Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
Unilateral spatial neglect (USN) is common after stroke and associated with poor functional recovery. Prism adaptation (PA) is one of the most supported modality able to ameliorate USN but underapplied due to several issues. Using immersive virtual reality and depth-sensing camera, we developed the virtual prism adaptation therapy (VPAT) to overcome the limitations in conventional PA. In this study, we investigated whether VPAT can induce behavioral adaptations and which cortical area is most significantly activated. Fourteen healthy subjects participated in this study. The experiment consisted of four sequential phases (pre-VAPT, VPAT-10°, VPAT-20°, and post-VPAT) with functional near-infrared spectroscopy recordings. Each phase consisted of alternating target pointing and resting (or clicking) blocks. To find out the most significantly activated area during pointing in different phases (VPAT-10°, VPAT-20°, and Post-VPAT) in contrast to pointing during the pre-VPAT phase, we analyzed changes in oxyhemoglobin concentration during pointing. The pointing errors of the virtual hand deviated to the right-side during early pointing blocks in the VPAT-10°and VPAT-20°phases. There was a left-side deviation of the real hand to the target in the post-VPAT phase. The most significantly activated channels were all located in the right hemisphere, and possible corresponding cortical areas included the dorsolateral prefrontal cortex and frontal eye field. In conclusion, VPAT may induce behavioral adaptation with modulation of the dorsal attentional network. Future clinical trials using multiple sessions of a high degree of rightward deviation VPAT over a more extended period are required in stroke patients with unilateral spatial neglect.
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