Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial

Abstract

Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.

Effects of Specific Virtual Reality-Based Therapy for the Rehabilitation of the Upper Limb Motor Function Post-Ictus: Randomized Controlled Trial

“…Their results suggest a significant difference between intervention groups, while the improvement of muscle strength has not shown significant differences before and after the intervention [ 17 , 52 , 53 ]. In our study, the increase in muscle strength in the upper limb and the differences found between the experimental and control groups can be explained by the placement of weights on the wrists during SVR training, coinciding with findings by Miclaus et al [ 54 ].…”

“…The use of VRET in treatments leading to functional recovery of the upper limb in stroke patients is based on a new, enriched, and interactive environment that influences neuroplasticity, especially in subacute phases of the disease, leading to participants manifesting the maximum level of brain reorganization [ 55 ]. No significant differences were found in the baseline evaluation of the intervention groups, so we can assume that the results are a consequence of the use of SVR technology in active and intensive training and the demands and challenges of the exergames [ 54 ]. The use of SVR as a rehabilitation method represents an alternative therapeutic concept that is attractive to patients as they focus on the demands of the exergames and not on the repetitions or the degree of difficulty of the exercise.…”

Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis

“…Different studies have assessed the effect of the clinical application of non-immersive VR in patients who have suffered a CNSD [ 26 ]. Although stroke is the leading CNSD in which non-immersive VR has been used [ 27 ], in other CNSDs that cause motor impairments such as cerebral palsy [ 28 ], multiple sclerosis [ 29 ], Parkinson’s disease [ 30 ] or spinal cord injury [ 31 ], non-immersive VR has been extensively studied with promising results. However, to train the disabled manual skills more specifically (e.g., GS, GMD and FMD), it is necessary to use VR haptic devices, such as the Leap Motion Controller (LMC) [ 32 ].…”

Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

“…As described in recent research regarding upper extremity in post-stroke rehabilitation using MIRA [ 37 ], a physiotherapist using the technology assessed the patient’s AROM additionally to the other assessments, to establish the protocol of exergames used in VR therapy. Therefore, VR therapy use required the following steps: Assess AROM with a goniometer, assess MAS, MRS, FIM, FMLE and FRT Assess AROM through Kinect sensor and MIRA software Establish the limits of ROM performed during exergames based on the AROM assessment Establish the level of technology tolerance to motion pattern and correctness (the adjustment of the tolerance levels for motion from 0 to 100%.…”