Home‐based virtual reality therapy for hand recovery after stroke

Abstract

Background: Many stroke survivors experience arm and hand weakness, but there are only limited efficacious options for arm therapy available. Objective: To assess the feasibility of unsupervised home-based use of a virtual reality device (Smart Glove) for hand rehabilitation post stroke. Design: Prospective single-arm study consisting of a 2-week run-in phase with no device use followed by an 8-week intervention period. Setting: Participants were recruited at the Stanford Neuroscience Outpatient Clinic. Participants: Twenty chronic stroke patients with upper extremity impairment. Interventions: Participants were instructed to use the Smart Glove 50 minutes per day, 5 days per week for 8 weeks. Main Outcome Measures: The following outcomes were measured: (1) compliance, (2) patients' impression of the intervention, and (3) efficacy using the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT), and the Stroke Impact Scale (SIS). Results: Of 20 participants, seven (35%) met target compliance of 40 days use, and six (30%) used the device for 20-39 days. Eighty-five percent of participants were satisfied with the therapy, with 80% reporting improvement in hand function. During the run-in phase there were no improvements in hand function. During the intervention, patients improved by a mean of 26.6 AE 48.8 seconds on the JTHFT (P = .03), by 16.1 AE 15.3 points on the hand-domain of the SIS (P < .01) and there was a trend toward improvement on the UE-FM (2.2 AE 5.5 points, P = .10). Conclusions: Unsupervised use of the Smart Glove in the home environment may improve hand/arm function in subacute/chronic stroke patients. A randomized controlled trial is needed to confirm these results.Disclosures: None

The use of home-based digital technology to support post-stroke upper limb rehabilitation: A scoping review

“…Of these, six articles reported on the creation of a virtual environment for rehabilitation gaming exercise specifically for the upper extremities. 29,47,56,79,82,89 Two articles 42,51 used a VR device (smart glove) for exercising the upper extremities as a rehabilitative intervention for stroke survivors.…”

“…More than 1/3 of the articles included have used or created VR or virtual environment as part of their intervention. 12,15,18,20,28,29,33,35,36,38,40,42,[45][46][47]51,56,58,69,72,78,79,82,84,89,91 VR enables the provision of rehabilitation offering rich experience and credibility in alternative environments such as at home. This minimizes auditory and visual distractions that possibly can happen in communal health care settings.…”

“…92 This emerging technology is widely being integrated in various medical fields. 93 Twenty-six articles 12,15,18,20,28,29,33,35,36,38,40,42,[45][46][47]51,56,58,69,72,78,79,82,84,89,91 used or created a VR intervention or a virtual environment for home-based upper limb rehabilitation after stroke.…”

“…30,50 Sensors Sensors were also used to detect the motion or movement of the upper extremities during the practice of rehabilitative interventions. Twenty-two articles 15,16,18,21,22,26,31,34,39,45,46,50,51,54,57,58,61,78,82,84,87,89 discussed the use of upper extremity-sensing digital technologies in home rehabilitation of stroke patients.…”

A Smart Glove Digital System Promotes Restoration of Upper Limb Motor Function and Enhances Cortical Hemodynamic Changes in Subacute Stroke Patients with Mild to Moderate Weakness: A Randomized Controlled Trial

“…A smart glove has the advantages of convenience, light weight, availability for haptic stimulation, and remote control. A smart glove can be used in an unsupervised environment such as the home to allow telerehabilitation [45].The RAPAEL ® Smart Glove digital system is wearable, lightweight, and flexible for hand movement [19]. None of the participants in this study who completed 20 training sessions with the RAPAEL ® Smart Glove digital system experienced adverse events.…”