Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial

Abstract

Background Immersive virtual reality (VR)-based motor control training (VRT) is an innovative approach to improve motor function in patients with stroke. Currently, outcome measures for immersive VRT mainly focus on motor function. However, serum biomarkers help detect precise and subtle physiological changes. Therefore, this study aimed to identify the effects of immersive VRT on inflammation, oxidative stress, neuroplasticity and upper limb motor function in stroke patients. Methods Thirty patients with chronic stroke were randomized to the VRT or conventional occupational therapy (COT) groups. Serum biomarkers including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF) were assessed to reflect inflammation, oxidative stress and neuroplasticity. Clinical assessments including active range of motion of the upper limb and the Fugl-Meyer Assessment for upper extremity (FMA-UE) were also used. Two-way mixed analyses of variance (ANOVAs) were used to examine the effects of the intervention (VRT and COT) and time on serum biomarkers and upper limb motor function. Results We found significant time effects in serum IL-6 (p = 0.010), HO-1 (p = 0.002), 8-OHdG (p = 0.045), and all items/subscales of the clinical assessments (ps < 0.05), except FMA-UE-Coordination/Speed (p = 0.055). However, significant group effects existed only in items of the AROM-Elbow Extension (p = 0.007) and AROM-Forearm Pronation (p = 0.048). Moreover, significant interactions between time and group existed in item/subscales of FMA-UE-Shoulder/Elbow/Forearm (p = 0.004), FMA-UE-Total score (p = 0.008), and AROM-Shoulder Flexion (p = 0.001). Conclusion This was the first study to combine the effectiveness of immersive VRT using serum biomarkers as outcome measures. Our study demonstrated promising results that support the further application of commercial and immersive VR technologies in patients with chronic stroke.

Towards Effective Telerehabilitation: Assessing Effects of Applying Augmented Reality in Remote Rehabilitation of Patients Suffering from Multiple Sclerosis

“…In our study we did not find that using rehabilitation with immersive interface is related to significant changes in serum neurotrophin levels (BDNF, PDGF) which is consistent with current literature data [5,35,42]. However, a recent study with stroke patients undergoing 5-8 weeks long VR-based treatment coupled with standard therapy has revealed changes in their neuroplasticity [16]. The lack of observable findings may be related to the duration of our study, which in our case may be too short (4 weeks) to result in any noticeable effects and was not conjunct with regular occupational therapy.…”

“…Recent work has shown, that changes in the concentration of brain plasticity biomarkers is responsible for further development of brain plasticity [36]. Recent results also suggest that an immersive environment such as VR can influence the levels of patients' neurothropins [16]. However, our analysis has shown no such changes among the MS patients undergoing AR-based treatment.…”

Virtual reality-induced motor function of the upper extremity and brain activation in stroke: study protocol for a randomized controlled trial

“…The primary outcome is the FMA-UE, which has been developed as an evaluative measure of the upper limb functionality recovery poststroke (25)(26)(27). The FMA-UE score is 66 points, with lower scores indicating more severely impaired UE and higher scores indicating better motor function improvements.…”

Realidad virtual y su utilidad como tratamiento fisioterapéutico para el accidente cerebrovascular: revisión sistemática

“…Se obtuvieron 17 artículos para incluir en la revisión bibliográfica. Todos los artículos incluidos en la revisión fueron de tipo ensayo clínico, ensayo controlado aleatorio (Adomavičienė et al, 2019;Anwar et al, 2021;Chen et al, 2022;Cho & Lee, 2019;Choi et al, 2019;Faria et al, 2020;Huang et al, 2022;Long et al, 2020;Maier et al, 2020;Oh et al, 2019;Park et al, 2021;Rodríguez-Hernández et al, 2021Sana et al, 2023;Schuster-Amft et al, 2018;Yang et al, 2022;Yao et al, 2020).…”