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Zhang C, Yu S. The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review. Games Health J 2024; 13:215-233. [PMID: 39159237 DOI: 10.1089/g4h.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Virtual reality (VR) technology has experienced a steady rise and has been widely applied in the field of rehabilitation. The integration of VR technology in rehabilitation has shown promising results in enhancing their motivation for treatment, thereby enabling patients to actively engage in rehab training. Despite the advancement, there is a dearth of comprehensive summary and analysis on the use of VR technology to enhance patient motivation in rehabilitation. Thus, this narrative review aims to evaluate the potential of VR technology in enhancing patient motivation during motor rehabilitation training. This review commences with an explanation of how enhancing motivation through the VR rehabilitation system could improve the efficiency and effectiveness of rehabilitation training. Then, the technology was analyzed to improve patient motivation in the present VR rehabilitation system in detail. Furthermore, these technologies are classified and summarized to provide a comprehensive overview of the state-of-the-art approaches for enhancing patient motivation in VR rehabilitation. Findings showed VR rehabilitation training utilizes game-like exercises to enhance the engagement and enjoyment of rehabilitation training. By immersing patients in a simulated environment with multisensory feedback, VR systems offer a unique approach to rehabilitation that can lead to improved patient motivation. Both ultimately lead to improved patient outcomes, which is not typically achievable with traditional rehabilitation methods. The review concludes that VR rehabilitation presents an opportunity to improve patient motivation and adherence to long-term rehabilitation training. However, to further enhance patient self-efficacy, VR rehabilitation should integrate psychology and incorporate methods. Moreover, it is necessary to build a game design theory for rehabilitation games, and the latest VR feedback technology should also be introduced.
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Affiliation(s)
- Chengjie Zhang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
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Victor BA, R A, Angel I S, Kumar B G. Enhancing Dynamic Balance and Postural Stability in Stroke Patients: The Impact of Immersive Virtual Reality Training. Cureus 2024; 16:e66299. [PMID: 39238751 PMCID: PMC11376469 DOI: 10.7759/cureus.66299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction Stroke is a major neurological event resulting from reduced or blocked blood flow to the brain, leading to significant morbidity. Immediate medical attention is essential to minimize brain damage and improve outcomes since it leads to many clinical deficits like locomotor impairment, instability in postural control, tonic alterations of the affected musculature, and an array of neurological dysfunctions if left unnoticed. Immersive virtual reality (VR) has emerged as a novel therapeutic tool in stroke rehabilitation, offering engaging and realistic environments for therapy. This study aims to evaluate the effectiveness of immersive VR training combined with functional gait exercises in improving dynamic balance and postural stability in stroke patients, compared to VR training alone. Methods This comparative study included 30 subjects from Madha Medical College and Hospital, Chennai, Tamil Nadu, India, divided into two groups. Group A (n=15) received immersive VR combined with functional gait exercises, while Group B (n=15) received immersive VR alone. Subjects were aged 40-60 years with stable blood pressure and a stroke duration of two weeks to six months. The study spanned 12 weeks, with 30-minute sessions on alternate days. Dynamic balance and postural stability were assessed using the Functional Gait Assessment (FGA) and Falls Efficacy Scale (FES). Pre-test and post-test scores were evaluated using parametric tests. Results Post-test mean values showed significant improvements in both groups. Group A demonstrated greater effectiveness, with lower FES scores (mean 36.66 ± 11.12) than Group B (mean 46.66 ± 9.75). FGA scores were higher in Group A (mean 28.00 ± 0.925) compared to Group B (mean 26.06 ± 1.66). Significant differences were observed in pre-test and post-test values within each group, supporting the hypothesis that combined VR and gait exercises offer superior rehabilitation outcomes. Conclusions Immersive VR combined with functional gait exercises significantly improves dynamic balance and postural stability in stroke patients compared to VR alone. This integrated approach can enhance motor function recovery, increase independence, and improve the quality of life. VR's capability to simulate real-life activities and provide immediate feedback allows for personalized rehabilitation programs. Further research is required to validate these findings and optimize VR-based rehabilitation protocols.
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Affiliation(s)
| | - Arunachalam R
- Neuro Physiotherapy, Madhav University, Pindwara, IND
| | - Sheela Angel I
- Neuro Physiotherapy, Vels Institute of Science, Technology & Advanced Studies, Chennai, IND
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Adham A, Le BT, Bonnal J, Bessaguet H, Ojardias E, Giraux P, Auzou P. Neural basis of lower-limb visual feedback therapy: an EEG study in healthy subjects. J Neuroeng Rehabil 2024; 21:114. [PMID: 38978051 PMCID: PMC11229246 DOI: 10.1186/s12984-024-01408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/20/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Video-feedback observational therapy (VOT) is an intensive rehabilitation technique based on movement repetition and visualization that has shown benefits for motor rehabilitation of the upper and lower limbs. Despite an increase in recent literature on the neurophysiological effects of VOT in the upper limb, there is little knowledge about the cortical effects of visual feedback therapies when applied to the lower limbs. The aim of our study was to better understand the neurophysiological effects of VOT. Thus, we identified and compared the EEG biomarkers of healthy subjects undergoing lower limb VOT during three tasks: passive observation, observation and motor imagery, observation and motor execution. METHODS We recruited 38 healthy volunteers and monitored their EEG activity while they performed a right ankle dorsiflexion task in the VOT. Three graded motor tasks associated with action observation were tested: action observation alone (O), motor imagery with action observation (OI), and motor execution synchronized with action observation (OM). The alpha and beta event-related desynchronization (ERD) and event-related synchronization (or beta rebound, ERS) rhythms were used as biomarkers of cortical activation and compared between conditions with a permutation test. Changes in connectivity during the task were computed with phase locking value (PLV). RESULTS During the task, in the alpha band, the ERD was comparable between O and OI activities across the precentral, central and parietal electrodes. OM involved the same regions but had greater ERD over the central electrodes. In the beta band, there was a gradation of ERD intensity in O, OI and OM over central electrodes. After the task, the ERS changes were weak during the O task but were strong during the OI and OM (Cz) tasks, with no differences between OI and OM. CONCLUSION Alpha band ERD results demonstrated the recruitment of mirror neurons during lower limb VOT due to visual feedback. Beta band ERD reflects strong recruitment of the sensorimotor cortex evoked by motor imagery and action execution. These results also emphasize the need for an active motor task, either motor imagery or motor execution task during VOT, to elicit a post-task ERS, which is absent during passive observation. Trial Registration NCT05743647.
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Affiliation(s)
- Ahmed Adham
- Department of Physical Rehabilitation, CHU of St Etienne, Saint-Étienne, France.
- Laboratory Trajectoires, INSERM 1028, CNRS 5229, University of Lyon-St-Etienne, Saint-Étienne, France.
- Univ. Grenoble Alpes, CEA, LETI, Clinatec, Grenoble, France.
| | - Ba Thien Le
- Department of Neurology, CHU of Orleans, Orleans, France
| | - Julien Bonnal
- Department of Neurology, CHU of Orleans, Orleans, France
| | - Hugo Bessaguet
- Department of Physical Rehabilitation, CHU of St Etienne, Saint-Étienne, France
- Jean Monnet University, Lyon 1, Université Savoie Mont-Blanc, "Laboratoire Inter-Universitaire de Biologie de La Motricité", 42023, Saint-Étienne, France
| | - Etienne Ojardias
- Department of Physical Rehabilitation, CHU of St Etienne, Saint-Étienne, France
- Jean Monnet University, Lyon 1, Université Savoie Mont-Blanc, "Laboratoire Inter-Universitaire de Biologie de La Motricité", 42023, Saint-Étienne, France
| | - Pascal Giraux
- Department of Physical Rehabilitation, CHU of St Etienne, Saint-Étienne, France
- Laboratory Trajectoires, INSERM 1028, CNRS 5229, University of Lyon-St-Etienne, Saint-Étienne, France
| | - Pascal Auzou
- Department of Neurology, CHU of Orleans, Orleans, France
- "Laboratoire Interdisciplinaire d'innovation et de Recherche en Santé d'Orléans", LI2RSO, University of Orleans, Orleans, France
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Matys-Popielska K, Popielski K, Sibilska-Mroziewicz A. Study of the Possibility of Using Virtual Reality Application in Rehabilitation among Elderly Post-Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2024; 24:2745. [PMID: 38732851 PMCID: PMC11086137 DOI: 10.3390/s24092745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact (p = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.
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Affiliation(s)
- Katarzyna Matys-Popielska
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, Poland;
| | - Krzysztof Popielski
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, Poland;
| | - Anna Sibilska-Mroziewicz
- Institute of Micromechanics and Photonics, Warsaw University of Technology, 02-525 Warsaw, Poland;
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Kwon IH, Shin WS, Choi KS, Lee MS. Effects of Real-Time Feedback Methods on Static Balance Training in Stroke Patients: A Randomized Controlled Trial. Healthcare (Basel) 2024; 12:767. [PMID: 38610189 PMCID: PMC11011765 DOI: 10.3390/healthcare12070767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effects of real-time feedback methods on static balance training in stroke patients. There are two types of real-time feedback methods, as follows: one is Knowledge of Result (KR), and the other is Knowledge of Performance (KP). METHOD Thirty stroke patients participated in this study and were randomly assigned to the KR group (n = 15) or the KP group (n = 15). All of the groups underwent real-time feedback training for four weeks (30 min per session, five sessions per week). The primary outcomes were sway length, sway velocity, and area 95%, which were assessed before and after the intervention. The secondary outcomes included the Berg Balance Scale, the Fugl Meyer Assessment for Lower Extremity, the Postural Assessment Scale for Stroke Trunk Impairment Scale, and the Fall Efficacy Scale. A group × time interaction was assessed using two-way ANOVA with repeated measures. RESULT There was a significant increase over time in all outcomes (p < 0.05). Significant differences were observed for a group × time interaction in sway length and area 95% (p < 0.05). CONCLUSIONS Real-time feedback training for static balance enhanced stroke patients' static balance abilities, clinical outcome assessments, and promoted self-efficacy against falls.
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Affiliation(s)
- Il-Ho Kwon
- Department of Physical Therapy, Graduate School of Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
| | - Won-Seob Shin
- Department of Physical Therapy, College of Health Medical Science, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea
| | - Kyu-Seong Choi
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
| | - Myung-Sun Lee
- Department of Beauty Design, College of Design and Art, Daejeon University, 62, Daehak-ro, Dong-gu, Daejeon 34520, Republic of Korea;
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Bajuaifer S, Grey MJ, Hancock NJ, Chandler E, Pomeroy VM. Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study. Physiotherapy 2024; 122:30-39. [PMID: 38237263 DOI: 10.1016/j.physio.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Mirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. OBJECTIVE identify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy DESIGN: 3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SETTING Participants' homes (intervention) and a movement analysis laboratory (measures). PARTICIPANTS Adults discharged from statutory stroke rehabilitation services. INTERVENTION Mirror movement therapy ankle exercises. OUTCOME MEASURES Motricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). RESULTS Five cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped CONCLUSION: The identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. CLINICAL TRIAL REGISTRATION NUMBER NCT04339803 (ClinicalTrials.gov) CONTRIBUTION OF THE PAPER: This early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.
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Bateni H, Carruthers J, Mohan R, Pishva S. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabil Res Pract 2024; 2024:1122286. [PMID: 38304610 PMCID: PMC10834096 DOI: 10.1155/2024/1122286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 02/03/2024] Open
Abstract
Within the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required.
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Affiliation(s)
- Hamid Bateni
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Jenna Carruthers
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Rebecca Mohan
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Seyedamirhossein Pishva
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO 64106, USA
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Sultan N, Khushnood K, Qureshi S, Altaf S, Khan MK, Malik AN, Mehmood R, Awan MMA. Effects of Virtual Reality Training Using Xbox Kinect on Balance, Postural Control, and Functional Independence in Subjects with Stroke. Games Health J 2023; 12:440-444. [PMID: 37327375 DOI: 10.1089/g4h.2022.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
Purpose: To determine the effects of virtual reality training using Xbox Kinect on balance, postural control, and functional independence in subjects with stroke. Methods: The parallel double-blind randomized control trial was conducted on 41 individuals based on selection criteria. Participants were divided into two groups by concealed envelope method. Intervention group received exergaming by Xbox Kinect, and control group was given exercises comprising balance training, upper limb strengthening, and core strengthening. Berg balance scale (BBS), functional independence measure (FIM), trunk impairment scale (TIS), and timed up and go (TUG) were the outcome measures. Data were analyzed using SPSS v21. Results: Mean age of the participants of Xbox and exercise group were 58.6 ± 3.3 and 58.1 ± 4.3 years, respectively. Within group improvement was observed in both groups from baseline to 8 weeks postintervention; BBS: 34 ± 4.7 to 40.9 ± 4.9 in intervention group and 34.1 ± 4.4 to 38.1 ± 7.6 in control group, TUG: 25.6 ± 3.9 to 21.4 ± 3.8 and 28.6 ± 5.0 to 25.9 ± 4.7, TIS: 15.2 ± 1.8 to 19.2 ± 1.3 and 13.2 ± 1.7 to 15.3 ± 1.6 and FIM: 58.7 ± 7.7 to 52.5 ± 7.8 and 66.2 ± 7.6 to 62.6 ± 7.2 in intervention and control group, respectively. Between group improvement was observed in TUG, TIS, and FIM in experimental group with P-values 0.003, <0.001, and <0.001, respectively. Conclusions: Wii Fit improved functional mobility, independence, and trunk coordination extension in the stroke patients, whereas balance could be equally improved from Wii Fit and exercises. Trial Registration Number: ACTRN12619001688178.
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Affiliation(s)
- Nasir Sultan
- Department of Physical Therapy, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Kiran Khushnood
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Sidra Qureshi
- Foundation University College of Physical Therapy, Foundation University Islamabad, Pakistan
| | - Shafaq Altaf
- Department of Physical Therapy, Shifa Tameer-e-Millat University, Islamabad, Pakistan. School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Kashif Khan
- Shifa Department of Rehabilitation, Shifa International Hospital, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Riafat Mehmood
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Malik Muhammad Ali Awan
- Faculty of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
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Krishnan S, Mandala MA, Wolf SL, Howard A, Kesar TM. Perceptions of stroke survivors regarding factors affecting adoption of technology and exergames for rehabilitation. PM R 2023; 15:1403-1410. [PMID: 36787167 DOI: 10.1002/pmrj.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 11/29/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Task-specific motor training and repetitive practice are essential components of clinical rehabilitation. Emerging evidence suggests that incorporating gaming interfaces (also referred to as "exergames"), including virtual reality and augmented reality (VR/AR)-based interfaces for motor training, can enhance the engagement and efficacy of poststroke rehabilitation. OBJECTIVE To investigate perceptions of individuals with stroke regarding technology and exergames for rehabilitation. DESIGN This qualitative phenomenological study included a convenience sample of 11 individuals with stroke (61.7 ± 12.4 years, 6 women and 5 men, 63.5 ± 41.2 months post stroke). SETTING Community. INTERVENTIONS N/A. OUTCOME MEASURES Semistructured open-ended focus-group interviews to understand their perceptions on technology and exergames to improve recovery were coded using thematic content analysis. RESULTS Individuals with stroke were comfortable using smartphones, computers, and rehabilitation technologies but had limited experiences using exergames and VR/AR devices. Individuals with stroke were motivated to use technologies and exergames to improve their functional recovery. Participants identified facilitators (eg, enhancing functional recovery, feedback, therapist supervision) and barriers (eg, safety, inaccessibility, inadequate knowledge) to adopting exergames in their daily lives. Participants wanted the exergames to be customizable, goal oriented, and enjoyable to maintain their engagement. They were willing to use exergames to improve their functional recovery but indicated that these games could not replace the therapist's supervision. CONCLUSIONS Despite having limited experiences with exergames, people post stroke perceived that exergames could promote functional recovery. The perspectives gained from the present study can inform user-centered game design for neurorehabilitation.
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Affiliation(s)
- Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mahender A Mandala
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Steven L Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Health Care Center
| | - Ayanna Howard
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
- The Ohio State University, College of Engineering, Columbus, Ohio, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Paolucci T, Agostini F, Mussomeli E, Cazzolla S, Conti M, Sarno F, Bernetti A, Paoloni M, Mangone M. A rehabilitative approach beyond the acute stroke event: a scoping review about functional recovery perspectives in the chronic hemiplegic patient. Front Neurol 2023; 14:1234205. [PMID: 37789885 PMCID: PMC10542412 DOI: 10.3389/fneur.2023.1234205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023] Open
Abstract
Background Stroke is a main cause of disability worldwide and its neuro-rehabilitative management is not limited to the acute phase but requires continuity in the rehabilitation approach especially in the chronic phase. The aim of this scoping review was to highlight the different treatment opportunities available in neurorehabilitation, effective for patients with chronic stroke sequelae, not only in terms of maintaining motor function but also improving it. Methods The literature search was conducted using the following databases: MEDLINE (PubMed), PEDro, Scopus, Web of Science (WOS), Cochrane from 2012 to February 2023. We selected Randomized Clinical Trials in English dealing with neurorehabilitation strategies in chronic hemiplegic patients after stroke focusing on motor function, muscular strength, gait, postural balance, spasticity, and quality of life. Results According to the inclusion criteria, 47 articles were selected for our review. All of them were analyzed following the primary outcome and the rehabilitation technique used. Despite the different protocols used within the same technique and despite the chronicity of the disease, all studies report an improvement after the rehabilitation treatment of motor function and quality of life. Conclusion The literature analyzed invites us to reflect respect to neurorehabilitation approach to the patient with chronic stroke sequelae often considered to have as its objective the maintenance of the present motor function and contain disability: instead, the review reports how, even in chronicity, the patient always reports margins of statistically and clinically significant improvement. The chronic stroke rehabilitation over 6 months has been proved effective in obtaining recovery in different settings.
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Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Science (DSMOB), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Elena Mussomeli
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Sara Cazzolla
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Conti
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francescapia Sarno
- Department of Medical, Oral and Biotechnological Science (DSMOB), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Andrea Bernetti
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
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Lyu T, Yan K, Lyu J, Zhao X, Wang R, Zhang C, Liu M, Xiong C, Liu C, Wei Y. Comparative efficacy of gait training for balance outcomes in patients with stroke: A systematic review and network meta-analysis. Front Neurol 2023; 14:1093779. [PMID: 37077566 PMCID: PMC10106590 DOI: 10.3389/fneur.2023.1093779] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/01/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundGrowing evidence suggests that gait training can improve stroke patients’ balance outcomes. However, it remains unclear which type of gait training is more effective in improving certain types of balance outcomes in patients with stroke. Thus, this network meta-analysis (NMA) included six types of gait training (treadmill, body-weight-supported treadmill, virtual reality gait training, robotic-assisted gait training, overground walking training, and conventional gait training) and four types of balance outcomes (static steady-state balance, dynamic steady-state balance, proactive balance, and balance test batteries), aiming to compare the efficacy of different gait training on specific types of balance outcomes in stroke patients and determine the most effective gait training.MethodWe searched PubMed, Embase, Medline, Web of Science, and Cochrane Library databases from inception until 25 April 2022. Randomized controlled trials (RCTs) of gait training for the treatment of balance outcomes after stroke were included. RoB2 was used to assess the risk of bias in the included studies. Frequentist random-effects network meta-analysis (NMA) was used to evaluate the effect of gait training on four categories of balance outcomes.ResultA total of 61 RCTs from 2,551 citations, encompassing 2,328 stroke patients, were included in this study. Pooled results showed that body-weight-support treadmill (SMD = 0.30, 95% CI [0.01, 0.58]) and treadmill (SMD = 0.25, 95% CI [0.00, 0.49]) could improve the dynamic steady-state balance. Virtual reality gait training (SMD = 0.41, 95% CI [0.10, 0.71]) and body-weight-supported treadmill (SMD = 0.41, 95% CI [0.02, 0.80]) demonstrated better effects in improving balance test batteries. However, none of included gait training showed a significant effect on static steady-state balance and proactive balance.ConclusionGait training is an effective treatment for improving stroke patients’ dynamic steady-state balance and balance test batteries. However, gait training had no significant effect on static steady-state balance and proactive balance. To achieve maximum efficacy, clinicians should consider this evidence when recommending rehabilitation training to stroke patients. Considering body-weight-supported treadmill is not common for chronic stroke patients in clinical practice, the treadmill is recommended for those who want to improve dynamic steady-state balance, and virtual reality gait training is recommended for those who want to improve balance test batteries.LimitationMissing evidence in relation to some types of gait training is supposed to be taken into consideration. Moreover, we fail to assess reactive balance in this NMA since few included trials reported this outcome.Systematic Review RegistrationPROSPERO, identifier CRD42022349965.
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Affiliation(s)
- Tianyi Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaxuan Lyu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xirui Zhao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ruoshui Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chaoyang Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Meng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Xiong
- L3 & Maintenance Solutions, SUSE Software (Beijing) Co., Ltd., Beijing, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People’s Hospital of Anhui Medical University, HeFei, Anhui, China
| | - Yulong Wei
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yulong Wei,
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Peláez-Vélez FJ, Eckert M, Gacto-Sánchez M, Martínez-Carrasco Á. Use of Virtual Reality and Videogames in the Physiotherapy Treatment of Stroke Patients: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4747. [PMID: 36981652 PMCID: PMC10049060 DOI: 10.3390/ijerph20064747] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
A stroke is a neurological condition with a high impact in terms of physical disability in the adult population, requiring specific and effective rehabilitative approaches. Virtual reality (VR), a technological approach in constant evolution, has great applicability in many fields of rehabilitation, including strokes. The aim of this study was to analyze the effects of a traditional neurological physiotherapy-based approach combined with the implementation of a specific VR-based program in the treatment of patients following rehabilitation after a stroke. Participants (n = 24) diagnosed with a stroke in the last six months were randomly allocated into a control group (n = 12) and an experimental group (n = 12). Both groups received one-hour sessions of neurological physiotherapy over 6 weeks, whilst the experimental group was, in addition, supplemented with VR. Patients were assessed through the Daniels and Worthingham Scale, Modified Ashworth Scale, Motor Index, Trunk Control Test, Tinetti Balance Scale, Berg Balance Scale and the Functional Ambulation Classification of the Hospital of Sagunto. Statistically significant improvements were obtained in the experimental group with respect to the control group on the Motricity Index (p = 0.005), Trunk Control Test (p = 0.008), Tinetti Balance Scale (p = 0.004), Berg Balance Scale (p = 0.007) and the Functional Ambulation Classification of the Hospital of Sagunto (p = 0.038). The use of VR in addition to the traditional physiotherapy approach is a useful strategy in the treatment of strokes.
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Affiliation(s)
- Francisco-Javier Peláez-Vélez
- Doctoral Program in Health, Disability, Dependency and Wellness, Campus de Ciencias de la Salud, University of Murcia, 30120 Murcia, Spain
| | - Martina Eckert
- Group on Acoustics and MultiMedia Applications (GAMMA), Centro de Investigación en Tecnologías Software y Sistemas Multimedia Para la Sostenibilidad (CITSEM), Universidad Politécnica de Madrid (UPM), 28031 Madrid, Spain
| | - Mariano Gacto-Sánchez
- Department of Physiotherapy, Campus de Ciencias de la Salud, University of Murcia, 30120 Murcia, Spain
| | - Ángel Martínez-Carrasco
- Department of Physiotherapy, Campus de Ciencias de la Salud, University of Murcia, 30120 Murcia, Spain
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13
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Mohammed AH, El-Serougy HR, Karim AEA, Sakr M, Sheha SM. Correlation between Selective Motor Control of the Lower Extremities and Balance in Spastic Hemiplegic Cerebral Palsy: a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:24. [PMID: 36872326 PMCID: PMC9987100 DOI: 10.1186/s13102-023-00636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) have motor deficits caused by spasticity, weakness, contractures, diminished selective motor control (SMC), and poor balance. The purpose of the current study was to evaluate the influence of mirror feedback on lower extremity selective motor control and balance in children with hemiplegic cerebral palsy. Understanding the relationship between SMC and balance will help children with hemiplegic CP receive more appropriate therapies. METHODS Forty-seven children of both sexes diagnosed with hemiplegic CP participated in the study. Group1 (Gr1 - control group) received conventional physical therapy training while group 2 (Gr2 - intervention group) received conventional physical therapy training in addition to bilateral lower extremity mirror therapy (MT). The primary outcome measure used was Selective Control Assessment of Lower Extremity scale (SCALE), while the secondary outcome measure was the Pediatric Balance Scale (PBS). RESULTS There were significant differences in Selective Control Assessment of Lower Extremity Scale (SCALE) and Pediatric Balance Scale (PBS) between both groups in favor of Gr2. After treatment, both groups improved significantly, yet Gr2 outperformed Gr1 by a large margin. CONCLUSION Mirror therapy may be a useful addition to home-based motor interventions for children with hemiplegic CP due to its relative simplicity, low cost, and high patient adherence. Additionally, it may help children improve their selective motor skills and balance. TRIAL REGISTRATION Current Controlled Trials using African Clinical Trials Registry website with ID number PACTR202105604636415 retrospectively registered on 21/01/202.
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Affiliation(s)
- Amira H Mohammed
- Department of Physical Therapy for Pediatric and its Surgery, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Hager R El-Serougy
- Department of Physical Therapy for Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt.
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
| | - Mohamad Sakr
- Department of Neurology, College of Medicine, Misr University for Science and Technology, 77, Giza, Egypt
| | - Samah M Sheha
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
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14
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Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation - a systematic review and meta-analysis. Top Stroke Rehabil 2023; 30:53-72. [PMID: 34747351 DOI: 10.1080/10749357.2021.1990468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a neurological disorder and one of the leading causes of disability worldwide. The patient may lose the ability to adequately move the extremities, perceive sensations, or ambulate independently. Recent experimental studies have reported the beneficial influence of virtual reality training strategies on improving overall functional abilities for stroke survivors. METHODS Conducted a systematic review of the literature using the following keywords to retrieve the data: stroke, virtual reality, motor deficits, neurorehabilitation, cognitive impairments, and sensory deficits. A random-effect meta-analysis was performed for seven scales - one cognitive (MMSE) and six motor (Fugl-Meyer, Berg Balance Scale, Time up and go, Wolf motor function, 10 m walk, Brunnstrom score). OBJECTIVE To organize and compare all the available data regarding the effectiveness of virtual reality for stroke rehabilitation. RESULTS This literature reviewed 150 studies and included 46 for qualitative and 27 for quantitative analysis. There was no statistically significant difference between groups in MMSE score (MD = 0.24, 95%CI = ((-0.42) -(0.9)), p = .47, I2 = 0%) and Fugl-Meyer score (MD = (-0.38), 95%CI = ((-12.88)-(12.11)), p = .95, I2 = 98%) . The statistical significance was not reached in any of the other outcomes. CONCLUSIONS This review supports that stroke rehabilitation programs incorporating virtual reality are associated with improved functional outcomes, but there is no statistically significant difference compared to standard therapy.
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Affiliation(s)
- Azka Khan
- Faculty of Rehabilitation and Allied Health Sciences Islamabad, Riphah International University, Rawalpindi, Pakistan
| | - Anna Podlasek
- Neuroscience and Vascular Simulation, School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK.,Nihr Nottingham Brc, University of Nottingham, Nottingham, UK.,Clinical Radiology,Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fahad Somaa
- King Abdulaziz University,Occupational Therapy Department, Faculty of Medical Rehabilitation Sciences, King AbdulAziz University Jeddah, Saudi, Arabia
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15
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Annaswamy TM, Bahirat K, Raval G, Chung YY, Pham T, Prabhakaran B. Clinical feasibility and preliminary outcomes of a novel mixed reality system to manage phantom pain: a pilot study. Pilot Feasibility Stud 2022; 8:232. [PMID: 36273191 PMCID: PMC9588245 DOI: 10.1186/s40814-022-01187-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background To assess the clinical feasibility of a virtual mirror therapy system in a pilot sample of patients with phantom pain. Methods Our Mixed reality system for Managing Phantom Pain (Mr. MAPP) mirrors the preserved limb to visualize the amputated limb virtually and perform exercises. Seven patients with limb loss and phantom pain agreed to participate and received the system for 1-month home use. Outcome measures were collected at baseline and 1 month. Results Four (of seven recruited) participants completed the study, which was temporarily suspended due to COVID-19 restrictions. At 1 month, in-game data showed a positive trend, but pain scores showed no clear trends. Functioning scores improved for 1 participant. Conclusions Mr. MAPP is feasible and has the potential to improve pain and function in patients with phantom pain. Trial registration Clinical Trials Registration, NCT04529083 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01187-w.
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Affiliation(s)
- Thiru M Annaswamy
- Department of Physical Medicine & Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA. .,Penn State Health Rehabilitation Hospital, Hummelstown, PA, USA.
| | | | - Gargi Raval
- Physical Medicine & Rehabilitation Service, VA North Texas Health Care System, Dallas, USA
| | - Yu Yen Chung
- Department of Computer Science, UT Dallas, Dallas, TX, USA
| | - Tri Pham
- UT Southwestern Medical School, Dallas, TX, USA
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16
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Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment. Rehabil Nurs 2022; 47:202-209. [PMID: 36210496 DOI: 10.1097/rnj.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001). CONCLUSION Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.
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17
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Bian M, Shen Y, Huang Y, Wu L, Wang Y, He S, Huang D, Mao Y. A non-immersive virtual reality-based intervention to enhance lower-extremity motor function and gait in patients with subacute cerebral infarction: A pilot randomized controlled trial with 1-year follow-up. Front Neurol 2022; 13:985700. [PMID: 36267888 PMCID: PMC9577285 DOI: 10.3389/fneur.2022.985700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction This study was conducted to evaluate whether a non-immersive virtual reality (VR)-based intervention can enhance lower extremity movement in patients with cerebral infarction and whether it has greater short-term and long-term effectiveness than conventional therapies (CTs). Materials and methods This was a single-blinded, randomized clinical controlled trial. Forty-four patients with subacute cerebral infarction were randomly allocated to the VR or CT group. All intervention sessions were delivered in the inpatient unit for 3 weeks. Outcomes were measured before (baseline) and after the interventions and at 3-month, 6-month and 1-year follow-ups. The outcomes included clinical assessments of movement and balance function using the Fugl–Meyer Assessment of Lower Extremity (FMA-LE) and Berg Balance Scale (BBS), and gait parameters in the sagittal plane. Results In the VR group, the walking speed after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater than baseline (p = 0.01, <0.001, 0.007, and <0.001, respectively). Compared with baseline, BBS scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significantly greater in both the VR group (p = 0.006, 0.002, <0.001, and <0.001, respectively) and CT group (p = <0.001, 0.002, 0.001, and <0.001, respectively), while FMA-LE scores after intervention, at 3-month, 6-month, and 1-year follow-ups were significant increased in the VR group (p = 0.03, <0.001, 0.003, and <0.001, respectively), and at 3-month, 6-month, and 1-year follow-ups in the CT group (p = 0.02, 0.004 and <0.001, respectively). In the VR group, the maximum knee joint angle in the sagittal plane enhanced significantly at 6-month follow-up from that at baseline (p = 0.04). Conclusion The effectiveness of the non-immersive VR-based intervention in our study was observed after the intervention and at the follow-ups, but it was not significantly different from that of CTs. In sum, our results suggest that non-immersive VR-based interventions may thus be a valuable addition to conventional physical therapies to enhance treatment efficacy. Clinical trial registration http://www.chictr.org.cn/showproj.aspx?proj=10541, ChiCTR-IOC-15006064.
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Affiliation(s)
- Minjie Bian
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yuxian Shen
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yijie Huang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lishan Wu
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yueyan Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Suyue He
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Dongfeng Huang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
- *Correspondence: Dongfeng Huang
| | - Yurong Mao
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Guangzhou, China
- Yurong Mao
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18
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Isenstein EL, Waz T, LoPrete A, Hernandez Y, Knight EJ, Busza A, Tadin D. Rapid assessment of hand reaching using virtual reality and application in cerebellar stroke. PLoS One 2022; 17:e0275220. [PMID: 36174027 PMCID: PMC9522266 DOI: 10.1371/journal.pone.0275220] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022] Open
Abstract
The acquisition of sensory information about the world is a dynamic and interactive experience, yet the majority of sensory research focuses on perception without action and is conducted with participants who are passive observers with very limited control over their environment. This approach allows for highly controlled, repeatable experiments and has led to major advances in our understanding of basic sensory processing. Typical human perceptual experiences, however, are far more complex than conventional action-perception experiments and often involve bi-directional interactions between perception and action. Innovations in virtual reality (VR) technology offer an approach to close this notable disconnect between perceptual experiences and experiments. VR experiments can be conducted with a high level of empirical control while also allowing for movement and agency as well as controlled naturalistic environments. New VR technology also permits tracking of fine hand movements, allowing for seamless empirical integration of perception and action. Here, we used VR to assess how multisensory information and cognitive demands affect hand movements while reaching for virtual targets. First, we manipulated the visibility of the reaching hand to uncouple vision and proprioception in a task measuring accuracy while reaching toward a virtual target (n = 20, healthy young adults). The results, which as expected revealed multisensory facilitation, provided a rapid and a highly sensitive measure of isolated proprioceptive accuracy. In the second experiment, we presented the virtual target only briefly and showed that VR can be used as an efficient and robust measurement of spatial memory (n = 18, healthy young adults). Finally, to assess the feasibility of using VR to study perception and action in populations with physical disabilities, we showed that the results from the visual-proprioceptive task generalize to two patients with recent cerebellar stroke. Overall, we show that VR coupled with hand-tracking offers an efficient and adaptable way to study human perception and action.
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Affiliation(s)
- E. L. Isenstein
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
| | - T. Waz
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
| | - A. LoPrete
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
- Center for Neuroscience and Behavior, American University, Washington, DC, United States of America
- Bioengineering Graduate Group, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Y. Hernandez
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- The City College of New York, CUNY, New York, NY, United States of America
| | - E. J. Knight
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - A. Busza
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - D. Tadin
- Department of Brain and Cognitive Sciences, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Center for Visual Science, University of Rochester, Rochester, NY, United States of America
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
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Rentz C, Far MS, Boltes M, Schnitzler A, Amunts K, Dukart J, Minnerop M. System Comparison for Gait and Balance Monitoring Used for the Evaluation of a Home-Based Training. SENSORS (BASEL, SWITZERLAND) 2022; 22:4975. [PMID: 35808470 PMCID: PMC9269735 DOI: 10.3390/s22134975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
There are currently no standard methods for evaluating gait and balance performance at home. Smartphones include acceleration sensors and may represent a promising and easily accessible tool for this purpose. We performed an interventional feasibility study and compared a smartphone-based approach with two standard gait analysis systems (force plate and motion capturing systems). Healthy adults (n = 25, 44.1 ± 18.4 years) completed two laboratory evaluations before and after a three-week gait and balance training at home. There was an excellent agreement between all systems for stride time and cadence during normal, tandem and backward gait, whereas correlations for gait velocity were lower. Balance variables of both standard systems were moderately intercorrelated across all stance tasks, but only few correlated with the corresponding smartphone measures. Significant differences over time were found for several force plate and mocap system-obtained gait variables of normal, backward and tandem gait. Changes in balance variables over time were more heterogeneous and not significant for any system. The smartphone seems to be a suitable method to measure cadence and stride time of different gait, but not balance, tasks in healthy adults. Additional optimizations in data evaluation and processing may further improve the agreement between the analysis systems.
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Affiliation(s)
- Clara Rentz
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, 52428 Juelich, Germany; (K.A.); (M.M.)
| | - Mehran Sahandi Far
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Juelich, 52428 Juelich, Germany; (M.S.F.); (J.D.)
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Maik Boltes
- Institute for Advanced Simulation (IAS-7), Research Centre Juelich, 52428 Juelich, Germany;
| | - Alfons Schnitzler
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany;
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Katrin Amunts
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, 52428 Juelich, Germany; (K.A.); (M.M.)
- C. and O. Vogt Institute for Brain Research, Medical Faculty, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Juelich, 52428 Juelich, Germany; (M.S.F.); (J.D.)
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Martina Minnerop
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, 52428 Juelich, Germany; (K.A.); (M.M.)
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany;
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Duesseldorf, 40225 Duesseldorf, Germany
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Augenstein TE, Kortemeyer D, Glista L, Krishnan C. Enhancing Mirror Therapy via Scaling and Shared Control: A Novel Open-Source Virtual Reality Platform for Stroke Rehabilitation. VIRTUAL REALITY 2022; 26:525-538. [PMID: 35600315 PMCID: PMC9119151 DOI: 10.1007/s10055-021-00593-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/03/2021] [Indexed: 06/03/2023]
Abstract
Mirror therapy is increasingly used in stroke rehabilitation to improve functional movements of the affected limb. However, the extent of mirroring in conventional mirror therapy is typically fixed (1:1) and cannot be tailored based on the patient's impairment level. Further, the movements of the affected limb are not actively incorporated in the therapeutic process. To address these issues, we developed an immersive VR system using HTC Vive and Leap Motion, which communicates with our free and open-source software environment programmed using SteamVR and the Unity 3D gaming engine. The mirror therapy VR environment was incorporated with two novel features: (1) scalable mirroring and (2) shared control. In the scalable mirroring, mirror movements were programmed to be scalable between 0 and 1, where 0 represents no movements, 0.5 represents 50% mirroring, and 1 represents 100% mirroring. In shared control, the contribution of the mirroring limb to the movements was programmed to be scalable between 0 to 1, where 0 represents 100% contribution from the mirroring limb (i.e., no mirroring), 0.5 represents 50% of movements from the mirrored limb and 50% of movements from the mirroring limb, and 1 represents full mirroring (i.e., no shared movements). Validation experiments showed that these features worked appropriately. The proposed VR-based mirror therapy is the first fully developed system that is freely available to the rehabilitation science community. The scalable and shared control features can diversify mirror therapy and potentially augment the outcomes of rehabilitation, although this needs to be verified through future experiments.
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Affiliation(s)
- Thomas E. Augenstein
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Kortemeyer
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Lawrence Glista
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Neuromuscular and Rehabilitation Robotics Laboratory (NeuRRo Lab), Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
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21
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Mugisha S, Job M, Zoppi M, Testa M, Molfino R. Computer-Mediated Therapies for Stroke Rehabilitation: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2022; 31:106454. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 12/29/2022] Open
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22
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Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031525. [PMID: 35162546 PMCID: PMC8834834 DOI: 10.3390/ijerph19031525] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Health 4.0 aligns with Industry 4.0 and encourages the application of the latest technologies to healthcare. Virtual reality (VR) is a potentially significant component of the Health 4.0 vision. Though VR in health care is a popular topic, there is little knowledge of VR-aided therapy from a macro perspective. Therefore, this paper was aimed to explore the research of VR in aiding therapy, thus providing a potential guideline for futures application of therapeutic VR in healthcare towards Health 4.0. A mixed research method was adopted for this research, which comprised the use of a bibliometric analysis (a quantitative method) to conduct a macro overview of VR-aided therapy, the identification of significant research structures and topics, and a qualitative review of the literature to reveal deeper insights. Four major research areas of VR-aided therapy were identified and investigated, i.e., post-traumatic stress disorder (PTSD), anxiety and fear related disorder (A&F), diseases of the nervous system (DNS), and pain management, including related medical conditions, therapies, methods, and outcomes. This study is the first to use VOSviewer, a commonly used software tool for constructing and visualizing bibliometric networks and developed by Center for Science and Technology Studies, Leiden University, the Netherlands, to conduct bibliometric analyses on VR-aided therapy from the perspective of Web of Science core collection (WoSc), which objectively and visually shows research structures and topics, therefore offering instructive insights for health care stakeholders (particularly researchers and service providers) such as including integrating more innovative therapies, emphasizing psychological benefits, using game elements, and introducing design research. The results of this paper facilitate with achieving the vision of Health 4.0 and illustrating a two-decade (2000 to year 2020) map of pre-life of the Health Metaverse.
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Choe YW, Kim MK. Could Self-Control and Emotion Influence Physical Ability and Functional Recovery after Stroke? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1042. [PMID: 34684079 PMCID: PMC8540988 DOI: 10.3390/medicina57101042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: This study was conducted to determine whether self-control and emotions could influence patients' physical ability and functional recovery after stroke. Materials and Methods: Twenty-four patients within eight weeks after a stroke were included in this study (age: 54.04 ± 10.31; days after stroke: 42.66 ± 8.84). The subjects participated in tests at the baseline, four weeks later, and eight weeks later. Subjects were asked to complete the following: (1) self-control level test, (2) positive and negative emotion test, (3) knee muscle strength testing, (4) static balance test, (5) gait measurement, and (6) activities of daily living evaluation. Results: The muscle strength of the knee, static balance, gait ability, and the Functional Independence Measure score increased significantly in the stroke patients over time. A significant correlation was noted between the emotion and physical variables in stroke patients. The self-control level was significantly associated with the change in the physical variables in stroke patients over time. Conclusions: The self-control level was positively related to the increases in functional recovery of stroke patients with time, while the emotions were related more to the physical abilities.
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Affiliation(s)
- Yu-Won Choe
- Department of Rehabilitation Sciences, Graduate School, Daegu University, Jillyang, Gyeongsan 712-714, Korea;
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan 712-714, Korea
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24
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Raciti L, Calabrò RS. Neurological complications of COVID-19: from pathophysiology to rehabilitation. An overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021317. [PMID: 34487099 PMCID: PMC8477084 DOI: 10.23750/abm.v92i4.10620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate how the SARS-COV2 is able to affect the nervous system, the main neurological manifestation, and the treatment used, including neurorehabilitation. METHODS Studies performed during the current year that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "Covid 19," "rehabilitation/treatment," and "neurological complications." RESULTS The exact route by which SARS-CoV-2 can penetrate the CNS is still unknown, although a possible retrograde transynaptic pathway from peripheral nerve endings, and/or through the olfactory bulb, have been suggested. An early management of COVID-19 by a multiprofessional team is fundamental to avoid long term sequaele. Rehabilitation is recommended to improve respiratory and cardiac function, as well as to avoid long term neurological complications. CONCLUSIONS As no specific conclusions in term of prognosis and treatment could be done, research and consensus paper are needed to provide NeuroCovid patients with the best treatment options, including neurorehabilitation.
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25
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Chen Q, Shen W, Sun H, Shen D, Cai X, Ke J, Zhang L, Fang Q. Effects of mirror therapy on motor aphasia after acute cerebral infarction: A randomized controlled trial. NeuroRehabilitation 2021; 49:103-117. [PMID: 34180428 DOI: 10.3233/nre-210125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mirror therapy (MT) has proven to be beneficial for treating patients suffering from motor aphasia after stroke. However, the impacts of MT on neuroplasticity remain unexplored. OBJECTIVE In this paper we conducted a randomized controlled trial to evaluate the treatment using the MT on motor aphasia following acute cerebral infarction. METHODS We randomly assigned 30 patients into test and control groups, with test group patients treated with MT, whereas control group patients were treated with sham MT. At 24 hours prior to and after the intervention, we obtained functional magnetic resonance imaging (fMRI) data from study subjects. At baseline, after treatment and 12-week follow-up, we additionally evaluated patients with the Modified Rankin Scale (mRS), the National Institutes of Health Stroke Scale (NIHSS), and the aphasia quotient (AQ) in the western aphasia test. RESULTS After 2 weeks of treatment, the test group demonstrated significant improvements in AQ values, naming, repetition, spontaneous speech, and mRS scores compared to the control group (P < 0.05). Furthermore, in the follow-up time point (12 weeks), we found that the test group exhibited significantly better NIHSS scores and AQ evaluation indicators than the control group (P < 0.05). Specifically, the fMRI study shows that functional connectivity significantly improved in test group patients mainly among frontal, temporal, and parietal lobes of the left hemisphere with each other than controls group. Meanwhile, we found significantly enhanced functional connectivity with the hippocampus (P < 0.01). CONCLUSIONS Our results indicate that the MT can expedite the recovery of language function during the early phases of stroke recovery. These findings may elucidate the underlying mechanism of MT and the application of this therapy as an adjunct rehabilitation technique in language recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Physical Medicine & Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Dan Shen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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26
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Amirthalingam J, Paidi G, Alshowaikh K, Iroshani Jayarathna A, Salibindla DBAMR, Karpinska-Leydier K, Ergin HE. Virtual Reality Intervention to Help Improve Motor Function in Patients Undergoing Rehabilitation for Cerebral Palsy, Parkinson's Disease, or Stroke: A Systematic Review of Randomized Controlled Trials. Cureus 2021; 13:e16763. [PMID: 34367835 PMCID: PMC8343554 DOI: 10.7759/cureus.16763] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
Abstract
There are many successful interventions in medicine, especially in neurology and rehabilitation. The neurosciences represent an area of medicine with tremendous recent research innovations, one of which is virtual reality. This paper aims to discover the powerful relationship between virtual reality and rehabilitation. We assessed the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation on motor function recovery of three patient groups: patients with a diagnosis of cerebral palsy, Parkinson's disease, or stroke. We conducted a systematic review using PubMed and included only articles that were randomized controlled trials that were published in the last five years. We used a general search in combination with a more focused Medical Subject Headings (MeSH) search. After thorough assessment and risk of bias evaluation using the Cochrane risk of bias tool, we included thirteen studies in this review. The majority of the clinical trials showed a statistically significant effect for improved motor function. More specifically, improvements in upper extremity motor function, gait, and balance in patients diagnosed with stroke were seen. Similarly, when evaluating patients with Parkinson's disease, improved gait and posture were also seen. When it came to cerebral palsy, however, there were no significant differences between the experimental group and the control. The level of improvement in motor function with a virtual reality intervention was striking, particularly since a few studies demonstrated sustained motor improvement a few months post-trial as well. Virtual reality-based rehabilitation has promising results for adult patients diagnosed with stroke or Parkinson's disease. For pediatric patients, on the other hand, a larger number of clinical trials would still need to be conducted to validate if virtual reality interventions have the capability of providing improved motor function recovery.
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Affiliation(s)
- Jashvini Amirthalingam
- General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gokul Paidi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Khadija Alshowaikh
- Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | | | | | - Huseyin Ekin Ergin
- General Practice, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Cai H, Lin T, Chen L, Weng H, Zhu R, Chen Y, Cai G. Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial. Trials 2021; 22:91. [PMID: 33494805 PMCID: PMC7836462 DOI: 10.1186/s13063-021-05031-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 01/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high incidence of cerebral apoplexy makes it one of the most important causes of adult disability. Gait disorder is one of the hallmark symptoms in the sequelae of cerebral apoplexy. The recovery of walking ability is critical for improving patients' quality of life. Innovative virtual reality technology has been widely used in post-stroke rehabilitation, whose effectiveness and safety have been widely verified. To date, however, there are few studies evaluating the effect of immersive virtual reality on stroke-related gait rehabilitation. This study outlines the application of immersive VR-assisted rehabilitation for gait rehabilitation of stroke patients for comparative evaluation with traditional rehabilitation. METHODS The study describes a prospective, randomized controlled clinical trial. Thirty-six stroke patients will be screened and enrolled as subjects within 1 month of initial stroke and randomized into two groups. The VRT group (n = 18) will receive VR-assisted training (30 min) 5 days/week for 3 weeks. The non-VRT group (n = 18) will receive functional gait rehabilitation training (30 min) 5 days/week for 3 weeks. The primary outcomes and secondary outcomes will be conducted before intervention, 3 weeks after intervention, and 6 months after intervention. The primary outcomes will include time "up & go" test (TUGT). The secondary outcomes will include MMT muscle strength grading standard (MMT), Fugal-Meyer scale (FMA), motor function assessment scale (MAS), improved Barthel index scale (ADL), step with maximum knee angle, total support time, step frequency, step length, pace, and stride length. DISCUSSION Virtual reality is an innovative technology with broad applications, current and prospective. Immersive VR-assisted rehabilitation in patients with vivid treatment scenarios in the form of virtual games will stimulate patients' interest through active participation. The feedback of VR games can also provide patients with performance awareness and effect feedback, which could be incentivizing. This study may reveal an improved method of stroke rehabilitation which can be helpful for clinical decision-making and future practice. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR1900025375 . Registered on 25 August 2019.
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Affiliation(s)
- Huihui Cai
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Tao Lin
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Department of Clinical Medicine, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Lina Chen
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Huidan Weng
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Ruihan Zhu
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Ying Chen
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China.
| | - Guoen Cai
- Department of Neurology, Fujian Medical University Union Hospital, Institute of Clinical Neurology, Fujian Medical University, Fuzhou, 350001, Fujian, China.
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28
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Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther 2021; 44:49-100. [PMID: 31834165 DOI: 10.1097/npt.0000000000000303] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with acute-onset central nervous system (CNS) injury, including stroke, motor incomplete spinal cord injury, or traumatic brain injury, often experience lasting locomotor deficits, as quantified by decreases in gait speed and distance walked over a specific duration (timed distance). The goal of the present clinical practice guideline was to delineate the relative efficacy of various interventions to improve walking speed and timed distance in ambulatory individuals greater than 6 months following these specific diagnoses. METHODS A systematic review of the literature published between 1995 and 2016 was performed in 4 databases for randomized controlled clinical trials focused on these specific patient populations, at least 6 months postinjury and with specific outcomes of walking speed and timed distance. For all studies, specific parameters of training interventions including frequency, intensity, time, and type were detailed as possible. Recommendations were determined on the basis of the strength of the evidence and the potential harm, risks, or costs of providing a specific training paradigm, particularly when another intervention may be available and can provide greater benefit. RESULTS Strong evidence indicates that clinicians should offer walking training at moderate to high intensities or virtual reality-based training to ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. In contrast, weak evidence suggests that strength training, circuit (ie, combined) training or cycling training at moderate to high intensities, and virtual reality-based balance training may improve walking speed and distance in these patient groups. Finally, strong evidence suggests that body weight-supported treadmill training, robotic-assisted training, or sitting/standing balance training without virtual reality should not be performed to improve walking speed or distance in ambulatory individuals greater than 6 months following acute-onset CNS injury to improve walking speed or distance. DISCUSSION The collective findings suggest that large amounts of task-specific (ie, locomotor) practice may be critical for improvements in walking function, although only at higher cardiovascular intensities or with augmented feedback to increase patient's engagement. Lower-intensity walking interventions or impairment-based training strategies demonstrated equivocal or limited efficacy. LIMITATIONS As walking speed and distance were primary outcomes, the research participants included in the studies walked without substantial physical assistance. This guideline may not apply to patients with limited ambulatory function, where provision of walking training may require substantial physical assistance. SUMMARY The guideline suggests that task-specific walking training should be performed to improve walking speed and distance in those with acute-onset CNS injury although only at higher intensities or with augmented feedback. Future studies should clarify the potential utility of specific training parameters that lead to improved walking speed and distance in these populations in both chronic and subacute stages following injury. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for persons with chronic stroke, incomplete spinal cord injury, and traumatic brain injury to improve walking speed and distance.
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Szczepańska-Gieracha J, Cieślik B, Rutkowski S, Kiper P, Turolla A. What can virtual reality offer to stroke patients? A narrative review of the literature. NeuroRehabilitation 2021; 47:109-120. [PMID: 32741792 DOI: 10.3233/nre-203209] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. OBJECTIVES To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. METHODS An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. RESULTS In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. CONCLUSION The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.
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Affiliation(s)
| | - Błażej Cieślik
- Jan Dlugosz University in Czestochowa, Czestochowa, Poland
| | | | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
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30
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Virtual Body Ownership Illusions for Mental Health: A Narrative Review. J Clin Med 2021; 10:jcm10010139. [PMID: 33401596 PMCID: PMC7796179 DOI: 10.3390/jcm10010139] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people’s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care.
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31
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Wang CC, Chao JK, Wang ML, Yang YP, Chien CS, Lai WY, Yang YC, Chang YH, Chou CL, Kao CL. Care for Patients with Stroke During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke. J Stroke Cerebrovasc Dis 2020; 29:105182. [PMID: 33066878 PMCID: PMC7375317 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jian-Kang Chao
- Department of Social Work, National Pingtung University of Science & Technology, Pingtung, Taiwan; Department of psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Mong-Lien Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Ping Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Chien-Shiu Chien
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Wei-Yi Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university; Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan.
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32
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Bauer ACM, Andringa G. The Potential of Immersive Virtual Reality for Cognitive Training in Elderly. Gerontology 2020; 66:614-623. [PMID: 32906122 DOI: 10.1159/000509830] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/17/2020] [Indexed: 11/19/2022] Open
Abstract
The number of elderly is growing rapidly, including those that struggle with cognitive decline and, consequently, activities of daily living. Developing interventions that slow down cognitive decline would greatly benefit the autonomy of these elderly, as well as their caretakers. Virtual reality (VR) is an immersive and interactive human-computer interface with real-time simulation that is suggested to be a promising tool to improve cognitive functioning. This literature review discusses the features of immersive VR, including its opportunities and limitations, that are of special relevance for improving cognition in elderly. First, the high flexibility of VR allows for personalized and safe training of potentially harmful situations and isolated aspects of tasks. Second, VR's dynamic and real-time feedback on performance provides a labor-extensive tool for caretakers in elderly care. Third, the acquisition of high resolution data enables the exposure of subtle changes over time, relevant for detecting the nature and extent of cognitive changes in elderly, including those with dementia. Fourth, immersive VR has been related to cybersickness. Finally, VR is immersive and enables the perception and expression of emotions, motor behaviors, and multiple senses. Aged subjects are found to have sparing of emotional learning and show increased reliance on multisensory integration for learning. Moreover, they experience high levels of flow, motivation, and presence in VR setups. Despite the clear potential of immersive VR, the studies available are small scale and have not been replicated. The digital illiteracy of elderly and healthcare personnel form an additional barrier for implementation. Hence, while replication of outcomes and standardization of VR interventions is required before it can be used in standard care, VR may provide a particularly effective tool for training cognition in elderly.
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Affiliation(s)
- Anna Cornelia Maria Bauer
- Department of Science, University College Roosevelt, Utrecht University, Middelburg, The Netherlands
| | - Gerda Andringa
- Department of Science, University College Roosevelt, Utrecht University, Middelburg, The Netherlands, .,Academic Workplace for the Elderly in Zeeland, Middelburg, The Netherlands,
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33
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Ghai S, Ghai I, Lamontagne A. Virtual reality training enhances gait poststroke: a systematic review and meta-analysis. Ann N Y Acad Sci 2020; 1478:18-42. [PMID: 32659041 DOI: 10.1111/nyas.14420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022]
Abstract
Virtual reality (VR)-based interventions are gaining widespread attention for managing neurological disorders such as stroke. A metastatistical consensus regarding the intervention is strongly warranted. In this study, we attempt to address this gap in the literature and provide the current state of evidence for the effects of VR on gait performance. We conducted both between- and within-group meta-analyses to provide a state of evidence for VR. Moreover, we conducted a search adhering to PRISMA guidelines on nine databases. Out of 1866 records, 32 studies involving a total of 809 individuals were included in this review. Considering all included studies, significant enhancements in gait parameters were observed with VR-based interventions compared with conventional therapy. A between-group meta-analysis reported beneficial significant medium effects of VR training on cadence (Hedge's g = 0.55), stride length ((STrL; Hedge's g = 0.46), and gait speed (Hedge's g = 0.30). Similarly, a within-group meta-analysis further revealed positive medium effects of VR on cadence (Hedge's g = 0.76), STrL (Hedge's g = 0.61), and gait speed (Hedge's g = 0.69). Additional subgroup analyses revealed beneficial effects of joint application of VR and robot-assisted gait training on gait speed (Hedge's g = 0.50). Collectively, findings from this review provide evidence for the effectiveness of VR-based gait training for stroke survivors.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, Quebec, Canada
| | | | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, Quebec, Canada
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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Balance and Dizziness Disorders in the Elderly: a Review. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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36
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Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag 2020; 16:75-85. [PMID: 32103968 PMCID: PMC7012218 DOI: 10.2147/tcrm.s206883] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
Abstract
In contrast to varied therapy approaches, mirror therapy (MT) can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. This paper attempts to systematically review and present the current perspectives on mirror therapy and its application in stroke rehabilitation, and dosage, feasibility and acceptability in stroke rehabilitation. An electronic database search across Google, PubMed, Web of Science, etc., generated 3871 results. After screening them based on the inclusion and exclusion criteria, we included 28 studies in this review. The data collected were divided on the basis of application in stroke rehabilitation, modes of intervention delivery, and types of control and outcome assessment. We found that most studies intervened for upper limb motor impairments post stroke. Studies were equally distributed between intervention in chronic and acute phases post stroke with therapy durations lasting between 1 and 8 weeks. MT showed definitive motor and sensory improvements although the extent of improvements in sensory impairments and hemineglect is limited. MT proves to be an effective and feasible approach to rehabilitate post-stroke survivors in the acute, sub-acute, and chronic phases of stroke, although its long-term effects and impact on activities of daily living need to be analysed extensively.
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Affiliation(s)
- Dorcas Bc Gandhi
- College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India.,Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Albert Sterba
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India
| | - Himani Khatter
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Jeyaraj D Pandian
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
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Morkisch N, Thieme H, Dohle C. How to perform mirror therapy after stroke? Evidence from a meta-analysis. Restor Neurol Neurosci 2019; 37:421-435. [DOI: 10.3233/rnn-190935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nadine Morkisch
- MEDIAN Klinik Berlin-Kladow, Berlin, Germany
- Center for Stroke Research Berlin, Charité – University Medicine Berlin, Berlin, Germany
| | - Holm Thieme
- First European School of Physiotherapy, Occupational therapy, Speech and Language therapy, Klinik Bavaria Kreischa, Kreischa, Germany
- HAWK University of Applied Sciences and Arts, Faculty of Social Work and Health, Hildesheim, Germany
| | - Christian Dohle
- MEDIAN Klinik Berlin-Kladow, Berlin, Germany
- Center for Stroke Research Berlin, Charité – University Medicine Berlin, Berlin, Germany
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The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7595639. [PMID: 31317037 PMCID: PMC6604476 DOI: 10.1155/2019/7595639] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/20/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Objective The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. Conclusion The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.
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Felsberg DT, Maher JP, Rhea CK. The State of Behavior Change Techniques in Virtual Reality Rehabilitation of Neurologic Populations. Front Psychol 2019; 10:979. [PMID: 31139106 PMCID: PMC6518969 DOI: 10.3389/fpsyg.2019.00979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Neurologic rehabilitation aims to restore function, address barriers to activity, and improve quality of life in those with injury to the nervous system. Virtual reality (VR) has emerged as a useful tool to enhance neurorehabilitation interventions and outcomes. However, the manner in which VR-based neurorehabilitation has been manipulated to optimize outcomes using theory-based frameworks has not been documented. Behavior Change Techniques (BCTs) are described as the smallest active ingredient in an intervention aimed to change behavior via theoretically-proposed pathways. The purpose of this review was to investigate the ways VR is being used in neurorehabilitation to improve upright mobility, and systematically code those VR interventions for active BCTs. Methods: Keyword searches were performed using database searches of PubMed, SPORTDiscus, and psycINFO. The search yielded 32 studies for inclusion. Coding for BCTs was conducted using the Behavior Change Techniques Taxonomy v1 (BCTTv1). Results: Behavioral Practice, Graded Tasks, Biofeedback, and Explicit Feedback were the most commonly used BCTs. All studies reported improvements in motor performance outcomes. However, none of the studies investigated the efficacy of each component of their VR intervention making it difficult to point to the most effective components of VR interventions overall. Conclusions: This review suggests that investigation into the specific components of VR interventions, along with purposeful implementation and reporting of BCTs will help improve understanding of the efficacy of VR as a neurorehabilitation tool. Future research could benefit from incorporating BCTs into the design process of VR interventions to produce optimal rehabilitation potential.
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Affiliation(s)
- Danielle T Felsberg
- Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Jaclyn P Maher
- Physical Activity and Lifetime Wellness Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Christopher K Rhea
- Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
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Mohammadi R, Semnani AV, Mirmohammadkhani M, Grampurohit N. Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:1787-1798. [PMID: 31031145 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/13/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to systematically review the effect of virtual reality on balance as compared to conventional therapy alone poststroke. METHODS The databases of PubMed, Cochrane, and Ovid were searched using select keywords. The randomized controlled trials published between January 2000 and August 2017 in English language were included if they assessed the effect of virtual reality on balance ability compared to conventional therapy alone in adults' poststroke. The Physiotherapy Evidence Database scale was used to assess the methodological quality. RESULTS Fourteen papers were included in this review. The experimental groups largely (n = 13) used virtual reality in combination with conventional therapy. Among the high quality studies, significant between-group improvement favoring virtual reality in combination with conventional therapy was found on Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 7) when compared to conventional therapy alone. The studies were limited by low powered, small sample sizes ranging from 14 to 40, and lack of blinding, concealed allocation, and reporting of missing data. Thirteen homogenous (n = 348, I2 = 37.6%, P = .083) studies were included in the meta-analysis using Berg Balance Scale. Significant improvement was observed in the experimental group compared to control group with a medium effect size of .64, confidence interval of .36-.92. CONCLUSIONS The findings of this review indicate that virtual reality when combined with conventional therapy is moderately more effective in improving balance than conventional therapy alone in individuals' poststroke.
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Affiliation(s)
- Roghayeh Mohammadi
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Namrata Grampurohit
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
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Ballantyne R, Rea PM. A Game Changer: 'The Use of Digital Technologies in the Management of Upper Limb Rehabilitation'. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1205:117-147. [PMID: 31894574 DOI: 10.1007/978-3-030-31904-5_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemiparesis is a symptom of residual weakness in half of the body, including the upper extremity, which affects the majority of post stroke survivors. Upper limb function is essential for daily life and reduction in movements can lead to tremendous decline in quality of life and independence. Current treatments, such as physiotherapy, aim to improve motor functions, however due to increasing NHS pressure, growing recognition on mental health, and close scrutiny on disease spending there is an urgent need for new approaches to be developed rapidly and sufficient resources devoted to stroke disease. Fortunately, a range of digital technologies has led to revived rehabilitation techniques in captivating and stimulating environments. To gain further insight, a meta-analysis literature search was carried out using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) method. Articles were categorized and pooled into the following groups; pro/anti/neutral for the use of digital technology. Additionally, most literature is rationalised by quantitative and qualitative findings. Findings displayed, the majority of the inclusive literature is supportive of the use of digital technologies in the rehabilitation of upper extremity following stroke. Overall, the review highlights a wide understanding and promise directed into introducing devices into a clinical setting. Analysis of all four categories; (1) Digital Technology, (2) Virtual Reality, (3) Robotics and (4) Leap Motion displayed varying qualities both-pro and negative across each device. Prevailing developments on use of these technologies highlights an evolutionary and revolutionary step into utilizing digital technologies for rehabilitation purposes due to the vast functional gains and engagement levels experienced by patients. The influx of more commercialised and accessible devices could alter stroke recovery further with initial recommendations for combination therapy utilizing conventional and digital resources.
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Affiliation(s)
- Rachael Ballantyne
- Anatomy Facility, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Paul M Rea
- Anatomy Facility, Thomson Building, School of Life Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8QQ, UK.
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Kamińska MS, Miller A, Rotter I, Szylińska A, Grochans E. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging 2018; 13:2329-2338. [PMID: 30532523 PMCID: PMC6241865 DOI: 10.2147/cia.s183502] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Virtual reality (VR) training using modern game consoles is an innovative rehabilitation method for fall-prone elderly people. The aim of this study was to assess the effectiveness of VR training using the "Xbox 360 Kinect" in people over 60 years of age. Materials and methods The study involved 23 people, including 19 women and 4 men (mean age 75.74±8.09 years). The following functional tests were employed as research instruments: the 6-minute walking test (6MWT), the Dynamic Gait Index (DGI), the tandem stance test (TST), the tandem walk test (TWT), and the Beck Depression Inventory (BDI). A "spring hand dynamometer" was also used. The participants underwent 30-day VR training using an Xbox 360 Kinect. They trained 3 times a week, with each exercise lasting 30 minutes. Results The 6MWT (P<0.001), the DGI (P=0.008), the TST (P<0.001), the TWT (P=0.002), and the BDI (P<0.001) outcomes were significantly improved. There were differences in the results for the strength of the "pressing muscles" in the right (P=0.106) and left (P=0.043) hands of the participants. Both participants under 80 years of age and those aged 80 years and over had visibly better results on the 6MWT (P<0.001 and P=0.008, respectively), the TST (P<0.001 and P=0.008, respectively), and the BDI (P=0.003 and P=0.012, respectively). Conclusion Training based on VR increases the possibilities of motor training and can help reduce the risk of falls by improving the static and dynamic balance.
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Affiliation(s)
- Magdalena Sylwia Kamińska
- Department of Primary Health Care, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland,
| | | | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
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Louie DR, Lim SB, Eng JJ. The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 28:107-120. [PMID: 30314760 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke. METHODS PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery. RESULTS Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD] = 1.04 [95% confidence interval [CI] = .43, 1.66], I2 = 73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = .46 [95% CI = .01, .90], I2 = 43%, and P = .05) and motor recovery (7 studies, SMD = .47 [95% CI = .21, .74], I2 = 0%, and P < .001). A significant pooled effect was not found for balance capacity. CONCLUSIONS Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.
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Affiliation(s)
- Dennis R Louie
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada
| | - Shannon B Lim
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada; Department of Physical Therapy, University of British Columbia, Canada.
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Juras G, Brachman A, Michalska J, Kamieniarz A, Pawłowski M, Hadamus A, Białoszewski D, Błaszczyk J, Słomka KJ. Standards of Virtual Reality Application in Balance Training Programs in Clinical Practice: A Systematic Review. Games Health J 2018; 8:101-111. [PMID: 30239217 DOI: 10.1089/g4h.2018.0034] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the effect of virtual reality (VR) games on improving balance in different groups of neurological patients with a particular focus on the study quality and to determine the gold standard in VR training in these groups. MATERIALS AND METHODS A systematic review of controlled trials published between January 2009 and December 2017 was conducted. The PubMed, SCOPUS, SPORTDiscus, and Medline databases were searched. Studies involved patients with stroke or Parkinson's disease or children with cerebral palsy. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS A total of 20 studies met the inclusion criteria. The PEDro scores ranged from 4 to 8 points. Analysis of the rehabilitation programs revealed a very large discrepancy in the planned volume of exercises in different subgroups of patients. CONCLUSIONS Overall, the comparison of VR interventions between conventional rehabilitation and no intervention exhibited significantly better results. However, these results should be interpreted with great caution due to the large diversity of the systems, games, and training volume used in the VR therapy. In all included studies, only several articles included objective methods to assess the effect of VR. In addition, most of the articles showed a high risk of bias, such as a lack of randomization and blinding or a small sample size. That is why further well-designed randomized control trials are required to evaluate the influence of VR on balance in different groups of neurological patients.
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Affiliation(s)
- Grzegorz Juras
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Brachman
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Justyna Michalska
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Michał Pawłowski
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Hadamus
- 2 Department of Rehabilitation, Division of Physiotherapy of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Białoszewski
- 2 Department of Rehabilitation, Division of Physiotherapy of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Błaszczyk
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Kajetan J Słomka
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
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Darbois N, Guillaud A, Pinsault N. Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review. Rehabil Res Pract 2018; 2018:6412318. [PMID: 30210873 PMCID: PMC6120256 DOI: 10.1155/2018/6412318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/06/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed. OBJECTIVES To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. METHOD Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. RESULTS In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. CONCLUSION Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.
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Affiliation(s)
- Nelly Darbois
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
| | - Albin Guillaud
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- Cortecs team, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
| | - Nicolas Pinsault
- Critical Thinking Research Federation FED 4276, University Grenoble-Alpes, Grenoble, France
- School of Physiotherapy, Grenoble-Alpes University Hospital, Grenoble, France
- ThEMAS team, TIMC-IMAG Laboratory, UMR CNRS-UGA 5525, Grenoble, France
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Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2018; 7:CD008449. [PMID: 29993119 PMCID: PMC6513639 DOI: 10.1002/14651858.cd008449.pub3] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side. OBJECTIVES To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study. SELECTION CRITERIA We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables. MAIN RESULTS We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD -0.89, 95% CI -1.67 to -0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI -0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported. AUTHORS' CONCLUSIONS The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.
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Affiliation(s)
- Holm Thieme
- Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria KreischaKreischa, SachsenGermany
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Nadine Morkisch
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
| | - Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Johann Behrens
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
| | - Bernhard Borgetto
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Christian Dohle
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
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Ha SY, Han JH, Sung YH. Effects of ankle strengthening exercise program on an unstable supporting surface on proprioception and balance in adults with functional ankle instability. J Exerc Rehabil 2018; 14:301-305. [PMID: 29740567 PMCID: PMC5931169 DOI: 10.12965/jer.1836082.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/25/2018] [Indexed: 11/22/2022] Open
Abstract
The present study was conducted to investigate the effect of ankle strengthening exercise applied on unstable supporting surfaces on the proprioceptive sense and balance in adults with functional ankle instability. As for the study method, 30 adults with functional ankle instability were randomly assigned to an ankle strengthening exercise group and a stretching group on unstable supporting surfaces, and the interventions were implemented for 40 min. Before and after the interventions, a digital dual inclinometer was used to measure the proprioceptive sense of the ankle, the Balancia program was used to measure static balance ability, and the functional reach test was used to measure dynamic balance ability. In the results, both proprioceptive sense and static dynamic balance ability were significantly different between before and after the intervention in the experimental group (P<0.05). When such results are put together, it can be seen that ankle strengthening exercise applied on unstable supporting surfaces may be presented as an effective treatment method for enhancing the proprioceptive sense and balance ability in adults with functional ankle instability.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Jun-Ho Han
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Korea
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Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2018; 32:1007-1021. [PMID: 29644880 DOI: 10.1177/0269215518766642] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the effects of mirror therapy on walking ability, balance and lower limb motor recovery in patients with stroke. Method: MEDLINE, EMBASE, Web of Science, CENTRAL, PEDro Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, Current controlled trials and Open Grey were searched for randomized controlled trials that investigated the effects of mirror therapy on lower limb function through January 2018. The primary outcomes included were walking speed, mobility and balance function. Secondary outcomes included lower limb motor recovery, spasticity and range of motion. Quality assessments were performed with the PEDro scale. Results: A total of 13 studies ( n = 572) met the inclusion criteria. A meta-analysis demonstrated a significant effect of mirror therapy on walking speed (mean difference (MD) 0.1 m/s, 95% confidence interval (CI): 0.08 to 0.12, P < 0.00001), balance function (standard mean difference (SMD) 0.66, 95% CI: 0.43 to 0.88, P < 0.00001), lower limb motor recovery (SMD 0.83, 95% CI: 0.62 to 1.05, P < 0.00001) and passive range of motion of ankle dorsiflexion (MD 2.07°, 95% CI: 082 to 3.32, P = 0.001), without improving mobility (SMD 0.43, 95% CI: −0.12 to 0.98, P = 0.12) or spasticity of ankle muscles (MD −0.14, 95% CI: −0.43 to 0.15, P = 0.35). Conclusion: The systematic review demonstrates that the use of mirror therapy in addition to some form of rehabilitation appears promising for some areas of lower limb function, but there is not enough evidence yet to suggest when and how to approach this therapy.
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Affiliation(s)
- Yi Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qingchuan Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Wei Gou
- Department of Rehabilitation Medicine, Pidu District People’s Hospital, Chengdu, People’s Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, 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 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 review authors contacted investigators to obtain missing information. MAIN RESULTS We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. 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 mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Belinda Lange
- Flinders UniversitySchool of Health Sciences, Discipline of PhysiotherapyAdelaideAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkNew JerseyUSA
| | - Gustavo Saposnik
- University of TorontoDepartment of Medicine (Neurology), St Michael's HospitalTorontoCanadaM5C 1R6
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
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