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Abstract

Objectives:

To investigate the effect of virtual reality (VR) rehabilitation on upper extremity motor performance of patients with early stroke.

Design:

Pilot randomized controlled trial.

Setting:

Rehabilitation wards.

Participants:

Twenty three adults with stroke (mean age (SD) = 58.35 (13.45) years and mean time since stroke (SD) = 16.30 (7.44) days).

Interventions:

Participants were randomly assigned to VR group (n=11) or control group (n=12). VR group received nine 30 minutes upper extremity VR therapy in standing (five weekdays in two weeks) plus conventional therapy, which included physical and occupational therapy. Control group received only conventional therapy, which was comparable to total training time received by VR group (mean training hours (SD):VR = 17.07 (2.86); control = 15.50 (2.79)).

Main outcome measures:

The main outcome measure was the Fugl-Meyer Assessment (FMA). Secondary outcomes included Action Research Arm Test, Motor Activity Log and Functional Independence Measure. Results were taken at baseline, post intervention and 1-month post intervention. Participants’ feedback and adverse effects were recorded.

Results:

All participants improved in FMA scores (mean change (SD) = 11.65 (8.56), P<.001). These effects were sustained at one month after intervention (mean (SD) change from baseline = 18.67 (13.26), P<.001). All other outcome measures showed similar patterns. There were no significant differences in improvement between both groups. Majority of the participants found VR training useful and enjoyable, with no serious adverse effects reported.

Conclusion:

Although additional VR training was not superior to conventional therapy alone, this study demonstrates the feasibility of VR training in early stroke.

Keywords

Rehabilitation stroke upper extremity (arm)virtual reality

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References

Saposnik

Levin

. Virtual reality in stroke rehabilitation: A meta-analysis and implications for clinicians. Stroke 2011; 42: 1380–1386.

Laver

George

Thomas

. Virtual reality for stroke rehabilitation. Cochrane Database Sys Rev 2011; 9: CD008349.

Timmermans

Seelen

Willmann

. Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design. J Neuroeng Rehab 2009; 6: 1–18.

Henderson

Korner-Bitensky

Levin

. Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Top Stroke Rehabil 2007; 14: 52–61.

Saposnik

Teasell

Mamdani

. Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke 2010; 41: 1477–1484.

Yavuzer

Senel

Atay

. ‘Playstation eyetoy games’ improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Eur J Phys Rehabil Med 2008; 44: 237–244.

da Silva Cameirão

Bermúdez i Badia

Duarte

. Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restor Neurol Neurosci 2011; 29: 287–298.

Piron

Tonin

Atzori

. The augmented-feedback rehabilitation technique facilitates the arm motor recovery in patients after a recent stroke. Stud Health Technol Inform 2003; 94: 265–267.

Jung

Tay

. Results from a prospective acute inpatient rehabilitation database: clinical characteristics and functional outcomes using the Functional Independence Measure. Ann Acad Med Singapore 2007; 36: 3–10.

10.

Fugl-Meyer

Jääskö

Leyman

. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med 1974; 7: 13–31.

11.

Folstein

McHugh

. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.

12.

Efird

. Blocked randomization with randomly selected block sizes. Int J Environ Res Publ Health 2010; 8: 15–20.

13.

Krakauer

. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 2006; 19: 84–90.

14.

Moller

. Neural Plasticity and Disorders of the Nervous System. Cambridge, UK: Cambridge University Press, 2006.

15.

van Vliet

Wulf

. Extrinsic feedback for motor learning after stroke: what is the evidence? Disabil Rehabil 2006; 28: 831–840.

16.

Rabadi

Rabdi

. Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke. Arch Phys Med Rehabil 2006; 87: 962–966.

17.

Lyle

. A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Internat J Rehabil Res 1981; 4: 483–492.

18.

Carroll

. A quantitative test of upper extremity function. J Chronic Diseases 1965; 18: 479–491.

19.

Taub

Miller

Novack

. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993; 74: 347–354.

20.

Taub

McCulloch

Uswatte

Morris

. Motor Activity Log (MAL) Manual. UAB CI Therapy Research Group. Available at: http://www.uab.edu/citherapy/images/pdf_files/CIT_Training_MAL_manual.pdf (accessed 2011).

21.

Granger

Hamilton

Keith

. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil 1986; 1: 59–74.

22.

Arya

Verma

Garg

. Estimating the minimal clinically important difference of an upper extremity recovery measure in subacute stroke patients. Top Stroke Rehabil 2011; 18: 599–610.

23.

Cohen

. Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates, 1988.

24.

Rosnow

Rosenthal

. Computing contrasts, effect sizes, and counternulls on other people’s published data: General procedures for research consumers. Pyschological Methods 1996; 1: 331–340.

25.

Ertelt

Small

Solodkin

. Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimage 2007; 36(Suppl 2): 164–173.

26.

Cirstea

Levin

. Compensatory strategies for reaching in stroke. Brain 2000; 123: 940–953.

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Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial

Abstract

Objectives:

Design:

Setting:

Participants:

Interventions:

Main outcome measures:

Results:

Conclusion:

Keywords

Get full access to this article

References

Supplementary Material