The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis

Abstract

Objective. The aim of this study was to perform a meta-analysis to examine whether virtual reality (VR) training is effective for lower limb function as well as upper limb and overall function in chronic stroke patients. Methods. Three databases, OVID, PubMed, and EMBASE, were used to collect articles. The search terms used were “cerebrovascular accident (CVA),” “stroke”, and “virtual reality”. Consequently, twenty-one studies were selected in the second screening of meta-analyses. The PEDro scale was used to assess the quality of the selected studies. Results. The total effect size for VR rehabilitation programs was 0.440. The effect size for upper limb function was 0.431, for lower limb function it was 0.424, and for overall function it was 0.545. The effects of VR programs on specific outcomes were most effective for improving muscle tension, followed by muscle strength, activities of daily living (ADL), joint range of motion, gait, balance, and kinematics. Conclusion. The VR training was effective in improving the function in chronic stroke patients, corresponding to a moderate effect size. Moreover, VR training showed a similar effect for improving lower limb function as it did for upper limb function.

Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence

“…When VR rehabilitation was applied in addition to conventional therapy, VR rehabilitation showed significant beneficial effects on the composite outcome of upper limb function (SMD = 0.49, 95 CI = 0.21 to 0.77). Two metanalyses by Aminov et al [ 63 ] and Lee et al [ 67 ] also showed similar moderate effect sizes for upper limb function in VR rehabilitation ( Table 4 ). Mekbib et al [ 65 ] only included RCTs using dose-matched conventional therapy and calculated the mean differences of FMA, BBT, and MAL, which all represent upper limb function.…”

“…selected systematic reviews and meta-analyses for review. Six meta-analyses were included for our evidence summary [ 63 , 64 , 65 , 66 , 67 , 68 ].…”

“…The general characteristics of the included meta-analyses are presented in Table 3 . Two studies included randomized controlled trials (RCTs) and quasi-randomized controlled trials [ 64 , 68 ] and three other studies only included RCTs [ 63 , 65 , 67 ]. Karamians et al included RCTs and prospective studies [ 66 ].…”

Effect of Post-Stroke Motor Training on EEG Movement-Related Cortical Potentials

“…After the stroke, re-learning of lost motor functions is achieved with training strategies such as physiotherapy (2,3), constraint-induced movement therapy (4,5), mirror-box therapy (6,7), virtual reality therapy (8,9), and robot-assisted therapy (10,11). All these types of training strategies promote the mechanism of neuroplasticity.…”

“…One of these patterns is known as event-related desynchronization/event-related synchronization (ERD/ERS). ERD is a frequency-speci c power decrease mostly in alpha (8)(9)(10)(11)(12)(13) and beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) frequency bands of EEG during the preparation of a movement until its onset which then increases after motor execution denoted by ERS (33). The other EEGderived pattern appears in a time-domain called movement-related cortical potential (MRCP).…”