[ARTICLE] A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke – Full Text


Introduction. This small pilot study aimed to examine the feasibility of an upper limb rehabilitation system (the YouGrabber) in a community rehabilitation centre, qualitatively explore participant experiences, and describe changes after using it.

Methods and Material. Chronic stroke participants attending a community rehabilitation centre in the UK were randomised to either a YouGrabber or a gym group and completed 18 training sessions over 12 weeks. The motor activity log, box and block, and fatigue severity score were administered by a blinded assessor before and after the intervention. Semistructured interviews were used to ascertain participants’ views about using the YouGrabber.

Results. Twelve participants (6 females) with chronic stroke were recruited. All adhered to the intervention. There were no adverse events, dropouts, or withdrawal. There were no significant differences between the YouGrabber and gym groups although there were significant within group improvements on the motor activity log (median change: 0.59, range: 0.2–1.25; ) within the YouGrabber group. Participants reported that the YouGrabber was motivational but they expressed frustration with technical challenges.

Conclusions. The YouGrabber appeared practical and may improve upper limb activities in people several months after stroke. Future work could examine cognition, cost effectiveness, and different training intensities.

1. Introduction

There are approximately 33 million stroke survivors worldwide [1]. Whilst the survival rate of stroke continues to improve, it is recognised that many survivors continue to be left with functional deficits that impact upon their quality of life and limit their return to vital functions and hobbies [1]. The ability to return to activities of daily living after stroke can be maximised by rehabilitative therapy which improves quality of life and facilitates independence [2]. A key component of physical therapy after stroke is repetition, or practice, of challenging movements that are focused on achieving a task or function [3]. This repeated task practice has been shown to facilitate and harness positive adaptations within the brain to aid recovery [4]. Whilst an ideal amount of practice to improve daily functioning has not been established [5], animal studies suggest that in excess of 400 repetitions are needed to promote plastic changes in the brain [3]. In clinical studies, two to three hours a day of practice for six weeks has been shown to elicit meaningful improvements in stroke survivors [6]. Meta-analyses of clinical trials also indicate that higher doses of practice promote better outcomes in impairments and activities of daily living for people after stroke [4, 79].

Facilitating increased practice of task orientated movements may be particularly helpful in improving the upper limb in people after stroke. Between half and two-thirds of stroke survivors report problems with their upper limb which significantly affects their activities of daily living [10] and has considerable negative effects upon participation and quality of life [11, 12]. Recovery of the upper limb may be particularly difficult as an individual’s use of the affected arm has been observed to be minimal after stroke [13]. Furthermore, restoration of the upper limb often is not the primary aim of initial rehabilitation for both the patient and therapist, who are likely to be more focused on regaining the ability to walk [14]. Consequently it is unsurprising that less than 10 minutes of a typical therapy session are focused upon activities for the upper limb [13, 15].

There is good quality evidence for the use of interventions which require repetitive, task orientated, and task specific activities to improve the recovery of the upper limb after stroke [16, 17]. These interventions include constraint induced movement therapy (CIMT), virtual reality, and interactive video games [17]. Interactive video gaming using forms of virtual reality (VR) have grown in popularity as a method to increase repeated practice of challenging and engaging movements for people after stroke. Training using interactive VR games can provide task oriented, unpredictable and graduated learning [18], and augmented feedback regarding performance and results which motivate and engage players [19].

Although there is insufficient evidence to compare different upper limb interventions [16], the literature suggests that interactive VR game training is at least as effective as conventional exercises to elicit improvements in the upper limb after stroke [20]. However, many studies use a broad range of gaming systems in mostly acute stroke survivors where participants were typically based in hospital settings [20]. Consequently, the effects of virtual reality gaming upon the upper limb function of community dwelling stroke survivors who have had their strokes many months or years ago are not established. Furthermore, only a few studies have considered the views of participants about using virtual reality gaming systems for rehabilitation of the upper limb. Whilst these views have been largely positive, similar findings cannot be assumed between different training locations and gaming systems [21].

Therefore, this small, prospective mixed methods study was developed to

  1. examine the feasibility of a custom made virtual reality upper limb interactive gaming tool called the YouGrabber® (YouRehab) in people after stroke who are attending a community outpatient rehabilitation centre,
  2. describe the changes in upper limb function after using the YouGrabber and estimate the magnitude of the change in order to inform the sample size needed for a future trial,
  3. explore the experiences of participants who had used the YouGrabber for rehabilitation of the upper limb after stroke.

Continue —> A Mixed Methods Small Pilot Study to Describe the Effects of Upper Limb Training Using a Virtual Reality Gaming System in People with Chronic Stroke


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