Augmented reality for stroke rehabilitation during COVID-19

Abstract

Background The lack of the rehabilitation professionals is a global issue and it is becoming more serious during COVID-19. An Augmented Reality Rehabilitation System (AR Rehab) was developed for virtual training delivery. The virtual training was integrated into the participants’ usual care to reduce the human trainers’ effort so that the manpower scarcity can be eased. This also resulted in the reduction of the contact rate in pandemics. Objective To investigate the feasibility of the AR Rehab-based virtual training when integrated into the usual care in a real-world pandemic setting, by answering questions of whether the integrated trials can help fulfill the training goal and whether the trials can be delivered when resources are limited because of COVID-19. Methods Chronic stroke participants were randomly assigned to either a centre-based group (AR-Centre) or a home-based group (AR-Home) for a trial consisting of 20 sessions delivered in a human–machine integrated intervention. The trial of the AR-Centre was human training intensive with 3/4 of each session delivered by human trainers (PTs/OTs/Assistants) and 1/4 delivered by the virtual trainer (AR Rehab). The trial of the AR-Home was virtual training intensive with 1/4 and 3/4 of each session delivered by human and virtual trainers, respectively. Functional assessments including Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Lower Extremity (FMA-LE), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), Barthel Index (BI) of Activities of Daily Living (ADL), and Physical Component Summary (SF-12v2 PCS) and Mental Component Summary (SF-12v2 MCS) of the 12-Item Short Form Health Survey (SF-12v2), were conducted before and after the intervention. User experience (UX) using questionnaires were collected after the intervention. Time and human resources required to deliver the human and virtual training, respectively, and the proportion of participants with clinical significant improvement were also used as supplementary measures. Results There were 129 patients from 10 rehabilitation centres enrolled in the integrated program with 39 of them were selected for investigation. Significant functional improvement in FMA-UE (AR-Centre: p = 0.0022, AR-Home: p = 0.0043), FMA-LE (AR-Centre: p = 0.0007, AR-Home: p = 0.0052), SF-12v2 PCS (AR-Centre: p = 0.027, AR-Home: p = 0.036) were observed in both groups. Significant improvement in balance ability (BBS: p = 0.0438), and mental components (SF-12v2 MCS: p = 0.017) were found in AR-Centre group, while activities of daily living (BI: p = 0.0007) was found in AR-Home group. Contact rate was reduced by 30.75–72.30% within AR-All, 0.00–60.00% within AR-Centre, and 75.00–90.00% within AR-Home. Conclusion The human–machine integrated mode was effective and efficient to reduce the human rehabilitation professionals’ effort while fulfilling the training goals. It eased the scarcity of manpower and reduced the contact rate during the pandemics.

Virtual and Augmented Reality in Post-stroke Rehabilitation: A Narrative Review

“…Motor-cognitive intervention concepts that target both physical and cognitive impairments are more beneficial for chronic stroke patients [ 47 ]. Moreover, VR/AR approaches are practical, feasible, automated, and can be conducted independently by the participants, thus releasing the workload on healthcare workers [ 80 ].…”

“…Furthermore, VR/AR technology requires more experts to maintain and utilize the systems effectively. However, the advantages of VR/AR, such as better functional gains, incorporation of activities of daily living (ADLs) into VR/AR devices, individualized training, enhanced motivation, and enjoyment, make it an exciting area for further exploration in stroke rehabilitation [ 19 , 66 , 80 ].…”

Realidad virtual y su utilidad como tratamiento fisioterapéutico para el accidente cerebrovascular: revisión sistemática

“…Se obtuvieron 17 artículos para incluir en la revisión bibliográfica. Todos los artículos incluidos en la revisión fueron de tipo ensayo clínico, ensayo controlado aleatorio (Adomavičienė et al, 2019;Anwar et al, 2021;Chen et al, 2022;Cho & Lee, 2019;Choi et al, 2019;Faria et al, 2020;Huang et al, 2022;Long et al, 2020;Maier et al, 2020;Oh et al, 2019;Park et al, 2021;Rodríguez-Hernández et al, 2021Sana et al, 2023;Schuster-Amft et al, 2018;Yang et al, 2022;Yao et al, 2020).…”

“…En 7 (Anwar et al, 2021;Choi et al, 2019;Faria et al, 2020;Huang et al, 2022;Long et al, 2020;Maier et al, 2020;Yang et al, 2022) estudios las intervenciones fueron a pacientes con ACV crónico, 7 (Chen et al, 2022;Oh et al, 2019;Rodríguez-Hernández et al, 2021Sana et al, 2023;Yao et al, 2020) estudios intervinieron en pacientes con ACV subagudo y en 3 estudios (Adomavičienė et al, 2019;Cho & Lee, 2019;Park et al, 2021;Schuster-Amft et al, 2018) la intervinieron a pacientes con ACV agudo.…”

“…En la duración de las intervenciones 4 estudios que intervinieron durante 4 semanas (Cho & Lee, 2019;Park et al, 2021;Schuster-Amft et al, 2018;Yang et al, 2022), 3 estudios (Anwar et al, 2021;Maier et al, 2020;Oh et al, 2019) intervinieron durante 6 semanas, 3 estudios (Adomavičienė et al, 2019;Choi et al, 2019;Rodríguez-Hernández et al, 2021) intervinieron durante 5 semanas, 2 estudios (Long et al, 2020;Rodríguez-Hernández et al, 2023) intervinieron durante 3 semanas, 2 estudios (Chen et al, 2022;Yao et al, 2020) intervinieron durante 2 semanas, 1 estudio (Sana et al, 2023) intervino durante 8 semanas, 1 estudio (Huang et al, 2022) intervino por 16 semanas, 1 estudio (Faria et al, 2020) intervino por 12 ocasiones, la frecuencia de la intervención en todos los estudios variaba de 2-5 días por semana y la duración de las sesiones de 20 a Al igual que en otro estudio (Schuster-Amft et al, 2018) comparó un entrenamiento convencional de movilidad pasiva, estiramientos, control postural, propiocepción, habilidades motoras y finas con un entrenamiento inmerso en RV utilizando un guante sensor de movimientos de dedos y brazos. Los resultados de ambos grupos fueron similares según la prueba de caja y bloque fue de 21,5 ± DE 16 al inicio y de 24,1 ± DE 17 mientras que los pacientes que tenían menor deterioro tenían mejores resultados, por lo que la RV puede ser una herramienta elegible para pacientes con discapacidades más leves.…”