Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke

Abstract

BackgroundVirtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors.MethodsThirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory).ResultsSignificant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating.ConclusionsOur results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments.Electronic supplementary materialThe online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.

Virtual Reality in Neurorehabilitation

“…Do pierwszej zaliczymy wyświetlacze, które można określić mianem tradycyjnych, takie jak płaskie ekrany, monitory komputerowe [5,6] oraz projektory LCD [7]. Szczególną odmianą tego sposobu wyświetlania VR są systemy CAVE (ang.…”

“…feedback) z wykorzystaniem obrazu, dotyku i dźwięku. Są to czujniki ruchu pozwalające pacjentowi na interakcję z konsolą/ komputerem poprzez interfejs wykorzystujący gesty wykonywane przy pomocy kończyn i całego ciała takie jak OpneNI™ [6] czy Kinect™ [7]. Ruch wykrywany jest w trzech wymiarach w czasie rzeczywistym, poprzez syntezę danych pochodzących z przyspieszeniomierzy, żyroskopów i kamer 3D.…”

“…The VR hardware can be divided into two groups. The first includes traditional displays such as flat screens [5,6] and LCD projectors [7]. In this group, Cave Automatic Virtual Environment (CAVE) is particularly noteworthy, since a stereoscopic image is displayed on the walls and floor of a cubic room.…”

“…Movement sensors such as OpneNI ™ [6] or Kinect ™ [7], allow the patient to interact with the console/PC interface using hands, gestures or body movements. The movement is detected in real time and three dimensions, through the synthesis of accelerometers, gyroscopes and 3D cameras data.…”

“…In the case of non-immersive VR, a flat image of a three-dimensional virtual world is displayed by the screens or projectors. The patient sees the external environment and the virtual one and receives signals from both [5,7].…”