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Lo WLA, Mao YR, Li L, Lin AH, Zhao JL, Chen L, Lin Q, Li H, Huang DF. Prospective clinical study of rehabilitation interventions with multisensory interactive training in patients with cerebral infarction: study protocol for a randomised controlled trial. Trials 2017; 18:173. [PMID: 28399935 PMCID: PMC5387359 DOI: 10.1186/s13063-017-1874-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 03/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multisensory interactive training has an increasingly prominent role in stroke rehabilitation. Currently, there is insufficient evidence to demonstrate its efficacy on gait improvement, upper limb and lower limb functional improvement, global motor function and cognitive improvement. A recent Cochrane review confirmed that published studies on virtual reality (VR) training have the limitations of lack of powered sample size, did not evaluate the benefits over a long-term period and lacked trial quality on cognitive function. Another systematic review also concluded that the evidence for the use of VR in gait and balance improvement is limited. This study investigates the effects of multisensory training on gait pattern, upper and lower limb biomechanics, upper limb gross and fine motor functions, and lower limb functional recovery over a medium- to long-term period. METHODS Two hundred and twenty-four acute stroke patients will be recruited from a single centre over a period of 6 years. Participants will be randomly assigned to either conventional therapy or conventional therapy with VR training. Outcomes will be recorded at baseline, post intervention and at 3, 6 and 12 months post intervention. Primary outcome measure is gait speed. Secondary outcome measures include kinematic data of upper and lower limb motion, muscle tone, Action Research Arm Test and Short Orientation Memory Concentration Test. DISCUSSION The results of this trial will provide in-depth understanding of the effect of early VR interventions on gait, upper and lower limb biomechanics and how it may relate to changes in functional outcomes and muscle tone. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration No.: ChiCTR-IOC-15006064 ). Registered on 11 May 2015.
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Affiliation(s)
- Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Yu Rong Mao
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Le Li
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ai Hua Lin
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Jiang Li Zhao
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ling Chen
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Hai Li
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Dong Feng Huang
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China.
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Ordnung M, Hoff M, Kaminski E, Villringer A, Ragert P. No Overt Effects of a 6-Week Exergame Training on Sensorimotor and Cognitive Function in Older Adults. A Preliminary Investigation. Front Hum Neurosci 2017; 11:160. [PMID: 28420973 PMCID: PMC5378780 DOI: 10.3389/fnhum.2017.00160] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/17/2017] [Indexed: 01/09/2023] Open
Abstract
Several studies investigating the relationship between physical activity and cognition showed that exercise interventions might have beneficial effects on working memory, executive functions as well as motor fitness in old adults. Recently, movement based video games (exergames) have been introduced to have the capability to improve cognitive function in older adults. Healthy aging is associated with a loss of cognitive, as well as sensorimotor functions. During exergaming, participants are required to perform physical activities while being simultaneously surrounded by a cognitively challenging environment. However, only little is known about the impact of exergame training interventions on a broad range of motor, sensory, and cognitive skills. Therefore, the present study aims at investigating the effects of an exergame training over 6 weeks on cognitive, motor, and sensory functions in healthy old participants. For this purpose, 30 neurologically healthy older adults were randomly assigned to either an experimental (ETG, n = 15, 1 h training, twice a week) or a control group (NTG, n = 15, no training). Several cognitive tests were performed before and after exergaming in order to capture potential training-induced effects on processing speed as well as on executive functions. To measure the impact of exergaming on sensorimotor performance, a test battery consisting of pinch and grip force of the hand, tactile acuity, eye-hand coordination, flexibility, reaction time, coordination, and static balance were additionally performed. While we observed significant improvements in the trained exergame (mainly in tasks that required a high load of coordinative abilities), these gains did not result in differential performance improvements when comparing ETG and NTG. The only exergaming-induced difference was a superior behavioral gain in fine motor skills of the left hand in ETG compared to NTG. In an exploratory analysis, within-group comparison revealed improvements in sensorimotor and cognitive tasks (ETG) while NTG only showed an improvement in a static balance test. Taken together, the present study indicates that even though exergames might improve gaming performance, our behavioral assessment was probably not sensitive enough to capture exergaming-induced improvements. Hence, we suggest to use more tailored outcome measures in future studies to assess potential exergaming-induced changes.
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Affiliation(s)
- Madeleine Ordnung
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Maike Hoff
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Elisabeth Kaminski
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
- Mind and Brain Institute, Charité and Humboldt UniversityBerlin, Germany
| | - Patrick Ragert
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain SciencesLeipzig, Germany
- Institute for General Kinesiology and Exercise Science, University of LeipzigLeipzig, Germany
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. Time spent in rehabilitation and effect on measures of activity after stroke. Hippokratia 2017. [DOI: 10.1002/14651858.cd012612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Beth Clark
- Poole Hospital NHS Foundation Trust; Stroke Care Unit; Poole Dorset UK BH15 2JB
| | - Jill Whitall
- University of Maryland; Department of Physical Therapy and Rehabilitation Science; Baltimore MD USA 21403
| | - Gert Kwakkel
- VU University Medical Center; Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam Neurosciences; De Boelelaan 1118 Amsterdam Netherlands 1007 MB
| | - Jan Mehrholz
- Technical University Dresden; Department of Public Health, Dresden Medical School; Fetscherstr. 74 Dresden Germany 01307
| | - Sean Ewings
- University of Southampton; Southampton Statistical Sciences Research Institute; Southampton Hampshire UK SO17 1BJ
| | - Jane Burridge
- University of Southampton; Research Group, Faculty of Health Sciences; Building 45, University of Southampton Southampton UK SO17 1BJ
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Dobkin BH. A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training. Neurorehabil Neural Repair 2017; 31:217-227. [PMID: 27885161 PMCID: PMC5315644 DOI: 10.1177/1545968316680490] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions. Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices. A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover. On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.
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105
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Hugues A, Di Marco J, Janiaud P, Xue Y, Pires J, Khademi H, Cucherat M, Bonan I, Gueyffier F, Rode G. Efficiency of physical therapy on postural imbalance after stroke: study protocol for a systematic review and meta-analysis. BMJ Open 2017; 7:e013348. [PMID: 28137928 PMCID: PMC5293873 DOI: 10.1136/bmjopen-2016-013348] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/11/2016] [Accepted: 01/03/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Stroke frequently results in balance disorders, leading to lower levels of activity and a diminution in autonomy. Current physical therapies (PT) aiming to reduce postural imbalance have shown a large variety of effects with low levels of evidence. The objectives are to determine the efficiency of PT in recovering from postural imbalance in patients after a stroke and to assess which PT is more effective. METHODS AND ANALYSIS We will search several databases from inception to October 2015. Only randomised controlled trials assessing PT to recover from poststroke postural imbalance in adults will be considered.Outcome measures will be the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke (PASS), the 'weight-bearing asymmetry' (WBA), the 'centre of pressure' (COP) and the 'limit of stability' (LOS). WBA, COP and LOS are measured by a (sitting or standing) static evaluation on force plate or another device.Two independent reviewers will screen titles, abstracts and full-text articles, evaluate the risk of bias and will perform data extraction. In addition to the outcomes, measures of independence will be analysed. This study will aim at determining the effects of PT on the function (WBA, COP, LOS), the activity (BBS, PASS) and the independence of patients. Subgroup analyses will be planned according to the location of brain lesion (hemispheric, brainstem or cerebellum), the time since stroke (early, late, chronic), the PT (type, main aim (direct effect or generalisation), overall duration), the type of approaches (top-down or bottom-up) and the methodological quality of studies. ETHICS AND DISSEMINATION No ethical statement will be required. The results will be published in a peer-reviewed journal. This meta-analysis aims at managing the rehabilitation after postural imbalance by PT after a stroke. TRIAL REGISTRATION NUMBER Prospero CRD42016037966;Pre-results.
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Affiliation(s)
- A Hugues
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - J Di Marco
- Service de médecine physique et réadaptation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France
| | - P Janiaud
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - Y Xue
- Pôle Information Médicale Évaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - J Pires
- Rovisco Pais Rehabilitation Centre, Tocha, Portugal
- Medicine Faculty of Oporto University, Oporto, Portugal
| | - H Khademi
- International Agency of Research on Cancer, World Health Organisation, Lyon, France
| | - M Cucherat
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
| | - I Bonan
- Service de médecine physique et de réadaptation, CHU Rennes, Rennes, France
| | - F Gueyffier
- UMR 5558 CNRS Lyon, Université de Lyon 1, Lyon, France
- Service de Pharmacologie Toxicologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - G Rode
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
- Inserm UMR-S 1028, CNRS UMR 5292, ImpAct, Centre de Recherche en Neurosciences de Lyon, Université Lyon, Bron, France
- Plate-forme Mouvement et Handicap, Hôpital Henry-Gabrielle, Hospices Civils de Lyon, Saint-Genis-Laval, France
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A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke. Rehabil Res Pract 2017; 2017:9569178. [PMID: 28197341 PMCID: PMC5286463 DOI: 10.1155/2017/9569178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/20/2016] [Accepted: 12/25/2016] [Indexed: 12/22/2022] Open
Abstract
Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it. Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants' views about using the YouGrabber. Results. Twelve participants (6 females) with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2–1.25; p < 0.05) within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges. Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.
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Wang ZR, Wang P, Xing L, Mei LP, Zhao J, Zhang T. Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients. Neural Regen Res 2017; 12:1823-1831. [PMID: 29239328 PMCID: PMC5745836 DOI: 10.4103/1673-5374.219043] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Virtual reality is nowadays used to facilitate motor recovery in stroke patients. Most virtual reality studies have involved chronic stroke patients; however, brain plasticity remains good in acute and subacute patients. Most virtual reality systems are only applicable to the proximal upper limbs (arms) because of the limitations of their capture systems. Nevertheless, the functional recovery of an affected hand is most difficult in the case of hemiparesis rehabilitation after a stroke. The recently developed Leap Motion controller can track the fine movements of both hands and fingers. Therefore, the present study explored the effects of a Leap Motion-based virtual reality system on subacute stroke. Twenty-six subacute stroke patients were assigned to an experimental group that received virtual reality training along with conventional occupational rehabilitation, and a control group that only received conventional rehabilitation. The Wolf motor function test (WMFT) was used to assess the motor function of the affected upper limb; functional magnetic resonance imaging was used to measure the cortical activation. After four weeks of treatment, the motor functions of the affected upper limbs were significantly improved in all the patients, with the improvement in the experimental group being significantly better than in the control group. The action performance time in the WMFT significantly decreased in the experimental group. Furthermore, the activation intensity and the laterality index of the contralateral primary sensorimotor cortex increased in both the experimental and control groups. These results confirmed that Leap Motion-based virtual reality training was a promising and feasible supplementary rehabilitation intervention, could facilitate the recovery of motor functions in subacute stroke patients. The study has been registered in the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).
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Affiliation(s)
- Zun-Rong Wang
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Ping Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Liang Xing
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Li-Ping Mei
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Jun Zhao
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Tong Zhang
- Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
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Dockx K, Bekkers EMJ, Van den Bergh V, Ginis P, Rochester L, Hausdorff JM, Mirelman A, Nieuwboer A. Virtual reality for rehabilitation in Parkinson's disease. Cochrane Database Syst Rev 2016; 12:CD010760. [PMID: 28000926 PMCID: PMC6463967 DOI: 10.1002/14651858.cd010760.pub2] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder that is best managed by a combination of medication and regular physiotherapy. In this context, virtual reality (VR) technology is proposed as a new rehabilitation tool with a possible added value over traditional physiotherapy approaches. It potentially optimises motor learning in a safe environment, and by replicating real-life scenarios could help improve functional activities of daily living. OBJECTIVES The objective of this review was to summarise the current best evidence for the effectiveness of VR interventions for the rehabilitation of people with PD in comparison with 1) active interventions, and 2) passive interventions. Our primary goal was to determine the effect of VR training on gait and balance. Secondary goals included examining the effects of VR on global motor function, activities of daily living, quality of life, cognitive function, exercise adherence, and the occurrence of adverse events. SEARCH METHODS We identified relevant articles through electronic searches of the Cochrane Movement Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, Embase, CINAHL, the Physiotherapy Evidence Database (PEDro), online trials registers, and by handsearching reference lists. We carried out all searches up until 26 November 2016. SELECTION CRITERIA We searched for randomised and quasi-randomised controlled trials of VR exercise interventions in people with PD. We included only trials where motor rehabilitation was the primary goal. DATA COLLECTION AND ANALYSIS Two review authors independently searched for trials that corresponded to the predefined inclusion criteria. We independently extracted and assessed all data for methodological quality. A third review author was responsible for conflict resolution when required. MAIN RESULTS We included 8 trials involving 263 people with PD in the review. Risk of bias was unclear or high for all but one of the included studies. Study sample sizes were small, and there was a large amount of heterogeneity between trials with regard to study design and the outcome measures used. As a result, we graded the quality of the evidence as low or very low. Most of the studies intended to improve motor function using commercially available devices, which were compared with physiotherapy. The interventions lasted for between 4 and 12 weeks.In comparison to physiotherapy, VR may lead to a moderate improvement in step and stride length (standardised mean difference (SMD) 0.69, 95% confidence interval (CI) 0.30 to 1.08; 3 studies; 106 participants; low-quality evidence). VR and physiotherapy interventions may have similar effects on gait (SMD 0.20, 95% CI -0.14 to 0.55; 4 studies; 129 participants; low-quality evidence), balance (SMD 0.34, 95% CI -0.04 to 0.71; 5 studies; 155 participants; low-quality evidence), and quality of life (mean difference 3.73 units, 95% CI -2.16 to 9.61; 4 studies; 106 participants). VR interventions did not lead to any reported adverse events, and exercise adherence did not differ between VR and other intervention arms.The evidence available comparing VR exercise with a passive control was more limited. The evidence for the main outcomes of interest was of very low quality due to the very small sample sizes of the two studies available for this comparison. AUTHORS' CONCLUSIONS We found low-quality evidence of a positive effect of short-term VR exercise on step and stride length. VR and physiotherapy may have similar effects on gait, balance, and quality of life. The evidence available comparing VR with passive control interventions was more limited. Additional high-quality, large-scale studies are needed to confirm these findings.
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Affiliation(s)
- Kim Dockx
- KU LeuvenDepartment of Rehabilitation SciencesTervuursevest 101, Postbus 1501LeuvenBelgium3001
| | - Esther MJ Bekkers
- KU LeuvenDepartment of Rehabilitation SciencesTervuursevest 101, Postbus 1501LeuvenBelgium3001
| | - Veerle Van den Bergh
- KU LeuvenDepartment of Rehabilitation SciencesTervuursevest 101, Postbus 1501LeuvenBelgium3001
| | - Pieter Ginis
- KU LeuvenDepartment of Rehabilitation SciencesTervuursevest 101, Postbus 1501LeuvenBelgium3001
| | - Lynn Rochester
- Newcastle UniversityInstitute for Ageing and HealthClinical Ageing Research UnitCampus for Ageing and VitalityNewcastle upon TyneUKNE4 5PL
| | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical CenterCenter for the Study of Movement, Cognition and Morbility, Neurological InstituteTel Aviv UniversityTel AvivIsrael64239
| | - Anat Mirelman
- Tel‐Aviv Sourasky Medical CenterDepartment of Neurology6 Weizmann StreetTel AvivIsrael64239
| | - Alice Nieuwboer
- KU LeuvenDepartment of Rehabilitation SciencesTervuursevest 101, Postbus 1501LeuvenBelgium3001
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Levac DE, Glegg SMN, Sveistrup H, Colquhoun H, Miller P, Finestone H, DePaul V, Harris JE, Velikonja D. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation. PLoS One 2016; 11:e0168311. [PMID: 27992492 PMCID: PMC5167266 DOI: 10.1371/journal.pone.0168311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. METHOD A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. RESULTS The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. CONCLUSION The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
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Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Stephanie M. N. Glegg
- Therapy Department, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hillel Finestone
- Physiatry, Élisabeth Bruyère Hospital and Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jocelyn E. Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Regional Rehabilitation Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Abstract
Advancements in medical care over the last decades have contributed to a continuous decline in immediate post-stroke mortality. The flipside of this development is that patients surviving the initial stroke are forced to live with sometimes extreme functional motor and/or language limitations for the remaining life span. The following overview presents evidence-based neurorehabilitative interventions to promote motor and language recovery in the acute and chronic post-stroke stages. Therapeutic approaches comprise intensive training, neuropharmacological drugs and non-invasive brain stimulation techniques, such as transcranial magnetic stimulation (TMS) or direct current stimulation (tDCS). Additionally, an outlook on promising future interventions for stroke neurorehabilitation is provided.
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111
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Grimm F, Naros G, Gharabaghi A. Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation. Front Neurosci 2016; 10:518. [PMID: 27895550 PMCID: PMC5108796 DOI: 10.3389/fnins.2016.00518] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 10/26/2016] [Indexed: 11/23/2022] Open
Abstract
Stroke patients with severe motor deficits of the upper extremity may practice rehabilitation exercises with the assistance of a multi-joint exoskeleton. Although this technology enables intensive task-oriented training, it may also lead to slacking when the assistance is too supportive. Preserving the engagement of the patients while providing “assistance-as-needed” during the exercises, therefore remains an ongoing challenge. We applied a commercially available seven degree-of-freedom arm exoskeleton to provide passive gravity compensation during task-oriented training in a virtual environment. During this 4-week pilot study, five severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living. The subjects received virtual reality feedback from their three-dimensional movements. The level of difficulty for the exercise was adjusted by a performance-dependent real-time adaptation algorithm. The goal of this algorithm was the automated improvement of the range of motion. In the course of 20 training and feedback sessions, this unsupervised adaptive training concept led to a progressive increase of the virtual training space (p < 0.001) in accordance with the subjects' abilities. This learning curve was paralleled by a concurrent improvement of real world kinematic parameters, i.e., range of motion (p = 0.008), accuracy of movement (p = 0.01), and movement velocity (p < 0.001). Notably, these kinematic gains were paralleled by motor improvements such as increased elbow movement (p = 0.001), grip force (p < 0.001), and upper extremity Fugl-Meyer-Assessment score from 14.3 ± 5 to 16.9 ± 6.1 (p = 0.026). Combining gravity-compensating assistance with adaptive closed-loop feedback in virtual reality provides customized rehabilitation environments for severely affected stroke patients. This approach may facilitate motor learning by progressively challenging the subject in accordance with the individual capacity for functional restoration. It might be necessary to apply concurrent restorative interventions to translate these improvements into relevant functional gains of severely motor impaired patients in activities of daily living.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University of Tuebingen Tuebingen, Germany
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Faria AL, Andrade A, Soares L, i Badia SB. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil 2016; 13:96. [PMID: 27806718 PMCID: PMC5094135 DOI: 10.1186/s12984-016-0204-z] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. There is substancial evidence on post-stroke cognitive rehabilitation benefits, but its implementation is generally limited by the use of paper-and-pencil methods, insufficient personalization, and suboptimal intensity. Virtual reality tools have shown potential for improving cognitive rehabilitation by supporting carefully personalized, ecologically valid tasks through accessible technologies. Notwithstanding important progress in VR-based cognitive rehabilitation systems, specially with Activities of Daily Living (ADL's) simulations, there is still a need of more clinical trials for its validation. In this work we present a one-month randomized controlled trial with 18 stroke in and outpatients from two rehabilitation units: 9 performing a VR-based intervention and 9 performing conventional rehabilitation. METHODS The VR-based intervention involved a virtual simulation of a city - Reh@City - where memory, attention, visuo-spatial abilities and executive functions tasks are integrated in the performance of several daily routines. The intervention had levels of difficulty progression through a method of fading cues. There was a pre and post-intervention assessment in both groups with the Addenbrooke Cognitive Examination (primary outcome) and the Trail Making Test A and B, Picture Arrangement from WAIS III and Stroke Impact Scale 3.0 (secondary outcomes). RESULTS A within groups analysis revealed significant improvements in global cognitive functioning, attention, memory, visuo-spatial abilities, executive functions, emotion and overall recovery in the VR group. The control group only improved in self-reported memory and social participation. A between groups analysis, showed significantly greater improvements in global cognitive functioning, attention and executive functions when comparing VR to conventional therapy. CONCLUSIONS Our results suggest that cognitive rehabilitation through the Reh@City, an ecologically valid VR system for the training of ADL's, has more impact than conventional methods. TRIAL REGISTRATION This trial was not registered because it is a small sample study that evaluates the clinical validity of a prototype virtual reality system.
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Affiliation(s)
- Ana Lúcia Faria
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Coimbra, Portugal
| | | | - Luísa Soares
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Universidade da Madeira, Funchal, Madeira Portugal
| | - Sergi Bermúdez i Badia
- Madeira Interactive Technologies Institute, Funchal, Madeira Portugal
- Universidade da Madeira, Funchal, Madeira Portugal
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113
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French BR, Boddepalli RS, Govindarajan R. Acute Ischemic Stroke: Current Status and Future Directions. MISSOURI MEDICINE 2016; 113:480-486. [PMID: 30228538 PMCID: PMC6139763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The evolving knowledge on stroke in conjunction with advances in the field of imaging, treatment approaches using recombinant tissue plasminogen activator (rtPA) or thrombectomy devices in recanalization, and efficient emergency stroke workflow processes have opened new frontiers in managing patients with an acute ischemic stroke. These frontiers have been reformed and overcome in overcoming the decades-long watch and wait approach towards patients with ischemic stroke. In this article, we focus on the current strategies for managing ischemic stroke and conclude by providing a brief overview of anticipating developments that can transform future stroke treatments.
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Affiliation(s)
- Brandi R French
- Brandi R. French, MD, Assistant Professor of Clinical Vascular Neurology, Medical Director of Inpatient Neurosciences Unit in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raja S Boddepalli
- Raja S. Boddepalli, MD, Research Assistant in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raghav Govindarajan
- Raghav Govindarajan MD, FISQua, FACSc, FCCP, MSMA member since 2013 and 2017 Boone County Medical society President, Assistant Professor in the Department of Neurology, University of Missouri - Columbia, Missouri
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Khan F, Amatya B, Galea MP, Gonzenbach R, Kesselring J. Neurorehabilitation: applied neuroplasticity. J Neurol 2016; 264:603-615. [PMID: 27778158 DOI: 10.1007/s00415-016-8307-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/06/2016] [Accepted: 10/07/2016] [Indexed: 12/28/2022]
Abstract
The prevalence of disability due to neurological conditions is escalating worldwide. Neurological disorders have significant disability-burden with long-term functional and psychosocial issues, requiring specialized rehabilitation services for comprehensive management, especially treatments tapping into brain recovery 'neuroplastic' processes. Neurorehabilitation is interdisciplinary and cross-sectorial, requiring coordinated effort of diverse sectors, professions, patients and community to manage complex condition-related disability. This review provides evidence for a range of neurorehabilitation interventions for four common neurological conditions: multiple sclerosis (MS), stroke, traumatic brain injury and Parkinson's disease using the Grade of Recommendation, Assessment, Development and Evaluation tool for quality of evidence. Although, existing best-evidence for many interventions is still sparse, the overall findings suggest 'strong' evidence for physical therapy and psychological intervention for improved patient outcomes; and. 'moderate' evidence for multidisciplinary rehabilitation for longer term gains at the levels of activity (disability) and participation in MS and stroke population. The effect of other rehabilitation interventions is inconclusive, due to a paucity of methodologically robust studies. More research is needed to improve evidence-base for many promising rehabilitation interventions.
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Affiliation(s)
- Fary Khan
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia.
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Bhasker Amatya
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Mary P Galea
- Department of Rehabilitation Medicine, Royal Melbourne Hospital, 34-54 Poplar Road, Parkville, Victoria, 3052, Australia
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Grattan Street, Parkville, Victoria, Australia
| | - Roman Gonzenbach
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
| | - Jürg Kesselring
- Department of Neurology and Neurorehabilitation, Rehabilitation Center, Valens, Switzerland
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115
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Pindus DM, Lim L, Rundell AV, Hobbs V, Aziz NA, Mullis R, Mant J. Primary care interventions and current service innovations in modifying long-term outcomes after stroke: a protocol for a scoping review. BMJ Open 2016; 6:e012840. [PMID: 27798023 PMCID: PMC5093648 DOI: 10.1136/bmjopen-2016-012840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Interventions delivered by primary and/or community care have the potential to reach the majority of stroke survivors and carers and offer ongoing support. However, an integrative account emerging from the reviews of interventions addressing specific long-term outcomes after stroke is lacking. The aims of the proposed scoping review are to provide an overview of: (1) primary care and community healthcare interventions by generalist healthcare professionals to stroke survivors and/or their informal carers to address long-term outcomes after stroke, (2) the scope and characteristics of interventions which were successful in addressing long-term outcomes, and (3) developments in current clinical practice. METHODS AND ANALYSIS Studies that focused on adult community dwelling stroke survivors and informal carers were included. Academic electronic databases will be searched to identify reviews of randomised controlled trials (RCTs) and controlled trials, trials from the past 5 years; reviews of observational studies. Practice exemplars from grey literature will be identified through advanced Google search. Reports, guidelines and other documents of major health organisations, clinical professional bodies, and stroke charities in the UK and internationally will be included. Two reviewers will independently screen titles, abstracts and full texts for inclusion of published literature. One reviewer will screen search results from the grey literature and identify relevant documents for inclusion. Data synthesis will include analysis of the number, type of studies, year and country of publication, a summary of intervention components/service or practice, outcomes addressed, main results (an indicator of effectiveness) and a description of included interventions. ETHICS AND DISSEMINATION The review will help identify components of care and care pathways for primary care services for stroke. By comparing the results with stroke survivors' and carers' needs identified in the literature, the review will highlight potential gaps in research and practice relevant to long-term care after stroke.
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Affiliation(s)
- Dominika M Pindus
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Lisa Lim
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - A Viona Rundell
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Victoria Hobbs
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Noorazah Abd Aziz
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Ricky Mullis
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Jonathan Mant
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
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Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JE, Velikonja D. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation. BMC Health Serv Res 2016; 16:557. [PMID: 27716179 PMCID: PMC5052802 DOI: 10.1186/s12913-016-1807-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
Abstract
Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Stephanie M N Glegg
- Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees (A121), Ottawa, ON, K1S 5S9, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave Toronto, Ontario, M5G 1V7, Canada
| | - Patricia A Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada
| | - Hillel Finestone
- Bruyere Research Institute, Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3 N6, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, IAHS Building Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington St. North, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster Univerity, 12 Main Street West, Hamilton, ON, l8S 1C7, Canada
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117
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Sankaranarayan H, Gupta A, Khanna M, Taly AB, Thennarasu K. Role of ankle foot orthosis in improving locomotion and functional recovery in patients with stroke: A prospective rehabilitation study. J Neurosci Rural Pract 2016; 7:544-549. [PMID: 27695234 PMCID: PMC5006466 DOI: 10.4103/0976-3147.185507] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study role of ankle foot orthosis (AFO) in improving locomotion and functional recovery after stroke. SETTING Neurological Rehabilitation Department of a university research tertiary hospital. PATIENTS AND METHODS AFO and activity based rehabilitation. MAIN OUTCOME MEASURES Distance (meters) covered during the 6-minute walk test (6MWT) and speed (meter/second) during the 10-meter walk test. Functional abilities assessed using Functional Independence Measure (FIM®). RESULTS Twenty-six patients (21 male) with stroke (mean duration 196.7 days, range 45-360 days) and mean age of 41.6 years (range 18-65 years, standard deviation [SD] 12.5) were included. Fourteen had right hemiplegia. The mean length of stay in the unit was 26.5 days (range 18-45 days, SD 5.5). All patients had equinus deformity with spastic foot drop and were provided with AFO. Walking endurance with 6MWT was 90 m on admission (without AFO). At discharge, it improved to 174 m with AFO and 121 m without AFOs (P < 0.001-with and without AFO at discharge). Walking speed improved from 0.4 m/s (admission) to 0.51 m/s with AFO, P = 0.004 and 0.45 m/s without AFO, P = 0.015) at discharge. Nine patients (34.6%) had clinically important difference-minimal clinically important difference (>0.16 m/s speed gain; >50 m endurance gain) at discharge. The mean FIM® score on admission was 84.3 ± 18.6. At discharge FIM® improved to 101.9 ± 13.7 (P < 0.001). CONCLUSIONS Use of AFOs improve gait parameters significantly in only one-third stroke patients in the study when combined with activity-based inpatient-rehabilitation.
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Affiliation(s)
- H. Sankaranarayan
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Arun B. Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - K. Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Kiper P, Zucconi C, Agostini M, Baba A, Dipalma F, Berlingieri C, Longhi C, Tonin P, Turolla A. Assessment of virtual teacher feedback for the recovery of the upper limb after a stroke. Study protocol for a randomized controlled trial. REHABILITACJA MEDYCZNA 2016. [DOI: 10.5604/01.3001.0009.5010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Enhanced feedback provided by virtual reality has been shown to promote motor learning both in healthy subjects and patients with motor impairments following lesions of the central nervous system. The aim of this study is to evaluate the effect of displaying a virtual teacher as visual feedback to promote the recovery of upper limb motor function after a stroke.
The protocol reports the design of a single blind randomized controlled trial (RCT), blinded to outcome assessment. Two different treatments based on virtual reality will be compared: in the “Teacher” group, the patients receive treatment with continuous displaying of a virtual teacher, while in the “No-Teacher” group, the same exercises will be proposed without visualization of a virtual teacher. The Fugl-Meyer upper extremity scale will be considered as the primary outcome, while the Functional Independence Measure scale, Reaching Performance Scale and Modified Ashworth Scale will be considered as secondary outcomes. Moreover, kinematic parameters such as mean duration (seconds), mean linear velocity (cm/s) and smoothness (i.e. number of sub-movements) will be registered when performing standardised tasks. All tests will be performed before and after treatments. Both treatments will last four weeks with a daily session lasting one hour, five days a week (20 overall sessions).
This study is designed to systematically assess the influence of using enhanced visual feedback for the recovery of upper limb motor function after a stroke. These findings will help to determine whether the use of a virtual teacher as enhanced visual feedback is effective for promoting better recovery of upper limb motor function over four weeks of post-stroke treatment.
Current Controlled Trials registration number: NCT02234531 (registered on 29 August 2014, ClinicalTrials. gov)
Kiper P., Zucconi C., Agostini M., Baba A., Dipalma F., Berlingieri C., Longhi C., Tonin P., Turolla A. Assessment of virtual teacher feedback for the recovery of the upper limb after a stroke. Study protocol for a randomized controlled trial. Med Rehabil 2016; 20(3): 13-20. DOI: 10.5604/01.3001.0009.5010
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Affiliation(s)
- Pawel Kiper
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
| | | | - Michela Agostini
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
| | - Alfonc Baba
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
| | | | - Carmine Berlingieri
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
| | - Claudia Longhi
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
| | - Paolo Tonin
- IRCCS San Camillo Hospital Foundation, Venice, Italy Unit for Cerebrovascular Diseases
| | - Andrea Turolla
- IRCCS San Camillo Hospital Foundation, Venice, Italy Laboratory of Kinematics and Robotics
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119
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Pedreira da Fonseca E, da Silva Ribeiro NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2016; 26:94-100. [PMID: 27693404 DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/15/2016] [Accepted: 08/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The study aimed to check the therapeutic effect of virtual reality associated with conventional physiotherapy on gait balance and the occurrence of falls after a stroke. METHODS This was a randomized, blinded clinical trial conducted with post-stroke patients, randomized into two groups-treatment group and control group-and subjected to balance assessments by the Dynamic Gait Index and investigation of falls before and after 20 intervention sessions. Statistically significant difference was considered at P < .05. RESULTS We selected 30 patients, but there were three segment losses, resulting in a total of 13 patients in the control group and 14 in the treatment group. There was an improvement in gait balance and reduced occurrence of falls in both groups. After intervention, the differences in gait balance in the control group (P = .047) and the reduction in the occurrence of falls in the treatment group (P = .049) were significant. However, in intergroup analysis, there was no difference in the two outcomes. CONCLUSIONS Therapy with games was a useful tool for gait balance rehabilitation in post-stroke patients, with repercussions on the reduction of falls.
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Affiliation(s)
- Erika Pedreira da Fonseca
- Católica University of Salvador, Salvador, Bahia, Brazil; Bahia School of Medicine and Public Health, Salvador, Brazil.
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120
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Park SK, Yang DJ, Uhm YH, Heo JW, Kim JH. The effect of virtual reality-based eccentric training on lower extremity muscle activation and balance in stroke patients. J Phys Ther Sci 2016; 28:2055-8. [PMID: 27512263 PMCID: PMC4968505 DOI: 10.1589/jpts.28.2055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effect of virtual reality-based
eccentric training on lower extremity muscle activity and balance in stroke patients.
[Subjects and Methods] Thirty stroke patients participated, with 15 patients allotted to
each of two eccentric training groups: one using a slow velocity (group I) and one using a
fast velocity (group II). The virtual reality-based eccentric training was performed by
the patients for 30 minutes once a day, 5 days a week, for 8 weeks using an Eccentron
system. Surface electromyography was used to measure the lower extremity muscle activity,
while a BioRescue was used to measure balancing ability. [Results] A significant
difference in lower extremity muscle activation and balance ability was observed in group
I compared with group II. [Conclusion] This study showed that virtual reality-based
eccentric training using a slow velocity is effective for improving lower extremity muscle
activity and balance in stroke patients.
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Affiliation(s)
- Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Jae Won Heo
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University, Republic of Korea
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121
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Pires MRGM, Göttems LBD, Silva LVS, Carvalho PA, Melo GFD, Fonseca RMGSD. [Development and validation of an instrument for evaluating the ludicity of games in health education]. Rev Esc Enferm USP 2016; 49:981-90. [PMID: 27419683 DOI: 10.1590/s0080-623420150000600015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Developing and validating an instrument to evaluate the playfulness of games in health education contexts. METHODOLOGY A methodological, exploratory and descriptive research, developed in two stages: 1. Application of an open questionnaire to 50 graduate students, with content analysis of the answers and calculation of Kappa coefficient for defining items; 2. Procedures for construction of scales, with content validation by judges and analysis of the consensus estimate by Content Validity Index(CVI). RESULTS 53 items regarding the restless character of the games in the dimensions of playfulness, the formative components of learning and the profiles of the players. CONCLUSION Ludicity can be assessed by validated items related to the degree of involvement, immersion and reinvention of the subjects in the game along with the dynamics and playability of the game.
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Affiliation(s)
- Maria Raquel Gomes Maia Pires
- Universidade de Brasília, Faculdade de Ciências da Saúde, Departamento de Enfermagem, Brasília, DF, Brazil.,Universidade de Brasília, Programa de Pós-Graduação em Gestão Pública, Brasília, DF, Brazil
| | - Leila Bernarda Donato Göttems
- Secretaria de Estado da Saúde do Distrito Federal, Fundação de Ensino e Pesquisa em Ciência da Saúde, Escola Superior de Ciências da Saúde, Programa de Pós Graduação em Ciências para a Saúde, Brasília, DF, Brazil
| | | | - Paloma Aparecida Carvalho
- Secretaria de Estado da Saúde do Distrito Federal, Centro Universitário do Distrito Federal, Hospital de Base, Brasília, DF, Brazil
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Saywell N, Taylor N, Rodgers E, Skinner L, Boocock M. Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2016; 31:145-157. [DOI: 10.1177/0269215516631384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury. Data sources: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic). Review methods: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence. Results: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl –Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy. Conclusion: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.
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Affiliation(s)
- Nicola Saywell
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Luke Skinner
- Waitemata District Health Board, Auckland, New Zealand
| | - Mark Boocock
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
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Saposnik G, Cohen LG, Mamdani M, Pooyania S, Ploughman M, Cheung D, Shaw J, Hall J, Nord P, Dukelow S, Nilanont Y, De Los Rios F, Olmos L, Levin M, Teasell R, Cohen A, Thorpe K, Laupacis A, Bayley M. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial. Lancet Neurol 2016; 15:1019-27. [PMID: 27365261 DOI: 10.1016/s1474-4422(16)30121-1] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke. METHODS In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912. FINDINGS The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 43·7 s [IQR 26·1-68·0] to 29·7 s [21·4-45·2], 32·0% reduction for VRWii vs 38·0 s [IQR 28·0-64·1] to 27·1 s [21·2-45·5], 28·7% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=0·70) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=0·60). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 4·1 s, 95% CI -14·4 to 22·6). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups. INTERPRETATION In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies. FUNDING Heart and Stroke Foundation of Canada and Ontario Ministry of Health.
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Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, St Michael's Hospital, University of Toronto, Canada; Stroke Program, St Michael's Hospital, University of Toronto, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
| | - Leonardo G Cohen
- Human Cortical Physiology and Stroke Neurorehabilitation Section, NINDS, NIH, Bethesda, USA
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | | | | | - Donna Cheung
- Stroke Program, St Michael's Hospital, University of Toronto, Canada
| | - Jennifer Shaw
- UHN-Toronto Rehabilitation Institute, University of Toronto, Canada
| | - Judith Hall
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Peter Nord
- Providence Healthcare, Toronto, Ontario, Canada
| | - Sean Dukelow
- Foothills Medical Centre, Calgary, Alberta, Canada
| | | | | | - Lisandro Olmos
- FLENI Rehabilitation Institute, Escobar, Buenos Aires, Argentina
| | - Mindy Levin
- Jewish Rehabilitation Hospital, CRIR Research Centre, McGill University, Montreal, Canada
| | - Robert Teasell
- Parkwood Institute, University of Western Ontario, London, Ontario, Canada
| | - Ashley Cohen
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Kevin Thorpe
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Mark Bayley
- UHN-Toronto Rehabilitation Institute, University of Toronto, Canada
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Hassett L, van den Berg M, Lindley RI, Crotty M, McCluskey A, van der Ploeg HP, Smith ST, Schurr K, Killington M, Bongers B, Howard K, Heritier S, Togher L, Hackett M, Treacy D, Dorsch S, Wong S, Scrivener K, Chagpar S, Weber H, Pearson R, Sherrington C. Effect of affordable technology on physical activity levels and mobility outcomes in rehabilitation: a protocol for the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial. BMJ Open 2016; 6:e012074. [PMID: 27266776 PMCID: PMC4908951 DOI: 10.1136/bmjopen-2016-012074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/16/2016] [Accepted: 05/16/2016] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION People with mobility limitations can benefit from rehabilitation programmes that provide a high dose of exercise. However, since providing a high dose of exercise is logistically challenging and resource-intensive, people in rehabilitation spend most of the day inactive. This trial aims to evaluate the effect of the addition of affordable technology to usual care on physical activity and mobility in people with mobility limitations admitted to inpatient aged and neurological rehabilitation units compared to usual care alone. METHODS AND ANALYSIS A pragmatic, assessor blinded, parallel-group randomised trial recruiting 300 consenting rehabilitation patients with reduced mobility will be conducted. Participants will be individually randomised to intervention or control groups. The intervention group will receive technology-based exercise to target mobility and physical activity problems for 6 months. The technology will include the use of video and computer games/exercises and tablet applications as well as activity monitors. The control group will not receive any additional intervention and both groups will receive usual inpatient and outpatient rehabilitation care over the 6-month study period. The coprimary outcomes will be objectively assessed physical activity (proportion of the day spent upright) and mobility (Short Physical Performance Battery) at 6 months after randomisation. Secondary outcomes will include: self-reported and objectively assessed physical activity, mobility, cognition, activity performance and participation, utility-based quality of life, balance confidence, technology self-efficacy, falls and service utilisation. Linear models will assess the effect of group allocation for each continuously scored outcome measure with baseline scores entered as a covariate. Fall rates between groups will be compared using negative binomial regression. Primary analyses will be preplanned, conducted while masked to group allocation and use an intention-to-treat approach. ETHICS AND DISSEMINATION The protocol has been approved by the relevant Human Research Ethics Committees and the results will be disseminated widely through peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER ACTRN12614000936628. Pre-results.
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Affiliation(s)
- Leanne Hassett
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Maayken van den Berg
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Richard I Lindley
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Hidde P van der Ploeg
- Department of Public & Occupational Health and EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
- School of Public Health/Sydney Medical School The University of Sydney, Sydney, New South Wales, Australia
| | | | - Karl Schurr
- Faculty of Arts and Business, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Maggie Killington
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Bert Bongers
- Faculty of Design, Architecture and Building, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kirsten Howard
- School of Public Health/Sydney Medical School The University of Sydney, Sydney, New South Wales, Australia
| | - Stephane Heritier
- Department of Epidemiology and Preventive Medicine/Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Maree Hackett
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Treacy
- Physiotherapy Department and Department of Aged Care and Rehabilitation, Bankstown-Lidcombe Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Simone Dorsch
- School of Physiotherapy Faculty of Health Sciences/Australian Catholic University, Sydney, New South Wales, Australia
| | - Siobhan Wong
- Physiotherapy Department and Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Katharine Scrivener
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sakina Chagpar
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Heather Weber
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Ross Pearson
- Consumer Advisor, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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125
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Kong KH, Loh YJ, Thia E, Chai A, Ng CY, Soh YM, Toh S, Tjan SY. Efficacy of a Virtual Reality Commercial Gaming Device in Upper Limb Recovery after Stroke: A Randomized, Controlled Study. Top Stroke Rehabil 2016; 23:333-40. [PMID: 27098818 DOI: 10.1080/10749357.2016.1139796] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the efficacy of a virtual reality commercial gaming device, Nintendo wii (NW) with conventional therapy and customary care in facilitating upper limb recovery after stroke. DESIGN Randomized, controlled, single-blinded study. SETTING Tertiary rehabilitation center. PARTICIPANTS 105 subjects admitted to in inpatient rehabilitation program within 6 weeks of stroke onset. INTERVENTIONS Subjects were randomly assigned to one of three groups of upper limb exercises: (1) NW gaming; (2) conventional therapy; (3) control. NW gaming and conventional therapy were provided fourtimes a week for 3 weeks. MAIN OUTCOME MEASURE(S) The main outcome measure was Fugl-Meyer assessment (FMA) of upper limb function. Secondary outcome measures included Action Research Arm Test, Functional Independence Measure, and Stroke Impact Scale. These measures were assessed at baseline, completion of intervention (week 3) and at 4 weeks and 8 weeks after completion of intervention. The primary outcome measure was the change in FMA scores at completion of intervention. RESULTS The mean age was 57.5±9.8 years, and subjects were enrolled at a mean of 13.7±8.9 days after stroke. The mean baseline FMA score was 16.4±14.2. There was no difference in FMA scores between all 3 groups at the end of intervention, and at 4 and 8 weeks after completion of intervention. Similar findings were also noted for the secondary outcome measures. CONCLUSION(S) Twelve sessions of augmented upper limb exercises via NW gaming or conventional therapy over a 3-week period was not effective in enhancing upper limb motor recovery compared to control.
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Affiliation(s)
- Keng-He Kong
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Yong-Joo Loh
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Ernest Thia
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Audrey Chai
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Chwee-Yin Ng
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Yan-Ming Soh
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Shirlene Toh
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
| | - Soon-Yin Tjan
- a Department of Rehabilitation Medicine , Tan Tock Seng Hospital , Singapore
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Bondarenko FV, Makarova MR, Turova EA. [Restoration of the complicated locomotor functions of the upper extremities in the patients surviving ischemic stroke]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2016; 93:11-15. [PMID: 27030562 DOI: 10.17116/kurort2016111-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
During the late and residual periods of stroke, it is necessary to pay attention to the training of complex spatial movements along with the traditional restoration of the balance and strength of para-articular muscles and the mobility of the paretic limb joints. The objective of the present study was to evaluate the effectiveness of robotic therapy for the recovery of the functions of the upper extremities in the late and residual periods of stroke. The study involved 52 patients who had survived ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All of them performed therapeutic physical exercises based on the standard technique during 5 days a week for 3 weeks. In addition, the treatment included massage, laser and pulsed current therapy. The patients of the main group (n=36) were additionally trained to perform complex spatial movements with special emphasis on their speed, fluidity, precision, and agility with the use of the Multi Joint System (MJS) robotic electromechanical device (40 min, 5 days/wk x 3wk). The analysis of the results of the study has demonstrated the statistically significant difference in the degree of improvement of the range of motion (ROM) in the elbow and shoulder joints, the speed and the accuracy of these movements between the patients of the main and control groups. It is concluded that the instrumental restoration of complex spatial movements of the upper extremities during the late and residual periods of stroke contributes not only to the improvement of the functional capabilities but also to the enhancement of independence and personal adjustment of the stroke patients.
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Affiliation(s)
- F V Bondarenko
- State autonomous healthcare facility "Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine", Moscow Health Department, Moscow, Russia, 105120
| | - M R Makarova
- State autonomous healthcare facility "Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine", Moscow Health Department, Moscow, Russia, 105120
| | - E A Turova
- State autonomous healthcare facility "Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine", Moscow Health Department, Moscow, Russia, 105120
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127
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Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Fergusson D, Levac D, Finestone H. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol 2016; 16:42. [PMID: 27036515 PMCID: PMC4815206 DOI: 10.1186/s12883-016-0563-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients. Methods/Design This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10–12 sessions of 30–45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant’s group allocation. Discussion The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation. Trial Registration https://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014. Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.
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Affiliation(s)
- L Sheehy
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada
| | - A Taillon-Hobson
- Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada
| | - H Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada
| | - M Bilodeau
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.,School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada
| | - D Fergusson
- Ottawa Hospital Research Institute, 501 Smyth Rd., Box 201B, Office L1298a, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada.,Department of Surgery, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - D Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 407-C Robinson Hall, 336 Huntington Ave., Boston, MA, 02115, USA
| | - H Finestone
- Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. .,Bruyère Continuing Care, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. .,Faculty of Medicine, University of Ottawa, 505 Smyth Road, Rm. 1200, Ottawa, ON, K1H 8M2, Canada.
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128
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Moro SB, Carrieri M, Avola D, Brigadoi S, Lancia S, Petracca A, Spezialetti M, Ferrari M, Placidi G, Quaresima V. A novel semi-immersive virtual reality visuo-motor task activates ventrolateral prefrontal cortex: a functional near-infrared spectroscopy study. J Neural Eng 2016; 13:036002. [PMID: 27001948 DOI: 10.1088/1741-2560/13/3/036002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In the last few years, the interest in applying virtual reality systems for neurorehabilitation is increasing. Their compatibility with neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS), allows for the investigation of brain reorganization with multimodal stimulation and real-time control of the changes occurring in brain activity. The present study was aimed at testing a novel semi-immersive visuo-motor task (VMT), which has the features of being adopted in the field of neurorehabilitation of the upper limb motor function. APPROACH A virtual environment was simulated through a three-dimensional hand-sensing device (the LEAP Motion Controller), and the concomitant VMT-related prefrontal cortex (PFC) response was monitored non-invasively by fNIRS. Upon the VMT, performed at three different levels of difficulty, it was hypothesized that the PFC would be activated with an expected greater level of activation in the ventrolateral PFC (VLPFC), given its involvement in the motor action planning and in the allocation of the attentional resources to generate goals from current contexts. Twenty-one subjects were asked to move their right hand/forearm with the purpose of guiding a virtual sphere over a virtual path. A twenty-channel fNIRS system was employed for measuring changes in PFC oxygenated-deoxygenated hemoglobin (O2Hb/HHb, respectively). MAIN RESULTS A VLPFC O2Hb increase and a concomitant HHb decrease were observed during the VMT performance, without any difference in relation to the task difficulty. SIGNIFICANCE The present study has revealed a particular involvement of the VLPFC in the execution of the novel proposed semi-immersive VMT adoptable in the neurorehabilitation field.
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Affiliation(s)
- Sara Basso Moro
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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129
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Cameirão MS, Smailagic A, Miao G, Siewiorek DP. Coaching or gaming? Implications of strategy choice for home based stroke rehabilitation. J Neuroeng Rehabil 2016; 13:18. [PMID: 26921185 PMCID: PMC4769516 DOI: 10.1186/s12984-016-0127-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 02/19/2016] [Indexed: 12/17/2022] Open
Abstract
Background The enduring aging of the world population and prospective increase of age-related chronic diseases urge the implementation of new models for healthcare delivery. One strategy relies on ICT (Information and Communications Technology) home-based solutions allowing clients to pursue their treatments without institutionalization. Stroke survivors are a particular population that could strongly benefit from such solutions, but is not yet clear what the best approach is for bringing forth an adequate and sustainable usage of home-based rehabilitation systems. Here we explore two possible approaches: coaching and gaming. Methods We performed trials with 20 healthy participants and 5 chronic stroke survivors to study and compare execution of an elbow flexion and extension task when performed within a coaching mode that provides encouragement or within a gaming mode. For each mode we analyzed compliance, arm movement kinematics and task scores. In addition, we assessed the usability and acceptance of the proposed modes through a customized self-report questionnaire. Results In the healthy participants sample, 13/20 preferred the gaming mode and rated it as being significantly more fun (p < .05), but the feedback delivered by the coaching mode was subjectively perceived as being more useful (p < .01). In addition, the activity level (number of repetitions and total movement of the end effector) was significantly higher (p < .001) during coaching. However, the quality of movements was superior in gaming with a trend towards shorter movement duration (p = .074), significantly shorter travel distance (p < .001), higher movement efficiency (p < .001) and higher performance scores (p < .001). Stroke survivors also showed a trend towards higher activity levels in coaching, but with more movement quality during gaming. Finally, both training modes showed overall high acceptance. Conclusions Gaming led to higher enjoyment and increased quality in movement execution in healthy participants. However, we observed that game mechanics strongly determined user behavior and limited activity levels. In contrast, coaching generated higher activity levels. Hence, the purpose of treatment and profile of end-users has to be considered when deciding on the most adequate approach for home based stroke rehabilitation.
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Affiliation(s)
- Mónica S Cameirão
- Faculdade das Ciências Exatas e da Engenharia, Universidade da Madeira, Campus Universitário da Penteada, 9020-105, Funchal, Portugal. .,Madeira Interactive Technologies Institute, Polo Científico e Tecnológico da Madeira, Caminho da Penteada, 9020-105, Funchal, Portugal.
| | - Asim Smailagic
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Guangyao Miao
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Dan P Siewiorek
- Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA, USA.
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130
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Shin JH, Kim MY, Lee JY, Jeon YJ, Kim S, Lee S, Seo B, Choi Y. Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial. J Neuroeng Rehabil 2016; 13:17. [PMID: 26911438 PMCID: PMC4765099 DOI: 10.1186/s12984-016-0125-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/12/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors. METHODS The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl-Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen-Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention. RESULTS The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group. CONCLUSIONS VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL. TRIAL REGISTRATION This study is registered under the title "Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke" and can be located in https://clinicaltrials.gov with the study identifier NCT02029651 .
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Affiliation(s)
- Joon-Ho Shin
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Samgaksan-ro 58, Gangbuk-gu, Seoul, 142-884, Korea.
| | - Mi-Young Kim
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Ji-Yeong Lee
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Yu-Jin Jeon
- National Rehabilitation Center, Ministry of Health and Welfare, Seoul, Korea.
| | - Suyoung Kim
- Department of Law, Hanyang University, Seoul, Korea.
| | | | - Beomjoo Seo
- School of Games, Hongik University, Seoul, Korea.
| | - Younggeun Choi
- Neofect, Yong-in, Korea.
- Department of Applied Computer Engineering, Dankook University, Yong-in, Korea.
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Singh T, Perry CM, Herter TM. A geometric method for computing ocular kinematics and classifying gaze events using monocular remote eye tracking in a robotic environment. J Neuroeng Rehabil 2016; 13:10. [PMID: 26812907 PMCID: PMC4728792 DOI: 10.1186/s12984-015-0107-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Robotic and virtual-reality systems offer tremendous potential for improving assessment and rehabilitation of neurological disorders affecting the upper extremity. A key feature of these systems is that visual stimuli are often presented within the same workspace as the hands (i.e., peripersonal space). Integrating video-based remote eye tracking with robotic and virtual-reality systems can provide an additional tool for investigating how cognitive processes influence visuomotor learning and rehabilitation of the upper extremity. However, remote eye tracking systems typically compute ocular kinematics by assuming eye movements are made in a plane with constant depth (e.g. frontal plane). When visual stimuli are presented at variable depths (e.g. transverse plane), eye movements have a vergence component that may influence reliable detection of gaze events (fixations, smooth pursuits and saccades). To our knowledge, there are no available methods to classify gaze events in the transverse plane for monocular remote eye tracking systems. Here we present a geometrical method to compute ocular kinematics from a monocular remote eye tracking system when visual stimuli are presented in the transverse plane. We then use the obtained kinematics to compute velocity-based thresholds that allow us to accurately identify onsets and offsets of fixations, saccades and smooth pursuits. Finally, we validate our algorithm by comparing the gaze events computed by the algorithm with those obtained from the eye-tracking software and manual digitization. RESULTS Within the transverse plane, our algorithm reliably differentiates saccades from fixations (static visual stimuli) and smooth pursuits from saccades and fixations when visual stimuli are dynamic. CONCLUSIONS The proposed methods provide advancements for examining eye movements in robotic and virtual-reality systems. Our methods can also be used with other video-based or tablet-based systems in which eye movements are performed in a peripersonal plane with variable depth.
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Affiliation(s)
- Tarkeshwar Singh
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC-29208, USA.
| | - Christopher M Perry
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC-29208, USA.
| | - Troy M Herter
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC-29208, USA.
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Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci 2016; 37:503-14. [PMID: 26781943 DOI: 10.1007/s10072-016-2474-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/18/2022]
Abstract
Gait abnormalities following neurological disorders are often disabling, negatively affecting patients' quality of life. Therefore, regaining of walking is considered one of the primary objectives of the rehabilitation process. To overcome problems related to conventional physical therapy, in the last years there has been an intense technological development of robotic devices, and robotic rehabilitation has proved to play a major role in improving one's ability to walk. The robotic rehabilitation systems can be classified into stationary and overground walking systems, and several studies have demonstrated their usefulness in patients after severe acquired brain injury, spinal cord injury and other neurological diseases, including Parkinson's disease, multiple sclerosis and cerebral palsy. In this review, we want to highlight which are the most widely used devices today for gait neurological rehabilitation, focusing on their functioning, effectiveness and challenges. Novel and promising rehabilitation tools, including the use of virtual reality, are also discussed.
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Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev 2015; 2015:CD006876. [PMID: 26559225 PMCID: PMC6465047 DOI: 10.1002/14651858.cd006876.pub4] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke. OBJECTIVES To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 3), MEDLINE (1950 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), SPORTDiscus (1949 to March 2015), PEDro (searched April 2015), Compendex (1972 to March 2015), and Inspec (1969 to March 2015). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables. MAIN RESULTS We included 34 trials (involving 1160 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.37, 95% confidence interval (CI) 0.11 to 0.64, P = 0.005, I² = 62%), arm function (SMD 0.35, 95% CI 0.18 to 0.51, P < 0.0001, I² = 36%), and arm muscle strength (SMD 0.36, 95% CI 0.01 to 0.70, P = 0.04, I² = 72%), but the quality of the evidence was low to very low. Electromechanical and robot-assisted arm training did not increase the risk of participant drop-out (RD 0.00, 95% CI -0.02 to 0.03, P = 0.84, I² = 0%) with moderate-quality evidence, and adverse events were rare. AUTHORS' CONCLUSIONS People who receive electromechanical and robot-assisted arm and hand training after stroke might improve their activities of daily living, arm and hand function, and arm and hand muscle strength. However, the results must be interpreted with caution because the quality of the evidence was low to very low, and there were variations between the trials in the intensity, duration, and amount of training; type of treatment; and participant characteristics.
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Affiliation(s)
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzGermany01896
| | | | - Joachim Kugler
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolDresdenGermany
| | - Bernhard Elsner
- Faculty of Medicine Carl Gustav Carus, TU DresdenDepartment of Public HealthFetscherstr. 74DresdenGermany01307
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134
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Ng L, Reid I, Gorelik A, Galea M, Khan F. Environmental enrichment for stroke and other non-progressive brain injury. Hippokratia 2015. [DOI: 10.1002/14651858.cd011879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Louisa Ng
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Isabella Reid
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
| | - Alexandra Gorelik
- Royal Melbourne Hospital; Melbourne EpiCentre Melbourne Health; Grattan Street, Parkville Melbourne Australia
| | - Mary Galea
- The University of Melbourne; Department of Medicine (Royal Melbourne Hospital); Royal Park Campus 34-54 Poplar Road Parkville Victoria Australia 3052
| | - Fary Khan
- Royal Melbourne Hospital, Royal Park Campus; Department of Rehabilitation Medicine; Poplar Road Parkville Melbourne Victoria Australia 3052
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135
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Fan H, Song F. An assessment of randomized controlled trials (RCTs) for non-communicable diseases (NCDs): more and higher quality research is required in less developed countries. Sci Rep 2015; 5:13221. [PMID: 26272174 PMCID: PMC4642521 DOI: 10.1038/srep13221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022] Open
Abstract
Research is crucial to implement evidence-based health interventions for control of non-communicable diseases (NCDs). This study aims to assess main features of randomized controlled trials (RCTs) for control of NCDs, and to identify gaps in clinical research on NCDs between high-income and less developed countries. The study included 1177 RCTs in 82 Cochrane Systematic reviews (CSRs) and evaluated interventions for adults with hypertension, diabetes, stroke, or heart diseases. Multivariate logistic regression analyses were conducted to explore factors associated with risk of bias in included RCTs. We found that 78.2% of RCTs of interventions for major NCDs recruited patients in high-income countries. The number of RCTs included in the CSRs was increasing over time, and the increasing speed was more noticeable for RCTs conducted in middle-income countries. RCTs conducted in less developed countries tended to be more recently published, less likely to be published in English, with smaller sample sizes, and at a higher risk of bias. In conclusion, there is still a lack of research evidence for control of NCDs in less developed countries. To brace for rising NCDs and avoid waste of scarce research resources, not only more but also higher quality clinical trials are required in low-and-middle-income countries.
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Affiliation(s)
- Hong Fan
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, P.R. China
| | - Fujian Song
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, U.K
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Abstract
This review covers the rationale, mechanisms, and availability of commercially available virtual environment-based interventions for stroke rehabilitation. It describes interventions for motor, speech, cognitive, and sensory dysfunction. Also discussed are the important features and mechanisms that allow virtual environments to facilitate motor relearning. A common challenge is the inability to translate success in small trials to efficacy in larger populations. The heterogeneity of stroke pathophysiology has been blamed, and experts advocate for the study of multimodal approaches. Therefore, this article also introduces a framework to help define new therapy combinations that may be necessary to address stroke heterogeneity.
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Affiliation(s)
- Michael J Fu
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, 2123 Martin Luther King Jr. Blvd., Cleveland, OH 44106, USA; Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA.
| | - Jayme S Knutson
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA
| | - John Chae
- Cleveland FES Center, Case Western Reserve University, 10701 East Blvd., Cleveland, OH 44106, USA; MetroHealth Rehabilitation Institute, MetroHealth System, 4229 Pearl Road, Suite N5, Cleveland, OH 44109, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, 4229 Pearl Road, Suite N2, Cleveland, OH 44109, USA; Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, 309 Wickenden Bldg, Cleveland, OH, USA
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137
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Feys P, Coninx K, Kerkhofs L, De Weyer T, Truyens V, Maris A, Lamers I. Robot-supported upper limb training in a virtual learning environment : a pilot randomized controlled trial in persons with MS. J Neuroeng Rehabil 2015. [PMID: 26202325 PMCID: PMC4511982 DOI: 10.1186/s12984-015-0043-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Despite the functional impact of upper limb dysfunction in multiple sclerosis (MS), effects of intensive exercise programs and specifically robot-supported training have been rarely investigated in persons with advanced MS. Aim To investigate the effects of additional robot-supported upper limb training in persons with MS compared to conventional treatment only. Methods Seventeen persons with MS (pwMS) (median Expanded Disability Status Scale of 8, range 3.5–8.5) were included in a pilot RCT comparing the effects of additional robot-supported training to conventional treatment only. Additional training consisted of 3 weekly sessions of 30 min interacting with the HapticMaster robot within an individualised virtual learning environment (I-TRAVLE). Clinical measures at body function (Hand grip strength, Motricity Index, Fugl-Meyer) and activity (Action Research Arm test, Motor Activity Log) level were administered before and after an intervention period of 8 weeks. The intervention group were also evaluated on robot-mediated movement tasks in three dimensions, providing active range of motion, movement duration and speed and hand-path ratio as indication of movement efficiency in the spatial domain. Non-parametric statistics were applied. Results PwMS commented favourably on the robot-supported virtual learning environment and reported functional training effects in daily life. Movement tasks in three dimensions, measured with the robot, were performed in less time and for the transporting and reaching movement tasks more efficiently. There were however no significant changes for any clinical measure in neither intervention nor control group although observational analyses of the included cases indicated large improvements on the Fugl-Meyer in persons with more marked upper limb dysfunction. Conclusion Robot-supported training lead to more efficient movement execution which was however, on group level, not reflected by significant changes on standard clinical tests. Persons with more marked upper limb dysfunction may benefit most from additional robot-supported training, but larger studies are needed. Trial registration This trial is registered within the registry Clinical Trials GOV (NCT02257606).
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Affiliation(s)
- Peter Feys
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
| | - Karin Coninx
- Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium.
| | - Lore Kerkhofs
- Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium.
| | - Tom De Weyer
- Expertise Centre for Digital Media - tUL - iMinds, Hasselt University, Wetenschapspark 2, 3590, Diepenbeek, Belgium.
| | - Veronik Truyens
- Rehabilitation and MS Center Overpelt, 3900, Overpelt, Belgium.
| | - Anneleen Maris
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
| | - Ilse Lamers
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3590, Diepenbeek, Belgium.
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138
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Baccini M, Barbero M, Gatti R. From a national to an international journal: a new opportunity for the physiotherapy community. Arch Physiother 2015; 5:1. [PMID: 29340170 PMCID: PMC5721718 DOI: 10.1186/s40945-015-0004-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Baccini
- Editor-in-Chief of Archives of Physiotherapy, Motion Analysis Laboratory, Azienda Sanitaria di Firenze, Piero Palagi Hospital, Florence, Italy
| | - Marco Barbero
- Rehabilitation Research Laboratory, Department of Business Economics, Health and Social Care, Manno, Switzerland
| | - Roberto Gatti
- President of the Italian Society of Physiotherapy, Laboratory of Analysis and Rehabilitation of Motor Function, Neuroscience Division, San Raffaele Hospital, Milan, Italy
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139
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Darekar A, McFadyen BJ, Lamontagne A, Fung J. Efficacy of virtual reality-based intervention on balance and mobility disorders post-stroke: a scoping review. J Neuroeng Rehabil 2015; 12:46. [PMID: 25957577 PMCID: PMC4425869 DOI: 10.1186/s12984-015-0035-3] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 04/13/2015] [Indexed: 02/04/2023] Open
Abstract
Rehabilitation interventions involving virtual reality (VR) technology have been developed for the promotion of functional independence post stroke. A scoping review was performed to examine the efficacy of VR-based interventions on balance and mobility disorders post stroke. Twenty-four articles in the English language examining VR game-based interventions and outcomes directed at balance and mobility disorders were included. Various VR systems (customized and commercially available) were used as rehabilitation tools. Outcome measures included laboratory and clinical measures of balance and gait. Outcome measures of dynamic balance showed significant improvements following VR-based interventions as compared to other interventions. Further, it was observed that VR-based intervention may have favorable effects in improving walking speed and the ability to deal with environmental challenges, which may also facilitate independent community ambulation. VR-based therapy thus has the potential to be a useful tool for balance and gait training for stroke rehabilitation. Utilization of motor learning principles related to task-related training may have been an important factor leading to positive results. Other principles such as repetition, feedback etc. were used in studies but were not explored explicitly and may need to be investigated to further improve the strength of results. Lastly, robust study designs with appropriate attention towards the intensity and dose-response aspects of VR training, clear study objectives and suitable outcomes would further aid in determining evidence-based efficacy for VR game-based interventions in the future.
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Affiliation(s)
- Anuja Darekar
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
| | - Bradford J McFadyen
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) at the Quebec Rehabilitation Institute and Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec, Canada.
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada. .,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), Laval, Quebec, Canada.
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140
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. PRIMARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. SECONDARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. MAIN RESULTS We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOME results were statistically significant for upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49 based on 12 studies with 397 participants). SECONDARY OUTCOMES there were no statistically significant effects for grip strength, gait speed or global motor function. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.43, 95% CI 0.18 to 0.69 based on eight studies with 253 participants); however, we were unable to pool results for cognitive function, participation restriction, quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 26% of participants screened were recruited. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Susie Thomas
- University of South Australia (City East)International Centre for Allied Health Evidence (iCAHE)GPO Box 2471AdelaideAustralia5000
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkUSA
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
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