Proprioception rehabilitation training system for stroke patients using virtual reality technology

Abstract

We investigated a virtual reality (VR) proprioceptive rehabilitation system that could manipulate the visual feedback of upper-limb during training and could do training by relying on proprioception feedback only. Virtual environments were designed in order to switch visual feedback on/off during upper-limb training. Two types of VR training tasks were designed for evaluating the effect of the proprioception focused training compared to the training with visual feedback. In order to evaluate the developed proprioception feedback virtual environment system, we recruited ten stroke patients (age: 54.7± 7.83years, on set: 3.29± 3.83 years). All patients performed three times PFVE task in order to check the improvement of proprioception function just before training session, after one week training, and after all training. In a comparison between FMS score and PFVE, the FMS score had a significant relationship with the error distance(r = -.662, n=10, p = .037) and total movement distance(r = -.726, n=10, p = .018) in PFVE. Comparing the training effect between in virtual environment with visual feedback and with proprioception, the click count, error distance and total error distance was more reduced in PFVE than VFVE. (Click count: p = 0.005, error distance: p = 0.001, total error distance: p = 0.007). It suggested that the proprioception feedback rather than visual feedback could be effective means to enhancing motor control during rehabilitation training. The developed VR system for rehabilitation has been verified in that stroke patients improved motor control after VR proprioception feedback training.

Digital therapeutics in neurology

“…To improve proprioception, sensorimotor training programs have been suggested to facilitate joint position sense and dynamic joint stability using rhythmic active motion, angle repositioning, and standing on an air cushion with support to stimulate muscular co-activation [11]. Kim et al investigated a new type of rehabilitation system to train proprioception of stroke patients using virtual reality technology [12]. The system requires that patients move their arm to the target position relying on proprioception feedback only.…”

Robotics-assisted visual-motor training influences arm position sense in three-dimensional space

“…In these studies, which included both uni-and bi-manual paradigms, the level of force assistance was adjusted based on individuals' motor function and their performance, and it was shown that such a protocol could improve the sense of limb position and movement, but retainment of gained benefits for stroke individuals might also be affected by the level of stroke-related impairment [10]. Proprioceptive training through delayed visual feedback in a virtual reality platform was addressed in [19,20]. In this regard, individuals with stroke were asked to transfer objects in a virtual environment to a predefined target without visual feedback of the location of their hands.…”

“…Most of the aforementioned studies focused on proprioceptive training through specifically administering a set of tasks for improving sensorimotor function [11]. Moreover, protocols implemented for assessing and improving position sense in upper limbs considered two-dimensional space and administered isolated movements mostly in the transverse plane [10,[12][13][14][15][16][17][18][19][20] and sagittal plane [22][23][24][25]. As a large number of activities of daily living require moving the upper-limbs in three-dimensional (3D) trajectories [26], there is a need for rehabilitation protocols that require participants to practice movements in 3D space.…”

“…Hand cursor and target location were displayed after each trial and subsequently were hidden so the participants could have another chance at reaching to the same target. It was reported that such a protocol that relied mostly on proprioceptive information had a significant positive impact on the limb position sense [ 19 , 20 ]. In a different study, performance feedback was provided in the form of haptic and vibro-tactile feedback, with reported benefits of proprioceptive training of the wrist to reach a certain degree of movement in wrist flexion-extension, wrist abduction-adduction, and forearm pronation-supination [ 21 ].…”

Important Parameters for Hand Function Assessment of Stroke Patients

“…These strategies are strongly associated with proprioception or the ability to sense the position of the body in time and space [31]. Stroke patients usually depend on visual function when they move part of their body for example, during eating and walking because they have impaired proprioception [32,33]. Tasks should have a clear guidance path so that the subject understands easily what they should do.…”