Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content

Brunner, Iris; Skouen, Jan Sture; Hofstad, Håkon; Aßmuss, Jörg; Becker, Frank; Pallesen, Hanne; Thijs, Liselot; Verheyden, Geert

doi:10.1186/s12883-016-0740-y

Cited by 49 publications

(47 citation statements)

References 34 publications

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“…In general, authors reported an overall median of 570 min of VR (or computer games) therapy delivered, with duration ranging from 20 to 60 min per session, and 8 to 36 sessions [ 24 ]. Otherwise, intensity of training is rarely reported for VR training (see [ 25 ] for an exception). However, this is a critical factor to estimate cost-effectiveness of VR-based interventions.…”

Section: Introductionmentioning

confidence: 99%

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Pérez-Marcos¹,

Chevalley

Schmidlin

et al. 2017

J NeuroEngineering Rehabil

103

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BackgroundTechnology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation.MethodsTen outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week).ResultsAll participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention.ConclusionsThis pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness.Trial registrationThis trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.

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Section: Introductionmentioning

confidence: 99%

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Pérez-Marcos¹,

Chevalley

Schmidlin

et al. 2017

J NeuroEngineering Rehabil

103

View full text Add to dashboard Cite

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“…Intensity of training is important. While more action is reported to take place on virtual reality rehabilitation than in conventional therapy in general [34], authors reported an overall median of 570 min of VR (or computer games) therapy delivered, with duration ranging from 20 to 60 minutes per session, and 8 to 36 sessions [35]. Our study has totaled 240 minutes of training over 12 sessions (mainly correlated to the usual length of stay in our service).…”

Section: Discussionmentioning

confidence: 76%

Non-Immersive Virtual Reality for Upper Limb Rehabilitation in Stroke Survivors - A Feasibility Study

Grigoras¹,

Matei²,

Ignat³

2018

Balneo

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We present the results of a feasibility study for the use of a commercially available non-immersive virtual reality system (SeeMe®) in upper limb motor rehabilitation of stroke survivors. The study included 8 chronic phase stroke survivors. All patients received 12 sessions with the system over 2 weeks, each session comprising 20 minutes of motor training using a sequence of 8 serious games. Outcome measures included the Fugl-Meyer assessment scale -upper limb section (FMA), the Stroke Impact Scale (SIS), the ingame assessment procedure of the SeeMe system and a feedback questionnaire. Following the rehabilitation program, we found no change on the clinical scales. Although some of the system generated parameters (score, endurance and reaction time or movement amplitude for each game) have improved significantly, in 3 of the 8 games none of the recorded variables has shown significant changes, with only one game showing significant improvement in 2 out of 3 parameters. The satisfaction questionnaire did not generally correlate with game performance (although this has happened in some of the games), but reflected correctly the increased interest of the subjects for the intervention and also their awareness of its real influence on motor abilities. This initial pilot study indicates that the SeeMe virtual reality system has the potential to be of use in clinical settings as a complement to conventional therapy. Future studies should include larger number of subjects, longer training duration, use more sensitive/dedicated measurements of improvement, and focus on a single game/exercise type.

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“…The features of the game for motor rehabilitation, such as diversity of game, variety of artificial environment or stimulation, can improve interest and motivation long‐term to help maintain repetitive intervention. Also, visuo‐auditory feedback provided through the game is an important challenge to promote cognitive effort and work performance, thereby enhancing cortical plasticity by motor learning . Several studies have shown that not only the effect of the game‐based intervention, but also providing an opportunity for appropriate performance training in consideration of safety, cost and time for the user, plays a role in the enhancement of motor function .…”

Section: Discussionmentioning

confidence: 99%

Effect of tongue‐strengthening training combined with a tablet personal computer game in healthy adults

Hwang

Kim

Lee

et al. 2020

J of Oral Rehabilitation

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Background: Game-based training has been shown to improve behavioural motor learning in various medical fields including rehabilitation.Objectives: This study aimed to investigate the effects of a tablet PC (personal computer) game-based tongue training on tongue strength, thickness and compliance in healthy adults.Methods: This study recruited 30 healthy volunteers. Subjects were randomly assigned to two groups (n = 15/group). Group 1 performed game-based tongue training, and group 2 performed tongue resistance training using the Iowa Oral Performance Instrument. Both groups performed the same tongue exercises as follows: frequency (isotonic = 30 times × 3, isometric = 20 seconds × 3), intensity (70% of 1-repeated maximum contraction) and intervention period (5 days for 6 weeks). The primary outcomes were tongue muscle strength and thickness. Secondary outcomes were assessed using a 0-to-10 numerical rating self-report scale that included motivation, interest/fun, physical effort and muscle fatigue/pain. Results:Both groups showed significant improvement in tongue strength and thickness, but there were no significant differences between the groups after the intervention. The self-report scale numerical rating revealed that group 1 had significantly higher motivation and interest/fun after the exercise than group 2. Group 1 had expended a significantly lower physical effort than group 2. No significant differences were noted between the 2 groups for muscle fatigue/pain. Conclusion:This study showed that both exercises had similar effects on tongue strength and thickness increase in healthy adults, but game-based tongue training was more fun and physically less demanding. K E Y W O R D Sgame, strength, thickness, tongue, training

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Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content

Cited by 49 publications

References 34 publications

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study

Non-Immersive Virtual Reality for Upper Limb Rehabilitation in Stroke Survivors - A Feasibility Study

Effect of tongue‐strengthening training combined with a tablet personal computer game in healthy adults

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