Virtual reality for stroke rehabilitation: an abridged version of a Cochrane Review.

Published in final form at http://www.minervamedica.it/index2.t?show=R33Y2015N04A0497 Copyright © 2015 EDIZIONI MINERVA MEDICAAim: Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation settings over the last ten years. The primary objective of this review was to determine the effectiveness of virtual reality on upper limb function and activity after stroke. The impact on secondary outcomes including gait, cognitive function and activities of daily living was also assessed. Methods: Randomised and quasi-randomised controlled trials comparing virtual reality with an alternative intervention or no intervention were eligible to be included in the review. The authors searched a number of electronic databases including: the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, clinical trial registers, reference lists, Dissertation Abstracts and contacted key researchers in the field. Search results were independently examined by two review authors to identify studies meeting the inclusion criteria. Results: A total of 37 randomised or quasi randomised controlled trials with a total of 1019 participants were included in the review. Virtual reality was found to be significantly more effective than conventional therapy in improving upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49)) based on 12 studies and significantly more effective than no therapy in improving upper limber function (SMD 0.44 (95%CI 0.15 to 0.73)) based on nine studies. The use of virtual reality also significantly improved activities of daily living function when compared to more conventional therapy approaches (SMD 0.43 (95%CI 0.18 to 0.69)) based on eight studies. Conclusion: While there are a large number of studies assessing the efficacy of virtual reality they tend to be small and many are at risk of bias. While there is evidence to support the use of virtual reality intervention as part of upper limb training programs, more research is required to determine whether it is beneficial in terms of improving lower limb function and gait and cognitive functio

Adopting Text Mining on Rehabilitation Therapy Repositioning for Stroke

Stroke is a common disabling disease that severely affects the daily life of patients. Accumulating evidence indicates that rehabilitation therapy can improve movement function. However, no clear guidelines have specific and effective rehabilitation therapy schemes, and the development of new rehabilitation techniques has been relatively slow. This study used a text mining approach, the ABC model, to identify an existing rehabilitation candidate therapy method that is most likely to be repositioned for stroke. In the model, we built the internal links of stroke (A), assessment scales (B), and rehabilitation therapies (C) in PubMed and the links were related to upper limb function measurements for patients with stroke. In the first step, using E-utility, we retrieved both stroke-related assessment scales and rehabilitation therapy records and then compiled two datasets, which were called Stroke_Scales and Stroke_Therapies, respectively. In the next step, we crawled all rehabilitation therapies co-occurring with the Stroke_Therapies and then named them as All_Therapies. Therapies that were already included in Stroke_Therapies were deleted from All_Therapies; therefore, the remaining therapies were the potential rehabilitation therapies, which could be repositioned for stroke after subsequent filtration by a manual check. We identified the top-ranked repositioning rehabilitation therapy and subsequently examined its clinical validation. Hand-arm bimanual intensive training (HABIT) was ranked the first in our repositioning rehabilitation therapies and had the most interaction links with Stroke_Scales. HABIT significantly improved clinical scores on assessment scales [Fugl-Meyer Assessment (FMA) and action research arm test (ARAT)] in the clinical validation study for acute stroke patients with upper limb dysfunction. Therefore, based on the ABC model and clinical validation, HABIT is a promising repositioned rehabilitation therapy for stroke, and the ABC model is an effective text mining approach for rehabilitation therapy repositioning. The findings in this study would be helpful in clinical knowledge discovery

Virtual reality for therapeutic purposes in stroke: a systematic review

[Resumen] Introducción. La realidad virtual (RV) se utiliza en rehabilitación con el objetivo de mejorar las capacidades funcionales. Es en estos últimos 5 años cuando aparece el mayor número de publicaciones sobre la utilización de RV en pacientes con patología neurológica, con el objetivo de determinar si este recurso terapéutico aporta mejoras en la recuperación de la función motora. Desarrollo. Se ha realizado una revisión sistemática consultando las bases de datos Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science y Sport-Discus. Se han incluido artículos publicados en los últimos 5 años, publicados en inglés y/o español, realizados en pacientes con ictus, y que utilicen la RV para mejorar la función motora. Finalmente, se han seleccionado 4 revisiones sistemáticas y 21 ensayos clínicos controlados y/o aleatorizados. La mayoría de los estudios tienen como objetivo mejorar la función motora del miembro superior, y/o mejorar la realización de las actividades de la vida diaria, aunque también hay algún artículo cuyo objetivo es mejorar la función motora del miembro inferior-mejorar la marcha, así como mejorar el equilibrio estático-dinámico. Discusión y conclusiones. Hay fuertes evidencias científicas de los efectos beneficiosos de la RV en la recuperación motora del miembro superior en pacientes con ictus. Se necesitan estudios que profundicen en cuáles son los cambios generados en la reorganización cortical, qué tipo de sistema de RV es mejor utilizar, determinar si los resultados se mantienen a largo plazo, y definir qué frecuencias e intensidades de tratamiento son las más adecuadas.[Abstract] Introduction. Virtual reality (VR) is used in the field of rehabilitation/physical therapy to improve patients’ functional abilities. The last 5 years have yielded numerous publications on the use of VR in patients with neurological disease which aim to establish whether this therapeutic resource contributes to the recovery of motor function. Development. The following databases were reviewed: Cochrane Original, Joanna Briggs Connect, Medline/Pubmed, Cinahl, Scopus, Isi Web of Science, and Sport-Discus. We included articles published in the last 5 years in English and/or Spanish, focusing on using RV to improve motor function in patients with stroke. From this pool, we selected 4 systematic reviews and 21 controlled and/or randomised trials. Most studies focused on increasing motor function in the upper limbs, and/or improving performance of activities of daily living. An additional article examines use of the same technique to increase motor function in the lower limb and/or improve walking and static-dynamic balance. Discussion and conclusions. Strong scientific evidence supports the beneficial effects of VR on upper limb motor recovery in stroke patients. Further studies are needed to fully determine which changes are generated in cortical reorganisation, what type of VR system is the most appropriate, whether benefits are maintained in the long term, and which frequencies and intensities of treatment are the most suitable

Virtual reality for stroke rehabilitation (review)

Published version made available following 12 month embargo from the date of publication [12 Feb 2015] according to publisher policy. Accessed 10/03/2015. Published version available from 13 February 2016

Effectiveness of commercial video gaming on fine motor recovery in chronic stroke within community-level rehabilitation

Introduction: Chronic stroke survivors often live with persisting upper extremity deficits that affect their daily life, and are traditionally offered little rehabilitation. Commercial gaming can act as a motivating way to complete rehabilitation. Purpose: To investigate the effectiveness of commercial gaming as an intervention for fine motor recovery in chronic stroke. Methods: Ten chronic phase post-stroke participants completed a 16-session program using the Nintendo Wii for 15 minutes 2x/week with their more affected hand. Measures used at four testing sessions included: Jebsen Hand Function Test (JHFT), Box and Blocks Test (BBT), Nine Hole Peg Test (NHPT), Stroke Impact Scale (SIS). Results: Significant improvements were found with the JHFT, BBT and NHPT from pre-testing to post-testing. There was an increase in perceived quality of life from pre-testing to post-testing, as determined by the SIS. Conclusion: Commercial gaming may be a viable resource for those with chronic stroke

Virtual reality based upper extremity stroke rehabilitation system.

Some studies suggest that the use of Virtual Reality technologies as an assistive technology in combination with conventional therapies can achieve improved results in post stroke rehabilitation. Despite the wealth of ongoing research applied to trying to build a virtual reality based system for upper extremity rehabilitation, there still exists a strong need for a training platform that would provide whole arm rehabilitation. In order to be practical such a system should ideally be low cost (affordable or inexpensive for a common individual or household) and involve minimal therapist involvement. This research outlines some of the applications of virtual reality that have undergone clinical trials with patients suffering from upper extremity functional motor deficits. Furthermore, this thesis presents the design, development, implementation and feasibility testing of a Virtual Reality-based Upper Extremity Stroke Rehabilitation System. Motion sensing technology has been used to capture the real time movement data of the upper extremity and a virtual reality glove has been used to track the flexion/extension of the fingers. A virtual room has been designed with an avatar of the human arm to allow a variety of training tasks to be accomplished. An interface has been established to incorporate the real time data from the hardware to a virtual scene running on a PC. Three different training scenes depicting a real world scenario have been designed. These have been used to analyze the motion patterns of the users while executing the tasks in the virtual environment simulation. A usability study with the healthy volunteers performing the training tasks have been undertaken to study the ease of use, ease of learning and improved motivation in the virtual environment. Moreover this system costing approximately 2725 pounds would provide home based rehabilitation of the whole arm augmenting conventional therapy on a positive level. Statistical analysis of the data and the evaluation studies with the self report methodologies suggests the feasibility of the system for post stroke rehabilitation in home environment

Factors affecting neuropsychological testing in the elderly and the use of a newly developed virtual reality test. Implications for the accurate and early diagnosis of Alzheimer's disease.

Neuropsychological testing is one method used in the diagnosis of Alzheimer’s disease and other cognitive disorders. However, the testing process may be affected by subtle external factors which if not controlled for may have the ability to affect the scores obtained. The primary aim of this thesis was to investigate the effects of some of these external factors, namely caffeine, non-oily fish consumption and time of day. A secondary aim was to evaluate the use of a novel virtual assessment as a possible tool for the early detection of AD. Healthy elderly participants over the age of sixty with no existing cognitive impairment or neurological condition were recruited to take part. For each external factor investigated participants were required to undertake a cognitive assessment. The results demonstrated that subtle external factors present during a typical testing session have the ability to significantly affect the scores obtained. Scores on one part of the virtual test correlated with existing tests used for the early detection of cognitive impairment and were significantly lower in participants classified as mildly impaired. With further modification this test has the potential to be used as an early detection tool. The results have implications for the interpretation of neuropsychological test scores which may be considered when classifying participants, determining treatment interventions, selecting participants for research and making a diagnosis. These findings have important considerations for psychological and cognitive research that investigates human brain function