WB Saunders; ElsevierLloréns Rodríguez, R.; Alcañiz Raya, ML. (2015). Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial. Sos Baynat s/n, Univesity of Jaume I, 12071 Castellón, Spain.Previous presentation of this material: no data have been presented before.

BackgroundAcquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo® Wii Balance Board® (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance.MethodsIn this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n = 9) versus standard rehabilitation (n = 8). Effectiveness was evaluated by means of traditional static and dynamic balance scales.ResultsThe final sample consisted of 11 men and 6 women. Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days. Patients using eBaViR had a significant improvement in static balance (p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group.ConclusionsThe results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed.

SAGE PublicationsLlorens Rodríguez, R.; Gil Gómez, JA.; Alcañiz Raya, ML.; Colomer Font, C.; Noe, E. (2015). Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke. Clinical Rehabilitation. 29(3):261-268. doi:10.1177/0269215514543333. Objective: To study the clinical effectiveness and the usability of a virtual reality based intervention compared to conventional physical therapy in the balance recovery of individuals with chronic stroke. Design: Randomized controlled trial Setting: Outpatient neurorehabilitation unit Participants: Twenty individuals with chronic stroke. Interventions: Participants were randomly assigned to either an experimental group or a control group. The intervention consisted of 20 one-hour sessions, 5 sessions per week. The experimental group combined thirty minutes with the virtual reality-based intervention with thirty minutes of conventional training. The control group underwent one hour conventional therapy. Main measures: Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-Meter Walking Test. Subjective data were collected from a feedback questionnaire at the end of the trial. Results: The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p<0.05) and in the 10-Meter Walking Test (p<0.05). Post-hoc analyses showed greater improvement in the experimental group, also in the Brunel Balance Assessment (χ2=2.5, p<0.01). The feedback score was 55. 7±3.4 (range: 15-65). Conclusions: The training of the stepping strategy through VR interventions that satisfy the motor learning principles can enhance the balance recovery in individuals with chronic stroke. Subjective data also revealed positive results regarding presence, comfort, and enjoyment. Design: Randomized controlled trial Setting: Outpatient neurorehabilitation unitParticipants: Twenty individuals with chronic stroke. Interventions:The intervention consisted of twenty one-hour sessions, five sessions per week. The experimental group combined thirty minutes with the virtual realitybased intervention with thirty minutes of conventional training. The control group underwent one hour conventional therapy. Main measures:Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-Meter Walking Test. Subjective data of the virtual reality based-intervention were collected from a feedback questionnaire at the end of the trial. Results:The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p<0.05) and in the 10-Meter Walking Test (p<0.05). Post-hoc analyses showed greater improvement in the experimental g...