Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial

Abstract

Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N = 23) and TR (N = 21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). Results. The F-M UE (P = 0.030), FIM (P = 0.021), time (P = 0.008), and peak (P = 0.018), were significantly higher in the RFVE group after treatment, but not speed (P = 0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P = 0.031), time (P = 0.011), and peak (P = 0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P = 0.005) when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291.

Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis

“…A meta-analysis was applied to compare changes in the effect size (pre-and post-intervention) between the intervention group (IG) and the control group (CG). Only metaanalyses with greater than or equal to four RCTs included 1 Broeren et al, 5 Housman et al, 39 Piron et al, 40 Kwon et al, 9 Sin et al, 23 Thielbar et al, 29 Kiper et al, 4 Rubio et al, 41 Lee et al, 43 Saposnik et al, 26 Shin et al, 42 Kong et al, 30 Brunner et al 28…”

“…1 Further, most survivors experience motor disorders, associated with a reduction in quality of life 3 and the ability to perform activities of daily living (ADL). 4 Neurorehabilitation involves a set of methods that aim at recovering neurological functions that were lost or diminished as a result of a brain or spinal damage. 1 Although virtual reality (VR) started gaining popularity in the late 1980s and 1990s, VR technologies have only recently begun to be de-veloped and studied over the past decade as a possible tool for evaluation and treatment within this discipline.…”

Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview

“…In recent years, much attention has been devoted to innovative technologies and its impact related to computational approaches [64][65][66][67][68]. From a technological perspective, computational models allow us to design and generate very complex systems.…”

“…This learning process based on a trial and error paradigm is promoted by augmentation of Knowledge of the Results (KR -feedback related to the nature of the results produced in terms of the movement goal) and on the Knowledge of the Performance (KP -feedback related to the nature of the movement pattern which was produced) [54,65,80]. The difference between supervised and reinforced learning is that the external environment determines only whether the task was done correctly or incorrectly and does not have to provide feedback for each stimulus throughout the whole duration of the task.…”

Effects of weight and height on hand selection: a low-cost virtual reality paradigm

“…We set out to develop a low-cost, quick, reproducible, and robust hand selection paradigm that would accomplish three goals: In the last two decades, virtual reality (VR) and virtual reality therapies (VRT) have begun to change the field of neurological rehabilitation and demonstrated their potential in several clinical studies [31][32][33][34][35][36]. However, clinically certified effective systems often cost over 10,000 euros.…”