Arm Motor Recovery Using a Virtual Reality Intervention in Chronic Stroke

Abstract

Introduction. Despite interest in virtual environments (VEs) for poststroke arm motor rehabilitation, advantages over physical environment (PE) training have not been established. Objective. The authors compared kinematic and clinical outcomes of dose-matched upper-limb training between a 3D VE and a PE in chronic stroke. Methods: Participants (n = 32) were randomized to a 3D VE or PE for training. They pointed to 6 workspace targets (72 trials, 12 trials/target, randomized) for 12 sessions over 4 weeks with similar feedback on precision, movement speed, and trunk displacement. Primary (kinematics, clinical arm motor impairment) and secondary (activity level, arm use) outcomes were compared by time (PRE, POST, and follow-up, RET), training environment, and impairment severity (mild, moderate-to-severe) using mixed-model analyses of variance (ANOVAs). Results. Endpoint speed, overall performance on a reach-to-grasp task, and activity levels increased in both groups. Only participants in the VE group improved shoulder horizontal adduction at POST (9.5°) and flexion at both POST (6.3°) and RET (13°). Impairment level affected outcomes. After VE training, the mild group increased elbow extension (RET, 25.5°). The moderate-to-severe group in VE increased arm use at POST (0.5 points) and reaching ability at RET (2.2 points). The moderate-to-severe group training in PE increased reaching ability earlier (POST, 1.7 points) and both elbow extension (10.7°) and arm use (0.4 points) at RET, but these changes were accompanied by increased compensatory trunk displacement (RET, 30.2 mm). Conclusion. VE training led to more changes in the mild group and a motor recovery pattern in the moderate-to-severe group indicative of less compensation, possibly because of a better use of feedback.

The use of Virtual Reality for upper limb rehabilitation of hemiparetic Stroke patients

“…The improvement in the motor recovery of upper limb was observed in patients here are congruent with other studies, such as in the measurements of Fugl-Meyer Scale (13), (23), (27,28), in the Box and Blocks Test (22), (27), and in the active ROM shoulder (29). Piron et al (28) used the VR to recuperate the upper limb in hemiparetic Stroke patients.…”

Gesture Therapy: An Upper Limb Virtual Reality-Based Motor Rehabilitation Platform

“…In general, computer games excel at providing feedback [8] further contributing to keep the player engaged [9]. Notwithstanding, the potential of VR to provide more and better feedback to the user remains to be fulfilled with only a few studies to date having demonstrated the added value of feedback delivered through VR [10].…”

Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke

“…Feedback provided during VR training may be used more effectively to improve the quality of UL movement [7]. However, in order to determine the importance of movement quality on functional recovery, it is necessary to assess whether movements made in virtual environments (VEs) are kinematically similar to those made in physical environments (PEs).…”