conclusion: VR-based sword fighting exercises significantly improved upper body movements in hemiplegic patients compared to conventional therapy, suggesting a promising role for VR in stroke rehabilitation.

Is motor learning of stroke patients in non-immersive virtual environment influenced by laterality of injury? A preliminary study

BackgroundStroke is the leading cause of long-term disability in adults, causing residual sensorimotor deficits in many survivors. Patients may have different impairments according to laterality of injury, as well as different responses to some therapies. ObjectiveThis preliminary study sought to investigate motor learning in rehabilitation of stroke patients with non-immersive virtual environment by process (electroencephalography) and product (performance) measures in stroke patients with left and right cerebral hemispheres damage. MethodsThe study included 10 chronic stroke patients; 5 with left brain injury (LI), mean age 48.8 years (±4.76), and 5 with right brain injury (RI), mean age 52 years (±10.93). Patients were evaluated for electroencephalographic activity (alpha and beta frequencies) and performance (absolute error) in a darts game on XBOX Kinect (Microsoft®). Then they underwent a virtual darts game training task, 12 sessions for 4 weeks (acquisition stage). After training, they were revaluated (long-term retention). ResultsRI group increased alpha power and decreased beta in ipsilesional areas, increased activation on left hemisphere and decreased the absolute error of performance; LI group increased right hemisphere activation and did not decrease the absolute error. ConclusionsPatients with right brain injury reduce neural effort and errors after virtual darts training, which did not happen to patients with left brain injury. Therefore, the laterality of lesion should be considered in studies that use virtual reality for stroke rehabilitation.

Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence.

Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.

Kinematic Validity of Reaching in a 2D Virtual Environment for Arm Rehabilitation After Stroke.

Increasing evidence supports the use of virtual reality for stroke rehabilitation. However, movement performance and quality may be diminished by the attributes of the virtual environment (VE), which may be detrimental to motor relearning. Our aim was to determine whether reach-to-grasp movements made in a low-cost 2DVE were kinematically similar to those made in a comparable physical environment (PE) in healthy subjects and subjects with stroke. Subjects (healthy = 15, stroke = 22) made unilateral and bilateral reach-to-grasp movements in a 2DVE and a similar PE. Arm and trunk kinematics were recorded with an optoelectronic measurement system (23 markers; 120 Hz). Temporal and spatial characteristics of the endpoint trajectory, arm and trunk movement patterns were compared between environments and groups. In each group, hand positioning at object contact time and trunk displacement were unaffected by the environment. Compared to PE, in VE, unilateral movements were less smooth and time to peak velocity was prolonged. In healthy subjects, bilateral movements were simultaneous and symmetrical in both environments. In subjects with stroke, movements were less symmetrical in VE. Aside from differences in endpoint displacement between environments, movement quality variables were unaffected by the 2DVE. Thus, using a low-cost 2DVE may be a valid approach for sensorimotor rehabilitation following stroke.

The design of virtual lower limb rehabilitation for post-stroke patients

Stroke is one of the leading causes that elicits to disability for adults over a long period. Post-stroke patients often have difficulties with joints and muscles in their legs, which prevents them from moving around. Lower limb rehabilitation helps to regain normal mobility and functionality of patients such as standing, walking and climbing stairs. The implementation of virtual reality in stroke rehabilitation helps to encourage patients on frequent engagement with exercise. This paper briefly presents the ongoing research regarding lower limb rehabilitation systems for post-stroke patient in virtual reality environment to provide an overview of the conceptual design, limitations, and suggestions for future work in this direction.

Virtual Reality in Stroke Rehabilitation

Virtual Reality in Stroke Rehabilitation

Effects of virtual reality based physical therapy interventions on balance and gait performances of chronic hemiparetic stroke patients - a literature review.

Background: Approximately 795.000 strokes occur each year in the United States of America. On average, every 40 seconds, an American suffers a stroke (AHA, 2014). Hemiparesis is a common post-stroke symptomatic condition (about 8/10 stroke survivors), with dramatic impact on balance, gait and activities of daily living. Approximately 2/3 of stroke survivors need an intensive rehabilitation provided by multidisciplinary teams, in which physiotherapy plays a significant role. Method: A systematic review was conducted in the PEDro database. Studies published after 2007 were searched. Results: Clinical trials including virtual rehabilitation interventions for stroke patients started to appear in the early 2000s. Meanwhile, the latest Cochrane systematic review titled “Virtual reality for stroke rehabilitation” includes 72 trials involving 2470 participants, showing an increasing therapeutically interest. The primary objective of this study is to clarify if virtual reality-based therapy can offer a genuine clinical alternative to conventional physical therapy in the treatment of chronic hemiparetic stroke patients, helping physiotherapists and individuals reach higher rehabilitation performance outcomes in terms of balance and ambulation. Conclusion: The three trials presented in this essay show that balance recovery benefits most from a combination of virtual reality-based and conventional physiotherapy. Moreover, virtual task-oriented exercises can be enjoyable and motivating, increasing patient compliance to rehabilitation.

Virtual Reality for Stroke Rehabilitation

Virtual Reality for Stroke Rehabilitation

Virtual reality for stroke rehabilitation.

Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.

Abstract TMP38: Virtual Reality in Stroke Rehabilitation: Identifying Responders in Evrest Multicentre Trial

Introduction: Despite the modest benefits of non-immersive virtual reality (VR) in small, single center studies, our largest trial (EVREST Muticentre) showed no significant difference in motor recovery when VR was compared to an active control. More crucial is to determine the presence of a treatment effect by evaluating respondents. Methods: Adults <3 months of stroke with a Chedoke-McMaster >3 were randomized to receive VR using the Nintendo Wii™ gaming system (VRWii) vs. recreational activities (playing cards, ‘Jenga’, domino) (RA). All participants received usual care consisting of conventional rehabilitation at each center. Participants received an intensive program of 10 sessions of either VR or RA, 60 minutes each, over a 2-week period. The primary outcome was a difference in motor performance between groups using the Wolf Motor Function test (WMFT) at the end of the intervention. We defined respondents based on the accepted minimally clinically important difference (MCID) of ≥20% improvement from the baseline WMFT. 1 Secondary outcomes included a MCID of 30% in the Stroke impact Scale (hand) and in the perception of improvement. 2 Results: Between May 2012 and Oct, 2015, 141 patients received either VRWii (n=71) or RA (n=70). Mean age was 62±12 years. Overall, 63 (53%) participants achieved the MCID (47% % in the VRWii vs 58% RA; p=0.32) at the end of the intervention and 81% 4-weeks post intervention (74 % in the VRWii vs 87% RA; p= 0.21). The total duration of each intervention between respondents and non-respondents was similar (589±57 vs. 579±31 min; p=0.47). Multivariable analysis revealed no difference in the response to VRWii compared to RA (OR 0.63; 95%CI 0.30-1.33). Other outcomes are summarized in the Table. Conclusions: The responder analysis in EVREST Multicenter showed no significant difference between groups (VRWii vs RA) for the primary and secondary outcomes. Our results are in agreement with prior analyses that compared mean change across groups.

Scoping review of outcome measures used in telerehabilitation and virtual reality for post-stroke rehabilitation

Introduction Despite the increased interest in telerehabilitation (TR), virtual reality (VR) and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and identify the most common outcome measures used in TR. For this review, we conducted a systematic search of the literature that reports outcome measures used in TR or VR for stroke rehabilitation. Our specific objectives included: 1) to identify the outcome measures used in TR and VR studies; and 2) to describe which parts of the International Classification of Functioning are measured in the studies. Methods We conducted a comprehensive search of relevant electronic databases (e.g. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PSYCOINFO, The Cochrane Central Register of Controlled Trial and the Physiotherapy Evidence Database). The scoping review included all study designs. Two reviewers conducted pilot testing of the data extraction forms and independently screened all the studies and extracted the data. Disagreements about inclusion or exclusion were resolved by consensus or by consulting a third reviewer. Results In total, 28 studies were included in this scoping review. The results were synthesized and reported considering the implications of the findings within the clinical practice and policy context. Discussion This scoping review identified a wide range of outcome measures used in VR and TR studies and helped identify gaps in current use of outcome measures in the literature. The review also informs researchers and end users (i.e. clinicians, policymakers and researchers) regarding the most appropriate outcome measures for TR or VR.

Virtual Reality for Stroke Rehabilitation.

Virtual Reality for Stroke Rehabilitation.

Survivors of chronic stroke – participant evaluations of commercial gaming for rehabilitation

Purpose: There has been an increase in research on the effect that virtual reality (VR) can have on physical rehabilitation following stroke. However, research exploring participant perceptions of VR for post-stroke rehabilitation has been limited.Method: Semi-structured interviews were conducted with 10 chronic stroke participants (10 males, mean age = 72.1, mean time since injury = 38.6 mos.) who had recently completed an upper extremity VR stroke rehabilitation programme.Results: Four main themes emerged: ‘the VR experience,’ ‘functional outcomes,’ ‘instruction,’ and the ‘future of VR in stroke rehabilitation,’ along with nine sub-themes. Participants illustrated the positive impact that VR training had on their functional abilities as well as their confidence towards completing activities of daily living (ADL). Participants also expressed the need for increased rehabilitation opportunities within the community.Conclusion: Overall, participants were optimistic about their experience with VR training and all reported that they had perceived functional gain. VR is an enjoyable rehabilitation tool that can increase a stroke survivor’s confidence towards completing ADL.Implications for RehabilitationAlthough there is an increase in rehabilitation programmes geared towards those with chronic stroke, we must also consider the participants’ perception of those programmes.Incorporating participant feedback may increase enjoyment and adherence to the rehabilitation programmes.The VR experience, as well as provision of feedback and instruction, are important aspects to consider when developing a VR programme for stroke survivors.VR for rehabilitation may be a feasible tool for increasing the survivors’ confidence in completing ADL post-stroke.

Outcome Measures in Tele-Rehabilitation and Virtual Reality for Stroke Survivors: Protocol for a Scoping Review.

Despite the increased interest about tele-rehabilitation, virtual reality and outcome measures for stroke rehabilitation, surprisingly little research has been done to map and summarize the most common outcome measures used in tele-rehabilitation. For this review, we propose to conduct a systematic search of the literature that reports outcome measures used in tele-rehabilitation or virtual reality for stroke rehabilitation. Specific objectives include: 1) to identify the outcome measures used in tele-rehabilitation studies; 2) to describe the psychometric properties of the outcome measures in the included studies; 3) to describe which parts of the International Classification of Functioning are measured in the studies. Methods: we will conduct a comprehensive search of relevant electronic databases (e.g., PUBMED, CINAHL, EMBASE, PSYCOINFO, Cochrane Central Register of Controlled Trial and PEDRO). The scoping review will include all study designs. Two reviewers will pilot-test the data extraction forms and will independently screen all the studies and extract the data. Disagreements about inclusion or exclusion will be resolved by consensus or by consulting a third reviewer. The results will be synthesized and reported considering the implications of the findings within the clinical practice and policy context. Dissemination: we anticipate that this scoping review will contribute to inform researchers and end-users (ie, clinicians and policy-makers), regarding the most appropriate outcome measures for tele-rehabilitation or virtual reality as well as help to identify gaps in current measures. Results will be disseminated through reports and open access journals, conference presentations, as well as newsletters, podcasts and meetings targeting all the relevant stakeholders.

The Reality of Virtual Reality In Stroke Rehabilitation

To design, implement and evaluate the effectiveness of a knowledge translation (KT) strategy to support therapists in acquiring proficiency with the Interactive Rehabilitation Exercise System (IREX; GestureTek) while emphasizing integration of motor learning strategies (MLS) during virtual reality (VR) interventions. VR systems are promising treatment options in stroke rehabilitation because they can incorporate MLS supporting motivating task-oriented practice.

Abstract T MP43: Utility of Augmented Reality in Relation to Virtual Reality in Stroke Rehabilitation

Introduction: Virtual Reality (VR) has been found useful for numerous rehabilitation applications, but has some intrinsic constraints such as the need for a visuospatial transformation when guiding movements. Augmented Reality (AR) is a new approach to human-computer interaction that enables patients to interact directly with virtual objects. The current study compared AR and VR in a stroke rehabilitation setting. METHODS: The Fruit Ninja game simulates a rehab setting by having subjects perform repeated goal-directed wrist/hand reaching tasks. Subjects held a cup-shaped color-marker in the paretic hand, then reached for a virtual fruit target that sliced in 2 when reached. This game was implemented in both AR and VR settings, with identical movement demands across the two. The target plus real-time visual feedback on hand movements were provided by a computer monitor in VR, and by a projection onto a tabletop in AR. After undergoing baseline assessments (arm motor Fugl-Meyer scale (FMA) and Box and Blocks (B&B)), 10 patients with hemiparetic stroke >6 mo prior and age >18 yr played three 1-min rounds each of the AR and VR games; 4 other subjects who were unable to hold the color-marker object were excluded from current analysis. RESULTS: Of the 10 patients, age = 59±10 yr (mean±SD), FMA score = 57±11 (range 31-66), Hand/Wrist FMA subscore = 22±3 (range 15-24), and B&B score = 41±13 (range 16-58). When playing the exact same Fruit Ninja game, all 10 patients scored significantly (p<0.0001) higher in the AR setting (60±9 targets, range 48-78) as compared to the VR setting (48±8 targets, range 37-64 setting. Also, AR scores were stronger correlates of FM Hand/Wrist (rho=0.68, p<0.04) and B&B scores (rho=0.70, p<0.03) than were VR scores. CONCLUSIONS: This study shows promising results with use of Augmented Reality in a patient-computer interface. Results also suggest advantages as compared to use of a Virtual Reality approach, possibly due to the fact that moving the hand requires a visuospatial transform in the VR setting but not in the AR setting. Compared to VR, AR scores were higher and correlated better with clinical scores, suggesting great potential for the use of Augmented Reality in a patient-computer interface during stroke rehabilitation.

Virtual Reality in Stroke Rehabilitation

Virtual Reality in Stroke Rehabilitation

Virtual Reality for Stroke Rehabilitation

Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. These approaches may be advantageous because they provide the opportunity to practice activities that are not or cannot be practiced within the clinical environment. Furthermore, virtual reality programs are often designed to be more interesting and enjoyable than traditional therapy tasks, thereby encouraging higher numbers of repetitions. The use of specialized virtual reality programs designed for rehabilitation is not yet commonplace in clinical settings. However, gaming consoles are ubiquitous. The primary objective of this review was to evaluate the effects of virtual reality and interactive video gaming compared with an alternative intervention or no intervention on upper limb, lower limb, and global motor function after stroke. Secondary outcomes included activity limitation and adverse events. We also explored feasibility of the approach by examining recruitment rates. ### Search Strategy We searched the Cochrane Stroke Trials Register (March 2010), the …

Virtual Reality in Stroke Rehabilitation

Approximately two thirds of stroke survivors continue to experience motor deficits of the arm resulting in diminished quality of life. Conventional rehabilitation provides modest and sometimes delayed effects. Virtual reality (VR) technology is a novel adjunctive therapy that could be applied in neurorehabilitation. We performed a meta-analysis to determine the added benefit of VR technology on arm motor recovery after stroke. We searched Medline, EMBASE, and Cochrane literature from 1966 to July 2010 with the terms "stroke," "virtual reality," and "upper arm/extremity." We evaluated the effect of VR on motor function improvement after stroke. From the 35 studies identified, 12 met the inclusion/exclusion criteria totaling 195 participants. Among them, there were 5 randomized clinical trials and 7 observational studies with a pre-/postintervention design. Interventions were delivered within 4 to 6 weeks in 9 of the studies and within 2 to 3 weeks in the remaining 3. Eleven of 12 studies showed a significant benefit toward VR for the selected outcomes. In the pooled analysis of all 5 randomized controlled trials, the effect of VR on motor impairment (Fugl-Meyer) was OR=4.89 (95% CI, 1.31 to 18.3). No significant difference was observed for Box and Block Test or motor function. Among observational studies, there was a 14.7% (95% CI, 8.7%-23.6%) improvement in motor impairment and a 20.1% (95% CI, 11.0%-33.8%) improvement in motor function after VR. VR and video game applications are novel and potentially useful technologies that can be combined with conventional rehabilitation for upper arm improvement after stroke.

Virtual Reality for Stroke Rehabilitation: assessment, training and the effect of virtual therapy

The motor function impairment deriving from stroke injury has a negative impact on autonomy and on the activities of daily living. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. To facilitate the activation of brain areas and consequently neuroplasticity, it may be advantageous to combine traditional motor rehabilitation with innovative technology, in order to promote motor re-learning and skill re-acquisition by means of an enhanced training. Following these principles, exercises should involve multiple sensory modalities exploiting the adaptive nature of the nervous system, in order to promote active patient participation. Movement re-learning could be improved by means of training in an enriched environment focused on optimizing the affordances between the motor system and the physical environment: virtual reality technologies allow for the possibility to create specific settings where the affordances are optimized. Several autors report that patients treated in virtual representation could, in both acute and chronic stroke, improve their arm motor function. Reinforced Feedback in a Virtual Environment (RFVE), can incorporate the elements necessary to maximize motor learning, such as repetitive and differentiated task practice, feedback of performance and results, and reinforcement of the motivation. The RFVE approach may lead to better rehabilitation outcomes in the treatment of the upper limb in stroke patients.