Virtual reality in the rehabilitation of patients with stroke: an integrative review

Abstract

Objective: To describe the intervention protocols to using commercial video games as virtual reality (VR) in rehabilitation of patients with stroke. Methods: Integrative review using the descriptors “rehabilitation”, “virtual reality exposure therapy” and “videogames” in the LILACS and PUBMED databases. Articles published from 2011 to 2018 were selected. Results: We found 1,396 articles, 1,383 were excluded and 13 were selected. Most of the articles were randomized clinical trials published in 2014 or later. The sample size varied from 5–47 adults, or adults and elders, with chronic stroke. The Nintendo Wii® was the most used video game system. The intervention happened two or three times a week, each session lasting from 30 to 60 minutes, over 2–12 weeks. Balance, upper limb motor functions, quality of life and daily living activities were the most common evaluated outcomes. The Fugl-Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Barthel Scale and SF-36 were the most common outcome measurement tools. Conclusions: The studies indicated improvement in dynamic balance, upper limb motor function and quality of life after rehabilitation using VR. The VR was more effective than conventional treatments for the outcome of dynamic balance. Two studies did not find any changes in static balance and daily living activities. Physical aspects and quality of life were the outcomes most evaluated by the researchers; as were the population with chronic strokes and protocols of long duration and low intensity. Few studies targeted immediate VR effects, performance in daily living activities and social participation.

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

“…The literature does not have a standardization of interventions and/or games used in virtual reality programs. Thus, the protocol chosen had the number of sessions and duration following the findings of Aramaki et al 26 . Therefore, the protocol consisted of three weekly sessions lasting 40 minutes each, developed over 12 weeks, for a total of 36 sessions.…”

Wii Fit Gaming System—How to Select among Balance Exercise and Measurement Tools

“…An important factor influencing the effectiveness of the intervention is the amount of time devoted to the training. Dosage and duration differs wildley in VR studies [1,7,10,11]. According to the Royal Duch Society of Physical Therapy the duration of therapy session should be 30 min for 5 days per a week for several weeks [15].…”

“…Their ages were from 37 to 78 (mean 58.11) years. Hemiparetic post-stroke (7 right-sided, 4 left-sided) patients with impaired walking ability were included in case of: (1) positive Romberg test, (2) minimum muscle strength on BMC scale 3 in the gluteal muscles and femoral quadriceps muscle, (3) spasticity between mild to moderate (MAS1+ or 2) in the impaired lower extremity. All of them agreed to take part in the study.…”

Genetic Aspects of Inflammation and Immune Response in Stroke

“…Once the disability is present, post-stroke survivors are included in rehabilitation treatment for optimal functional improvements and prevention of further functional decline [ 28 , 29 ]. Nowadays, special consideration is given to promising interventions including virtual reality in the rehabilitation and telerehabilitation of stroke affected patients [ 30 , 31 , 32 ]. Furthermore, patient-tailored treatment along with personalized management in the post-stroke period will hopefully bring to better health care and quality of life for these patients.…”