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Xu H, Hou J, Zhou J, Wang S. Effects of Virtual Reality on Preoperative Anxiety in Adult Patients: An Updated Meta-analysis. J Perianesth Nurs 2024:S1089-9472(24)00193-X. [PMID: 39340515 DOI: 10.1016/j.jopan.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/09/2024] [Accepted: 05/17/2024] [Indexed: 09/30/2024]
Abstract
PURPOSE To determine the effectiveness of virtual reality (VR) on preoperative anxiety in adult patients. DESIGN A systematic review and meta-analysis of randomized controlled trials. METHODS A systematic search was carried out using PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, PsycINFO, China National Knowledge Infrastructure (CNKI), WANFANG DATA, Chinese Science and Technology Periodical Database (VIP), and Sino-Med from inception to December 18, 2022. All eligible randomized controlled trials published were included (published in English and Chinese). The Cochrane Collaboration "Risk of Bias" tool was used to assess the methodological quality of the included studies. Review Manager software 5.4 was used for data analysis. FINDINGS Nine studies with sample sizes ranging from 72 to 255 and 1,046 participants were identified. The results of the meta-analysis showed that VR significantly reduced preoperative anxiety in adults (standardized mean difference = -0.48, 95% CI: -0.93 to -0.03, P = .04). Our results suggested that VR improved postoperative satisfaction scores more effectively compared with control care (mean difference = 15.29, 95% CI: 6.25 to 24.33, P = .0009). CONCLUSIONS Study results support that VR has a positive effect in reducing preoperative anxiety in adults. VR can also significantly improve patients' satisfaction after surgery. However, the results need to be further assessed due to the small sample sizes and high heterogeneity.
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Affiliation(s)
- Hongyan Xu
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jiakun Hou
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jing Zhou
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Shanshan Wang
- Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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2
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Hao J, Crum G, Siu KC. Effects of virtual reality on stroke rehabilitation: An umbrella review of systematic reviews. Health Sci Rep 2024; 7:e70082. [PMID: 39328980 PMCID: PMC11424326 DOI: 10.1002/hsr2.70082] [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: 04/02/2024] [Revised: 08/03/2024] [Accepted: 09/03/2024] [Indexed: 09/28/2024] Open
Abstract
Background and Aims Virtual reality is an emerging technology in rehabilitation. This umbrella review aimed to identify, critically appraise, and summarize current systematic reviews on the effects of virtual reality on stroke rehabilitation. Methods Five biomedical databases, PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched from inception to December 30th, 2023, for systematic reviews with or without meta-analyses published in English. Two reviewers independently conducted abstract screening, full-text selection, and quality assessments. The methodological quality of included studies was evaluated by the Assessing the Methodological Quality of Systematic Reviews 2. Results were qualitatively synthesized according to domains of function to ascertain the effects of virtual reality intervention on functional improvement within stroke rehabilitation. Results A total of 78 articles were included; 23 were systematic reviews, and 55 were systematic reviews with meta-analyses. Among them, 30 studies were evaluated as critically low quality, 32 as low, 15 as moderate, and one as good. Outcomes regarding upper extremity motor function, upper extremity activity, participation, functional independence, balance, functional mobility, walking speed, and cognitive function were summarized. While positive effects in favor of virtual reality were revealed by a majority of systematic reviews on these outcomes, evidence supporting the significantly different effects of virtual reality compared to conventional rehabilitation on participation and cognitive function was lacking. Conclusion The umbrella review demonstrated promising clinical outcomes regarding the use of virtual reality as an advanced therapeutic approach in stroke rehabilitation to optimize patient care. Future systematic reviews and meta-analyses in this field should adhere to established guidelines to enhance the quality of evidence.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
| | - Gretchen Crum
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
| | - Ka-Chun Siu
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions University of Nebraska Medical Center Omaha Nebraska USA
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Hussain F, Khursheed M, Afzal S, Khan MU, Hasan A, Hasnain SM. Effects of Virtual Reality-Based Mirror Therapy on Upper Extremity Motor Function, Manual Performance and Gross Manual Dexterity Among Stroke Patients: A Meta-Analysis. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:1219-1234. [PMID: 39257864 PMCID: PMC11385280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
In recent years, innovative technologies have gained prominence in stroke patient rehabilitation worldwide, with virtual reality-based mirror therapy (VRBMT) emerging as a notable example. Hence, the present study aims to determine the efficacy of VRBMT on upper extremity motor function, manual performance, and gross manual dexterity among stroke patients. The systematic search utilized Population, Intervention, Comparison, Outcome, and Design (PICOD) paradigm, and the study searched was based on 2012-2023, utilizing different databases. The meta-analysis data was evaluated using MedCalc version 18.11.3. The Pooled effect size mean was statistically examined using a fixed and random effect model. Among the 6 studies selected, 4 studies involving upper-limb stroke patients were identified between the VRBMT. Pooled analysis of VRBMT revealed no significant effect on motor function [standardized mean difference (SMD) 0.815; 95% CI 0.00 to 81.37; P = 0.5562]. The remaining 2 of 6 studies participated in the study of the manual performance stroke patients (SMD 0.869; 95% CI 0.00 to 93.22; P = 0.0684). The pooled analysis of VRBMT revealed no significant effect. The last 2 of 6 included studies on gross manual dexterity in stroke. The pooled analysis also showed no significant effects on VRBMT (SMD 0.198; 95% CI 0.00 to 0.00; P = 0.6951). The present study concluded although VRBMT exhibits potential as a novel method for stroke rehabilitation, its effects on gross manual dexterity, manual performance, and upper extremity motor function are not statistically significant may be due to a limited number of studies on VRBMT in stroke patients.
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Affiliation(s)
- Fouzia Hussain
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Mahnoor Khursheed
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Sumera Afzal
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Muhammad Usman Khan
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Ahad Hasan
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Syed Meeran Hasnain
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
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Victor BA, R A, Angel I S, Kumar B G. Enhancing Dynamic Balance and Postural Stability in Stroke Patients: The Impact of Immersive Virtual Reality Training. Cureus 2024; 16:e66299. [PMID: 39238751 PMCID: PMC11376469 DOI: 10.7759/cureus.66299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction Stroke is a major neurological event resulting from reduced or blocked blood flow to the brain, leading to significant morbidity. Immediate medical attention is essential to minimize brain damage and improve outcomes since it leads to many clinical deficits like locomotor impairment, instability in postural control, tonic alterations of the affected musculature, and an array of neurological dysfunctions if left unnoticed. Immersive virtual reality (VR) has emerged as a novel therapeutic tool in stroke rehabilitation, offering engaging and realistic environments for therapy. This study aims to evaluate the effectiveness of immersive VR training combined with functional gait exercises in improving dynamic balance and postural stability in stroke patients, compared to VR training alone. Methods This comparative study included 30 subjects from Madha Medical College and Hospital, Chennai, Tamil Nadu, India, divided into two groups. Group A (n=15) received immersive VR combined with functional gait exercises, while Group B (n=15) received immersive VR alone. Subjects were aged 40-60 years with stable blood pressure and a stroke duration of two weeks to six months. The study spanned 12 weeks, with 30-minute sessions on alternate days. Dynamic balance and postural stability were assessed using the Functional Gait Assessment (FGA) and Falls Efficacy Scale (FES). Pre-test and post-test scores were evaluated using parametric tests. Results Post-test mean values showed significant improvements in both groups. Group A demonstrated greater effectiveness, with lower FES scores (mean 36.66 ± 11.12) than Group B (mean 46.66 ± 9.75). FGA scores were higher in Group A (mean 28.00 ± 0.925) compared to Group B (mean 26.06 ± 1.66). Significant differences were observed in pre-test and post-test values within each group, supporting the hypothesis that combined VR and gait exercises offer superior rehabilitation outcomes. Conclusions Immersive VR combined with functional gait exercises significantly improves dynamic balance and postural stability in stroke patients compared to VR alone. This integrated approach can enhance motor function recovery, increase independence, and improve the quality of life. VR's capability to simulate real-life activities and provide immediate feedback allows for personalized rehabilitation programs. Further research is required to validate these findings and optimize VR-based rehabilitation protocols.
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Affiliation(s)
| | - Arunachalam R
- Neuro Physiotherapy, Madhav University, Pindwara, IND
| | - Sheela Angel I
- Neuro Physiotherapy, Vels Institute of Science, Technology & Advanced Studies, Chennai, IND
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Gouhie FA, Barbosa KO, Cruz ABR, Wellichan MM, Zampolli TM. Cognitive effects of piracetam in adults with memory impairment: A systematic review and meta-analysis. Clin Neurol Neurosurg 2024; 243:108358. [PMID: 38878641 DOI: 10.1016/j.clineuro.2024.108358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Piracetam, a widely recognized nootropic drug, is hypothesized to enhance memory function through its influence on synaptic plasticity and neurotransmitter levels. However, despite its popularity, there remains a lack of conclusive evidence regarding its impact on memory. Therefore, the present study aims to explore the effects of piracetam on memory in individuals with impaired cognitive function, comparing it to a placebo control group. OBJECTIVES This study will evaluate how piracetam affects memory function, compared to placebo in adults with impairment in this area. METHODS We carried out bibliographical research and meta-analysis of scientific clinical trials comparing memory function in people taking piracetam with those in the placebo group. The PubMed, Dimensions, Embase, and Cochrane Library databases were used. Statistical analysis was performed in R Studio version 4.3.1. RESULTS In our analysis, 199 articles were identified, of which we included eighteen studies, comprising a total of 886 patients, of which Piracetam was the treatment option in 442 (49.88 %) patients. Memory enhancement (SMD 0.75; 95 % CI [-0.19; 1.69]; p=0.12; I²=96 %) had no clinical difference between the intervention and the control group. CONCLUSION Upon the conclusion of this study, it is apparent that we cannot definitively ascertain the impact of piracetam on memory function. Further research is warranted to provide a clearer understanding of the cognitive effects of piracetam in individuals with memory impairment. This investigation serves as a significant contribution to the ongoing quest to elucidate the potential benefits of piracetam in the field of cognitive neuroscience.
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Affiliation(s)
- Felipe Araujo Gouhie
- Faculty of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil.
| | - Karina Oliveira Barbosa
- Faculty of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
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Zhang J, Wu M, Li J, Song W, Lin X, Zhu L. Effects of virtual reality-based rehabilitation on cognitive function and mood in multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials. Mult Scler Relat Disord 2024; 87:105643. [PMID: 38735202 DOI: 10.1016/j.msard.2024.105643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/16/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a disabling neurological disease that causes cognitive impairment and mental problems that occur in all MS phenotypes but are most common in patients with secondary progressive MS. Various degrees of cognitive impairment and mental health concerns are common among patients with MS (PwMS). Virtual reality (VR)-based rehabilitation is an innovative approach aimed at enhancing cognitive function and mood in PwMS. This study aims to perform a meta-analysis to assess the effects of VR-based rehabilitation on cognitive function and mood in PwMS. METHODS Using PubMed, Embase, the Cochrane Library, Web of Science, and the Physiotherapy Evidence Database (PEDro), a thorough database search was performed to identify randomized controlled trials (RCTs) examining the effects of VR on PwMS. Trials published until October 31, 2023, that satisfied our predetermined inclusion and exclusion criteria were included. Data were extracted, literature was examined, and the methodological quality of the included trials was assessed. StataSE version 16 was used for the meta-analysis. RESULTS Our meta-analysis included 461 patients from 10 RCTs. PRIMARY OUTCOMES The Montreal Cognitive Assessment (MoCA) (weighted mean difference [WMD]=1.93, 95 % confidence interval [CI]=0.51-3.36, P = 0.008, I² = 75.4 %) the Spatial Recall Test (SPART) (WMD=3.57, 95 % CI=1.65-5.50, P < 0.001, I² = 0 %), immediate recall (standard mean difference [SMD]=0.37, 95 % CI=0.10-0.64, P = 0.007, I² = 0 %) and delayed recall ([SMD]=0.30, 95 % CI=0.06-0.54, P = 0.013, I² = 35.4 %) showed improvements in comparison to the control group in terms of global cognitive function immediate recall, delayed recall, and visuospatial abilities. SECONDARY OUTCOMES Compared to the control group, anxiety improved (standard mean difference [SMD]=0.36, 95 % CI=0.10-0.62, P = 0.007, I² = 43.1 %). However, there were no significant differences in processing speed, attention, working memory or depression. CONCLUSIONS This systematic review provides valuable evidence for improving cognitive function and mood in PwMS through VR-based rehabilitation. In the future, VR-based rehabilitation may be a potential method to treat cognitive function and emotional symptoms of MS. SYSTEMATIC REVIEW REGISTRATION PROSPERO; identifier: CRD42023474467.
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Affiliation(s)
- Jiongliang Zhang
- Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Minmin Wu
- Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Jinting Li
- Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Wenjing Song
- Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Xiaoguang Lin
- Heilongjiang University of Chinese Medicine, Harbin 150000, China
| | - Luwen Zhu
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin 150000, China.
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Gao L, Pan L, Yang H. Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024. [PMID: 38937902 DOI: 10.1111/jocn.17306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024]
Affiliation(s)
- Ling Gao
- Department of Anesthesia Operation Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Pan
- Department of Obstetrics and Gynecology, People's Hospital of Xindu District, Chengdu, China
| | - Hao Yang
- Data Quality Control Center, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Alashram AR. Combined robot-assisted therapy virtual reality for upper limb rehabilitation in stroke survivors: a systematic review of randomized controlled trials. Neurol Sci 2024:10.1007/s10072-024-07628-z. [PMID: 38837113 DOI: 10.1007/s10072-024-07628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Upper limb impairments are among the most common consequences following a stroke. Recently, robot-assisted therapy (RT) and virtual reality (VR) have been used to improve upper limb function in stroke survivors. OBJECTIVES This review aims to investigate the effects of combined RT and VR on upper limb function in stroke survivors and to provide recommendations for researchers and clinicians in the medical field. METHODS We searched PubMed, SCOPUS, REHABDATA, PEDro, EMBASE, and Web of Science from inception to March 28, 2024. Randomized controlled trials (RCTs) involving stroke survivors that compared combined RT and VR interventions with either passive (i.e., sham, rest) or active (i.e., traditional therapy, VR, RT) interventions and assessed outcomes related to upper limb function (e.g., strength, muscle tone, or overall function) were included. The Cochrane Collaboration tool was used to evaluate the methodological quality of the included studies. RESULTS Six studies were included in this review. In total, 201 patients with stroke (mean age 57.84 years) were involved in this review. Four studies were considered 'high quality', while two were considered as 'moderate quality' on the Cochrane Collaboration tool. The findings showed inconsistent results for the effects of combined RT and VR interventions on upper limb function poststroke. CONCLUSION In conclusion, there are potential effects of combined RT and VR interventions on improving upper limb function, but further research is needed to confirm these findings, understand the underlying mechanisms, and assess the consistency and generalizability of the results.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Ammam, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Alashram AR. Combined noninvasive brain stimulation virtual reality for upper limb rehabilitation poststroke: A systematic review of randomized controlled trials. Neurol Sci 2024; 45:2523-2537. [PMID: 38286919 DOI: 10.1007/s10072-024-07360-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," while two were categorized as "moderate quality". There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Niering M, Seifert J. The effects of visual skills training on cognitive and executive functions in stroke patients: a systematic review with meta-analysis. J Neuroeng Rehabil 2024; 21:41. [PMID: 38532485 PMCID: PMC10967170 DOI: 10.1186/s12984-024-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
The visual system and associated skills are of particular importance in stroke rehabilitation. The process of neuroplasticity involved in restoring cognitive function during this period is mainly based on anatomical and physiological mechanisms. However, there is little evidence-based knowledge about the effects of visual skills training that could be used to improve therapeutic outcomes in cognitive rehabilitation. A computerized systematic literature search was conducted in the PubMed, Medline, and Web of Science databases from 1 January 1960 to 11 Febuary 2024. 1,787 articles were identified, of which 24 articles were used for the calculation of weighted standardized mean differences (SMD) after screening and eligibility verification. The findings revealed moderate effects for global cognitive function (SMD = 0.62) and activities of daily living (SMD = 0.55) as well as small effects for executive function (SMD = 0.20) - all in favor of the intervention group. The analyses indicate that the results may not be entirely robust, and should therefore be treated with caution when applied in practice. Visual skills training shows positive effects in improving cognitive and executive functions, especially in combination with high cognitive load and in an early phase of rehabilitation. An improvement in activities of daily living can also be observed with this type of intervention. The high heterogeneity of the studies and different treatment conditions require the identification of a relationship between certain visual skills and executive functions in future research.
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Affiliation(s)
- Marc Niering
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany
| | - Johanna Seifert
- Institute of Biomechanics and Neurosciences, Nordic Science, Hannover, Germany.
- Department of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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Rose Sin Yi L, Jing Jing S, Hammoda AO, Jonathan B, Ladislav B, Jing Q. Effects of virtual reality-based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta-analysis. J Clin Nurs 2024; 33:1169-1184. [PMID: 38234275 DOI: 10.1111/jocn.16986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/24/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024]
Abstract
AIMS To examine the effects of virtual reality-based cognitive interventions on cognitive function and activities of daily living among stroke patients, and to identify the optimal design for such intervention. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, EMBASE, Cochrane, CINANL, JBI-EBP and Web of Science from inception to October 2023. METHODS Methodological quality was assessed by Risk of Bias Tool. Meta-analyses were assessed by Review Manager 5.4. Subgroup analyses were conducted to explore the influence of study design. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to assess the certainty of evidence. RESULTS Twenty-five randomized controlled trials (1178 participants) were included. Virtual reality-based cognitive interventions demonstrated moderate-to-large effects in improving global cognitive function (SMD = 0.43; 95% CI [0.01, 0.85]), executive function (SMD = 0.84; 95% CI [0.25, 1.43]) and memory (SMD = 0.65; 95% CI [0.15, 1.16]) compared to control treatments. No significant effects were found on language, visuospatial ability and activities of daily living. Subgroup analyses indicated one-on-one coaching, individualized design and dynamic difficulty adjustment, and interventions lasting ≥ 6 weeks had particularly enhanced effects, especially for executive function. CONCLUSIONS Virtual reality-based cognitive interventions improve global cognitive function, executive function and memory among stroke patients. IMPLICATIONS FOR THE PATIENT CARE This review underscores the broad cognitive advantages offered by virtual technology, suggesting its potential integration into standard stroke rehabilitation protocols for enhanced cognitive recovery. IMPACT The study identifies key factors in virtual technology interventions that effectively improve cognitive function among stroke patients, offering healthcare providers a framework for leveraging such technology to optimize cognitive outcomes in stroke rehabilitation. REPORTING METHOD PRISMA 2020 statement. PROSPERO REGISTRATION NUMBER CRD42022342668.
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Affiliation(s)
- Lin Rose Sin Yi
- School of Nursing, Elaine C. Hubbard Center for Nursing Research on Aging, University of Rochester, Rochester, New York, USA
| | - Su Jing Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Abu-Odah Hammoda
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Bayuo Jonathan
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Batalik Ladislav
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Physiotherapy and Rehabilitation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Qin Jing
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Moulaei K, Sharifi H, Bahaadinbeigy K, Dinari F. Efficacy of virtual reality-based training programs and games on the improvement of cognitive disorders in patients: a systematic review and meta-analysis. BMC Psychiatry 2024; 24:116. [PMID: 38342912 PMCID: PMC10860230 DOI: 10.1186/s12888-024-05563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/28/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Cognitive impairments present challenges for patients, impacting memory, attention, and problem-solving abilities. Virtual reality (VR) offers innovative ways to enhance cognitive function and well-being. This study explores the effects of VR-based training programs and games on improving cognitive disorders. METHODS PubMed, Scopus, and Web of Science were systematically searched until May 20, 2023. Two researchers selected and extracted data based on inclusion and exclusion criteria, resolving disagreements through consultation with two other authors. Inclusion criteria required studies of individuals with any cognitive disorder engaged in at least one VR-based training session, reporting cognitive impairment data via scales like the MMSE. Only English-published RCTs were considered, while exclusion criteria included materials not primarily focused on the intersection of VR and cognitive disorders. The risk of bias in the included studies was assessed using the MMAT tool. Publication bias was assessed using funnel plots and Egger's test. The collected data were utilized to calculate the standardized mean differences (Hedges's g) between the treatment and control groups. The heterogeneity variance was estimated using the Q test and I2 statistic. The analysis was conducted using Stata version 17.0. RESULTS Ten studies were included in the analysis out of a total of 3,157 retrieved articles. VR had a statistically significant improvement in cognitive impairments among patients (Hedges's g = 0.42, 95% CI: 0.15, 0.68; p_value = 0.05). games (Hedges's g = 0.61, 95% CI: 0.30, 0.39; p_value = 0.20) had a more significant impact on cognitive impairment improvement compared to cognitive training programs (Hedges's g = 0.29, 95% CI: -0.11, 0.69; p_value = 0.24). The type of VR intervention was a significant moderator of the heterogeneity between studies. CONCLUSION VR-based interventions have demonstrated promise in enhancing cognitive function and addressing cognitive impairment, highlighting their potential as valuable tools in improving care for individuals with cognitive disorders. The findings underscore the relevance of incorporating virtual reality into therapeutic approaches for cognitive disorders.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Dinari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Marín-Medina DS, Arenas-Vargas PA, Arias-Botero JC, Gómez-Vásquez M, Jaramillo-López MF, Gaspar-Toro JM. New approaches to recovery after stroke. Neurol Sci 2024; 45:55-63. [PMID: 37697027 PMCID: PMC10761524 DOI: 10.1007/s10072-023-07012-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/07/2023] [Indexed: 09/13/2023]
Abstract
After a stroke, several mechanisms of neural plasticity can be activated, which may lead to significant recovery. Rehabilitation therapies aim to restore surviving tissue over time and reorganize neural connections. With more patients surviving stroke with varying degrees of neurological impairment, new technologies have emerged as a promising option for better functional outcomes. This review explores restorative therapies based on brain-computer interfaces, robot-assisted and virtual reality, brain stimulation, and cell therapies. Brain-computer interfaces allow for the translation of brain signals into motor patterns. Robot-assisted and virtual reality therapies provide interactive interfaces that simulate real-life situations and physical support to compensate for lost motor function. Brain stimulation can modify the electrical activity of neurons in the affected cortex. Cell therapy may promote regeneration in damaged brain tissue. Taken together, these new approaches could substantially benefit specific deficits such as arm-motor control and cognitive impairment after stroke, and even the chronic phase of recovery, where traditional rehabilitation methods may be limited, and the window for repair is narrow.
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Affiliation(s)
- Daniel S Marín-Medina
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia.
| | - Paula A Arenas-Vargas
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan C Arias-Botero
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuela Gómez-Vásquez
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Manuel F Jaramillo-López
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jorge M Gaspar-Toro
- Grupo de Investigación NeuroUnal, Neurology Unit, Universidad Nacional de Colombia, Bogotá, Colombia
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Hu Y, Yuan X, Ye P, Chang C, Hu YH, Zhang W, Li K. Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses. JMIR Serious Games 2023; 11:e52022. [PMID: 37997773 PMCID: PMC10690102 DOI: 10.2196/52022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/25/2023] Open
Abstract
Background Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied. Objective We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes. Methods We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ≤2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality. Results In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as "high" based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ≥4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively. Conclusions VR in nursing has positive effects-relieving patients' pain, anxiety, and depression and improving cognitive function-despite the included studies' limited quality. However, applying VR in nursing to improve patients' motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed.
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Affiliation(s)
- Yanjie Hu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xingzhu Yuan
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Peiling Ye
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Chengting Chang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yue Han Hu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Weihua Zhang
- School of Computer Science, Sichuan University, Chengdu, China
| | - Ka Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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Li XW, Xin YF, Chang AH, Zhang XG, Weng Y, Yang JH, Fu QZ. Correlation study between motor rehabilitation level and psychological state in patients with limb movement disorders after stroke. World J Psychiatry 2023; 13:912-918. [DOI: 10.5498/wjp.v13.i11.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The psychological state of patients with post stroke limb movement disorders undergoes a series of changes that affect rehabilitation training and recovery of limb motor function.
AIM To determine the correlation between motor rehabilitation and the psychological state of patients with limb movement disorders after stroke.
METHODS Eighty patients with upper and lower limb dysfunction post stroke were retrospectively enrolled in our study. Based on Hospital Anxiety and Depression Scale (HADS) scores measured before rehabilitation, patients with HADS scores ≥ 8 were divided into the psychological group; otherwise, the patients were included in the normal group. Motor function and daily living abilities were compared between the normal and psychological groups. Correlations between the motor function and psychological status of patients, and between daily living ability and psychological status of patients were analyzed.
RESULTS After 1, 2, and 3 wk of rehabilitation, both the Fugl-Meyer assessment and Barthel index scores improved compared to their respective baseline scores (P < 0.05). A greater degree of improvement was observed in the normal group compared to the psychological group (P < 0.05). There was a negative correlation between negative emotions and limb rehabilitation (-0.592 ≤ r ≤ -0.233, P < 0.05), and between negative emotions and daily living ability (-0.395 ≤ r ≤ -0.199, P < 0.05).
CONCLUSION There is a strong correlation between motor rehabilitation and the psychological state of patients with post stroke limb movement disorders. The higher the negative emotions, the worse the rehabilitation effect.
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Affiliation(s)
- Xiao-Wan Li
- Department of Medical Rehabilitation, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Yu-Fu Xin
- Department of Medical Rehabilitation, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Ai-Hui Chang
- Department of Medical Rehabilitation, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Xiao-Ge Zhang
- Department of Medical Rehabilitation, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Yan Weng
- Department of Medical Rehabilitation, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Jia-Hao Yang
- Department of Logistics, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
| | - Qi-Zhi Fu
- Department of Medical Intensive Care Unit, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang 471003, Henan Province, China
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Droc G, Isac S, Nita E, Martac C, Jipa M, Mihai DI, Cobilinschi C, Badea AG, Ojog D, Pavel B, Tanasescu MD, Isac T. Postoperative Cognitive Impairment and Pain Perception after Abdominal Surgery-Could Immersive Virtual Reality Bring More? A Clinical Approach. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2034. [PMID: 38004083 PMCID: PMC10673060 DOI: 10.3390/medicina59112034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Impaired cognition and pain after surgery contribute to prolonged hospital stays and increased mortality rates. Thus, the development of preemptive algorithms for reducing their impact should be prioritized. The main objectives of the present study were to evaluate the efficiency of using virtual reality (VR) to treat postoperative cognitive decline and pain perception. Materials and Methods: The study was a prospective, monocentric, clinical study that included 51 patients who have undergone major abdominal surgery. The patients were divided into two groups: Control (n = 25) and VR (n = 26). The VR sessions consisted of 5-8 min exposure at 24-48 h after surgery. We considered the outcome variables, the mini-mental state examination, and visual analogue scale at 24-48 h after surgery. The dependent variables were age, social status, educational level, and duration of surgery. Results: We did not observe any differences in postoperative cognition deficit with regard to VR. The VR, however, successfully reduced postoperative pain intensity. Moreover, the patients' age, surgery duration, level of education, and social status influenced the MMSE score at 24-48 h after surgery. Conclusions: Even if using VR does not alleviate short-term postoperative cognitive impairments, it could affect pain perception. Further studies are needed to support the use of VR in perioperative contexts.
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Affiliation(s)
- Gabriela Droc
- Department of Anesthesiology and Intensive Care, Fundeni Clinical Institute, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Sebastian Isac
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Elisabeta Nita
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Cristina Martac
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Miruna Jipa
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Diana Irene Mihai
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Cristian Cobilinschi
- Department of Orthopedics and Anesthesiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Andrada-Georgiana Badea
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Damiana Ojog
- Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, 022328 Bucharest, Romania; (E.N.); (C.M.); (M.J.); (D.I.M.); (D.O.)
| | - Bogdan Pavel
- Department of Physiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria-Daniela Tanasescu
- Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Teodora Isac
- Department of Internal Medicine II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Park M, Ha Y. Effects of Virtual Reality-Based Cognitive Rehabilitation in Stroke Patients: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:2846. [PMID: 37957991 PMCID: PMC10648724 DOI: 10.3390/healthcare11212846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
During the process of recovering functional ability after damage caused by a stroke, it is important to restore cognitive function via cognitive rehabilitation. To achieve successful rehabilitation, it is important for patients to have a sense of efficacy in their ability to manage their disease well. Therefore, a virtual reality-based cognitive rehabilitation program based on self-efficacy theory was developed, and its effects were compared with conventional and computer-assisted cognitive rehabilitation. The virtual reality-based cognitive rehabilitation program consisted of sessions lasting 30 min each five days a week for eight weeks. After applying the virtual reality-based cognitive rehabilitation program, there were significant differences in group-by-time interactions regarding stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life. In addition, there were significant group differences among the three groups in terms of stroke self-efficacy and health-related quality of life. In conclusion, our virtual reality-based cognitive rehabilitation program developed based on self-efficacy theory is effective for inpatients with stroke and improves their stroke self-efficacy, cognitive function, visual perception, activities of daily living, and health-related quality of life.
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Affiliation(s)
- Mingyeong Park
- Depart of Nursing, Jinju Health College, Jinju 52655, Republic of Korea
| | - Yeongmi Ha
- College of Nursing & Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
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Dąbrowská M, Pastucha D, Janura M, Tomášková H, Honzíková L, Baníková Š, Filip M, Fiedorová I. Effect of Virtual Reality Therapy on Quality of Life and Self-Sufficiency in Post-Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1669. [PMID: 37763788 PMCID: PMC10536396 DOI: 10.3390/medicina59091669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The consequences of stroke have a significant impact on self-sufficiency and health-related quality of life (HRQoL). Virtual reality (VR)-based rehabilitation has the potential to impact these modalities, but information on timing, volume, and intensity is not yet available. The aim of this randomized controlled trial (1:1) was to evaluate the impact of conventional rehabilitation combined with VR on self-care and domains of HRQoL in patients ≤6 months post-stroke. Materials and Methods: The intervention group completed a total of 270 min of conventional VR + rehabilitation sessions. The control group underwent conventional rehabilitation only. Primary assessments with the WHO disability assessment schedule 2.0 (WHODAS 2) questionnaire were conducted before rehabilitation (T0), after completion of the intervention (T1), and at the 4-week follow-up (T2); secondary outcomes included self-sufficiency and balance assessments. Results: Fifty patients completed the study (mean age 61.2 ± 9.0 years, time since stroke 114.3 ± 39.4 days). There were no statistically significant differences between the groups in WHODAS 2, self-sufficiency, and balance scores (p > 0.05). Conclusions: In the experimental group, there was a statistically significant difference in WHODAS 2, assessment of self-sufficiency, and balance scores before and after therapy (p < 0.05). VR appears to be a suitable tool to supplement and modify rehabilitation in patients after stroke.
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Affiliation(s)
- Marcela Dąbrowská
- Department of Epidemiology and Public Health Protection, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic;
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Dalibor Pastucha
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
| | - Miroslav Janura
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Faculty of Physical Culture, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
| | - Hana Tomášková
- Department of Epidemiology and Public Health Protection, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic;
| | - Lucie Honzíková
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Šárka Baníková
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
| | - Michal Filip
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
| | - Iva Fiedorová
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, 703 00 Ostrava, Czech Republic; (M.J.); (L.H.); (Š.B.); (M.F.); (I.F.)
- Department of Rehabilitation and Sports Medicine, University Hospital of Ostrava, 708 52 Ostrava, Czech Republic
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Gatica-Rojas V, Cartes-Velásquez R. Telerehabilitation in Low-Resource Settings to Improve Postural Balance in Older Adults: A Non-Inferiority Randomised Controlled Clinical Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6726. [PMID: 37754586 PMCID: PMC10531484 DOI: 10.3390/ijerph20186726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 09/28/2023]
Abstract
Background: Several exercise methods with virtual reality devices have been used in treatments for older adults and patients with neurodegenerative diseases, although the mechanisms continue to be elucidated. The aim of this study is to establish the feasibility and effectiveness of a rehabilitation programme using low-cost virtual reality aimed at improving postural balance in older adults. It also seeks to compare low-cost virtual reality under two delivery modalities, telerehabilitation (TR) in elderly centres and face-to-face (FtF) in rehabilitation centres. Methods: The study is set up as a non-inferiority two-arm parallel triple-blind randomised controlled clinical trial. Sixteen persons aged 65 to 75-years-old will be included. Eighteen Wii therapy sessions (25-30 min) will be provided through both FtF (control group, n = 8) and TR (exposure group, n = 8), both with a Nintendo Wii balance board. Data will be collected at baseline (week 0), during the Wii therapy sessions (weeks 2, 4, and 6), and during the follow-up (weeks 8 and 10). The primary outcome will be the area of centre-of-pressure (CoP) sway; secondary outcomes will be medial-lateral and anterior-posterior velocity and standard deviation of CoP; and tertiary outcomes will be clinical measures: single-leg stand, timed up-and-go tests, Barthel Index, and Tinetti's scale. Statistical analyses will be performed using SPSS 20.00 for Windows. The trial adheres to the Declaration of Helsinki and the Chilean laws of rights and duties of the patient and research in humans. Ethical approval was obtained from the Ethics Committee of the University of Talca. Written informed consent will be obtained from participants. Discussion: In this trial, older adults from a Chilean city with a large rural and underserved population share will be included to test the feasibility and effectiveness of a rehabilitation programme using low-cost VR aimed at improving postural balance to generate evidence to support decision makers generating public health policy. Trial registration: Australian New Zeeland Clinical Trials Registration (ACTRN12621001380886).
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Affiliation(s)
- Valeska Gatica-Rojas
- Telerehabilitation Technology Centre and Neurosciences in Human Movement, Faculty of Health Sciences, Universidad de Talca, Av. Lircay S/N, Talca 3460000, Chile
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Deng H, Zhang R, Wang C, Zhang B, Wang J, Wang S, Zhang J, Shari NI, Leong Bin Abdullah MFI. The efficacy of virtual reality exposure therapy for the treatment of alcohol use disorder among adult males: a randomized controlled trial comparing with acceptance and commitment therapy and treatment as usual. Front Psychiatry 2023; 14:1215963. [PMID: 37674551 PMCID: PMC10477784 DOI: 10.3389/fpsyt.2023.1215963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Background This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines. Methods Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants. Discussion As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future. Clinical trial registration NCT05841823 (ClinicalTrials.gov).
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Affiliation(s)
- Hongdu Deng
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Ruiling Zhang
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Chuansheng Wang
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Bingyu Zhang
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Jiali Wang
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Shilin Wang
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Jie Zhang
- Second Affiliated Hospital, Xinxiang Medical University, Henan, China
| | - Nurul Izzah Shari
- School of Human Resource Development and Psychology, Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia, Skudai, Johor, Malaysia
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Zou J, Chen Q, Wang J, Gu M, Jiang X, Mao M. Effects of virtual reality for psychological health of ICU patients: a study protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e073660. [PMID: 37479513 PMCID: PMC10364162 DOI: 10.1136/bmjopen-2023-073660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Virtual reality (VR) has been shown to have a certain influence on the psychological health of intensive care unit (ICU) patients. However, its specific effects-particularly on psychological health problems, such as psychological well-being, quality of life (QOL) and patient satisfaction-remain unclear. METHOD AND ANALYSIS This study follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Electronic data search is carried out on PubMed, Web of Science, CINAHL, EBSCO, EMBASE, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, Wan Fang, VIP and Chinese Biology Medicine Database. The inclusion criteria follow the PICO principle, wherein ICU patients who have been hospitalised for 24 hours or more are included. Studies using VR-based interventions to improve the psychological health of ICU patients, compared with waitlist controls or traditional therapy groups; outcome assessments containing psychological well-being, QOL and patient satisfaction; and those designed as randomised controlled trials (RCTs) and quasi-experimental research are included. Search time is from inception of each database to July 2023. No language restriction is considered. Studies for inclusion are screened by two independent reviewers for data extraction. Any dispute is resolved through discussion. Unresolved disputes are decided on by consulting a third author. For the risk of bias assessment in RCTs and non-RCTs, the Cochrane risk-of-bias tool for randomised trials and risk of bias in non-randomised studies of interventions tool are used, respectively. For meta-analysis, RevMan V.5.3 is used. ETHICS AND DISSEMINATION This protocol study does not include clinical research and thus does not require ethical approval. Research findings will be released in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023400428.
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Affiliation(s)
- Junjun Zou
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Qian Chen
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Jiajia Wang
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Mengqian Gu
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Xiaoquan Jiang
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Mingyue Mao
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
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Lin C, Ren Y, Lu A. The effectiveness of virtual reality games in improving cognition, mobility, and emotion in elderly post-stroke patients: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:167. [PMID: 37415057 DOI: 10.1007/s10143-023-02061-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023]
Abstract
This review is aimed to assess the effectiveness of virtual reality (VR) games on cognition, mobility, and emotion in elderly stroke patients. We selected relevant articles from eight databases from 2011 to 2022 and extracted articles on cognitive ability (general cognition, mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA) et al.), mobility (modified Barthel index (MBI), Fugl-Meyer assessment (FMA), Berg balance scale (BBS), functional independence measure motor (FIM MOT)), and emotion (depression/anxiety). Twenty-nine studies including 1311 participants were included in the analysis. In the results, virtual reality games were more effective in improving overall cognitive function in stroke patients compared to conventional therapies. In addition, the intervention group in the MMSE (SMD = 0.6, 95%CI = 0.26-0.95, P = 0.0007), MoCA (MD = 1.97, 95%CI = 1.3-2.64, P < 0.00001), and attention test (MD = 0.25, 95% CI = 0.01-0.49, P < 0.00001) scores were also higher. In terms of physical function, MBI (SMD = 0.61, 95%CI = 0.14-1.08, P = 0.01), FMA (SMD = 0.47, 95%CI = 0.02-0.93, P = 0.04), BBS (SMD = 0.78, 95%CI = 0.42-1.15, P < 0.0001), and FIM MOT (MD = 5.87, 95%CI = 2.57-9.17, P = 0.0005) indicators showed better results. It is also observed that virtual reality games can effectively relieve depression and improve mental health in stroke patients. Sports game training, especially with VR equipment, had a positive impact on improving the cognitive performance, mobility, and emotional state of stroke patients compared to a control group. Although the improvement in cognitive ability is relatively low, the effect of improving physical activity and depression is obvious.
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Affiliation(s)
- Chenli Lin
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, 215021, China
- School of Physical Education & Health Care, East China Normal University, Shanghai, Shanghai, 200241, China
| | - Yuanyuan Ren
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, 215021, China
| | - Aming Lu
- Physical Education and Sport Science, Soochow University, Suzhou, Jiangsu Province, 215021, China.
- Functional Assessment and Physical Training Laboratory of Soochow University, Soochow University, Suzhou, Jiangsu Province, 215021, China.
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Liu Y, Wang R, Zhang Y, Feng L, Huang W. Virtual reality psychological intervention helps reduce preoperative anxiety in patients undergoing carotid artery stenting: a single-blind randomized controlled trial. Front Psychol 2023; 14:1193608. [PMID: 37457093 PMCID: PMC10342209 DOI: 10.3389/fpsyg.2023.1193608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This study aimed to explore the effectiveness and applicability of a psychological intervention using virtual reality (VR) to reduce preoperative anxiety in patients undergoing carotid artery stenting (CAS). Methods A total of 114 patients aged 18-86 years who were scheduled to undergo CAS were randomized to the VR and control groups. Patients in the VR group used a VR headset to view a 16-min psychological intervention video, while those in the control group used a tablet for viewing. The primary assessment instrument was the State Anxiety Inventory (S-AI), which was given 20 min before and after the intervention and 24 h after surgery. Secondary assessment tools were the Self-efficacy for Managing Chronic Disease (SEMCD-6) scale, which was completed before the intervention and 24 h after the operation, a smart bracelet to assess sleep quality, monitored in the evening before the operation, and the VR Suitability and Satisfaction Questionnaire, completed 24 h after the operation. Results The two groups were similar in terms of demographic information, preintervention STAI scores and preintervention SEMCD-6 scores (p > 0.05). S-AI scores were lower in both groups after the intervention and surgery, and the scores of the VR group were lower than those of the control group (p = 0.036, p = 0.014). SEMCD-6 scores post-surgery had improved in both groups, but the VR group had significantly higher scores than the control group (p = 0.005). Smart bracelet measurements showed no significant differences in postintervention sleep quality between the two groups (p = 0.540). For satisfaction, the VR group scored higher in all aspects except scheduling. A total of 47 (85.45%) patients reported having a comfortable experience, and only 5 (9.09%) experienced mild adverse effects. Conclusion The use of a virtual reality psychological intervention was beneficial to reduce the anxiety of patients before CAS and improved their self-efficacy. As virtual reality devices evolve and demonstrate better comfort and safety, more comprehensive and in-depth research of the use of VR to reduce patient anxiety should be performed in the future.Clinical trial registration:https://www.chictr.org.cn/showproj.aspx?proj=186412, identifier ChiCTR2200066219.
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Affiliation(s)
- Yanhua Liu
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Rui Wang
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Yang Zhang
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Feng
- Department of Neurology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
| | - Wenxia Huang
- General Practice Medical Center, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, China
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Zheng Z, Li C, Xie RH, Xie H, Fu F, Pan Y, Liao J, Chen X, Yue L. Effectiveness of telehealth interventions on depression symptoms after stroke: A systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00730-9. [PMID: 37247784 DOI: 10.1016/j.jad.2023.05.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Depression symptoms are common after stroke, and affect survivors' recovery of neurological function, ability to return to society, and quality of life. Telehealth has been shown to improve depression symptoms and quality of life among patients post-stroke. However, evidence from clinical trials has not previously been systematically synthesized. OBJECTIVE This study aimed to systematically evaluate the effectiveness of telehealth interventions in reducing depression symptoms among patients post-stroke. METHODS Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of telehealth interventions for post-stroke depression symptoms. The quality of included studies was assessed using the Cochrane risk of bias tool. RevMan 5.4 software was used for the meta-analysis. Data were synthesized by fixed (I2 ≤ 50 %) or random (I2 > 50 %) effects models based on a heterogeneity test. RESULTS In total, 10 studies with 1717 participants were included, eight of which were eligible for the meta-analysis. There were no significant differences in efficacy between the telehealth and control groups for depression symptoms (standardized mean difference [SMD] = -0.16, 95 % confidence interval [CI] -0.67 to 0.36; P = .54), quality of life (SMD = 0.00, 95%CI -0.18 to 0.18; P = .99), limb function (SMD = 0.46, 95%CI -0.26 to 1.18; P = .21), and daily living ability (SMD = 0.38, 95%CI -1.39 to 2.15; P = .67). The telemedicine group had significantly lower anxiety scores than the control group (SMD = -1.05, 95%CI -1.22 to -0.89; P < .001). LIMITATIONS The number of RCTs included in the review was relatively small. CONCLUSIONS The efficacy of telehealth interventions in reducing depression symptoms in patients post-stroke is no different from conventional nursing. However, large-scale, high-quality randomized controlled trials are needed to further explore the potential of telehealth interventions in improving mental health among patients post-stroke.
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Affiliation(s)
- Zhimin Zheng
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chunxia Li
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ri-Hua Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Hualing Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Fen Fu
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuhua Pan
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinyu Liao
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoying Chen
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liqun Yue
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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25
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Effects of virtual reality exposure therapy on state-trait anxiety in individuals with dentophobia. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Lee KN, Kim HJ, Choe K, Cho A, Kim B, Seo J, Myung W, Park JY, Oh KJ. Effects of Fetal Images Produced in Virtual Reality on Maternal-Fetal Attachment: Randomized Controlled Trial. J Med Internet Res 2023; 25:e43634. [PMID: 36826976 PMCID: PMC10007014 DOI: 10.2196/43634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Maternal-fetal attachment (MFA) has been reported to be associated with the postpartum mother-infant relationship. Seeing the fetus through ultrasound might influence MFA, and the effect could be increased by more realistic images, such as those generated in virtual reality (VR). OBJECTIVE The aim was to determine the effect of fetal images generated in VR on MFA and depressive symptoms through a prenatal-coaching mobile app. METHODS This 2-arm parallel randomized controlled trial involved a total of 80 pregnant women. Eligible women were randomly assigned to either a mobile app-only group (n=40) or an app plus VR group (n=40). The VR group experienced their own baby's images generated in VR based on images obtained from fetal ultrasonography. The prenatal-coaching mobile app recommended health behavior for the pregnant women according to gestational age, provided feedback on entered data for maternal weight, blood pressure, and glucose levels, and included a private diary service for fetal ultrasound images. Both groups received the same app, but the VR group also viewed fetal images produced in VR; these images were stored in the app. All participants filled out questionnaires to assess MFA, depressive symptoms, and other basic medical information. The questionnaires were filled out again after the interventions. RESULTS Basic demographic data were comparable between the 2 groups. Most of the assessments showed comparable results for the 2 groups, but the mean score to assess interaction with the fetus was significantly higher for the VR group than the control group (0.4 vs 0.1, P=.004). The proportion of participants with an increased score for this category after the intervention was significantly higher in the VR group than the control group (43% vs 13%, P=.005). The feedback questionnaire revealed that scores for the degree of perception of fetal appearance all increased after the intervention in the VR group. CONCLUSIONS The use of a mobile app with fetal images in VR significantly increased maternal interaction with the fetus. TRIAL REGISTRATION ClinicalTrials.gov NCT04942197; https://clinicaltrials.gov/ct2/show/NCT04942197.
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Affiliation(s)
- Kyong-No Lee
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyeon Ji Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kiroong Choe
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Aeri Cho
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Bohyoung Kim
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Jinwook Seo
- Department of Computer Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Jee Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyung Joon Oh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea
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Zhang B, Jin X, Kuang X, Shen B, Qiu D, Peng J, Chen E, Dai X, Chen X, Wong CL. Effects of a Virtual Reality-Based Meditation Intervention on Anxiety and Depression Among Patients With Acute Leukemia During Induction Chemotherapy: A Randomized Controlled Trial. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00104. [PMID: 36693237 DOI: 10.1097/ncc.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Emerging evidence supports that virtual reality (VR)-based meditation interventions may improve anxiety and depression among patients with cancer. However, empirical studies involving patients with acute leukemia during induction chemotherapy are limited. OBJECTIVE This study aimed to examine the effects of VR-based meditation intervention on alleviating anxiety and depression and improving the quality of life among patients with acute leukemia during induction chemotherapy. METHODS This randomized controlled trial recruited 63 patients newly diagnosed with acute leukemia. Participants were randomly assigned to an intervention group (received VR-based meditation for 20 min daily for 14 days) and a control group. Anxiety, depression, and quality of life were measured using the State Anxiety Inventory, the Center for Epidemiological Studies Depression Scale, and the Functional Assessment of Cancer Therapy-Leukemia Questionnaire, respectively. All outcomes were measured at baseline and post-intervention. RESULTS Compared with patients in the control group, those in the intervention group demonstrated a significantly greater reduction in anxiety (P = .04) and improvement in quality of life (P = .04). However, no significant difference was noted in depression levels between groups (P = .09), although a decreasing trend was observed in the intervention group. CONCLUSION Virtual reality-based meditation intervention effectively alleviated anxiety and improved the quality of life among acute leukemia patients during induction chemotherapy. Future randomized controlled trials with larger sample sizes and longer follow-up periods are warranted. IMPLICATION FOR PRACTICE Virtual reality-based meditation can be applied in clinical practice virtually anytime and anywhere to provide a convenient intervention for anxiety reduction for acute leukemia patients during induction chemotherapy.
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Affiliation(s)
- Bixia Zhang
- Author Affiliations: The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong (Dr Jin and Dr Wong); The Second Clinical College of Guangzhou University of Chinese Medicine (Ms Zhang); Nursing Department, Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine (Ms Kuang); Nursing Department, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine (Ms Zhang and Dr Shen); Nursing Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine and Guangdong Provincial Hospital of Traditional Chinese Medicine (Ms Qiu); and Department of Hematology and Oncology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine and Guangdong Provincial Hospital of Traditional Chinese Medicine (Ms Peng, Ms X Chen, Dr Dai, and Mr E Chen), China
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28
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Darekar A. Virtual Reality for Motor and Cognitive Rehabilitation. Curr Top Behav Neurosci 2023; 65:337-369. [PMID: 37041455 DOI: 10.1007/7854_2023_418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Virtual Reality (VR) affords clinicians the ability to deliver safe, controlled, task-specific customised interventions that are enjoyable, motivating and engaging. Elements of training in VR comply with principles of learning implicated in new skill acquisition and re-learning skills post-neurological disorders. However, heterogeneity in the description of VR systems and the description and control of 'active' ingredients of interventions (like dosage, type of feedback, task specificity, etc.) have led to inconsistency in the synthesis and interpretation of evidence related to the effectiveness of VR-based interventions, particularly in post-stroke and Parkinson's Disease (PD) rehabilitation. This chapter attempts to describe VR interventions with respect to their compliance with principles of neurorehabilitation, with the goal of optimising interventions for effective training and facilitation of maximum functional recovery. This chapter also advocates using a uniform framework to describe VR systems to promote homogeneity in literature in order to help in the synthesis of evidence. An overview of the evidence revealed that VR systems are effective in mediating deficits in upper extremity, posture and gait function seen in people post-stroke and PD. Generally, interventions were more effective when they were delivered as an adjunct to conventional therapy and were customised for rehabilitation purposes, in addition to complying with principles of learning and neurorehabilitation. Although recent studies imply that their VR intervention is compliant with principles of learning, only a few explicitly describe how these principles are incorporated as 'active ingredients' of the intervention. Finally, VR interventions targeting community ambulation and cognitive rehabilitation are yet limited and therefore warrant attention.
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Application of Immersive Virtual-Reality-Based Puzzle Games in Elderly Patients with Post-Stroke Cognitive Impairment: A Pilot Study. Brain Sci 2022; 13:brainsci13010079. [PMID: 36672060 PMCID: PMC9856594 DOI: 10.3390/brainsci13010079] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: The society is aging in China, and the cognitive level of elderly post-stroke patients gradually declines. Face-to-face cognitive functional training is no longer sufficient. Immersive virtual reality (IVR) is a promising rehabilitation training device. In this study, we developed an IVR-based puzzle game to explore its effectiveness, feasibility, and safety in elderly stroke patients with cognitive dysfunction. Methods: A total of 30 patients with mild post-stroke cognitive impairment after stroke were randomly assigned to a control or IVR group. Patients in both groups received routine rehabilitation therapy. Patients in the control group received traditional cognitive training, and those in the IVR group received IVR-based puzzle game therapy. Before and after treatment, Montreal cognitive assessment (MOCA), trail-making test-A (TMT-A), digit symbol substitution test (DSST), digital span test (DST), verbal fluency test (VFT), and modified Barthel index (MBI) were evaluated in both groups. In addition, the IVR group was administered a self-report questionnaire to obtain feedback on user experience. Results: There was no significant difference in the baseline data between the two groups. After six weeks of treatment, the cognitive assessment scores were improved in both groups. Moreover, the IVR group showed more improvements than the control group in the DSST (Z = 2.203, p = 0.028 < 0.05, η2 = 0.16); MOCA (T = 1.186, p = 0.246 > 0.05, d = 0.44), TMT-A (T = 1.791, p = 0.084 > 0.05, d = 0.65), MBI (T = 0.783, p = 0.44 > 0.05, d = 0.28), FDST (Z = 0.78, p = 0.435 > 0.05, η2 = 0.02), BDST (Z = 0.347, p = 0.728 > 0.05, η2 = 0.004), and VFT(Z = 1.087, p = 0.277 > 0.05, η2 = 0.039) did not significantly improve. The significant difference in DSST represents an improvement in executive function and visual−spatial cognitive characteristics. The other assessment scores did not show such features. Therefore, we did not observe significant differences through this measure. According to the results of the self-report questionnaire, most of the patients were satisfied with the equipment stability and training content. Several individuals reported mild adverse reactions. Conclusions: This pilot study suggests that IVR-based puzzle games are a promising approach to improve post-stroke cognitive function, especially executive cognitive function, and visual−spatial attention in older adults.
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Huang D, Yan S, Shen S, Lv S, Lai S, Zhong S, Jia Y. Effects of virtual reality working memory training on event-based prospective memory in patients with major depressive disorder. J Psychiatr Res 2022; 156:91-99. [PMID: 36244203 DOI: 10.1016/j.jpsychires.2022.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/17/2022] [Accepted: 09/24/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Event-based prospective memory (EBPM) refers to remembering to perform delayed intention when specific events occur. EBPM deficit is present in patients with major depressive disorder (MDD) and hinders recovery from the illness. Working memory training (WMT) has been reported to enhance EBPM but its effect on EBPM in MDD remains unclear. We investigated whether virtual reality (VR)-based WMT can improve EBPM in MDD patients. METHODS Forty-six MDD patients and 41 healthy controls (HC) were recruited. Among the former ones, the first 23 consecutive patients were allocated to the experimental group (MDD-VR) and the next 23 consecutive patients to the waitlist control group (MDD-W). EBPM accuracy was used to assess EBPM performance. Hamilton Depression Rating Scale (HDRS) and Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) were employed to assess the cognitive functions and the depressive symptoms. RESULTS At baseline, EBPM accuracy did not significantly differ between MDD-VR and MDD-W but was lower in both of these two groups than in HC (both p < 0.001). Group-by-time interactions on EBPM accuracy (F = 4.614, p = 0.031) and CPFQ score (F = 5.754, p = 0.021) were present, whereas no significant group-by-time interaction or group effects were observed for HDRS score (both p > 0.05). After VR intervention, MDD-VR showed an increase in EBPM accuracy (Cohen's d = 1.20 [95% CI: 0.53, 1.86], p = 0.001). CONCLUSIONS Our results demonstrated that VR-based WMT could improve EBPM deficits in MDD patients. Large-scale studies of a VR-based WMT program are indicated.
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Affiliation(s)
- Dong Huang
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shuya Yan
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; School of Management, Jinan University, Guangzhou, 510316, China
| | - Shiyi Shen
- School of Management, Jinan University, Guangzhou, 510316, China
| | - Sihui Lv
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China; School of Management, Jinan University, Guangzhou, 510316, China
| | - Shunkai Lai
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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Guo QF, He L, Su W, Tan HX, Han LY, Gui CF, Chen Y, Jiang HH, Gao Q. Virtual reality for neurorehabilitation: A bibliometric analysis of knowledge structure and theme trends. Front Public Health 2022; 10:1042618. [PMID: 36438265 PMCID: PMC9684719 DOI: 10.3389/fpubh.2022.1042618] [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: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Background As an emerging technology, virtual reality (VR) has been broadly applied in the medical field, especially in neurorehabilitation. The growing application of VR therapy promotes an increasing amount of clinical studies. In this paper, we present a bibliometric analysis of the existing studies to reveal the current research hotspots and guide future research directions. Methods Articles and reviews on the related topic were retrieved from the Science Citation Index Expanded of Web of Science Core Collection database. VOSviewer and Citespace software were applied to systematically analyze information about publications, countries, institutions, authors, journals, citations, and keywords from the included studies. Results A total of 1,556 papers published between 1995 and 2021 were identified. The annual number of papers increased gradually over the past three decades, with a peak publication year in 2021 (n = 276). Countries and institutions from North America and Western European were playing leading roles in publications and total citations. Current hotspots were focused on the effectiveness of VR therapy in cognitive and upper limb motor rehabilitation. The clusters of keywords contained the four targeted neurological diseases of VR, while the burst keywords represented that the latest studies were directed toward more defined types of VR therapy and greater study design. Conclusions Our study offers information regarding to the current hotspots and emerging trends in the VR for rehabilitation field. It could guide future research and application of VR therapy in neurorehabilitation.
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Affiliation(s)
- Qi-Fan Guo
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lin He
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Su
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Xin Tan
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lian-Yi Han
- Biostatistics Group, State Key Laboratory of Genetic Engineering, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
| | - Chen-Fan Gui
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Chen
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Han-Hong Jiang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Qiang Gao
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Li Z, Yang L, Qiu H, Wang X, Zhang C, Zhang Y. Comparative efficacy of 5 non-pharmacological therapies for adults with post-stroke cognitive impairment: A Bayesian network analysis based on 55 randomized controlled trials. Front Neurol 2022; 13:977518. [PMID: 36247793 PMCID: PMC9554560 DOI: 10.3389/fneur.2022.977518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAs a common sequela after stroke, cognitive impairment negatively impacts patients' activities of daily living and overall rehabilitation. Non-pharmacological therapies have recently drawn widespread attention for their potential in improving cognitive function. However, the optimal choice of non-pharmacological therapies for post-stroke cognitive impairment (PSCI) is still unclear. Hence, in this study, we compared and ranked 5 non-pharmacological therapies for PSCI with a Bayesian Network Meta-analysis (NMA), to offer a foundation for clinical treatment decision-making.MethodsPubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Chinese Biomedical Medicine, China National Knowledge Infrastructure, Wangfang Database, and China Science and Technology Journal Database were searched from database inception to December 31, 2021, to collect Randomized Controlled Trials for PSCI. All of the studies were assessed (according to Cochrane Handbook for Systematic Reviews) and then data were extracted by two researchers separately. Pairwise meta-analysis for direct comparisons was performed using Revman. NMA of Bayesian hierarchical model was performed by WinBUGS and ADDIS. STATA was used to construct network evidence plots and funnel plots.ResultsA total of 55 trials (53 Two-arm trials and 2 Three-arm trials) with 3,092 individuals were included in this study. In the pair-wise meta-analysis, Transcranial Magnetic Stimulation (TMS), Virtual Reality Exposure Therapy (VR), Computer-assisted cognitive rehabilitation (CA), Transcranial Direct Current Stimulation (tDCS), and Acupuncture were superior to normal cognition training in terms of MoCA, MMSE, and BI outcomes. Bayesian NMA showed that the MoCA outcome ranked Acupuncture (84.7%) as the best therapy and TMS (79.7%) as the second. The MMSE outcome ranked TMS (76.1%) as the best therapy and Acupuncture as the second (72.1%). For BI outcome, TMS (89.1%) ranked the best.ConclusionsTMS and Acupuncture had a better effect on improving cognitive function in post-stroke patients according to our Bayesian NMA. However, this conclusion still needs to be confirmed with large sample size and high-quality randomized controlled trials.Registrationhttps://inplasy.com (No. INPLASY202260036).
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Affiliation(s)
- Zhendong Li
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Lei Yang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Hangjian Qiu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoqian Wang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Chengcheng Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Yuejuan Zhang
- Department of Nursing, The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, China
- *Correspondence: Yuejuan Zhang
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Kim Y, Hong S, Choi M. Effects of Serious Games on Depression in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37753. [PMID: 36066964 PMCID: PMC9490522 DOI: 10.2196/37753] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a severe psychological concern that negatively affects health in older adults. Serious games applied in various fields are considered appropriate interventions, especially in mental health care. However, there is a lack of evidence regarding the effects of serious games on depression in older adults. OBJECTIVE This study aimed to investigate the characteristics and effectiveness of serious games for depression in older adults. METHODS A systematic review and meta-analysis of randomized controlled trials were conducted. In total, 5 electronic databases (PubMed, CINAHL, Embase, PsycINFO, and Cochrane Library) were searched to identify relevant studies published until July 6, 2021. A total of 2 reviewers independently conducted study selection, data extraction, and quality appraisals. The risk of bias in the included studies was assessed using the JBI Critical Appraisal Checklist. For the meta-analysis, the effect size was calculated as the standardized mean difference (SMD) by using a random effects model. RESULTS A total of 17 studies with 1280 older adults were included in the systematic review, and 15 studies were included in the meta-analysis. Serious game interventions were classified into 3 types: physical activity (PA), cognitive function, and both PA and cognitive function. The meta-analysis demonstrated that serious games reduced depression in older adults (SMD -0.54, 95% CI -0.79 to -0.29; P<.001). Serious games had a more significant effect size in community or home settings (SMD -0.61, 95% CI -0.95 to -0.26; P<.001) than in hospital settings (SMD -0.46, 95% CI -0.85 to -0.08; P=.02); however, the difference between groups was not significant. Among the types of games, games for PA (SMD -0.60, 95% CI -0.95 to -0.25; P<.001) and games for both (SMD -0.73, 95% CI -1.29 to -0.17; P=.01) had a significant effect on reducing depression in older adults. However, no significant correlations were observed between the duration or number of serious games and depression. CONCLUSIONS Serious games were beneficial in reducing depression in older adults. Regardless of the study setting, serious games appeared to reduce depression. Particularly, serious games including PA had a significant impact on reducing depression. Furthermore, high-quality randomized controlled trials are needed to establish substantial evidence for the effectiveness of serious games on depression in older adults. TRIAL REGISTRATION PROSPERO CRD42021242573; https://tinyurl.com/26xf7ym5.
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Affiliation(s)
- Yesol Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Soomin Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Mona Choi
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea.,Yonsei Evidence Based Nursing Centre of Korea, A JBI Affiliated Group, Seoul, Republic of Korea
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Shahmoradi L, Rezayi S. Cognitive rehabilitation in people with autism spectrum disorder: a systematic review of emerging virtual reality-based approaches. J Neuroeng Rehabil 2022; 19:91. [PMID: 35982460 PMCID: PMC9389666 DOI: 10.1186/s12984-022-01069-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Emerging virtual technologies and cognitive rehabilitation methods are two new treatment approaches that can be used to strengthen cognitive functions in Autism Spectrum Disorder (ASD). The main aim of this study was to examine the effect of using virtual reality-based approaches on cognitive disorders of children and adults with ASD. Methods This systematic review was conducted on scientific papers to determine the effects of virtual reality-based technologies on the cognitive functions of children and adults with ASD. We identified 688 studies related to this topic and filtered them down to 17 articles, and then extracted the effects of interventions on cognitive outcomes. Results A total of 17 studies met the inclusion criteria, in which 226 persons with ASD had taken place. The sample size in the selected studies ranged from 1 to 56 participants (Median: 8, Q1: 3.5, Q3: 15.5). Four of the studies were case–control studies, ten were pre-test/post-test studies, and three were Randomized Control Trials (RCTs). Results of 16 studies showed significant progress in various cognitive indexes, such as task learning, attention, executive functioning, and daily skills in people with ASD. In most studies, virtual technologies had beneficial effects on reducing cognitive problems, but existing limitations could reduce their effectiveness. These limitations included the cost of virtual reality devices, inappropriate size of software, the weight of devices, potential addiction, intolerance of wearing glasses or headsets by people with autism (especially in children), and the possibility of eye injury. Conclusion Applying appropriate virtual-based approaches could improve cognitive indexes in people with ASD. However, further studies are needed to investigate the real effects of these technologies in the long run.
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Affiliation(s)
- Leila Shahmoradi
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sorayya Rezayi
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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Wu JJ, Zheng MX, Hua XY, Wei D, Xue X, Li YL, Xing XX, Ma J, Shan CL, Xu JG. Altered effective connectivity in the emotional network induced by immersive virtual reality rehabilitation for post-stroke depression. Front Hum Neurosci 2022; 16:974393. [PMID: 35982688 PMCID: PMC9378829 DOI: 10.3389/fnhum.2022.974393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Post-stroke depression (PSD) is a serious complication of stroke that significantly restricts rehabilitation. The use of immersive virtual reality for stroke survivors is promising. Herein, we investigated the effects of a novel immersive virtual reality training system on PSD and explored induced effective connectivity alterations in emotional networks using multivariate Granger causality analysis (GCA). Forty-four patients with PSD were equally allocated into an immersive-virtual reality group and a control group. In addition to their usual rehabilitation treatments, the participants in the immersive-virtual reality group participated in an immersive-virtual reality rehabilitation program, while the patients in the control group received 2D virtual reality rehabilitation training. The Hamilton Depression Rating Scale, modified Barthel Index (MBI), and resting-state functional magnetic resonance imaging (rsfMRI) data were collected before and after a 4-week intervention. rsfMRI data were analyzed using multivariate GCA. We found that the immersive virtual reality training was more effective in improving depression in patients with PSD but had no statistically significant improvement in MBI scores compared to the control group. The GCA showed that the following causal connectivities were strengthened after immersive virtual reality training: from the amygdala, insula, middle temporal gyrus, and caudate nucleus to the dorsolateral prefrontal cortex; from the insula to the medial prefrontal cortex; and from the thalamus to the posterior superior temporal sulcus. These causal connectivities were weakened after treatment in the control group. Our results indicated the neurotherapeutic use of immersive virtual reality rehabilitation as an effective non-pharmacological intervention for PSD; the alteration of causal connectivity in emotional networks might constitute the neural mechanisms underlying immersive-virtual reality rehabilitation in PSD.
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Affiliation(s)
- Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mou-Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dong Wei
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xin Xue
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Lin Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chun-Lei Shan
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Chun-Lei Shan,
| | - Jian-Guang Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Jian-Guang Xu,
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Chen X, Liu F, Lin S, Yu L, Lin R. Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2022; 103:1422-1435. [PMID: 35417757 DOI: 10.1016/j.apmr.2022.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke cognitive impairment (PSCI). DATA SOURCES Four Chinese databases and 6 English databases were systematically searched for studies published until August 31, 2021, by using Medical Subject Headings of the National Library of Medicine terms such as virtual reality, cognition disorders, cognitive dysfunction, and stroke and free terms such as virtual environment, VR, cognition impairment, cerebrovascular accident, and PSCI. STUDY SELECTION Randomized controlled trials treating PSCI with VR training were included. The control groups received conventional treatments such as conventional rehabilitation training and drug therapy; the experimental groups received VR rehabilitation training. The outcome measures were cognitive function and ADL. DATA EXTRACTION Two researchers independently extracted key information from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using RevMan v5.4. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. DATA SYNTHESIS Twenty-one studies (1149 participants) were included. Meta-analyses found that compared with the control group, VR rehabilitation training increased Mini-Mental State Examination, Montreal Cognitive Assessment, Loewenstein Occupational Therapy Cognitive Assessment, Rivermead Behavioral Memory Test Second Edition, Barthel Index, Modified Barthel Index, and FIM scores; event-related potential 300 (P300) amplitude; and the N-acetylaspartate/creatinine (Cr) ratio on proton magnetic resonance spectroscopy (1H-MRS) and reduced P300 latency; Trail Making Test scores; and the choline-containing compounds/Cr ratio on 1H-MRS (all P<.05). These results indicated that VR training improved cognitive function and ADL in PSCI. CONCLUSIONS VR rehabilitation training promotes the rehabilitation of cognitive function and recovery of ADL in patients with PSCI and may be a good complementary approach to conventional cognitive interventions.
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Affiliation(s)
- Xinming Chen
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian
| | - Fang Liu
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian.
| | - Shaohong Lin
- Nursing College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian
| | | | - Ruhui Lin
- Academy of Integrative Medicine, Fujian University of Traditional Chinese Medicine Fuzhou, China
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