Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system

Abstract

BackgroundRehabilitation programs designed to develop skill in upper extremity (UE) function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR) provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis.MethodsTwo participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training.ResultsBoth participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE.ConclusionTwo participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participant's level of movement ability and rate of performance improvement.

Os efeitos da realidade virtual na reabilitação do acidente vascular encefálico: Uma revisão sistemática

“…Já o único estudo incluído na revisão que avaliou os efeitos na recuperação do equilíbrio não evidenciou diferença entre o treino com e sem RV para os indivíduos pós-AVE. Como se trata apenas de um estudo, mais estudos necessitam ser delineados a fim de permitir inferir sobre os efeitos do uso de RV na recuperação do equilíbrio após um AVE. Stewart et al (2007) Portanto, dos três estudos inseridos na revisão, os dois com maior tamanho amostral e rigor metodológico, evidenciaram efeitos superiores do uso de RV na recuperação do membro superior. Tal recuperação foi mensurada, tanto do ponto de vista de desempenho motor, quanto na realização de tarefas funcionais em ambiente real, o que levanta a possibilidade de observar os efeitos do uso da RV em relação à transferência funcional da realização de tarefas em mundo virtual para o desempenho em mundo real.…”

Haptic Feedback in Motor Hand Virtual Therapy Increases Precision and Generates Less Mental Workload

“…Additionally, from the performance perspective, the capability of the patient to conduct the exercises or tasks in the VE is evaluated, e.g. [12]- [14]. Finally, regarding knowledge transfer from the virtual to the real environment, it is determined by evaluating the patient after several therapy sessions by means of diverse clinical tests (e.g.…”

Systematic review of the effects of exercise therapy on the upper extremity of patients with spinal-cord injury

“…These variations can be controlled with virtual reality. 32 Moreover, humans can learn motor skills in a virtual environment and transfer the motor learning to the real world. 33 In addition to virtual reality, robotics is intended to be an adjunctive tool to increase the intensity of therapy.…”

“…Virtual reality is a promising modality for the creation of favorable practice environments in neurorehabilitation. 32 By means of virtual reality in rehabilitation it is possible to focus on different key concepts of motor (re-)learning: repetitive practice, feedback about performance and motivation. 30 Advantages of the use of virtual reality is the ability to make tasks easier, less dangerous, more fun, more challenging and easier to learn because of the salient feedback that can be provided during practice.…”

“…30 Advantages of the use of virtual reality is the ability to make tasks easier, less dangerous, more fun, more challenging and easier to learn because of the salient feedback that can be provided during practice. 30,32 Although the amount of practice is an important variable for motor learning, variations in direction, timing and speed are needed to optimize the development of skills. These variations can be controlled with virtual reality.…”