Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

Abstract

More innovative technologies are used worldwide in patient’s rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen’s d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen’s d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen’s d 0.693), muscle strength (p < 0.05, Cohen’s d 0.924), lower extremity functionality (p < 0.05, Cohen’s d 0.984) and postural balance (p < 0.05, Cohen’s d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.

The Effect of Augmented Reality-Based Proprioceptive Training Program on Balance, Positioning Sensation and Flexibility in Healthy Young Adults: A Randomized Controlled Trial

“…Miklaus et al (2021) announced that combining high-level exercise, including visual feedback, improves cognitive function and effectively controls motion. Exercise in virtual reality (VR), including visual feedback, has created a favorable environment for rehabilitation of the lower extremity of chronic patients after stroke and has better results in straight leg raise growth, which correlates flexibility with ROM [ 39 ]. AR equipment can also have the same effect as VR because it recognizes the subject’s body, shows the subject’s location through the screen, and analyzes and provides the patient’s posture and movement at the same time as visual feedback.…”

Efektivitas Realitas Virtual sebagai Alternatif Terapi Keseimbangan Postur Tubuh Pasien Stroke Kronis

“…Semua pasien penelitian berada pada stage stroke kronis, dengan rata -rata disebutkan lebih dari 6 bulan sebagai kriteria inklusi [5], [8]- [11]. Rehabilitasi biasanya harus dimulai setelah pasien melewati fase subakut dan memasuki fase kronis, diikuti dengan program rehabilitasi yang konstan dan konsisten yang perlu dilanjutkan sepanjang hidup [10]. Terlepas dari tahap patologi, prinsip dasarnya adalah untuk merangsang dan mengaktifkan struktur somatik melalui aktivitas dengan tugas yang berbeda [10].…”

Telerehabilitation—A Viable Option for the Recovery of Post-Stroke Patients

“…It requires at least a few sessions of exergames to be performed by the patient before home training, so they can be familiarized with virtual reality technology. It is essential for patients to learn from the physiotherapist how to correctly perform the exercises as a complement to the virtual assistance provided by the technology used [34,35].…”