Virtual reality as effective as stroke therapy

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Using virtual reality therapy to improve arm and hand movement after a stroke is as effective as regular therapy, according to a Danish study.

“Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke,” said study author Dr Iris Brunner, of Aarhus University, Hammel Neuro-centre in Denmark. “Future studies could also look at whether people could use virtual reality therapy remotely from their homes, which could lessen the burden and cost of traveling to a medical centre for standard therapy.”

The study involved 120 people with an average age of 62 who had suffered a stroke on average about a month before the study started. All of the participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms. The participants had four to five hour-long training sessions per week for four weeks. The participants’ arm and hand functioning was tested at the beginning of the study, after the training ended and again three months after the start of the study.

Half of the participants had standard physical and occupational therapy. The other half had virtual reality training that was designed for rehabilitation and could be adapted to the person’s abilities. The participants used a screen and gloves with sensors to play several games that incorporated arm, hand and finger movements.

“Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results,” Brunner said. “These results suggest that either type of training could be used, depending on what the patient prefers.”

Brunner noted that the virtual reality system was not an immersive experience. “We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training,” she said.

Abstract
Objective: To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.
Methods: In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.
Results: Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.
Conclusions: Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.

Authors
Iris Brunner, Jan Sture Skouen, Håkon Hofstad, Jörg Aßmus, Frank Becker, Anne-Marthe Sanders, Hanne Pallesen, Lola Qvist Kristensen, Marc Michielsen, Liselot Thijs, Geert Verheyden

American Academy of Neurology material
Neurology abstract


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