A novel glasses-free virtual reality rehabilitation system on improving upper limb motor function among patients with stroke: A feasibility pilot study

et al. 2022

Neural Plasticity

Background. Impaired cognitive ability to anticipate the required control for an upcoming task in patients with stroke may affect rehabilitation outcome. The cortical excitability of task-related motor anticipation for upper limb movement induced by virtual reality (VR) training remains unclear. Aims. To investigate the effect of VR training on the cortical excitability of motor anticipation when executing upper limb movement in patients with subacute stroke. Methods. A total of thirty-six stroke survivors with upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 3 months were recruited. Participants were randomly allocated to the VR intervention group or conventional therapy group. Event-related potentials (ERPs) and electromyography (EMG) were used to simultaneously record the cortical excitability and muscle activities during palmar grasp motion. Outcome measures of the contingent negative variation (CNV) latency and amplitude, EMG reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA), Action Research Arm Test (ARAT), and National Institutes of Health Stroke Scale (NIHSS) were recorded pre- and postintervention. The between-group difference was analysed by mixed model ANOVA. Results. The EMG onset time of the paretic hand in the VR group was earlier than that observed in the control group ( t = 2.174 , p = 0.039 ) postintervention. CNV latency reduction postintervention was larger in the VR group than in the control group ( t = 2.411 , p = 0.021 ) during paretic hand movement. The reduction in CNV amplitude in the VR group was larger in the VR group than in the control group ( p < 0.001 for all electrodes except for C3) when executing paretic hand movement. ARAT and UL-FMA scores were significantly higher in the VR group than in the control group ( p = 0.019 and p = 0.037 , respectively) postintervention. No significant difference in the reduction in NIHSS was found between the VR and control groups ( p = 0.072 ). Conclusions. VR intervention is superior to conventional therapy to improve the cognitive neural process of motor anticipation and reduce the excessive compensatory activation of the contralesional hemisphere. The improvements observed in the cognitive neural process corroborated with the improvements in hand function.

Section: Discussionsupporting

confidence: 93%

The Effect of Virtual Reality on Motor Anticipation and Hand Function in Patients with Subacute Stroke: A Randomized Trial on Movement-Related Potential

et al. 2022

Neural Plasticity

“… b Anjum et al [ 34 ] did not report the number or ratio of male participants in their study. c Ain et al [ 32 ], Anjum et al [ 34 ], Crosbie et al [ 38 ], Ersoy and Iyigun [ 39 ], Jo et al [ 66 ], Levin et al [ 50 ], Mokhtar et al [ 67 ], Park et al [ 65 ], Shin et al [ 57 ], Standen et al [ 61 ], Xie et al [ 63 ], and Zondervan et al [ 64 ] did not report the participants’ stroke types. d VR: virtual reality.…”

Section: Resultsmentioning

confidence: 99%

“…Thus, no significant improvement in fine motor function was observed. This finding suggests that VR systems that use input mechanisms that would facilitate fine motor movements, such as Leap Motion or gloves with sensors [ 41 , 63 ], may be more suitable for supporting fine movement exercises.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Using Virtual Reality–Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials

2022

J Med Internet Res

Background In recent years, efforts have been made to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises. Therefore, it is important to review and analyze the existing research evidence of its effectiveness. Objective Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke. Methods This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CINAHL Plus, MEDLINE, Web of Science, Embase, and Cochrane Library databases were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to after intervention, after intervention to follow-up assessment, and baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether the differences in treatment outcomes depended on age, stroke recovery stage, VR program type, therapy delivery format, similarities in intervention duration between study groups, intervention duration in VR groups, and trial length. Results A total of 42 publications representing 43 trials (aggregated sample size=1893) were analyzed. Compared with the control groups that used either conventional therapy or no therapy, the intervention groups that used VR to support exercise therapy showed significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95% CI 0.21-0.68; P<.001), range of motion (goniometer; SMD 1.01, 95% CI 0.50-1.52; P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95% CI 0.28-1.30; P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95% CI 0.06-0.40; P=.01, and modified Rankin Scale; SMD 0.57, 95% CI 0.01-1.12; P=.046). Significant subgroup differences were observed in hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence that the benefits of VR-supported exercise therapy were maintained after the intervention ended. Conclusions VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that of the 12 rehabilitation outcomes examined during the course of VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion), and both significant and nonsignificant improvements were observed in another 2 (muscle strength and independence in day-to-day activities), depending on the measurement tools or methods used. Trial Registration PROSPERO CRD42021256826; https://tinyurl.com/2uarftbh

“…A total of 4153 relevant studies were obtained in the preliminary search, including 385 from CNKI, 770 from Wanfang, 493 from PubMed, 1081 from EMBASE, and 1424 from the Cochrane Library. After exclusion of duplicate studies and strictly adherence to the inclusion and exclusion criteria, 74 randomized controlled trials 8–81 were included. Except for a three-arm experiment, 52 all double-arm experiments with a total of 5128 patients.…”

Section: Resultsmentioning

confidence: 99%

Comparison of different rehabilitation techniques of traditional Chinese and western medicine in the treatment of motor dysfunction after stroke based on frequency method: A network meta-analysis

Wang³

et al. 2022

Am J Phys Med Rehabil

ObjectiveThe aim of the study is to evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis.MethodsCNKI, Wanfang, PubMed, Embase, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials of rehabilitation techniques for poststroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0.ResultsSeventy-four randomized controlled trials involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl-Meyer Assessment, Action Research Arm Test, and Berg Balance Scale: biofeedback therapy > mirror therapy > repetitive transcranial magnetic stimulation > acupuncture therapy > transcranial direct current stimulation > Taichi > common therapy, virtual reality > transcranial direct current stimulation > repetitive transcranial magnetic stimulation > mirror therapy > common therapy, and acupuncture therapy > virtual reality > neuromuscular electrical stimulation > mirror therapy > common therapy > transcranial direct current stimulation, respectively.ConclusionsBiofeedback therapy had the best comprehensive effect, while virtual reality was the best intervention for improving the index of action research arm test and Fugl-Meyer Assessment–lower extremity. Acupuncture therapy improved lower limb balance function.