Effect of virtual reality rehabilitation on motor function in patients with stroke : a narrative review

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021Introdução: O acidente vascular cerebral é uma das principais causas de morte e incapacidade no mundo, sendo descrita como uma epidemia global. Défices motores causados por esta etiologia, afetam as tarefas diárias, bem como, a atividade profissional destas pessoas, resultando num dia-a-dia repleto de obstáculos. Desta forma, a reabilitação tem um papel fulcral, na melhoria destas queixas e consequentemente na qualidade de vida. A realidade virtual é uma ferramenta, que nos recentes anos tem vindo a ganhar um papel cada vez de maior importância para estes doentes. Nesta revisão narrativa, pretendemos comparar a reabilitação convencional com a reabilitação baseada na realidade virtual e perceber, desta forma, se existe benefício na combinação de ambas. Métodos: A nossa estratégia de pesquisa consistiu na pesquisa de ensaios clínicos randomizados em três diferentes plataformas (PubMed, sci-Elo e medRxiv), publicados nos últimos 10 anos cujo objetivo primário se focasse na função motora dos membros superiores. Usamos as seguintes palavras-chave como ponto de partida para a pesquisa de artigos: “Virtual Reality”, “rehabilitation”, “stroke”. Após ser aplicada a estratégia de pesquisa acima mencionada, obtivemos um total de 100 artigos. Após análise destes mesmos 100 artigos, somente 26 tinham os critérios necessários para a sua utilização na revisão, com uma amostra total de 1382 pacientes envolvidos nesta revisão de narrativa. Resultados: Como referido previamente, dos 100 artigos, somente 26 foram utilizados para a construção desta revisão narrativa. Os 74 artigos foram excluídos por não preencherem os critérios necessários para a sua inclusão. O facto do artigo não se focar na função motora do membro superior, foi a principal causa de exclusão de artigos. Outras razões como duplicados, não ter acesso livre, não focar o seu estudo na reabilitação do acidente vascular cerebral e não focar no estudo da realidade virtual também foram motivos para exclusão. Conclusão: Devido a inúmeras variáveis entre os diferentes ensaios, é impossível a conclusão de possíveis conexões entre a intervenção e os resultados obtidos. Sugere-se a realização de estudos em que certas variáveis como a intervenção realizada ao grupo de intervenção, o número de sessões, a duração das mesmas, sejam homogeneizados.Introduction: Stroke is one of the leading causes of death and disability and has been described as a worldwide epidemic. Motor function deficits due to stroke affect the patients' performance in daily tasks as well as in their jobs, which results in an increased difficulty in their everyday life. This way, rehabilitation in these patients plays an important role trying to improve their motor function and therefore their quality of life. Virtual reality, in recent years, has been increasingly more popular in this type of patients. In this narrative review, we aim to compare conventional therapy versus virtual reality-based therapy and find out if there is any kind of benefit in combining conventional therapy with virtual reality-based therapy. Methods: Our search strategy consisted in searching for randomized controlled trials published in the last 10 years with the primary outcome focusing on upper limb motor function, in three different platforms (PubMed, sci-Elo and medRxiv) using the following keywords: “virtual reality”, “rehabilitation”, “stroke”. After applied our search strategy we ended up with a total of 100 articles. After analyzing the 100 trials, only 26 of them met the necessary criteria to take part of this review, with a total sample of 1382 patients involved in the narrative review. Results: As previously mentioned, of the 100 articles, only 26 were used to build this narrative review. 74 articles excluded for not meeting the necessary criteria to make part of this review. The fact that the article did not focus on the motor function of the upper limb was the main reason for the exclusion of articles. Other reasons such as duplicates, not having open access, not focusing their study on stroke rehabilitation and not focusing on the study on virtual reality were also reasons for exclusion. Conclusion: Due to numerous variables between the different trials, it is impossible to conclude possible connections between the intervention and the results obtained. It is suggested that studies should be carried out with certain variables, such as the intervention carried out in the intervention group, the number of sessions, the duration of the sessions, homogenized

Reinforced Feedback in Virtual Environment for Plantar Flexor Poststroke Spasticity Reduction and Gait Function Improvement

Background. Ankle spasticity is a frequent phenomenon that limits functionality in poststroke patients. Objectives. Our aim was to determine if there was decreased spasticity in the ankle plantar flex (PF) muscles in the plegic lower extremity (LE) and improvement of gait function in stroke patients after traditional rehabilitation (TR) in combination with virtual reality with reinforced feedback, which is termed "reinforced feedback virtual environment" (RFVE). Methods. The evaluation, before and after treatment, of 10 hemiparetic patients was performed using the Modified Ashworth Scale (MAS), Functional Ambulatory Category (FAC), and Functional Independence Measure (FIM). The intervention consisted of 1 hour/day of TR plus 1 hour/day of RFVE (5 days/week for 3 weeks; 15 sessions in total). Results. The MAS and FAC reached statistical significance (P<0.05). The changes in the FIM did not reach statistical significance (P=0.066). The analysis between the ischemic and haemorrhagic patients showed significant differences in favour of the haemorrhagic group in the FIM scale. A significant correlation between the FAC and the months after the stroke was established (P=-0.711). Indeed, patients who most increased their score on the FAC at the end of treatment were those who started the treatment earliest after stroke. Conclusions. The combined treatment of TR and RFVE showed encouraging results regarding the reduction of spasticity and improvement of gait function. An early commencement of the treatment seems to be ideal, and future research should increase the sample size and assessment tools

Assessing the immediate impact of a movement tracking-based intervention for unilateral spatial neglect experienced by stroke survivors

Includes bibliographical references.2015 Summer.To view the abstract, please see the full text of the document

A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

BACKGROUND:Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. OBJECTIVE:To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. METHODS:A pilot randomised controlled trial was conducted. Stroke participants had 18 one-hour sessions of RT (Armeo®Spring) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session. The primary outcome measure was the Fugl-Meyer assessment (FMA) for UL impairments and secondary were: UL function, activities and stroke impact collected at baseline, post-intervention and three-month follow-up. RESULTS:22 participants (12 sub-acute and 10 chronic) completed the trial. No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up (p = 0.123). A significant ‘time’ x ‘stage of stroke’ was found for FMA (p = 0.016). A higher percentage improvement was noted in UL function, activities and stroke impact in people with sub-acute compared to chronic stroke. CONCLUSIONS:Adding tDCS did not result in an additional effect on UL impairment in stroke. RT may be of more benefit in the sub-acute than chronic phase

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.Comment: 47 pages, 20 figures, 17 tables (including annexes), part of the MDPI Sesnsors "Special Issue Smart Sensors and Measurements Methods for Quality of Life and Ambient Assisted Living

A new motion-based tool for occupation and monitoring of residents in nursing homes

Population ageing bring new challenges in healthcare and has raised issues concerning innovative solutions to optimize the management of elderly. As recommended, new interactive tools must be accessible to users, acceptable, easy to use, motivating and useful for both residents and staff. Virtual Reality is a good candidate to fulfill these specifications. Based on our expertise in Human Computer Interaction and Neuropsychology of ageing, we are developing a platform to offer interactive activities adapted to very-old and dependent people living in nursing homes. It is based on the use of a low-cost markerless RGB-D sensor (AstraTM, Orbbec) to track user body motion. Implemented activities were designed to involve various cognitive abilities, such as sorting game, search game, ball game. In addition, a module records several biomechanical data and generates reports for caregivers. This paper aims to discuss the special needs of research context and to present the designed interaction platform

Expanding Rehabilitation Beyond the Clinic—Strategies to Increase Total Restorative Therapy Time for Adults with Hemiplegia

Background: Positive neuroplastic changes involving cortical reorganization after stroke are experience dependent and are facilitated more effectively when rehabilitation occurs with high volume. Structured experiences to promote adaptive changes can be implemented during scheduled therapies in any rehabilitation setting. However, time spent in supervised restorative therapy is limited regardless of setting. Time spent in therapeutic activity can be extended by a variety of options that patients can engage in independently, that are low-cost, and that have evidence to support their use as a supplement to physical and occupational therapy. Purpose: The purpose of this paper is to present four such options for supplemental therapeutic activities to support restorative rehabilitation, including mental practice, mirror therapy, low cost virtual reality, and community group exercise classes. A sample of the evidence supporting their feasibility and effectiveness is presented. Practical guidelines for implementation are provided based on the evidence. Recommendations: Evidence based interventions can be used to extend total restorative rehabilitation time as an extension of therapy activities performed in the clinic. They are feasible and effective and can support positive neuroplastic changes in individuals with hemiplegia. These strategies can and should be implemented across practice settings by physical therapists, occupational therapists, and speech language pathologists

Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview

Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional “pen and paper” therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases–Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life