Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series

Cortés‐Pérez, Irene; Nieto-Escámez, Francisco Antonio; Obrero‐Gaitán, Esteban

doi:10.3390/brainsci10050296

Cited by 45 publications

(34 citation statements)

References 61 publications

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“…Therefore, despite the patients' heterogeneous profiles, ranging from subacute to chronic stroke phases, post-stroke recovery may be influenced by neuroplasticity and by the physiotherapy or rehabilitation environment as well. New studies show that even in the chronic post-stroke period, neuroplasticity is positively influenced by the use of VR therapy, with a positive impact not only on the motor function but also on the processes of the central nervous system, and with positive results on balance and posture [16,44,49,50].…”

Section: Discussionmentioning

confidence: 99%

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

et al. 2020

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Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.

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Section: Discussionmentioning

confidence: 99%

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

et al. 2020

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“…The intensity and difficulty degree can be graded and provides the user with information about the reached objectives in real time [7][8][9][10]. There are different types of VR, including: immersive, in which the patient is fully integrated in the virtual environment and interacts with it through some type of hardware, such as data gloves or VR glasses, semi-immersive, in which the patient is visualised within the virtual environment through a screen and interacts with it through their movements or with some remote controller but without losing contact with the real world, and nonimmersive, in which the patient interacts with the virtual environment through a computer-generated character represented on a screen with a peripheral device controller [8,[11][12][13]. Immersive VR systems have shown good results in the treatment of motor deficits, among which are balance and gait alterations, in stroke patients.…”

Section: Introductionmentioning

confidence: 99%

Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review

2020

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Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy.

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“…In these studies, HMD had good or better outcomes compared to the traditional training programs. In a small cohort, Cortés-Pérez et al ( 2020 ) compared the effects of VR balance training with conventional physiotherapy in three stroke patients. After 2 months, the patient under VR training showed higher improvements of balance and obtained higher walking speed as compared to those with conventional physiotherapy.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, perspective-taking capacity should be considered when designing virtual scenarios for older adults. Concerning the interaction with avatars, only one study included animal avatars (Cortés-Pérez et al, 2020 ). It seems that other contextual information around the avatars, including ground and objects, could act as visual reference points for the participants to adjust their balance.…”

Section: Discussionmentioning

confidence: 99%

“…They might have a fear of imbalance and decreased gait performance, preventing them from benefiting from rehabilitation. Patients with neurological conditions (PD and stroke) show improvement of balance and reduction of the risk of falls after VR training as compared to non-VR training (Caudron et al, 2014 , Cortés-Pérez et al, 2020 ). Vestibular patients who are suffering from chronic balance impairments are likely to benefit from HMD VR training.…”

Section: Discussionmentioning

confidence: 99%

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The Influence of Virtual Reality Head-Mounted Displays on Balance Outcomes and Training Paradigms: A Systematic Review

Soltani¹,

Andrade²

2021

Front. Sports Act. Living

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Background: Falls are the leading causes of (non)fatal injuries in older adults. Recent research has developed interventions that aim to improve balance in older adults using virtual reality (VR).Purpose: We aimed to investigate the validity, reliability, safety, feasibility, and efficacy of head mounted display (HMD) systems for assessing and training balance in older adults.Methods: We searched EBSCOhost, Scopus, Web of Science, and PubMed databases until 1 September 2020 to find studies that used HMD systems for assessing or training balance. The methodological quality was assessed using a modified version of Downs and Black. We also appraised the risk of bias using Risk of Bias Assessment tool for Non-randomized Studies (RoBANS).Results: A total of 19 articles (637 participants) were included for review. Despite heterogenous age ranges and clinical conditions across studies, VR HMD systems were valid to assess balance and could be useful for fall prevention and for improving postural control and gait patterns. These systems also have the capacity to differentiate healthy and balance-impaired individuals. During VR versions of traditional balance tests, older adults generally acquire a cautious behavior and take more time to complete the tasks.Conclusion: VR HMD systems can offer ecologically valid scenarios to assess and train functional balance and can be used alone or in addition to other interventions. New norms and protocols should be defined according to participants' age, health status, and severity of their illness when using VR HMD systems for balance assessment and training. For safe and feasible training, attention must be given to display type, VR elements and scenarios, duration of exposure, and system usability. Due to high risk of bias and overall poor quality of the studies, further research is needed on the effectiveness of HMD VR training in older adults.

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Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series

Cited by 45 publications

References 61 publications

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review

The Influence of Virtual Reality Head-Mounted Displays on Balance Outcomes and Training Paradigms: A Systematic Review

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