1
|
Carrera RM, Tao C, Agrawal SK. Designing and Analyzing In-Place Motor Tasks in Virtual Reality With Goal Functions. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2928-2938. [PMID: 39106130 DOI: 10.1109/tnsre.2024.3439500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Goal functions make virtual goal-oriented motor tasks easier to analyze and manipulate by explicitly linking movement to outcome. However, they have only been used to study constrained (e.g., planar) upper limb movements. We present a design framework for integrating goal functions with unconstrained postural and upper limb movements in a virtual reality (VR) device. VR tasks designed with the framework can mimic unconstrained natural motions and thus train a range of functional movements yet remain analytically tractable. We created three in-place VR motor tasks: a bow-and-arrow, a reach-and-strike, and a punching bag task. Each task was adjusted to subject-specific workspace limits and anthropometrics. We studied the effects of 3 days of practice and 3 reach/lean distances on task performance in 12 healthy adults. Subjects performed all tasks on day 1 with moderate proficiency and improved with practice at all reach/lean distances. Task-specific results showed that performance decreased and movement variability increased near the edge of the reaching workspace; viewing angles and the imperfect depth cues in VR likely led to biases in performance and practice could attenuate the former effect; in reach-and-strike, subjects learned movement patterns similar to those seen in a real-world striking sport. These results show that our framework can deliver tasks useful for analyzing and training motor performance and can guide future in-place motor training. Post-hoc, we demonstrated the feasibility of generalizable methods that adjust required movement speeds and task difficulty for impaired populations.
Collapse
|
2
|
Embrechts E, McGuckian TB, Rogers JM, Dijkerman CH, Steenbergen B, Wilson PH, Nijboer TCW. Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis. Arch Phys Med Rehabil 2023; 104:1720-1734. [PMID: 37295704 DOI: 10.1016/j.apmr.2023.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. DATA SOURCES AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. STUDY SELECTION Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). DATA EXTRACTION Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. DATA SYNTHESIS CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CONCLUSIONS CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.
Collapse
Affiliation(s)
- Elissa Embrechts
- Rehabilitation Sciences and Physical Therapy, Research group MOVANT, University of Antwerp, Belgium; Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Jeffrey M Rogers
- Faculty of Health Sciences, University of Sydney, New South Wales, Australia
| | - Chris H Dijkerman
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Bert Steenbergen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Tanja C W Nijboer
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands; Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
3
|
Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, Filoni S, Waldner A, Mazzoleni S, Focacci A, Ferraro F, Bonaiuti D, Franceschini M. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. J Clin Med 2023; 12:jcm12020439. [PMID: 36675371 PMCID: PMC9861649 DOI: 10.3390/jcm12020439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector robot) in comparison to the conventional overground gait training in subacute stroke survivors. METHODS In a multicenter controlled clinical trial, 89 subacute stroke survivors conducted twenty sessions of robot-assisted gait training (Robotic Group) or overground gait training (Control Group) in addition to the standard daily therapy. The robotic training was performed with an exoskeleton (RobotEXO-group) or an end-effector (RobotEND-group). Clinical outcomes were assessed before (T0) and after (T1) the treatment. The walking speed during the 10-Meter Walk Test (10 MWT) was the primary outcome of this study, and secondary outcomes were the 6-Minute Walk Test (6 MWT), Timed Up and Go test (TUG), and the modified Barthel Index (mBI). RESULTS The main characteristics assessed in the Robotic and Control groups did not differ at baseline. A significant benefit was detected from the 10 MWT in the Robotic Group at the end of the study period (primary endpoint). A benefit was also observed from the following parameters: 6 MWT, TUG, and mBI. Moreover, patients belonging to the Robot Group outperformed the Control Group in gait speed, endurance, balance, and ADL. The RobotEND-group improved their walking speed more than the RobotEXO-group. CONCLUSION The stationary robot-assisted training improved walking ability better than the conventional training in subacute stroke survivors. These results suggest that people with subacute stroke may benefit from Robot-Assisted training in potentiating gait speed and endurance. Our results also support that end-effector robots would be superior to exoskeleton robots for improving gait speed enhancement.
Collapse
Affiliation(s)
- Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, 98124 Messina, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Antonino Naro
- Stroke Unit, Policlinico Universitario G. Martino, 98123 Messina, Italy
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Correspondence: (R.S.C.); (M.G.); Tel.: +39-0652252319 (M.G.)
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Federica Tamburella
- Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab.), Spinal Rehabilitation Laboratory (SPIRE Lab.), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia, 00124 Rome, Italy
| | - Serena Filoni
- Fondazione Centri di Riabilitazione Padre Pio Onlus, 71013 San Giovani Rotondo, Italy
| | - Andreas Waldner
- Department of Neurorehabilitation, Melittaklinik Hospital, 39100 Bolzano, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, 70121 Bari, Italy
| | - Antonella Focacci
- S.C. Medicina Fisica e Riabilitazione, ASL 4 Ospedale di Sestri Levante, 16124 Genova, Italy
| | - Francesco Ferraro
- Struttura Complessa di Riabilitazione Neuromotoria ASST Mantova Presidio di Bozzolo, 46012 Bozzolo, Italy
| | - Donatella Bonaiuti
- Italian Scientific Society of Physical Medicine and Rehabilitation (SIMFER), 00198 Rome, Italy
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, 00163 Rome, Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00123 Rome, Italy
| | | |
Collapse
|
4
|
Research progress in the application of motor-cognitive dual task training in rehabilitation of walking function in stroke patients. JOURNAL OF NEURORESTORATOLOGY 2022. [DOI: 10.1016/j.jnrt.2022.100028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
5
|
Taguchi J, Takami A, Makino M. Changes in cerebral blood flow before, during, and after forward and backward walking in stroke patients trained using virtual reality walking videos with deliberately induced inaccuracies in walking speed estimations. J Phys Ther Sci 2022; 34:668-672. [PMID: 36213187 PMCID: PMC9535245 DOI: 10.1589/jpts.34.668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/11/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to examine the effects of virtual reality (VR)
training, with deliberately induced inaccuracies in walking speed estimations, on brain
activity. [Participants and Methods] The study participants were 21 stroke patients, and
the walking tasks involved forward and backward walking. While the VR walking speed was
set at 3 km/h, estimation errors were induced by using an actual walking speed of 1 km/h
during the walking tasks. Cerebral blood flow was measured using two functional
near-infrared spectroscopy (fNIRS) channels located over the left and right prefrontal
cortices, to determine changes in oxyhemoglobin levels from the resting state. Cerebral
hemodynamics were compared during and after the VR training. [Results] The backward
walking task induced a significant increase in cerebral blood flow in the right prefrontal
cortex during and after the VR training. No significant changes were observed during the
forward walking task. [Conclusion] In the backward walking condition, greater activation
of the right prefrontal cortex was observed during and immediately after the VR training.
Watching VR may have led to inaccurate walking-speed estimations, necessitating postural
control (which may be attributed to the activation of the prefrontal cortex) during
walking.
Collapse
Affiliation(s)
- Jun Taguchi
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Akiyoshi Takami
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Misato Makino
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| |
Collapse
|
6
|
Zhang S, Ito D, Ogura R, Tominaga T, Ono Y. Acute Effect of Treadmill Walking under Optic Flow Stimulation on Gait Function in Individuals with Stroke and Healthy Controls. ADVANCED BIOMEDICAL ENGINEERING 2022. [DOI: 10.14326/abe.11.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sinan Zhang
- Electrical Engineering Program, Graduate School of Science and Technology, Meiji University
| | | | | | - Takanori Tominaga
- Organization for the Strategic Coordination of Research and Intellectual Properties, Meiji University
| | - Yumie Ono
- Department of Electronics and Bioinformatics, School of Science and Technology, Meiji University
| |
Collapse
|
7
|
Zhou Q, Yang H, Zhou Q, Pan H. Effects of cognitive motor dual-task training on stroke patients: A RCT-based meta-analysis. J Clin Neurosci 2021; 92:175-182. [PMID: 34509248 DOI: 10.1016/j.jocn.2021.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/03/2021] [Accepted: 08/14/2021] [Indexed: 11/16/2022]
Abstract
Based on a randomized controlled trial (RCT), this meta-analysis aimed to comprehensively analyze the effects of cognitive motor dual-task training (CMDT) on stroke patients. The electronic databases PubMed, Embase, and the Cochrane Library were searched for papers on the influence of CMDT on stroke patients. Weighted mean difference (WMD) and 95% confidence interval (95% CI) were used as effect sizes. Cochran's Q and I2 tests were performed for heterogeneity. Thirteen articles involving 326 patients were included in the study. The meta-analysis showed that CMDT significantly improved the walking balance of patients with stroke (P = 0.01). In addition, CMDT significantly improved the gait ability of patients with stroke (P < 0.0001). Furthermore, CMDT had a significant effect on the improvement of upper limb ability in patients with stroke (P < 0.00001). CMDT could significantly improve balance ability, gait, and upper limb function in patients with chronic stroke, which is worthy of clinical promotion.
Collapse
Affiliation(s)
- Qiang Zhou
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
| | - Hongchang Yang
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China.
| | - Quanfu Zhou
- Department of Physical Education, Nanjing Agricultural University, Nanjing, Jiangsu 210095, China
| | - Hongyao Pan
- Department of Physical Education, Hohai University, Nanjing, Jiangsu 210098, China
| |
Collapse
|
8
|
Takami A, Watanabe K, Makino M. Immediate effect of video viewing with an illusion of walking at a faster speed using virtual reality on actual walking of stroke patients. J Phys Ther Sci 2021; 33:560-564. [PMID: 34393363 PMCID: PMC8332643 DOI: 10.1589/jpts.33.560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to provide cerebral stroke patients with virtual reality videos of gait occurring at a faster speed than their actual measured gait speed and ascertain the effect on generating errors of gait. [Participants and Methods] The participants were 12 stroke patients. They were given a 2-minute virtual reality presentation of gait occurring at a speed faster than their actual measured comfortable walking speed. Immediately following the presentation, their 10-m walking speed was measured again to observe the immediate effect of the intervention, after which the time required to walk at maximum gait speed was measured. Stride length, cadence, and walking speed before and after the intervention were compared. In addition, heard an immersive feeling. [Results] At a comfortable walking speed, the cadence improved significantly post-intervention. Walking speed and stride length also tended to increase. At the maximum walking speed, there were no significant differences in any parameter. There was no problem with the immersive feeling. [Conclusion] After watching virtual reality videos of gait at a speed faster than the patients' actual gait speed, their walking speed tended to increase in comfortable walking. It was speculated that this technique could be applied to walking training, depending on the device.
Collapse
Affiliation(s)
- Akiyoshi Takami
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Koh Watanabe
- Hirosaki Stroke and Rehabilitation Center, Japan
| | - Misato Makino
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| |
Collapse
|
9
|
Takami A, Taguchi J, Makino M. Changes in cerebral blood flow during forward and backward walking with speed misperception generated by virtual reality. J Phys Ther Sci 2021; 33:565-569. [PMID: 34393364 PMCID: PMC8332638 DOI: 10.1589/jpts.33.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/01/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effect of speed misperception on brain activity, created by a speed difference between actual walking and virtual reality walking videos. [Participants and Methods] The participants were 20 healthy young people. The walking speed in the video was set to 3 km/h to induce an error, while the actual walking speed was 1 km/h. Cerebral blood flow was measured using an optical imaging brain function measurement device. Left and right prefrontal cortices were analyzed using two channels and oxyhemoglobin level change from rest was used as a cerebral blood flow index. A t-test compared the cerebral blood flow dynamics before, during, and after the virtual reality video viewing under forward and backward walking conditions. [Results] Regarding changes in oxyhemoglobin levels during walking after watching the virtual reality video, cerebral blood flow increased especially in the backward walking state, where the difference was large in the right prefrontal cortex. [Conclusion] The backward walking that caused misperception by virtual reality is an extraordinary movement compared to forward walking. Thus, it is necessary to voluntarily adjust the movement by the cerebral cortex, and it is thought that activation of the prefrontal cortex occurs.
Collapse
Affiliation(s)
- Akiyoshi Takami
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| | - Jun Taguchi
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan.,Hirosaki Stroke and Rehabilitation Center, Japan
| | - Misato Makino
- Graduate School of Health Sciences, Hirosaki University: 66-1 Honcho, Hirosaki-shi, Aomori 036-8564, Japan
| |
Collapse
|
10
|
Hong SY, Moon Y, Choi JD. Effects of Cognitive Task Training on Dynamic Balance and Gait of Patients with Stroke: A Preliminary Randomized Controlled Study. Med Sci Monit Basic Res 2020; 26:e925264. [PMID: 32773732 PMCID: PMC7439598 DOI: 10.12659/msmbr.925264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background The decreased postural control ability of stroke patients affects their ability to balance in various postures such as sitting and standing. This study aimed to determine whether cognitive task training for stroke patients is effective in improving walking and balancing abilities. Material/Methods Seventeen stroke patients (10 males, 7 females) were randomized by ballot to be assigned to the cognitive task group (CBT) or the general task group (GBT). For the cognitive task training, a dual task of balance and cognition using traffic signals, a familiar form to the subjects, was applied as a program. In both groups the interventions were performed for 30 min a day, 3 times a week, for 4 weeks. The timed up and go test (TUG), the Berg balance scale (BBS), and gait ability evaluation were performed to compare the therapeutic effects. Results After the intervention, the BBS showed significant differences in both groups (p<0.05). The cognitive task training group had significant improvement in all outcome scores after the intervention (p<0.05). The TUG score of the CBT group significantly decreased to 6.17 s (p<0.05), but that of the GBT showed no statistically significant change. Conclusions Cognitive task training could be used in clinical rehabilitation as a more effective intervention method to improve balance and gait ability of stroke patients.
Collapse
Affiliation(s)
- Su-Yeon Hong
- Department of Physical Therapy, Cheongju IM Rehabilitation Hospital, Cheongju, South Korea
| | - Young Moon
- Department of Physical Therapy, The Graduate School, Daejeon University, Daejeon, South Korea
| | - Jong-Duk Choi
- Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, South Korea
| |
Collapse
|
11
|
Felsberg DT, Maher JP, Rhea CK. The State of Behavior Change Techniques in Virtual Reality Rehabilitation of Neurologic Populations. Front Psychol 2019; 10:979. [PMID: 31139106 PMCID: PMC6518969 DOI: 10.3389/fpsyg.2019.00979] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/12/2019] [Indexed: 01/06/2023] Open
Abstract
Background: Neurologic rehabilitation aims to restore function, address barriers to activity, and improve quality of life in those with injury to the nervous system. Virtual reality (VR) has emerged as a useful tool to enhance neurorehabilitation interventions and outcomes. However, the manner in which VR-based neurorehabilitation has been manipulated to optimize outcomes using theory-based frameworks has not been documented. Behavior Change Techniques (BCTs) are described as the smallest active ingredient in an intervention aimed to change behavior via theoretically-proposed pathways. The purpose of this review was to investigate the ways VR is being used in neurorehabilitation to improve upright mobility, and systematically code those VR interventions for active BCTs. Methods: Keyword searches were performed using database searches of PubMed, SPORTDiscus, and psycINFO. The search yielded 32 studies for inclusion. Coding for BCTs was conducted using the Behavior Change Techniques Taxonomy v1 (BCTTv1). Results: Behavioral Practice, Graded Tasks, Biofeedback, and Explicit Feedback were the most commonly used BCTs. All studies reported improvements in motor performance outcomes. However, none of the studies investigated the efficacy of each component of their VR intervention making it difficult to point to the most effective components of VR interventions overall. Conclusions: This review suggests that investigation into the specific components of VR interventions, along with purposeful implementation and reporting of BCTs will help improve understanding of the efficacy of VR as a neurorehabilitation tool. Future research could benefit from incorporating BCTs into the design process of VR interventions to produce optimal rehabilitation potential.
Collapse
Affiliation(s)
- Danielle T Felsberg
- Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Jaclyn P Maher
- Physical Activity and Lifetime Wellness Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - Christopher K Rhea
- Virtual Environment for Assessment and Rehabilitation (VEAR) Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| |
Collapse
|
12
|
Mohammadi R, Semnani AV, Mirmohammadkhani M, Grampurohit N. Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 28:1787-1798. [PMID: 31031145 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/13/2019] [Accepted: 03/31/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The objective of this study was to systematically review the effect of virtual reality on balance as compared to conventional therapy alone poststroke. METHODS The databases of PubMed, Cochrane, and Ovid were searched using select keywords. The randomized controlled trials published between January 2000 and August 2017 in English language were included if they assessed the effect of virtual reality on balance ability compared to conventional therapy alone in adults' poststroke. The Physiotherapy Evidence Database scale was used to assess the methodological quality. RESULTS Fourteen papers were included in this review. The experimental groups largely (n = 13) used virtual reality in combination with conventional therapy. Among the high quality studies, significant between-group improvement favoring virtual reality in combination with conventional therapy was found on Berg Balance Scale (n = 7) and Timed Up and Go Scale (n = 7) when compared to conventional therapy alone. The studies were limited by low powered, small sample sizes ranging from 14 to 40, and lack of blinding, concealed allocation, and reporting of missing data. Thirteen homogenous (n = 348, I2 = 37.6%, P = .083) studies were included in the meta-analysis using Berg Balance Scale. Significant improvement was observed in the experimental group compared to control group with a medium effect size of .64, confidence interval of .36-.92. CONCLUSIONS The findings of this review indicate that virtual reality when combined with conventional therapy is moderately more effective in improving balance than conventional therapy alone in individuals' poststroke.
Collapse
Affiliation(s)
- Roghayeh Mohammadi
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | | | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Namrata Grampurohit
- Department of Occupational Therapy, College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Faria AL, Cameirão MS, Couras JF, Aguiar JRO, Costa GM, Bermúdez i Badia S. Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke - A Pilot Study. Front Psychol 2018; 9:854. [PMID: 29899719 PMCID: PMC5988851 DOI: 10.3389/fpsyg.2018.00854] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients' capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.
Collapse
Affiliation(s)
- Ana L. Faria
- Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
- Madeira Interactive Technologies Institute, Funchal, Portugal
| | - Mónica S. Cameirão
- Madeira Interactive Technologies Institute, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | | | | | | | - Sergi Bermúdez i Badia
- Madeira Interactive Technologies Institute, Funchal, Portugal
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| |
Collapse
|
14
|
Cognitive and motor dual task gait training improve dual task gait performance after stroke - A randomized controlled pilot trial. Sci Rep 2017. [PMID: 28642466 PMCID: PMC5481328 DOI: 10.1038/s41598-017-04165-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study investigated effects of cognitive and motor dual task gait training on dual task gait performance in stroke. Participants (n = 28) were randomly assigned to cognitive dual task gait training (CDTT), motor dual task gait training (MDTT), or conventional physical therapy (CPT) group. Participants in CDTT or MDTT group practiced the cognitive or motor tasks respectively during walking. Participants in CPT group received strengthening, balance, and gait training. The intervention was 30 min/session, 3 sessions/week for 4 weeks. Three test conditions to evaluate the training effects were single walking, walking while performing cognitive task (serial subtraction), and walking while performing motor task (tray-carrying). Parameters included gait speed, dual task cost of gait speed (DTC-speed), cadence, stride time, and stride length. After CDTT, cognitive-motor dual task gait performance (stride length and DTC-speed) was improved (p = 0.021; p = 0.015). After MDTT, motor dual task gait performance (gait speed, stride length, and DTC-speed) was improved (p = 0.008; p = 0.008; p = 0.008 respectively). It seems that CDTT improved cognitive dual task gait performance and MDTT improved motor dual task gait performance although such improvements did not reach significant group difference. Therefore, different types of dual task gait training can be adopted to enhance different dual task gait performance in stroke.
Collapse
|
15
|
Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis. Phys Ther 2016; 96:1905-1918. [PMID: 27174255 DOI: 10.2522/ptj.20160054] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Virtual reality (VR) training is considered to be a promising novel therapy for balance and gait recovery in patients with stroke. PURPOSE The aim of this study was to conduct a systematic literature review with meta-analysis to investigate whether balance or gait training using VR is more effective than conventional balance or gait training in patients with stroke. DATA SOURCES A literature search was carried out in the databases PubMed, Embase, MEDLINE, and Cochrane Library up to December 1, 2015. STUDY SELECTION Randomized controlled trials that compared the effect of balance or gait training with and without VR on balance and gait ability in patients with stroke were included. DATA EXTRACTION AND SYNTHESIS Twenty-one studies with a median PEDro score of 6.0 were included. The included studies demonstrated a significant greater effect of VR training on balance and gait recovery after stroke compared with conventional therapy as indicated with the most frequently used measures: gait speed, Berg Balance Scale, and Timed "Up & Go" Test. Virtual reality was more effective to train gait and balance than conventional training when VR interventions were added to conventional therapy and when time dose was matched. LIMITATIONS The presence of publication bias and diversity in included studies were limitations of the study. CONCLUSIONS The results suggest that VR training is more effective than balance or gait training without VR for improving balance or gait ability in patients with stroke. Future studies are recommended to investigate the effect of VR on participation level with an adequate follow-up period. Overall, a positive and promising effect of VR training on balance and gait ability is expected.
Collapse
|
16
|
Bang YS, Son KH, Kim HJ. Effects of virtual reality training using Nintendo Wii and treadmill walking exercise on balance and walking for stroke patients. J Phys Ther Sci 2016; 28:3112-3115. [PMID: 27942130 PMCID: PMC5140810 DOI: 10.1589/jpts.28.3112] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study is to investigate the effects of virtual reality
training using Nintendo Wii on balance and walking for stroke patients. [Subjects and
Methods] Forty stroke patients with stroke were randomly divided into two exercise program
groups: virtual reality training (n=20) and treadmill (n=20). The subjects underwent their
40-minute exercise program three times a week for eight weeks. Their balance and walking
were measured before and after the complete program. We measured the left/right
weight-bearing and the anterior/posterior weight-bearing for balance, as well as stance
phase, swing phase, and cadence for walking. [Results] For balance, both groups showed
significant differences in the left/right and anterior/posterior weight-bearing, with
significant post-program differences between the groups. For walking, there were
significant differences in the stance phase, swing phase, and cadence of the virtual
reality training group. [Conclusion] The results of this study suggest that virtual
reality training providing visual feedback may enable stroke patients to directly adjust
their incorrect weight center and shift visually. Virtual reality training may be
appropriate for patients who need improved balance and walking ability by inducing their
interest for them to perform planned exercises on a consistent basis.
Collapse
Affiliation(s)
- Yo-Soon Bang
- Department of Occupational Therapy, Gwangju University, Republic of Korea
| | - Kyung Hyun Son
- Department of Physical Therapy, Hanlyo University, Republic of Korea
| | - Hyun Jin Kim
- Department of Physical Therapy, Hanlyo University, Republic of Korea
| |
Collapse
|
17
|
Lee MM, Shin DC, Song CH. Canoe game-based virtual reality training to improve trunk postural stability, balance, and upper limb motor function in subacute stroke patients: a randomized controlled pilot study. J Phys Ther Sci 2016; 28:2019-24. [PMID: 27512255 PMCID: PMC4968497 DOI: 10.1589/jpts.28.2019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was aimed at investigating the preliminary therapeutic efficacy and usefulness of canoe game-based virtual reality training for stroke patients. [Subjects and Methods] Ten stroke patients were randomly assigned to an experimental group (EG; n=5) or a control group (CG; n=5). Patients in both groups participated in a conventional rehabilitation program, but those in the EG additionally participated in a 30-min canoe game-based virtual reality training program 3 days a week for 4 weeks. Therapeutic efficacy was assessed based on trunk postural stability, balance, and upper limb motor function. In addition, the usefulness of canoe game-based virtual reality training was assessed in the EG and therapist group (TG; n=20), which consisted of physical and occupational therapists, by using the System Usability Scale (SUS). [Results] Improvements in trunk postural stability, balance, and upper limb motor function were observed in the EG and CG, but were greater in the EG. The mean SUS scores in the EG and TG were 71 ± 5.2 and 74.2 ± 4.8, respectively. [Conclusion] Canoe game-based virtual reality training is an acceptable and effective intervention for improving trunk postural stability, balance, and upper limb motor function in stroke patients.
Collapse
Affiliation(s)
- Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Republic of Korea
| | - Doo-Chul Shin
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Chang-Ho Song
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| |
Collapse
|
18
|
Iruthayarajah J, McIntyre A, Cotoi A, Macaluso S, Teasell R. The use of virtual reality for balance among individuals with chronic stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2016; 24:68-79. [DOI: 10.1080/10749357.2016.1192361] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|