Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system

Baniña, Melanie C.; Molad, Roni; Solomon, John S.; Berman, Sigal; Soroker, Nachum; Frenkel‐Toledo, Silvi; Liebermann, Dario G.; Levin, Mindy F.

doi:10.1080/17483107.2020.1765421

Cited by 19 publications

(24 citation statements)

References 25 publications

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“…Robotic and virtual-reality UL training technologies have been shown in trials to be as good as, or superior to, conventional supervised therapy, when used typically at least several times a week, over 2-4 months, in sessions of 30-60 minutes, achieving 300-600 repetitions per session. [44][45][46][47][48][49][50][51][52] However, in these trials, intervention sessions are generally set up and/or supervised by therapists, to encourage highintensity training and support complex equipment set up etc. 53 These aspects can be problematic when translating technologies to practice, because higher doses of training entails higher staffing requirements, offsetting their costeffectiveness.…”

Section: Discussionmentioning

confidence: 99%

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Broderick

Almedom

Burdet

et al. 2021

Neurorehabil Neural Repair

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Background. One of the strongest modifiable determinants of rehabilitation outcome is exercise dose. Technologies enabling self-directed exercise offer a pragmatic means to increase dose, but the extent to which they achieve this in unselected cohorts, under real-world constraints, is poorly understood. Objective. Here we quantify the exercise dose achieved by inpatient stroke survivors using an adapted upper limb (UL) exercise gaming (exergaming) device and compare this with conventional (supervised) therapy. Methods. Over 4 months, patients presenting with acute stroke and associated UL impairment were screened at a single stroke centre. Participants were trained in a single session and provided with the device for unsupervised use during their inpatient admission. Results. From 75 patients referred for inpatient UL therapy, we recruited 30 (40%), of whom 26 (35%) were able to use the device meaningfully with their affected UL. Over a median enrolment time of 8 days (IQR: 5–14), self-directed UL exercise duration using the device was 26 minutes per day (median; IQR: 16–31), in addition to 25 minutes daily conventional UL therapy (IQR: 12–34; same cohort plus standard care audit; joint n = 50); thereby doubling total exercise duration (51 minutes; IQR: 32–64) relative to standard care (Z = 4.0, P <.001). The device enabled 104 UL repetitions per day (IQR: 38–393), whereas conventional therapy achieved 15 UL repetitions per day (IQR: 11–23; Z = 4.3, P <.001). Conclusion. Self-directed adapted exergaming enabled participants in our stroke inpatient cohort to increase exercise duration 2-fold, and repetitions 8-fold, compared to standard care, without requiring additional professional supervision.

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Section: Discussionmentioning

confidence: 99%

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Broderick

Almedom

Burdet

et al. 2021

Neurorehabil Neural Repair

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“…It has been widely documented that VR systems offer the ability to provide an intensive training with a high number of movement repetitions per session (Perez-Marcos et al, 2017). It is suggested repetition of movement and duration of training are factors that may optimize motor rehabilitation outcome and ability to perform ADL, although dose-response effects and difficulty level of each task should be assessed to ensure an optimal therapy dosing (Baniña et al, 2020;Dromerick et al, 2009;Kleim & Jones, 2008). VR systems are believed to help increasing the rehabilitation dosage and to provide significant amounts of therapy to patients thus enabling simulated practice of functional tasks (Laver et al, 2017).…”

Section: Benefits Of Integrating Virtual Reality As a Therapy Tool For Therapistsmentioning

confidence: 99%

“…VR systems are believed to help increasing the rehabilitation dosage and to provide significant amounts of therapy to patients thus enabling simulated practice of functional tasks (Laver et al, 2017). Perez-Marcos et al ( 2017) and Baniña et al (2020) reported that training with a VR-based motor rehabilitation system was indeed feasible and could provide high rehabilitation doses, with a high number of repetitions per session and active training time for more efficient training sessions. In Perez-Marcos et al 's study (2017), various shoulder, arm and wrist exercises were proposed and integrated into functional tasks, like grasping or pointing at virtual objects, and led to significant improvements in upper limb function of chronic stroke patients.…”

Section: Benefits Of Integrating Virtual Reality As a Therapy Tool For Therapistsmentioning

confidence: 99%

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

Bui

Luauté

Farnè

2021

Front. Virtual Real.

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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.

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“…A research therapist trained the participant in how to use the platform independently or with the help of a carer if requested. Specifically, participants were taught safety precautions and were trained to (1) turn the device and tablet on and off, (2) don and doff the device, (3) calibrate the device, (4) play each of the games on the tablet, (5) navigate the menus, (6) track their progress, (7) use the handbook and (8) charge the devices. The research therapist advised each participant on the starting duration and frequency of use based on signs of pain and poststroke fatigue during the visit.…”

Section: Open Accessmentioning

confidence: 99%

“…So, it just gives you confidence and reassurance in what you're doing. '(7,(266)(267)(268). 'If I didn't understand or if the response wasn't what I was expecting then I would refer to the detailed instructions to see if I could improve…”

mentioning

confidence: 99%

Safety, feasibility, acceptability and preliminary effects of the Neurofenix platform for Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): results of a feasibility intervention study

et al. 2022

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ObjectivesTo investigate the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper limb (UL).DesignA non-randomised intervention design with a parallel process evaluation.SettingParticipants’ homes, South-East England.ParticipantsThirty adults (≥18 years), minimum 12-week poststroke, not receiving UL rehabilitation, scoring 9–25 on the Motricity Index (elbow and shoulder), with sufficient cognitive and communicative abilities to participate.InterventionsParticipants were trained to use the platform, followed by 1 week of graded game-play exposure and 6-week training, aiming for a minimum 45 min, 5 days/week.OutcomesSafety was determined by assessing pain and poststroke fatigue at 8 and 12 weeks, and adverse events (AEs). Impairment, activity and participation outcomes were measured. Intervention feasibility was determined by the amount of specialist training and support required to complete the intervention, time and days spent training, and number of UL movements performed. Acceptability was assessed by a satisfaction questionnaire and semistructured interviews.ResultsParticipants (14 women; mean (SD) age 60.0 (11.3) years) were a median of 4.9 years poststroke (minimum-maximum: 1–28 years). Twenty-seven participants completed the intervention. The odds of having shoulder pain were lower at 8 weeks (OR 0.45, 95% CI 0.24 to 0.83, p=0.010) and 12 weeks (OR 0.46, 95% CI 0.25 to 0.86, p=0.014) compared with baseline. Fugl-Meyer upper extremity, Motor Activity Log and passive range of movement improved. No other gains were recorded. Poststroke fatigue did not change. Thirty mild and short-term AEs and one serious (unrelated) AE were reported by 19 participants. Participants trained with the platform for a median of 17.4 hours over 7 weeks (minimum-maximum: 0.3–46.9 hours), equating to a median of 149 min per week. The median satisfaction score was 36 out of 40.ConclusionThe Neurofenix platform is a safe, feasible and well accepted way to support UL training for people at least three months poststroke.Trial registration numberISRCTN60291412.

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Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system

Cited by 19 publications

References 25 publications

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

Self-Directed Exergaming for Stroke Upper Limb Impairment Increases Exercise Dose Compared to Standard Care

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

Safety, feasibility, acceptability and preliminary effects of the Neurofenix platform for Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): results of a feasibility intervention study

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