Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study

Abstract

Stroke is one of the most common causes of acquired disability, leaving numerous adults with cognitive and motor impairments, and affecting patients’ capability to live independently. Virtual Reality (VR) based methods for stroke rehabilitation have mainly focused on motor rehabilitation but there is increasing interest toward the integration of cognitive training for providing more effective solutions. Here we investigate the feasibility for stroke recovery of a virtual cognitive-motor task, the Reh@Task, which combines adapted arm reaching, and attention and memory training. 24 participants in the chronic stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Both groups were enrolled in conventional occupational therapy, which mostly involves motor training. Additionally, the VR group underwent training with the Reh@Task and the control group performed time-matched conventional occupational therapy. Motor and cognitive competences were assessed at baseline, end of treatment (1 month) and at a 1-month follow-up through the Montreal Cognitive Assessment, Single Letter Cancelation, Digit Cancelation, Bells Test, Fugl-Meyer Assessment Test, Chedoke Arm and Hand Activity Inventory, Modified Ashworth Scale, and Barthel Index. Our results show that both groups improved in motor function over time, but the Reh@Task group displayed significantly higher between-group outcomes in the arm subpart of the Fugl-Meyer Assessment Test. Improvements in cognitive function were significant and similar in both groups. Overall, these results are supportive of the viability of VR tools that combine motor and cognitive training, such as the Reh@Task. Trial Registration: This trial was not registered because it is a small clinical study that addresses the feasibility of a prototype device.

Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial

“…In this randomized controlled pilot trial, we tested a novel rehabilitation program in VR that trains several cognitive domains in conjunction. Together with a few other clinical trials [38,65], we are among the first in addressing the multidimensionality of cognitive impairment after stroke, by providing a VR-based cognitive training that adapts its difficulty optimally to the ability of the patient while providing an embodied training with rewarding feedback [81]. Our data set reveals interesting insights when a heterogeneous sample without a specific cognitive deficit is selected.…”

“…As there is no existing study from which estimations for our primary outcome measurements could have been obtained, the sample size had to be predicted instead of calculated through a power analysis. Based on our previous experiments that proved to be achievable with the resources and time available [32,64], other trials with similar interventions [38,65] and the doctor's estimation of recruitment pace, a sample size of 30 participants was deemed adequate. The trial concluded when the sample size for a complete case analysis was reached.…”

The Impact of Rehabilitation-oriented Virtual Reality Device in Patients With Ischemic Stroke in the Early Subacute Recovery Phase: Study Protocol for a Phase III, Single-Blinded, Randomized, Controlled Clinical Trial

“…12 Standard rehabilitation protocols are considered as less intensive given their repetitive nature, poor cognitive stimuli, and lack of direct feedback stimuli. 14 In this scenario, the use of VR is a relatively novel adjunct, which can compensate for the lack of intensive treatments. Recent reviews and meta-analysis summarize the recent results of the use of VR as a facilitator on motor rehabilitation programs, with positive results.…”

Wrist Rehabilitation System Using Augmented Reality for Hemiplegic Stroke Patient Rehabilitation: A Feasibility Study

“…Particularly, the patient was able to reach the highest score of the proximal arm (34/34) and wrist/hand (23/24). Compared to the other methods, Faria et al reported that both VR and control group showed significant improvements at the end of treatment in wrist/hand Fugl-Meyer (p = 0.034 and p = 0.04) [39]. However, these improvements were significant with respect to baseline, but they were modest for both groups at end of treatment (0.8 ± 1.4 in VR versus 1.3 ± 2.3 in control).…”