Positive Effect of Manipulated Virtual Kinematic Intervention in Individuals with Traumatic Stiff Shoulder: A Pilot Study

Abstract

Virtual reality enables the manipulation of a patient’s perception, providing additional motivation to real-time biofeedback exercises. We aimed to test the effect of manipulated virtual kinematic intervention on measures of active and passive range of motion (ROM), pain, and disability level in individuals with traumatic stiff shoulder. In a double-blinded study, patients with stiff shoulder following proximal humerus fracture and non-operative treatment were randomly divided into a non-manipulated feedback group (NM-group; n = 6) and a manipulated feedback group (M-group; n = 7). The shoulder ROM, pain, and disabilities of the arm, shoulder and hand (DASH) scores were tested at baseline and after 6 sessions, during which the subjects performed shoulder flexion and abduction in front of a graphic visualization of the shoulder angle. The biofeedback provided to the NM-group was the actual shoulder angle while the feedback provided to the M-group was manipulated so that 10° were constantly subtracted from the actual angle detected by the motion capture system. The M-group showed greater improvement in the active flexion ROM (p = 0.046) and DASH scores (p = 0.022). While both groups improved following the real-time virtual feedback intervention, the manipulated intervention provided to the M-group was more beneficial in individuals with traumatic stiff shoulder and should be further tested in other populations with orthopedic injuries.

Performance Evaluation of an Immersive Virtual Reality Application for Rehabilitation after Arthroscopic Rotator Cuff Repair

“…Despite the many advantages that VR is projected to bring to the field of shoulder rehabilitation, the validity and effectiveness of kinematic intervention in virtual environments for orthopedic rehabilitation have only been explored by a few studies [3,[27][28][29], none of which mention evaluating the performance of VR applications against pre-established criteria like clinical guidelines and/or staged ROM goals. Hence, the performed investigation compared the movements performed during different levels of the VR app against the gold-standard values using a motion capture system.…”

“…The growing impact of VR on shoulder rehabilitation is undeniable, as seen by the promising results of the present study, as well as the several new experimental trials working on the development of these VR applications. One double-blinded pilot study found that manipulated virtual real-time presentation of a subject's movements during shoulder exercises promoted greater active flexion ROM [3]. Another study investigated the influence of game features and practice type, task-oriented or imitation-oriented, on shoulder muscle activity [40].…”

“…The application of Virtual Reality (VR) as a diagnostic and therapeutic tool is emerging as a viable alternative for musculoskeletal rehabilitation of the upper limb [1][2][3]. Unlike in orthopedic rehabilitation, VR has been widely used in the field of neurorehabilitation, such as stroke, brain injury, and cerebral palsy [4][5][6][7][8][9].…”

“…In the orthopedic rehabilitation field, few studies have evaluated the effectiveness of kinematic intervention in virtual environments in patients with shoulder stiffness, subacromial impingement syndrome, scapular dyskinesis, and RC diseases [3,[27][28][29][30]. Chang et al, in a mono-centric randomized controlled trial with patients undergoing RCR, compared a control group following conventional home rehabilitation to the experimental one, which used an augmented reality (AR)-based digital healthcare system [28].…”