Use of client-centered virtual reality in rehabilitation after stroke: a feasibility study

Abstract

Patient-centered virtual reality (VR) programs could assist in the functional recovery of people after a stroke. Objectives: To analyze the feasibility of a rehabilitation protocol using client-centered VR and to evaluate changes in occupational performance and social participation. Methods: This was a mixed methods study. Ten subacute and chronic stroke patients participated in the rehabilitation program using games in non-immersive VR for 40 minutes/day, three days/week, for 12 weeks. Sociodemographic information was collected and the outcome variables included were the Canadian Occupational Performance Measure (COPM) and the Participation Scale. A field diary was used to record the frequency of attendance and adherence of participants and an interview was conducted at the end of program. Results: There were significant and clinically-relevant statistical improvements in the COPM performance score (p < 0.001; CI = 1.29 − 4.858) and in the COPM satisfaction score (p < 0.001; CI = 1.37 − 5.124), with a difference greater than 4.28 points for performance and 4.58 points for satisfaction. The change in the scores for participation was statistically significant (p = 0.046), but there was no clinical improvement (dcohen = −0.596, CI = −1.862 − 0.671). The majority of participants reported more than 75% consecutive attendance of sessions and there was 100% adherence to the program. In the interviews, the participants described their post-stroke difficulties; how the video game motivated their engagement in rehabilitation; and the improvement of occupational performance and social participation after participating in the program. Conclusions: VR is a viable tool for the rehabilitation of stroke patients with functional gains, mainly regarding occupational performance and performance satisfaction.

Effects of Virtual Reality Training on Occupational Performance and Self-efficacy of Patients With Stroke: A Randomized Controlled Trial

“…[40] In our study, positive changes in the score of occupational performance were observed in both groups; the score was 2 points greater than the baseline, indicating a clinically signi cant improvement in occupational performance, and no between-group difference was found. The result of our study was consistent with those of current studies, [25,41] although the number of VR-related studies using occupational performance as an outcome indicator is insu cient. Furthermore, it was reported that a patient-centered treatment enables therapists to fully consider each patient's satisfaction, desire, and goals, which in turn makes the promotion of enthusiasm among participants easier, thereby resulting in adherence to intervention and patient satisfaction.…”

“…Furthermore, it was reported that a patient-centered treatment enables therapists to fully consider each patient's satisfaction, desire, and goals, which in turn makes the promotion of enthusiasm among participants easier, thereby resulting in adherence to intervention and patient satisfaction. [25] However, the VR training in our study was not designed for target therapeutic activities. The movements in the VR games were designed in a single direction; thus, the VR group could not transform the therapeutic activity to complex daily activities during training.…”

“…[21,32,43,44] Previous studies found that VR could increase participants' con dence, motivation to participate, and functional activities based on the remodeling and reorganization of brain function. [25,45,46] Learning by mimicking models and "mirroring" neural networks may induce the formation of an imitative tissue around the motor cortex. Similarly, participants receiving sensory feedback in VR training were likely to learn the target motor behavior.…”

“…The sample size was calculated based on published studies. The effect size of COPM performance, COPM satisfaction and self-e cacy were 3.038, 3.262, [25,35] and 0.7, [35] respectively. In addition, the sample size was calculated according to the estimated effect size of 0.7 on self-e cacy, with a statistical power of 80% and ∂ = 0.5.…”

“…[19][20][21] Some studies showed that different outcome measures related to the effect of VR training still need to be speci ed. [22][23][24] The number of published clinical trials that used occupational performance [25,26]and self-e cacy [21,27] as primary outcomes in VR training are few.…”