Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis

Karamians, Reneh; Proffitt, Rachel; Kline, David; Gauthier, Lynne

doi:10.1016/j.apmr.2019.10.195

Cited by 102 publications

(78 citation statements)

References 85 publications

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“…One possible explanation is that group B participants experienced physical and occupational therapy fatigue or another effect of 'override' or interference, contributing to decline in strength. In conjunction with the motor skill improvements noted for group A, improvements are present in functional measures, namely the ARAT (Table 3), which has been used in recent meta-analytic study [27] as one of the major outcome measures to assess the effectiveness of virtual reality interventions for upper extremity rehabilitation post-stroke. Even though our results did not reach statistical significance due to small group sizes, they reveal a clear pattern: only one of the subjects in this group (A02) with left-sided impairment did not improve in ARAT (and 6 improved).…”

Section: Discussionmentioning

confidence: 99%

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Keller

̌Sťetkářová

Macri³

et al. 2020

J NeuroEngineering Rehabil

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Background Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. Methods In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills. Results AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. Conclusions Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. Trial registration The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.

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Section: Discussionmentioning

confidence: 99%

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Keller

̌Sťetkářová

Macri³

et al. 2020

J NeuroEngineering Rehabil

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“…selected systematic reviews and meta-analyses for review. Six meta-analyses were included for our evidence summary [ 63 , 64 , 65 , 66 , 67 , 68 ].…”

Section: Clinical Evidence and Considerations For Vr In Motor Rehamentioning

confidence: 99%

“…Two studies included randomized controlled trials (RCTs) and quasi-randomized controlled trials [ 64 , 68 ] and three other studies only included RCTs [ 63 , 65 , 67 ]. Karamians et al included RCTs and prospective studies [ 66 ]. The number of studies and participants included in each meta-analysis ranged from 21 to 72 and 562 to 2470, respectively.…”

Section: Clinical Evidence and Considerations For Vr In Motor Rehamentioning

confidence: 99%

“…VR rehabilitation included rehabilitations using both custom-built virtual environments and commercial video gaming consoles (e.g., Nintendo Wii or Xbox Kinect) in the selected meta-analyses. Outcomes were usually the composite outcomes of upper limb function or activities and Karamians et al only included studies using one of the following outcome measures: Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and Action Research Arm Test (ARAT) [ 66 ]. Mekbib et al only included studies using one of the three following outcomes: FMA, Box and Block Test (BBT), and Motor Activity Log (MAL) [ 65 ].…”

Section: Clinical Evidence and Considerations For Vr In Motor Rehamentioning

confidence: 99%

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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

Kim

Cho²,

et al. 2020

JCM

133

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Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.

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“…In the last decade there is vast research on the use of virtual reality (VR) technologies for rehabilitation, speci cally of the upper limb. While being cheap, accessible and encourage high-intensity training (45), one of the problems that still remain unsolved is that upper limb kinematics have been reported to be altered compared to physical environments (46,47). The virtual environment still lacks the ability of providing haptic feedback to the user (46) and by that practicing force-regulation as part of reach-tograsp training.…”

Section: Physical Environment Of Training In Stroke Rehabilitationmentioning

confidence: 99%

A Robot Goes to Rehab: A Novel Gamified System for Stroke Rehabilitation using a Socially Assistive Robot: Methodology & Feasibility Testing

Polak¹,

Levy-Tzedek²

2020

Preprint

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Background: Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Methods: Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients, such as reaching to a cup, or turning a key in a lock. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 14 stroke patients exercised with this platform (in either the robot or the computer configuration) over a 5-week period, 3 times per week, for a total of 210 sessions. Results: The stroke patients reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with the platform even after the study ended. Conclusions: These results are especially encouraging during the COVID-19 pandemic, when the requirement to reduce physical contact and keep a social distance accentuates the need for alternative rehabilitative tools, such as SARs, to enable patients to have an uninterrupted (even if modified) rehabilitation regime. Trial Registration: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://clinicaltrials.gov/ct2/show/NCT03651063

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Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis

Cited by 102 publications

References 85 publications

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

A Robot Goes to Rehab: A Novel Gamified System for Stroke Rehabilitation using a Socially Assistive Robot: Methodology & Feasibility Testing

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Effectiveness of Virtual Reality- and Gaming-Based Interventions for Upper Extremity Rehabilitation Poststroke: A Meta-analysis

Cited by 102 publications

References 85 publications

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

A Robot Goes to Rehab: A Novel Gamified System for Stroke Rehabilitation using a Socially Assistive Robot: Methodology &amp; Feasibility Testing

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Resources

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A Robot Goes to Rehab: A Novel Gamified System for Stroke Rehabilitation using a Socially Assistive Robot: Methodology & Feasibility Testing