Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Abstract

BackgroundTechnology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.MethodsTen outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).ResultsAll participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.ConclusionsThis pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.

Effects of robot therapy on upper body kinematics and arm function in persons post stroke: a pilot randomized controlled trial

“…These findings confirmed previous results indicating that robotic rehabilitation may be more effective than conventional treatments for chronic participants [16,90]. Moreover, they supported the notion that cortical reorganization is present also in the chronic stages post-stroke [86] and can be enhanced by high-intensity treatments [94][95][96].…”

Design a Haptic-Combined Virtual Reality System to Improve Box and Block Test (BBT) for Upper Extremity Function Assessment

“…Some quantitative kinematic and biomechanical parameters have been considered critical references for off-site assessment [24]. In addition, VR environments with high immersion and interaction improve patient motivation to participate in unsupervised assessments [23,25,26]. Recently, haptic devices have been incorporated into VR rehabilitation.…”

The Effects of Virtual Reality on Upper Limb Function in Chronic Stroke Patients: A Clinical Trial

“…The improvement of the measures in the intervention group is because of the advantageous effects of traditional occupational therapy practices along with VR practices. Daily living activities did not significantly affect the groups [5,30,31]. Additionally, the high satisfaction rate of participants indicates the joyful and motivational nature of such activities accompanied by traditional treatments.…”