Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial

Abstract

BackgroundSitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients.Methods/DesignThis is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10–12 sessions of 30–45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant’s group allocation.DiscussionThe treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation.Trial Registrationhttps://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014.Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.

Serious Game Platform as a Possibility for Home-Based Telerehabilitation for Individuals With Cerebral Palsy During COVID-19 Quarantine – A Cross-Sectional Pilot Study

“…Thus, as the participants execute body movements, such as the repetition of muscle contractions ( Alvarez et al, 2017 ) during the serious game, the level of physical activity will gradually enhance ( Gomes et al, 2019 ) with an adaptation to an aerobic activity and improvement in physical capacity and efficiency of the cardiorespiratory system ( Powell et al, 2011 ). This is in accordance with Sheehy et al (2016) , who stated that serious game is enjoyable and may motivate patients to perform more repetitions of their movement in a ludic environment, with goal-oriented movements, contributing to increased intensity and, consequently, physical activity.…”

Videojuegos comerciales en la rehabilitación de pacientes con ictus subagudo: estudio piloto

“…Además, se empleó una herramienta de bajo coste e interactiva que se podía implementar en cualquier entorno con accesibilidad a un coste re ducido, y que se podía utilizar para uso clínico en pacientes ingresados en hospitales tras un ictus. Autores como Sheehy et al [48] destacan la impor tancia de utilizar los videojuegos como comple mento por su bajo coste y accesibilidad, y afirman que usar realidad virtual semiinmersiva producía cambios significativos en el equilibrio en sedesta ción de pacientes tras un ictus. En esa línea de in vestigación, McEwen et al [49] resaltan que las inter venciones mediante realidad virtual complementa rias al tratamiento convencional mejoran la movili dad y el equilibrio en el ictus, y por ello se piensa en una mejora sobre la calidad de vida, por lo que nuestros resultados están en esta línea.…”

Effects of Video-Game Based Therapy on Balance, Postural Control, Functionality, and Quality of Life of Patients with Subacute Stroke: A Randomized Controlled Trial

“…is could be because both treatment modalities are effective for balance recovery in subacute stroke patients; however, the semi-immersive videogame approach could present more benefits for dynamic balance assessed by the Tinetti gait test, Functional Reach test, and Get Up and Go test. Some studies affirm that when VR is combined with conventional therapy, it is moderately more effective at improving dynamic balance than conventional therapy alone in patients after a stroke [51][52][53][54][55][56]. A recent systematic review has suggested that VR interventions using protocols based on more than 10 sessions may have a positive impact on dynamic balance and the recovery of gait [57].…”