Virtual Reality (VR) is expanding worldwide in education, training, gaming, and healthcare to achieve distinct outcomes. This paper aimed to identify to what extent physiotherapy based on mixed VR technology and occupational therapy serves the functionality of healthy subjects’ upper extremities; it also analyzed the benefits of this protocol for therapy guidelines in hand dexterity re-habilitation. Fifteen VR exergames and occupational therapy sessions were performed for 60 min in three weeks with a sample of sixteen people. The Jebsen Taylor Hand Function Test Scale (JTHFTS), Nine-Hole Peg test (9 Hole), Box and Blocks Test (BBT), and Timed Functional Test for the Arm and Shoulder (TFAST) were used for pre and post-therapy assessment. Linear regression was used to identify healthy subjects’ main tasks, predicting upper extremity dexterity. The results of pre- and post-exercise assessments suggested significant improvements for both upper extremities, dominant and non-dominant. BBT, the nine-hole peg test, and FAST showed significant differences in pre- and post-therapy, favoring prophylactical exercises. Hence, in the linear regression results for the dominant hand, five models emerged as potential predictors for upper extremity agility. The capacity to pick up large light objects seemed to bring the most critical influence on hand dexterity. However, regarding the non-dominant hand, the results suggested that writing ability was the most potent predictor of dexterity. In this respect, the protocol used in this research can be used as a guideline for further upper extremity dexterity training since VR exergames combined with occupational therapy can bring essential contributions to upper limb proprioception and dexterity functioning.
Post-stroke sequelae, spinal cord injury and multiple sclerosis are the most common and disabling diseases of upper motor neurons. These diseases cause functional limitations and prevent patients from performing activities of daily living. This review aims to identify the potential of functional electrical stimulation (FES) for locomotor rehabilitation and daily use in upper motor neuron diseases. A systematic search was conducted. For the search strategy, MeSH terms such as “stroke”, “functional electrical stimulus*” and “FES”, “post-stroke”, “multiple sclerosis”, and “spinal cord injury*” were used. Of the 2228 papers from the raw search results, 14 articles were analyzed after inclusion and exclusion criteria were applied. Only four articles were randomized clinical trials, but with low numbers of participants. RehaMove, Microstim and STIWELL were reported in three independent studies, whereas Odstock was used in four articles. The results of the studies were very heterogeneous, although for lower extremity stimulation (11 out of 14 papers), walking speed was reported only in 6. Berg Balance Scale, Timed Up and Go, Functional Ambulation Category, 6-Minute Walk Test, 10-Meter Walk Test, Fugl-Meyer Assessment, Motricity Index and Action Research Arm Test were reported for functional assessment. For clinical assessment, the Modified Barthel Index, the Rivermead Mobility Index and the Stroke Impact Scale were used. Four studies were spread over 6 months, two investigated the effects of FES during one session, and the other eight were conducted for 3 to 8 weeks. Improvements were reported related to gait speed, functional ambulation, hand agility and range of motion. FES can be considered for large-scale use as a neuroprosthesis in upper neuron motor syndromes, especially in patients with impaired gait patterns. Further research should focus on the duration of the studies and the homogeneity of the reported results and assessment scales, but also on improvements to devices, accessibility and quality of life.
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