1
|
Prajjwal P, Chandrasekar KK, Battula P, Gaviria E, Awe MO, Inban P, Almutairi AS, Das A, Tekuru Y, Marsool MDM, Reddy MM, Mitra S, Bamba H, Singh G, Jain H, Gadam S, Hussin OA. The efficacy of virtual reality-based rehabilitation in improving motor function in patients with stroke: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:5425-5438. [PMID: 39238962 PMCID: PMC11374195 DOI: 10.1097/ms9.0000000000002403] [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: 05/26/2024] [Accepted: 07/11/2024] [Indexed: 09/07/2024] Open
Abstract
Background Stroke is a major cause of adult disability, prompting the exploration of innovative rehabilitation methods. Virtual rehabilitation (VR), leveraging technological advances, has gained popularity as a treatment for stroke recovery. Methodology The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published in English within the last decade, adhering to the PRISMA guidelines. The authors searched databases such as Medline/PubMed, and the Cochrane Library using specific search keywords and Medical Subject Headings (MeSH). The methodological quality was assessed using the PEDro scale, focusing on RCTs involving adult stroke patients undergoing VR rehabilitation, with outcomes related to motor function and quality of life. Results The authors included 15 studies in our meta-analysis. VR rehabilitation offers several advantages over traditional therapy, such as enhanced feedback and increased patient motivation. Engaging VR environments helps improve focus during treatment, potentially boosting recovery from post-stroke impairments. VR therapies significantly benefit motor function, which can improve activities of daily living and overall quality of life. Conclusion VR has demonstrated efficacy in improving motor function and quality of life for stroke survivors. Future research should explore patient variability and refine intervention methods. Incorporating VR into rehabilitation programs could optimize stroke recovery outcomes.
Collapse
Affiliation(s)
| | | | - Pavani Battula
- Department of Neurology, NTR University of Health Sciences, Hyderabad
| | | | | | | | - Adel S Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arpan Das
- Department of Neurology, RG Kar Medical College and Hospital, Kolkata
| | - Yogesh Tekuru
- Department of Neurology, RVM Institute of Medical Sciences and Research Center, Laxmakkapally
| | | | | | | | - Hyma Bamba
- Internal Medicine, Government Medical College and Hospital, Chandigarh
| | - Gurmehar Singh
- Internal Medicine, Government Medical College and Hospital, Chandigarh
| | - Hritvik Jain
- Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | | | | |
Collapse
|
2
|
Bedar K, Bubanovich C, Rosemore J, Radford K, Taylor KL. Virtual Reality Intervention and Its Impact on Upper Extremity Function in the Stroke Population: A Scoping Review. Games Health J 2023; 12:429-439. [PMID: 37948555 DOI: 10.1089/g4h.2022.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The aim of this scoping review was to examine virtual reality (VR) interventions used within rehabilitation and their effect on the functional outcomes of individuals with stroke. Specifically, this study sought to determine the impact of VR on the upper extremity (UE) use of participants as it relates to body function, occupational participation, and overall UE function (UEfxn). Twenty-six articles were selected for inclusion and results were extracted to determine common themes of outcomes among the effects of VR intervention (VRI). Thematic analysis included details about the VRIs used, as well as the change in UE outcomes post-VRI. Overall, positive change in UEfxn was found across many of the studies, indicating that VR technologies may be an effective intervention technique for individuals, poststroke. Findings of this review encourage clinicians to conduct further research regarding VR technology for UE rehabilitation poststroke.
Collapse
Affiliation(s)
- Kylee Bedar
- Occupational Therapy Program, Murray State University, Paducah, Kentucky, USA
| | - Cara Bubanovich
- Occupational Therapy Program, Murray State University, Paducah, Kentucky, USA
| | - Jordan Rosemore
- Occupational Therapy Program, Murray State University, Paducah, Kentucky, USA
| | - Kayley Radford
- Occupational Therapy Program, Murray State University, Paducah, Kentucky, USA
| | - Kelly L Taylor
- Occupational Therapy Program, Murray State University, Paducah, Kentucky, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Leong SC, Tang YM, Toh FM, Fong KNK. Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis. J Neuroeng Rehabil 2022; 19:93. [PMID: 36002898 PMCID: PMC9404551 DOI: 10.1186/s12984-022-01071-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Virtual reality (VR), augmented reality (AR), and mixed reality (MR) are emerging technologies in the field of stroke rehabilitation that have the potential to overcome the limitations of conventional treatment. Enhancing upper limb (UL) function is critical in stroke impairments because the upper limb is involved in the majority of activities of daily living (ADL). METHODS This study reviewed the use of virtual, augmented and mixed reality (VAMR) methods for improving UL recovery and ADL, and compared the effectiveness of VAMR treatment to conventional rehabilitation therapy. The databases ScienceDirect, PubMed, IEEE Xplore, and Web of Science were examined, and 50 randomized control trials comparing VAMR treatment to standard therapy were determined. The random effect model and fixed effect model are applied based on heterogeneity. RESULTS The most often used outcomes of UL recovery and ADL in stroke rehabilitation were the Fugl-Meyer Assessment for Upper Extremities (FMA-UE), followed by the Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), and the Functional Independence Measure (FIM). According to the meta-analysis, VR, AR, and MR all have a significant positive effect on improving FMA-UE for UL impairment (36 studies, MD = 3.91, 95 percent CI = 1.70-6.12, P = 0.0005) and FIM for ADL (10 studies, MD = 4.25, 95 percent CI = 1.47-7.03, P = 0.003), but not on BBT and WMFT for the UL function tests (16 studies, MD = 2.07, 95 percent CI = - 0.58-4.72, P = 0.13), CONCLUSIONS: VAMR therapy was superior to conventional treatment in UL impairment and daily function outcomes, but not UL function measures. Future studies might include further high-quality trials examining the effect of VR, AR, and MR on UL function measures, with an emphasis on subgroup meta-analysis by stroke type and recovery stage.
Collapse
Affiliation(s)
- Sze Chit Leong
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Hong Kong SAR
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, Hong Kong SAR
| | - Yuk Ming Tang
- Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Hong Kong SAR.
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, Hong Kong SAR.
| | - Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Hong Kong SAR
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Hong Kong SAR
| |
Collapse
|
5
|
Chen J, Or CK, Chen T. Effectiveness of Using Virtual Reality-Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e24111. [PMID: 35723907 PMCID: PMC9253973 DOI: 10.2196/24111] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/19/2021] [Accepted: 04/18/2022] [Indexed: 01/19/2023] Open
Abstract
Background In recent years, efforts have been made to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises. Therefore, it is important to review and analyze the existing research evidence of its effectiveness. Objective Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke. Methods This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CINAHL Plus, MEDLINE, Web of Science, Embase, and Cochrane Library databases were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to after intervention, after intervention to follow-up assessment, and baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether the differences in treatment outcomes depended on age, stroke recovery stage, VR program type, therapy delivery format, similarities in intervention duration between study groups, intervention duration in VR groups, and trial length. Results A total of 42 publications representing 43 trials (aggregated sample size=1893) were analyzed. Compared with the control groups that used either conventional therapy or no therapy, the intervention groups that used VR to support exercise therapy showed significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95% CI 0.21-0.68; P<.001), range of motion (goniometer; SMD 1.01, 95% CI 0.50-1.52; P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95% CI 0.28-1.30; P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95% CI 0.06-0.40; P=.01, and modified Rankin Scale; SMD 0.57, 95% CI 0.01-1.12; P=.046). Significant subgroup differences were observed in hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence that the benefits of VR-supported exercise therapy were maintained after the intervention ended. Conclusions VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that of the 12 rehabilitation outcomes examined during the course of VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion), and both significant and nonsignificant improvements were observed in another 2 (muscle strength and independence in day-to-day activities), depending on the measurement tools or methods used. Trial Registration PROSPERO CRD42021256826; https://tinyurl.com/2uarftbh
Collapse
Affiliation(s)
- Jiayin Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tianrong Chen
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong, Hong Kong, China (Hong Kong)
| |
Collapse
|
6
|
Meireles CV, Ferreira SF, Avelino PR, Menezes KKPD. Effects of virtual reality training in the upper limb motor coordination of individuals post- stroke: a systematic review with meta-analysis. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/19039029012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT After a stroke, 75% of people are affected in their upper limbs, remaining with sequelae at these limbs. Results from recent clinical trials have been contradictory regarding the effectiveness of Virtual Reality (VR) therapy in rehabilitating upper limb motor coordination in this population. This study aimed to perform a systematic literature review with meta-analysis to investigate the effects of VR training on upper limb motor coordination in patients post-stroke. Searches were performed in the electronic databases PubMed, LILACS, SciELO, PEDro, in addition to manual searches. The whole process was performed by two independent raters. The methodological quality of the studies was assessed by the PEDro scale. In total, we selected 18 studies, out of which only 13 were included in the meta-analysis. In general, VR training was effective in improving upper limb motor coordination (SMD 0.32; 95% CI 0.08-0.56; I2=42%; p<0.01). When subgroup analysis assessed control group type, VR training was superior than no intervention (SMD 0.36; 95% CI: 0.06-0.66; p<0.05). However, when compared to other interventions, we found no significant difference (SMD 0.26; 95% CI: −0.12-0.64; p=0.18). Overall, VR training is effective in improving upper limb motor coordination in post-stroke individuals compared to no intervention. However, it shows no superiority when compared to other types of intervention used in the rehabilitation of upper limb motor coordination in these patients.
Collapse
|
7
|
Meireles CV, Ferreira SF, Avelino PR, Menezes KKPD. Efeitos do treino de realidade virtual na coordenação motora dos membros superiores de indivíduos após acidente vascular encefálico: uma revisão sistemática com meta-análise. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/19039029012022pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Após um acidente vascular encefálico (AVE), 75% das pessoas tem o membro superior acometido, permanecendo com sequelas nessa extremidade. Resultados de ensaios clínicos recentes são contraditórios quanto à eficácia da terapia de realidade virtual (RV) na reabilitação da coordenação motora dos membros superiores dessa população. Assim, o objetivo deste trabalho foi realizar uma revisão sistemática da literatura, com meta-análise, a fim de investigar os efeitos do treinamento com RV na coordenação motora dos membros superiores em pacientes pós-AVE. Para isso, foram feitas buscas nas bases de dados PubMed, LILACS, SciELO, PEDro e buscas manuais. Esse processo foi realizado por dois avaliadores independentes, e a qualidade metodológica dos estudos foi avaliada pela escala PEDro. Foram selecionados 18 estudos, sendo que apenas 13 foram incluídos na meta-análise. De forma geral, o treino de RV se mostrou eficaz na melhora da coordenação motora dos membros superiores da população (SMD 0,32; IC95% 0,08 a 0,56; I2=42%; p<0,01). Após uma análise de subgrupos, o treino de RV demonstrou ser superior quando comparado a nenhuma intervenção (SMD 0,36; IC95% 0,06 a 0,66; p<0,05). No entanto, quando comparado a outras intervenções, não houve diferença significativa (SMD 0,26; IC95% −0,12 a 0,64; p=0,18). De forma geral, o treino de RV é eficaz na melhora da coordenação motora dos membros superiores de indivíduos pós-AVE em comparação a nenhuma intervenção. No entanto, não é superior quando comparado a outros tipos de intervenção utilizados na reabilitação da coordenação motora dos membros superiores dos pacientes.
Collapse
|
8
|
Zhang Q, Fu Y, Lu Y, Zhang Y, Huang Q, Yang Y, Zhang K, Li M. Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e31007. [PMID: 34787571 PMCID: PMC8663637 DOI: 10.2196/31007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788
Collapse
Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yu Fu
- Department of Computer Science, Aberystwyth University, Wales, United Kingdom
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Qifang Huang
- School of Nursing, Peking University, Beijing, China
| | - Yajie Yang
- School of Nursing, Peking University, Beijing, China
| | - Ke Zhang
- Department of Psychology, Shanxi Datong University, Datong City, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
| |
Collapse
|
9
|
Doumas I, Everard G, Dehem S, Lejeune T. Serious games for upper limb rehabilitation after stroke: a meta-analysis. J Neuroeng Rehabil 2021; 18:100. [PMID: 34130713 PMCID: PMC8204490 DOI: 10.1186/s12984-021-00889-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. OBJECTIVES Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. METHOD This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. RESULTS Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness. CONCLUSION This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.
Collapse
Affiliation(s)
- Ioannis Doumas
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Gauthier Everard
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Stéphanie Dehem
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium.
| |
Collapse
|
10
|
Domínguez-Téllez P, Moral-Muñoz JA, Salazar A, Casado-Fernández E, Lucena-Antón D. Game-Based Virtual Reality Interventions to Improve Upper Limb Motor Function and Quality of Life After Stroke: Systematic Review and Meta-analysis. Games Health J 2020; 9:1-10. [PMID: 32027185 DOI: 10.1089/g4h.2019.0043] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Stroke is the main cause of disability in adulthood. Recent advances in virtual reality (VR) technologies have led to its increased use in the rehabilitation of stroke patients. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effectiveness of game-based reality on upper limb (UL) motor function and quality of life after stroke. In March 2018, a search of the following databases was performed: PubMed, PEDro, Web of Science, Scopus, The Cochrane Library, and Medline at EBSCO. The selection criteria were all RCTs published in English or Spanish during the past 10 years. The PEDro scale was used to evaluate the methodological quality of the studies. A total of 20 clinical trials were included in the systemic review, of which 15 contributed information to the meta-analysis. Favorable results were found for VR interventions on UL motor function (Fugl-Meyer Assessment for upper extremity, standardized mean difference [SMD] = 1.53, 95% CI [0.51-2.54]) and quality of life (functional independence measure, SMD = 0.77, 95% CI [0.05-1.49]). The results demonstrate the potential benefits of VR interventions on the recovery of UL motor function and on quality of life after stroke.
Collapse
Affiliation(s)
| | - Jose A Moral-Muñoz
- Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Alejandro Salazar
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, Cadiz, Spain.,Department of Statistics and Operational Research, University of Cadiz, Cadiz, Spain.,Observatory of Pain, Grünenthal Foundation-University of Cadiz, Cadiz, Spain
| | | | | |
Collapse
|
11
|
Ersoy C, Iyigun G. Boxing training in patients with stroke causes improvement of upper extremity, balance, and cognitive functions but should it be applied as virtual or real? Top Stroke Rehabil 2020; 28:112-126. [PMID: 32574096 DOI: 10.1080/10749357.2020.1783918] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Upper extremity hemiparesis is one of the most common post-stroke disabilities requiring rehabilitation. Objective: To compare the effects of virtual and real boxing training in addition to neurodevelopmental treatment on the upper extremity, balance, and cognitive functions in hemiparetic stroke patients. Methods: Forty hemiparetic stroke patients were assigned to either real boxing group-RBG (n=20) or virtual boxing group-VBG (n=20), for a total of 24 sessions (3 sessions/week for 8 weeks). The primary outcome was upper extremity motor ability (Wolf Motor Function Test-WMFT). The secondary outcomes were arm-hand dexterity (Manual Dexterity Test-MMDT), goal-oriented performance (Video Boxing Analysis-VBA), balance functions (Fullerton Advanced Balance Scale-FAB-T), and cognitive functions (Addenbrooke's Cognitive Examination-Revised-ACE-R). Results: There was small treatment effect on ACE-R, small-medium effect for WFMT and MMDT and large effect on bilateral punching time [VBA (Cohen's d- VBG=0.83; RBG=0.95)] and balance [FAB-T (Cohen's d - VBG=0.89; RBG=0.82)] after treatment in both groups. No significant differences were found for training effects between the groups for upper extremity functions [WMFT (p=0.799; Cohen's d=-0.07), MMDT-PT (p=0.327; Cohen's d=-0.10), MMDT-THTPT (p=0.779; Cohen's d=-0.17) and VBA bilateral punch number (p=0.068; Cohen's d=0.15)], balance functions [FAB-T (p=0.602; Cohen's d=-0.19)] and cognitive functions [ACE-R total (p=0.947, Cohen's d=0.09)]. Conclusion: The study showed that virtual and real boxing training methods, in addition to neurodevelopmental treatment, are effective in improving upper extremity, balance, and cognitive functions in patients with hemiparetic stroke. The training effects were higher on bilateral punching time and balance functions for both groups. There was no superiority of either approach.
Collapse
Affiliation(s)
- Ceren Ersoy
- Department of Physiotherapy and Rehabilitation, Eastern Mediterranean University Faculty of Health Sciences , Famagusta, Turkey
| | - Gozde Iyigun
- Department of Physiotherapy and Rehabilitation, Eastern Mediterranean University Faculty of Health Sciences , Famagusta, Turkey
| |
Collapse
|
12
|
Karamians R, Proffitt R, Kline D, Gauthier LV. Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis. Arch Phys Med Rehabil 2020; 101:885-896. [DOI: 10.1016/j.apmr.2019.10.195] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/14/2022]
|
13
|
Vision-based serious games and virtual reality systems for motor rehabilitation: A review geared toward a research methodology. Int J Med Inform 2019; 131:103909. [DOI: 10.1016/j.ijmedinf.2019.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/19/2019] [Accepted: 06/17/2019] [Indexed: 02/03/2023]
|
14
|
Burdea G, Kim N, Polistico K, Kadaru A, Grampurohit N, Roll D, Damiani F. Assistive game controller for artificial intelligence-enhanced telerehabilitation post-stroke. Assist Technol 2019; 33:117-128. [PMID: 31180276 DOI: 10.1080/10400435.2019.1593260] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Off-the-shelf gaming technology is designed for young, fit, and motor intact individuals. Artificial intelligence (AI) has a role in making controllers and therapeutic games adaptable to the disabled. Post-stroke rehabilitation outcomes can be enhanced by gaming technology within the home to enable engaging telerehabilitation. BrightBrainer™ Grasp (BBG) is a novel therapeutic game controller designed to adapt to arm and hand impairments post-stroke. It mediates intensive arm reach, grasp and finger extension training and has the ability to track relevant outcomes. The newly designed controller uses BrightBrainer gamification system with AI technology to provide automatic adaptation, requiring minimal clinician input. This article describes the BBG design, hardware, force and movement detection and calibration, and its integration with the therapeutic games. The use of AI in adapting a library of custom therapeutic games is also described. Results of a usability study with healthy individuals and related design modifications are presented, with implications for future trials.
Collapse
Affiliation(s)
- Grigore Burdea
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Nam Kim
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Kevin Polistico
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Ashwin Kadaru
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Namrata Grampurohit
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Doru Roll
- Bright Cloud International Corp, Center for Commercialization of Innovative Technologies, North Brunswick, New Jersey, USA
| | - Frank Damiani
- Patient Care Services, Roosevelt Care Center, Edison, New Jersey, USA
| |
Collapse
|
15
|
Pollock A, Hazelton C, Rowe FJ, Jonuscheit S, Kernohan A, Angilley J, Henderson CA, Langhorne P, Campbell P. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev 2019; 5:CD008388. [PMID: 31120142 PMCID: PMC6532331 DOI: 10.1002/14651858.cd008388.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Visual field defects are estimated to affect 20% to 57% of people who have had a stroke. Visual field defects can affect functional ability in activities of daily living (commonly affecting mobility, reading and driving), quality of life, ability to participate in rehabilitation, and depression and anxiety following stroke. There are many interventions for visual field defects, which are proposed to work by restoring the visual field (restitution); compensating for the visual field defect by changing behaviour or activity (compensation); substituting for the visual field defect by using a device or extraneous modification (substitution); or ensuring appropriate diagnosis, referral and treatment prescription through standardised assessment or screening, or both. OBJECTIVES To determine the effects of interventions for people with visual field defects after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, the Cochrane Eyes and Vision Group Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, AMED, PsycINFO, and PDQT Databse, and clinical trials databases, including ClinicalTrials.gov and WHO Clinical Trials Registry, to May 2018. We also searched reference lists and trials registers, handsearched journals and conference proceedings, and contacted experts. SELECTION CRITERIA Randomised trials in adults after stroke, where the intervention was specifically targeted at improving the visual field defect or improving the ability of the participant to cope with the visual field loss. The primary outcome was functional ability in activities of daily living and secondary outcomes included functional ability in extended activities of daily living, reading ability, visual field measures, balance, falls, depression and anxiety, discharge destination or residence after stroke, quality of life and social isolation, visual scanning, adverse events, and death. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We undertook an assessment of methodological quality for allocation concealment, blinding of outcome assessors, method of dealing with missing data, and other potential sources of bias. We assessed the quality of evidence for each outcome using the GRADE approach. MAIN RESULTS Twenty studies (732 randomised participants, with data for 547 participants with stroke) met the inclusion criteria for this review. However, only 10 of these studies compared the effect of an intervention with a placebo, control, or no treatment group, and eight had data which could be included in meta-analyses. Only two of these eight studies presented data relating to our primary outcome of functional abilities in activities of daily living. One study reported evidence relating to adverse events.Three studies (88 participants) compared a restitutive intervention with a control, but data were only available for one study (19 participants). There was very low-quality evidence that visual restitution therapy had no effect on visual field outcomes, and a statistically significant effect on quality of life, but limitations with these data mean that there is insufficient evidence to draw any conclusions about the effectiveness of restitutive interventions as compared to control.Four studies (193 participants) compared the effect of scanning (compensatory) training with a control or placebo intervention. There was low-quality evidence that scanning training was more beneficial than control or placebo on quality of life, measured using the Visual Function Questionnaire (VFQ-25) (two studies, 96 participants, mean difference (MD) 9.36, 95% confidence interval (CI) 3.10 to 15.62). However, there was low or very-low quality evidence of no effect on measures of visual field, extended activities of daily living, reading, and scanning ability. There was low-quality evidence of no significant increase in adverse events in people doing scanning training, as compared to no treatment.Three studies (166 participants) compared a substitutive intervention (a type of prism) with a control. There was low or very-low quality evidence that prisms did not have an effect on measures of activities of daily living, extended activities of daily living, reading, falls, or quality of life, and very low-quality evidence that they may have an effect on scanning ability (one study, 39 participants, MD 9.80, 95% CI 1.91 to 17.69). There was low-quality evidence of an increased odds of an adverse event (primarily headache) in people wearing prisms, as compared to no treatment.One study (39 participants) compared the effect of assessment by an orthoptist to standard care (no assessment) and found very low-quality evidence that there was no effect on measures of activities of daily living.Due to the quality and quantity of evidence, we remain uncertain about the benefits of assessment interventions. AUTHORS' CONCLUSIONS There is a lack of evidence relating to the effect of interventions on our primary outcome of functional ability in activities of daily living. There is limited low-quality evidence that compensatory scanning training may be more beneficial than placebo or control at improving quality of life, but not other outcomes. There is insufficient evidence to reach any generalised conclusions about the effect of restitutive interventions or substitutive interventions (prisms) as compared to placebo, control, or no treatment. There is low-quality evidence that prisms may cause minor adverse events.
Collapse
Affiliation(s)
- Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 6th Floor, Govan Mbeki Building, Cowcaddens Road, Glasgow, UK, G4 0BA
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Rogers JM, Duckworth J, Middleton S, Steenbergen B, Wilson PH. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil 2019; 16:56. [PMID: 31092252 PMCID: PMC6518680 DOI: 10.1186/s12984-019-0531-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/03/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors. METHODS Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later. RESULTS Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up. CONCLUSION A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner. TRIAL REGISTRATION this pilot study was not registered.
Collapse
Affiliation(s)
- Jeffrey M Rogers
- The University of Sydney, Faculty of Health Sciences, Sydney, NSW, Australia.
| | | | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Australia and Australian Catholic University, Sydney, NSW, Australia
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Centre for Disability and Development Research (CeDDR) and School of Behavioural and Health Science, Australian Catholic University, Melbourne, VIC, Australia
| |
Collapse
|
17
|
Maier M, Rubio Ballester B, Duff A, Duarte Oller E, Verschure PFMJ. Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis. Neurorehabil Neural Repair 2019; 33:112-129. [PMID: 30700224 PMCID: PMC6376608 DOI: 10.1177/1545968318820169] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming. Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT). Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures. Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.
Collapse
Affiliation(s)
- Martina Maier
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Armin Duff
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Esther Duarte Oller
- 2 Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain
| | - Paul F M J Verschure
- 1 Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Barcelona, Spain.,3 Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
| |
Collapse
|
18
|
Aminov A, Rogers JM, Middleton S, Caeyenberghs K, Wilson PH. What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes. J Neuroeng Rehabil 2018; 15:29. [PMID: 29587853 PMCID: PMC5870176 DOI: 10.1186/s12984-018-0370-2] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 03/11/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects. METHODS Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge's g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/Function, Activity, and Participation levels of the International Classification of Functioning. RESULTS Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33-0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28-0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34-0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28-0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury. CONCLUSION VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.
Collapse
Affiliation(s)
- Anna Aminov
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Jeffrey M Rogers
- South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Sandy Middleton
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Karen Caeyenberghs
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Disability and Development Research (CeDDR), Australian Catholic University, Melbourne, VIC, Australia
| | - Peter H Wilson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia.
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia.
- Centre for Disability and Development Research (CeDDR), Australian Catholic University, Melbourne, VIC, Australia.
| |
Collapse
|
19
|
Torres-Narváez M, Sánchez-Romero J, Pérez-Viatela A, Betancur Arias E, Villamil-Ballesteros J, Valero-Sánchez K. Entrenamiento motor en el continuo de la realidad a la virtualidad. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n1.59834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. La trasformación de la capacidad de movimiento de las personas es un reto que el fisioterapeuta asume como estrategia de aprendizaje motor.Objetivo. Plantear los referentes teóricos y prácticos más relevantes en el uso de ambientes terapéuticos en el continuo de la realidad a la virtualidad en el entrenamiento motor de pacientes con accidente cerebrovascular y enfermedad de Parkinson. Materiales y métodos. Revisión de la literatura que analiza y aporta de manera conceptual, en el área de la rehabilitación y la fisioterapia, información sobre entrenamiento y aprendizaje motor.Resultados. Se evidencia potencial en el uso de la realidad virtual para la rehabilitación de alteraciones del movimiento debidas a disfunciones neurológicas. Las herramientas tecnológicas propias de la realidad virtual permiten un mayor conocimiento de los resultados con respecto a las características del movimiento, lo cual ayuda a mejorar el aprendizaje motor, en comparación con el entrenamiento tradicional.Conclusiones. Se requiere objetivar el proceso de rehabilitación para medir con precisión los cambios que producen estrategias de aprendizaje en las capacidades de movimiento de las personas con deficiencias del sistema neuromuscular para generar evidencia del impacto que tienen los programas de entrenamiento motor en el continuo de la realidad a la virtualidad.
Collapse
|
20
|
|
21
|
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.
Collapse
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
| | | |
Collapse
|
22
|
Saywell N, Taylor N, Rodgers E, Skinner L, Boocock M. Play-based interventions improve physical function for people with adult-acquired brain injury: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2016; 31:145-157. [DOI: 10.1177/0269215516631384] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To undertake a systematic review and meta-analysis of the effectiveness of play-based interventions compared to traditional therapy in rehabilitation of adults with adult-acquired brain injury. Data sources: The search was performed using Medline; Cinahl Plus; Health Source (Nursing/Academic Edition); Psychology and behavioural sciences collection; Biomedical reference collection (basic). Review methods: Studies included were randomised controlled trials that investigated the effect of play-based interventions on physical function of adults with adult acquired brain injury. Two independent reviewers identified eligible studies and assessed methodological quality using a modified Downs and Black. Meta-analysis compared standardised differences in means, to determine effect sizes for grouped functional outcome measures. The GRADE scoring system was used to determine the level of clinical evidence. Results: Thirty studies met the inclusion criteria, 13 were considered high quality and 17 moderate quality. Studies predominantly involved post-stroke participants, with only three studies including participants with traumatic brain injury. When compared to traditional therapy, dose-matched studies of play-based interventions showed a significant effect on independence (Effect size (ES) = 0.6) and physical performance (ES = 0.43), as measured using the Fugl –Meyer. For non-dose matched studies, play-based interventions showed a significant improvement for balance (ES = 0.76) compared with traditional therapy. In all studies that measured participant enjoyment, play-based therapy was rated as more enjoyable than traditional therapy. Conclusion: Play-based interventions for people with adult acquired brain injury are more effective in improving balance and independence, which may be due to them being more enjoyable than traditional therapy.
Collapse
Affiliation(s)
- Nicola Saywell
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | | | | | - Luke Skinner
- Waitemata District Health Board, Auckland, New Zealand
| | - Mark Boocock
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
23
|
Saposnik G, Cohen LG, Mamdani M, Pooyania S, Ploughman M, Cheung D, Shaw J, Hall J, Nord P, Dukelow S, Nilanont Y, De Los Rios F, Olmos L, Levin M, Teasell R, Cohen A, Thorpe K, Laupacis A, Bayley M. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial. Lancet Neurol 2016; 15:1019-27. [PMID: 27365261 DOI: 10.1016/s1474-4422(16)30121-1] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke. METHODS In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912. FINDINGS The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 43·7 s [IQR 26·1-68·0] to 29·7 s [21·4-45·2], 32·0% reduction for VRWii vs 38·0 s [IQR 28·0-64·1] to 27·1 s [21·2-45·5], 28·7% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=0·70) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=0·60). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 4·1 s, 95% CI -14·4 to 22·6). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups. INTERPRETATION In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies. FUNDING Heart and Stroke Foundation of Canada and Ontario Ministry of Health.
Collapse
Affiliation(s)
- Gustavo Saposnik
- Division of Neurology, St Michael's Hospital, University of Toronto, Canada; Stroke Program, St Michael's Hospital, University of Toronto, Canada; Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
| | - Leonardo G Cohen
- Human Cortical Physiology and Stroke Neurorehabilitation Section, NINDS, NIH, Bethesda, USA
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | | | | | - Donna Cheung
- Stroke Program, St Michael's Hospital, University of Toronto, Canada
| | - Jennifer Shaw
- UHN-Toronto Rehabilitation Institute, University of Toronto, Canada
| | - Judith Hall
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Peter Nord
- Providence Healthcare, Toronto, Ontario, Canada
| | - Sean Dukelow
- Foothills Medical Centre, Calgary, Alberta, Canada
| | | | | | - Lisandro Olmos
- FLENI Rehabilitation Institute, Escobar, Buenos Aires, Argentina
| | - Mindy Levin
- Jewish Rehabilitation Hospital, CRIR Research Centre, McGill University, Montreal, Canada
| | - Robert Teasell
- Parkwood Institute, University of Western Ontario, London, Ontario, Canada
| | - Ashley Cohen
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Kevin Thorpe
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Andreas Laupacis
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada
| | - Mark Bayley
- UHN-Toronto Rehabilitation Institute, University of Toronto, Canada
| | | |
Collapse
|
24
|
Song GB, Ryu HJ. Effects of gait training with rhythmic auditory stimulation on gait ability in stroke patients. J Phys Ther Sci 2016; 28:1403-6. [PMID: 27313339 PMCID: PMC4905878 DOI: 10.1589/jpts.28.1403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/19/2016] [Indexed: 11/25/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the gait abilities and motor recovery
abilities in stroke patients following overground gait training with or without rhythmic
auditory stimulation. [Subjects and Methods] Forty patients with hemiplegia resulting from
stroke were divided into a rhythmic auditory stimulation gait training group (n=20) and a
gait training group (n=20). The rhythmic auditory simulation gait group and gait training
group both performed gait training. Rhythmic auditory stimulation was added during gait
training in the rhythmic auditory stimulation gait training group. The gait training was
performed in 30 minute sessions, five times a week, for a total four weeks. [Results] Gate
ability significantly improved in both groups, and the rhythmic auditory stimulation gait
training group showed more significant increases in cadence, step length, and Dynamic Gait
Index. [Conclusion] The results of this study showed that gait training with rhythmic
auditory stimulation was more effective at improving gait ability.
Collapse
Affiliation(s)
- Gui-Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
| | - Hyo Jeong Ryu
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University: 201 Daegudae-ro, Gyeongsan-si, Gyeongsangbuk-do 712-714, Republic of Korea
| |
Collapse
|
25
|
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1596] [Impact Index Per Article: 199.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
Collapse
|
26
|
Viñas-Diz S, Sobrido-Prieto M. Realidad virtual con fines terapéuticos en pacientes con ictus: revisión sistemática. Neurologia 2016; 31:255-77. [DOI: 10.1016/j.nrl.2015.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 06/04/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022] Open
|
27
|
|
28
|
Kato N, Tanaka T, Sugihara S, Shimizu K, Kudo N. A study of the effect of visual depth information on upper limb movement by use of measurement of smoothness. J Phys Ther Sci 2016; 28:1134-41. [PMID: 27190441 PMCID: PMC4868201 DOI: 10.1589/jpts.28.1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study verified that the smoothness of reaching movements is able to quantitatively evaluate the effects of two- and three-dimensional images on movement in healthy people. In addition, clinical data of cerebrovascular accident patients were also analyzed by the same method. [Subjects] Ten healthy adult volunteers and two male patients with previous cerebrovascular accidents participated. [Methods] The subjects were tasked with reaching for objects shown on a display. The target and virtual limb, rendered with computer graphics, were shown on the display. Movements of the virtual limb were synchronized with those of the subject. Healthy subjects reached for targets with their dominant arm, and cerebrovascular accident patients used their paretic arm. A polarized display and polarized glasses were used when the subjects were shown three-dimensional images. In the present study, jerk cost was used to quantify the smoothness of movement. [Results] Six of the 10 healthy subjects had significantly smoother reaching movements when viewing the three-dimensional images. The two cerebrovascular accident patients tended to have smoother movements in response to the three-dimensional images. [Conclusion] Analysis of the smoothness of movement was able to detect the influence of the depth cue in vision on movement quantitatively for the healthy subjects and cerebrovascular accident patients.
Collapse
Affiliation(s)
- Norio Kato
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Toshiaki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Syunichi Sugihara
- Institute of Gerontology, The University of Tokyo,
Japan
- Sapporo Syuyukai Hospital, Japan
| | - Koichi Shimizu
- Institute of Gerontology, The University of Tokyo,
Japan
| | - Nobuki Kudo
- Institute of Gerontology, The University of Tokyo,
Japan
| |
Collapse
|
29
|
Ibrahim MS, Mattar AG, Elhafez SM. Efficacy of virtual reality-based balance training versus the Biodex balance system training on the body balance of adults. J Phys Ther Sci 2016; 28:20-6. [PMID: 26957722 PMCID: PMC4755968 DOI: 10.1589/jpts.28.20] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/05/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated efficacy of virtual reality (VR)-based balance training
on enhancing balance and postural reactions of adults as a low-cost new modality compared
to the established Biodex Balance System (BBS). [Subjects] Thirty normal adults of both
genders were divided randomly into two equal-sized experimental groups of 15: BBS balance
training and VR balance training. [Methods] The training programmes were conducted in 12
sessions, three 15-min sessions per week. The Nintendo® Wii Fit Plus (NWFP) and
its balance board were used to train of the VR group. Each participant answered a
questionnaire concerning usability, enjoyment, balance improvement, and fatigue at the end
of the training programs. [Results] The study found a significant increase the measure of
mean overall balance (OLB) in both groups. No significant difference was found between the
groups, but a significant decrease in the mean balance-test time was found for both
groups, with no significant difference between the two training methods. The VR programme
was rated highly enjoyable by 81.8% of the group. [Conclusion] The Wii Fit Plus system
with the balance board as a new VR balance-training technique, can be considered an
effective and enjoyable tool for the training of adults’ body balance.
Collapse
Affiliation(s)
- Manal S. Ibrahim
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University: 7 Ahmed Ezzayyat Street, Bein Essarayat, Giza, Egypt
| | - Ayman G. Mattar
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University: 7 Ahmed Ezzayyat Street, Bein Essarayat, Giza, Egypt
| | - Salam M. Elhafez
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University: 7 Ahmed Ezzayyat Street, Bein Essarayat, Giza, Egypt
| |
Collapse
|
30
|
Choi SY, Yoo DH, Lee JS. Usefulness of the driveABLE cognitive assessment in predicting the driving risk factor of stroke patients. J Phys Ther Sci 2015; 27:3133-5. [PMID: 26644660 PMCID: PMC4668151 DOI: 10.1589/jpts.27.3133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/10/2015] [Indexed: 01/13/2023] Open
Abstract
[Purpose] This study examined the usefulness of the DriveABLE cognitive assessment tool
(DCAT) in predicting the driving risk factor of stroke patients, and compared the
cognitive and driving functions of two groups discriminated by DCAT. [Subjects and
Methods] A total of forty-two stroke patients with a driver’s license participated in this
study. Two participants with communication problems were excluded. DCAT was used to
evaluate the risk potential to the driver, and the subjects were classified into two
groups according to the probability of driving risk estimated by the DCAT evaluation. The
safe driver group (SDG) and unsafe driver group (USDG) underwent a driving simulator and
cognitive function assessments. [Results] The results of the SDG and USDG were compared.
The SDG showed higher cognitive function than the USDG. In addition, the SDG showed higher
ability than the USDG in most of the tests associated with the driving function (pedal
reaction time, average reaction time, centerline crossing, road edge excursion, off-road
accidents, collisions). [Conclusion] DCAT is a useful tool for predicting the risk of
driving. In addition, it can predict the driving ability of stroke patients related to the
cognitive function. Nevertheless, a multi-faceted study of associated with driving and
cognitive functions for safe driving will be needed.
Collapse
Affiliation(s)
- Seong Youl Choi
- Department of Occupational Therapy, Youngdong University, Republic of Korea
| | - Doo Han Yoo
- Department of Occupational Therapy, Konyang University, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Konyang University, Republic of Korea
| |
Collapse
|
31
|
Song GB, Park EC. Effect of virtual reality games on stroke patients' balance, gait, depression, and interpersonal relationships. J Phys Ther Sci 2015; 27:2057-60. [PMID: 26311925 PMCID: PMC4540816 DOI: 10.1589/jpts.27.2057] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/17/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the study was to determine the effects of training using virtual
reality games on balance and gait ability, as well as the psychological characteristics of
stroke patients, such as depression and interpersonal relationships, by comparing them
with the effects of ergometer training. [Subjects] Forty stroke patients were randomly
divided into a virtual reality group (VRG, N = 20) and an ergometer training group (ETG, N
= 20). [Methods] VRG performed training using the Xbox Kinect. ETG performed training
using an ergometer bicycle. Both groups received training 30 min per day, five times per
week, for eight weeks. [Results] Both the VRG and ETG subjects exhibited a significant
difference in weight distribution ratio on the paralyzed side and balance ability. Both
the VRG and ETG patients showed significant improvement in psychological measures BDI and
RCS, after the intervention, and the VRG sowed a more significant increase in BDI than the
ETG. [Conclusion] According to the result of this study, virtual reality training and
ergometer training were both effective at improving balance, gait abilities, depression,
and interpersonal relationships among stroke patients.
Collapse
Affiliation(s)
- Gui Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
| | - Eun Cho Park
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| |
Collapse
|
32
|
Shin JW, Song GB, Hwangbo G. Effects of conventional neurological treatment and a virtual reality training program on eye-hand coordination in children with cerebral palsy. J Phys Ther Sci 2015; 27:2151-4. [PMID: 26311943 PMCID: PMC4540838 DOI: 10.1589/jpts.27.2151] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/03/2015] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The purpose of the study was to evaluate the effects of conventional
neurological treatment and a virtual reality training program on eye-hand coordination in
children with cerebral palsy. [Subjects] Sixteen children (9 males, 7 females) with
spastic diplegic cerebral palsy were recruited and randomly assigned to the conventional
neurological physical therapy group (CG) and virtual reality training group (VRG).
[Methods] Eight children in the control group performed 45 minutes of therapeutic exercise
twice a week for eight weeks. In the experimental group, the other eight children
performed 30 minutes of therapeutic exercise and 15 minutes of a training program using
virtual reality twice a week during the experimental period. [Results] After eight weeks
of the training program, there were significant differences in eye-hand coordination and
visual motor speed in the comparison of the virtual reality training group with the
conventional neurological physical therapy group. [Conclusion] We conclude that a
well-designed training program using virtual reality can improve eye-hand coordination in
children with cerebral palsy.
Collapse
Affiliation(s)
- Ji-Won Shin
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Gui-Bin Song
- Department of Physical Therapy, Yeungnam University College, Republic of Korea
| | - Gak Hwangbo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| |
Collapse
|
33
|
Lee KH. Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1. J Phys Ther Sci 2015; 27:1637-40. [PMID: 26180287 PMCID: PMC4499950 DOI: 10.1589/jpts.27.1637] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/07/2015] [Indexed: 11/24/2022] Open
Abstract
This study aimed to determine the effects of a virtual reality exercise program using the
Interactive Rehabilitation and Exercise System (IREX) on the recovery of motor and
cognitive function and the performance of activities of daily living in stroke patients.
[Subjects] The study enrolled 10 patients diagnosed with stroke who received occupational
therapy at the Department of Rehabilitation Medicine of Hospital A between January and
March 2014. [Methods] The patients took part in the virtual reality exercise program for
30 minutes each day, three times per week, for 4 weeks. Then, the patients were
re-evaluated to determine changes in upper extremity function, cognitive function, and
performance of activities of daily living 4 weeks after the baseline assessment. [Results]
In the experimental group, there were significant differences in the Korea-Mini Mental
Status Evaluation, Korean version of the modified Barthel index, and Fugl-Meyer assessment
scores between the baseline and endpoint. [Conclusion] The virtual reality exercise
program was effective for restoring function in stroke patients. Further studies should
develop systematic protocols for rehabilitation training with a virtual reality exercise
program.
Collapse
Affiliation(s)
- Kyoung-Hee Lee
- Department of Occupational Therapy, Baekseok University, Republic of Korea
| |
Collapse
|
34
|
Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. PRIMARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. SECONDARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. MAIN RESULTS We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOME results were statistically significant for upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49 based on 12 studies with 397 participants). SECONDARY OUTCOMES there were no statistically significant effects for grip strength, gait speed or global motor function. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.43, 95% CI 0.18 to 0.69 based on eight studies with 253 participants); however, we were unable to pool results for cognitive function, participation restriction, quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 26% of participants screened were recruited. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.
Collapse
Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Susie Thomas
- University of South Australia (City East)International Centre for Allied Health Evidence (iCAHE)GPO Box 2471AdelaideAustralia5000
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkUSA
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| |
Collapse
|
35
|
Lohse KR, Hilderman CGE, Cheung KL, Tatla S, Van der Loos HFM. Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS One 2014; 9:e93318. [PMID: 24681826 PMCID: PMC3969329 DOI: 10.1371/journal.pone.0093318] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/28/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The objective of this analysis was to systematically review the evidence for virtual reality (VR) therapy in an adult post-stroke population in both custom built virtual environments (VE) and commercially available gaming systems (CG). METHODS MEDLINE, CINAHL, EMBASE, ERIC, PSYCInfo, DARE, PEDro, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were systematically searched from the earliest available date until April 4, 2013. Controlled trials that compared VR to conventional therapy were included. Population criteria included adults (>18) post-stroke, excluding children, cerebral palsy, and other neurological disorders. Included studies were reported in English. Quality of studies was assessed with the Physiotherapy Evidence Database Scale (PEDro). RESULTS Twenty-six studies met the inclusion criteria. For body function outcomes, there was a significant benefit of VR therapy compared to conventional therapy controls, G = 0.48, 95% CI = [0.27, 0.70], and no significant difference between VE and CG interventions (P = 0.38). For activity outcomes, there was a significant benefit of VR therapy, G = 0.58, 95% CI = [0.32, 0.85], and no significant difference between VE and CG interventions (P = 0.66). For participation outcomes, the overall effect size was G = 0.56, 95% CI = [0.02, 1.10]. All participation outcomes came from VE studies. DISCUSSION VR rehabilitation moderately improves outcomes compared to conventional therapy in adults post-stroke. Current CG interventions have been too few and too small to assess potential benefits of CG. Future research in this area should aim to clearly define conventional therapy, report on participation measures, consider motivational components of therapy, and investigate commercially available systems in larger RCTs. TRIAL REGISTRATION Prospero CRD42013004338.
Collapse
Affiliation(s)
- Keith R. Lohse
- School of Kinesiology, Auburn University, Auburn, Alabama, United States of America
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Courtney G. E. Hilderman
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katharine L. Cheung
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandy Tatla
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - H. F. Machiel Van der Loos
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|