[Abstract + References] Effects of virtual reality on stroke rehabilitation: An umbrella review of systematic reviews

Abstract

Background and aims: Virtual reality is an emerging technology in rehabilitation. This umbrella review aimed to identify, critically appraise, and summarize current systematic reviews on the effects of virtual reality on stroke rehabilitation.

Methods: Five biomedical databases, PubMed, Embase, CINAHL, PsycINFO, and Scopus were searched from inception to December 30th, 2023, for systematic reviews with or without meta-analyses published in English. Two reviewers independently conducted abstract screening, full-text selection, and quality assessments. The methodological quality of included studies was evaluated by the Assessing the Methodological Quality of Systematic Reviews 2. Results were qualitatively synthesized according to domains of function to ascertain the effects of virtual reality intervention on functional improvement within stroke rehabilitation.

Results: A total of 78 articles were included; 23 were systematic reviews, and 55 were systematic reviews with meta-analyses. Among them, 30 studies were evaluated as critically low quality, 32 as low, 15 as moderate, and one as good. Outcomes regarding upper extremity motor function, upper extremity activity, participation, functional independence, balance, functional mobility, walking speed, and cognitive function were summarized. While positive effects in favor of virtual reality were revealed by a majority of systematic reviews on these outcomes, evidence supporting the significantly different effects of virtual reality compared to conventional rehabilitation on participation and cognitive function was lacking.

Conclusion: The umbrella review demonstrated promising clinical outcomes regarding the use of virtual reality as an advanced therapeutic approach in stroke rehabilitation to optimize patient care. Future systematic reviews and meta-analyses in this field should adhere to established guidelines to enhance the quality of evidence.

References

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[WEB] Deep Brain Stimulation Shows Benefit For Stroke Survivors

Researchers at Cleveland Clinic report in Nature Medicine that using deep brain stimulation (DBS) for post-stroke rehabilitation of patients targeting the dentate nucleus is safe and feasible. The dentate nucleus is a region in the brain that regulates fine control of voluntary movements, cognition, language, and sensory functions.u00a0

Stroke is a leading cause of long-term disability, in America alone an estimated 800,000 people suffer strokes every year.  Most people will survive the acute phase, but persistent neurological issues resulting from the stroke will most likely jeopardize the survivors’ quality of life as well as productivity. Approximately 50% of stroke survivors will continue to exhibit disability severities that require assistance with their day-to-day lives and activity. 

In the EDEN Trial (Electrical Stimulation of the Dentate Nucleus for Upper Extremity Hemiparesis Due to Ischemic Stroke Trial) 9 out of 12 participants demonstrated improvements in both motor impairment and function, and those with at least minimal preservation of distal motor function at enrollment were found to have almost tripled their initial scores according to the researchers. 

“These are reassuring for patients as the participants in the study had been disabled for more than a year and, in some cases, three years after stroke. This gives us a potential opportunity for much needed improvements in rehabilitation in the chronic phases of stroke recovery,” said principal investigator Dr. Machado, chair of Cleveland Clinic’s Neurological Institute. “The quality-of-life implications for study participants who responded to therapy have been significant.”

“We saw patients in the study regain levels of function and independence they did not have before enrolling in the research,” Dr. Machado said. “This was a smaller study and we look forward to expanding as we have begun the next phase.”

This study included 12 patients with chronic, moderate to severe hemiparesis of the upper extremities as a result of a unilateral middle cerebral artery stroke within 12-36 months before enrolling in the trial. Participants underwent DBS surgery to implant electrodes in their cerebellum which were used to deliver small electric pulses to promote the recovery of control of their movements once connected to a small pacemaker-like device. 

Following discharge and surgery recovery participants completed physical therapy beginning at first with the DBS devices off for several weeks, and then with the device turned on for 4-8 months. The most significant improvements were observed after turning on the DBS device, according to the researchers. No major complications were reported during the study, and the majority of the participants improved to a degree that is considered to be meaningful in rehabilitation. 

“The safety and feasibility data from this early study combined with the potential symptom improvements certainly support the need for additional, larger trials to see if cerebellar DBS is indeed a potential treatment for post-stroke motor impairment,” said Brooks Gross, Ph.D., program director, National Institute of Neurological Disorders and Stroke.

Dr. Machado, who patented this innovative DBS method for stroke recovery believes this treatment could have a consistently high rate of success for stroke survivors. Although these initial results are promising he indicates that more extensive research is required. 

“There are currently no effective methods to improve the outcomes of physical rehabilitation for the hundreds of thousands of stroke survivors,” said co-principal investigator Dr. Baker, Cleveland Clinic Lerner Research Institute. “The results of the study found that deep brain stimulation, paired with physical therapy, improved movement in patients who were more than a year out from their stroke and whose motor improvements had largely plateaued. This tells us the research warrants further investigation in larger patient samples.”

Accompanying videos:

https://www.dropbox.com/scl/fo/rq3mvpc3lvsql0k0cgt2j/h?dl=0&preview=DBS+and+stroke_nonbranded.mp4&rlkey=4ujc9nim32xiv5fcsvs8gxswf

As with anything you read on the internet, this article should not be construed as medical advice; please talk to your doctor or primary care provider before changing your wellness routine. This article is not intended to provide a medical diagnosis, recommendation, treatment, or endorsement.

Content may be edited for style and length.

References/Sources/Materials provided by:

bishoph@ccf.org

realeca@ccf.org

https://my.clevelandclinic.org/?

https://newsroom.clevelandclinic.org/2023/08/14/cleveland-clinic-study-shows-deep-brain-stimulation-encouraging-for-stroke-patients/

https://www.nature.com/articles/s41591-023-02507-0

https://www.dropbox.com/scl/fo/rq3mvpc3lvsql0k0cgt2j/h?dl=0&preview=DBS+and+stroke_nonbranded.mp4&rlkey=4ujc9nim32xiv5fcsvs8gxswf

https://www.cdc.gov/stroke/facts.htm

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[Abstract + References] Combined noninvasive brain stimulation virtual reality for upper limb rehabilitation poststroke: A systematic review of randomized controlled trials

Abstract

Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as “high quality,” while two were categorized as “moderate quality”. There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted.

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[ARTICLE] Virtual Reality Training Using Nintendo Wii Games for Patients With Stroke: Randomized Controlled Trial – Full Text

Abstract

Background

Stroke is a leading cause of disability. It is difficult to devise an optimal rehabilitation plan once stroke survivors are back home. Conventional rehabilitative therapies are extensively used in patients with stroke to recover motor functioning and disability, but these are arduous and expensive. Virtual reality (VR) video games inspire patients to get involved in their therapeutic exercise routine in a fun way. VR in the form of games provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development in rehabilitation. The effects of upper limb sensorimotor functioning and balance are the main focus of this trial.

Objective

The aim of this study is to compare the effects of VR training and routine physical therapy on balance and upper extremity sensorimotor function in patients with stroke.

Methods

It was a single assessor-blinded randomized clinical trial. A total of 74 participants with their first chronic stroke were included and rehabilitated in a clinical setting. The lottery method was used to randomly assign patients to either the VR group (n=37) or the routine physical therapy group (n=37). The VR group received a 1-hour session of VR training for 3 weekdays over 6 weeks, and the routine physical therapy group received different stretching and strengthening exercises. The outcome measuring tools were the Berg Balance Scale for balance and the Fugl-Meyer Assessment (upper extremity) scale for sensorimotor, joint pain, and range assessment. The assessment was done at the start of treatment and after the 6 weeks of intervention. Data analysis was done using SPSS 22.

Results

The trial was completed by 68 patients. A significant difference between the two groups was found in the Berg Balance Scale score (P<.001), Fugl-Meyer Assessment for motor function (P=.03), and Fugl-Meyer Assessment for joint pain and joint range (P<.001); however, no significant difference (P=.19) in the Fugl-Meyer Assessment for upper extremity sensation was noted.

Conclusions

VR training is helpful for improving balance and function of the upper extremities in the routine life of patients with stroke; although, it was not found to be better than conventional training in improving upper limb sensation. VR training can be a better option in a rehabilitation plan designed to increase functional capability.

Introduction

Stroke is a leading cause of disability, and it is difficult to devise an optimal rehabilitation plan for patients with stroke once they are discharged from the hospital [1]. Almost 85% of patients with stroke have hemiparesis after stroke while 55% to 75% of stroke survivors have motor dysfunction. South Asian people (people of India, Pakistan, Sri Lanka, Bangladesh, Nepal, and Bhutan) have a higher risk of stroke because of compromised cardiac and metabolic rate [2,3]. Treatment for stroke is initiated with drugs [4], and surgery might be another option to repair any constriction or narrowing of blood vessels [5,6]. Patient rehabilitation is an important part of treatment. The main purpose of rehabilitation is to improve the quality of life for patients with stroke and make them independent [7,8]. Conventional rehabilitative therapies are extensively used to help patients with stroke recover motor functioning and disability. However, the application of conventional techniques is arduous and expensive, and requires transportation of patients to tertiary care hospitals especially in countries like Pakistan where hospitals are less in number. Virtual reality (VR) training in the form of games [9] provides a fruitful, secure, and challenging learning environment for motor control and neural plasticity development after stroke. VR video games inspire patients to get involved in their therapeutic exercise routine in a fun way [10]. Depending on the remodeling and reorganization of brain function, previous studies found that VR can be a great alternative for quick functional recovery after stroke [11]. Mirror neurons in the cortex can be activated through observational learning by VR training. Participants who received sensory input in VR training were also more likely to learn the desired motor behavior [12]. The feedback can help to promote the development of use-dependent cortical plasticity, which could lead to improved motor control. Furthermore, the functional improvement induced by VR training could significantly boost participants’ confidence and self-efficacy in a new environment. Moreover, another advantage of VR is that it can greatly save on labor and cost of patients [13].

Stroke is seen to be more prevalent in countries like Pakistan, as the people are more inclined toward using local drugs like naswar, pipe smoking, and beetle leaf chewing (paan). Thus, there is higher incidence of stroke in middle-aged populations (<45 years) [14–16]. The study aimed for a younger population with stroke and found cost-effective treatment protocols at the same time. The unique needs of young people with stroke and the promising opportunity provided by a low-cost serious game would be a beneficial addition in treatment strategy. There is inadequate evidence in the literature to generalize effects on upper limb sensorimotor function and gait through commercial gaming in young patients with stroke. Studies on effectiveness of VR programs in comparison to traditional methods on functional-motor improvement of an upper limb are needed in low-resource countries to reduce cost and time through target-oriented interventions. This study was conducted to compare the effects of VR training and routine physical therapy on balance and function of upper limbs in patients with stroke from the lower- and middle-class populations. This study is conducted to accept or reject the hypothesis that VR has a significantly better effect on balance and upper limb function in patients with stroke.[…]

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[Abstract] Patterns of Functional Change Five to Ten Years after Moderate-Severe Traumatic Brain Injury

Abstract

This study aims to characterize the patterns of functional change experienced between 5 and 10 years after moderate-severe traumatic brain injury (TBI). The study included TBI Model Systems national database participants (N = 372) at six sites who experienced TBI, received inpatient rehabilitation, and were followed at 5 and 10 years post-TBI. Outcome measures included self- or proxy-reported Functional Independence Measure (FIM^TM) structured interview at 5 and 10 years post-TBI and domain change indices (DCIs) at 10 years to assess subjective change over the previous 5 years. When all seven FIM and subjective DCI subscales were considered together, 69% reported improvement in at least one subscale and 41% reported decline in at least one subscale; 51% reported more domains improved than declined, and 20% reported more domains declined than improved. Age at injury, post-traumatic amnesia duration, FIM, and depression and anxiety at year 5 were associated with FIM change and DCI measures. Although most persons with moderate-severe TBI do not experience widespread change from year 5 to 10 on individual FIM subscales or perceived domain-specific subscales, the vast majority do report change in one or more domains, with more improvement than decline and more change in subjective DCI than in FIM. Clinicians and researchers should be alert to the possibility of both positive and deleterious changes many years after TBI.

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[Abstract] Functional Change from Five to Fifteen Years after Traumatic Brain Injury

Abstract

Few studies have assessed the long-term functional outcomes of traumatic brain injury (TBI) in large, well-characterized samples. Using the Traumatic Brain Injury Model Systems cohort, this study assessed the maintenance of independence between years 5 and 15 post-injury and risk factors for decline. The study sample included 1381 persons with TBI who received inpatient rehabilitation, survived to 15 years post-injury, and were available for data collection at 5 or 10 years and 15 years post-injury. The Functional Independence Measure (FIM) and Disability Rating Scale (DRS) were used to measure functional outcomes. The majority of participants had no changes during the 10-year time frame. For FIM, only 4.4% showed decline in Self-Care, 4.9% declined in Mobility, and 5.9% declined in Cognition. Overall, 10.4% showed decline in one or more FIM subscales. Decline was detected by DRS Level of Function (24% with >1-point change) and Employability (6% with >1-point change). Predictors of decline factors across all measures were age >25 years and, across most measures, having less than or equal to a high school education. Additional predictors of FIM decline included male sex (FIM Mobility and Self-Care) and longer rehabilitation length of stay (FIM Mobility and Cognition). In contrast to studies reporting change in the first 5 years post-TBI inpatient rehabilitation, a majority of those who survive to 15 years do not experience functional decline. Aging and cognitive reserve appear to be more important drivers of loss of function than original severity of the injury. Interventions to identify those at risk for decline may be needed to maintain or enhance functional status as persons age with a TBI.

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[ARTICLE] Effects of sensory stimulation on upper limb strength, active joint range of motion and function in chronic stroke virtual reality training – Full text PDF

Abstract

Objective: This study aimed to investigate the upper limb strength, active joint range of motion (AROM), and upper limb function in persons with chronic stroke using virtual reality training in combination with upper limb sensory stimulation.
Design: Two-group pretest-posttest design.
Methods: 20 subjects were divided into two groups of 10, the sensory motor stimulation and virtual reality training (SMVR) and virtual reality training (VR) groups. The training was conducted for 30 minutes per session, three times a week for 8 weeks.The participants’ upper limb strength was measured via the hand-held dynamometer, joint angle AROM was measured via dual inclinometer, function was measured using the Jebson-Taylor hand function test and the manual function test.
Results: Significant differences were observed in all groups before and after the training for upper extremity strength, AROM, and function (p<0.05). Between the two groups, the SMVR group showed significant improvement in muscle strength, AROM, and Jebsen-Taylor hand function test scores compared with the VR groups (p<0.05).
Conclusions: In this study, we confirmed that sensory stimulation and VR had positive effects on upper extremity strength, AROM, and function of persons with chronic stroke. The results suggest that in the future, VR in combination with sensory stimulation of the upper limb is likely to become an effective method (a rehabilitation training program) to improve the upper limb function of persons with chronic stroke.

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[ARTICLE] Design Criteria of Soft Exogloves for Hand Rehabilitation-Assistance Tasks – Full Text

Abstract

This paper establishes design criteria for soft exogloves (SEG) to be used as rehabilitation or assistance devices. This research consists in identifying, selecting, and grouping SEG features based on the analysis of 91 systems that have been proposed during the last decade. Thus, function, mobility, and usability criteria are defined and explicitly discussed to highlight SEG design guidelines. Additionally, this study provides a detailed description of each system that was analysed including application, functional task, palm design, actuation type, assistance mode, degrees of freedom (DOF), target fingers, motions, material, weight, force, pressure (only for fluids), control strategy, and assessment. Such characteristics have been reported according to specific design methodologies and operating principles. Technological trends are contemplated in this contribution with emphasis on SEG design opportunity areas. In this review, suggestions, limitations, and implications are also discussed in order to enhance future SEG developments aimed at stroke survivors or people with hand disabilities.

1. Introduction

Hand and finger motions are imperative for grasping and manipulation tasks. Nonetheless, people who have suffered from cerebral palsy (CP), stroke, or spinal cord injury (SCI) have great difficulty in accomplishing these activities of daily living (ADL) by themselves. A person with any of these pathologies could present clenched fist, spasticity, uncoordinated motions, loss of strength, or diminished dexterity. These are consequences of a neuronal impairment that is responsible for controlling motricity, muscle endurance, and tonicity [1]. Worldwide, more than 15 million people are affected each year [2], and only 11.6% of the stroke survivors are able to recover dexterity [3]. Patients with these disabilities can, freely, flex their hand muscles but show abnormal resistance when extending them [4], requiring physical rehabilitation or assistance.

Other hand motor deficits are caused by ageing or hand deformities such as rheumatoid arthritis or osteoarthritis, because cartilage weakens, muscle mass decreases, and joint stiffness increases [5]. More than 50 million elderly people have difficulties to achieve accurate gripping and pinching forces, and their range of motion (ROM) is limited as well as their work area [6].

Therefore, people with hand disabilities can initiate a prompt rehabilitation protocol in order to start recovering motor skills, stop joint stiffness, and increase their independence and self-esteem [7]. Physical and occupational therapies are the most common treatments to recover patients’ movements, for example, adduction-abduction or flexion-extension of finger, wrist, or elbow joints. However, these routines can be exhausting, time-consuming, and, relatively, costly since patients require the assistance of a therapist whose availability is uncertain [8].

Normally, rehabilitation programs are customized for each patient due to their impairment, age, and anthropometric dimensions. Moreover, these robot procedures are classified into three main assistance levels: passive assisted mode (PAM), active assisted mode (AAM), and active resistive mode (ARM) depending on the recovery status of patients and support of a robot [9].

Literature has reported that rehabilitation protocols can be executed by robots or soft wearable devices which have emerged as a therapy tool with safe human interactions, low weight, and affordable systems [10]. Particularly, SEG have become an alternative approach in the effort to overcome hand dysfunctions and assist patients with handling tasks. SEG have the ability to combine conventional therapy with wearable systems to mimic the natural movement of fingers in order to increase their mobility, preventing spasticity and joint stiffness [11].

SEG have mainly evolved in terms of their design, fabrication, and control [12]. Pioneering designs started using sport gloves incorporating a control system [13, 14]. Then, SEG proposals explored synthetic leather [15], rubber [16, 17], and fabrics [18, 19] to provide flexible human-robotic interactions as in the case of bike gloves [20]. Elastomers have become the primary option to empower flexibility and lightness [21]. Moreover, instead of closed palm designs (CPD) where the whole hand is covered with the glove, open palm designs (OPD) with bare hands use elastomers trying to behave as a natural extension of the human hand to compete with skin properties in order to achieve a suitable contact with objects [22, 23]. Other assistance SEG have been developed for material handling in hazardous environments, support in heavy-lifting tasks [24, 25], or extravehicular tasks in space [26].

Mostly, SEG systems have been driven by electrical energy or fluid (pneumatic or hydraulic) pressurization. Regarding electrical power supplies, tendon-driven systems employ linear actuators to push and pull cables embedded in Teflon tubes [27]. Pneumatic actuation includes fiber-reinforced elastomer actuators (FREAs), inflatable chambers, or pneumatic artificial muscles, commonly known as McKibben muscles [28].

People with hand dysfunctions demand for reliable SEG to improve their quality of life. Nevertheless, the lack of affordable and accessible SEG for hand impairment patients with low-cost manufacturing processes is still a significant challenge. Therefore, this paper has reviewed the progress in the field of SEG for neuromuscular rehabilitation and assistance to overcome hand motor dysfunctions.

The main contribution of this paper is the identification and classification of 13 design criteria to provide a set of guidelines for SEG developments based on an extensive review of the state of the art and of the technique from the last decade. Moreover, a detailed description of 91 SEG systems is provided along with implications, limitations, and suggestions for future developments.

This paper is organized as follows. Section 2 presents, classifies, and discusses the criteria that are proposed for SEG design based on reported devices and specific literature. Section 3 reports SEG’s development guidelines together with the characteristics of the 91 reviewed devices. Section 4 provides a discussion concerning significant aspects (limitations, implications, and suggestions) to be taken into account for future developments of SEG systems. Conclusions are at the end of this document in Section 5.[…]

Continue —-> Design Criteria of Soft Exogloves for Hand Rehabilitation-Assistance Tasks

[ARTICLE] Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors – Full Text

Abstract

Virtual reality (VR) games has the potential to improve patient outcomes in stroke rehabilitation. However, there is limited information on VR games as an adjunct to standard physiotherapy in improving upper limb function. This study involved 36 participants in both experimental (n = 18) and control (n = 18) groups with a mean age (SD) of 57 (8.20) and 63 (10.54) years, respectively. Outcome measures were the Fugl-Meyer assessment for upper extremities (FMA-UE), Wolf motor function test (WMFT), intrinsic motivation inventory (IMI), Lawton of instrumental activities of daily living (IADL), and stroke impact scale (SIS) assessed at pre-post intervention. The experimental group had 0.5 h of upper limb (UL) VR games with 1.5 h of standard physiotherapy, and the control group received 2 h of standard physiotherapy. The intervention for both groups was performed once a week for eight consecutive weeks. The results showed a significant time–group interaction effect for IMI (p = 0.001), Lawton IADL (p = 0.01) and SIS domain of communication (p = 0.03). A significant time effect was found in FMA-UE (p = 0.001), WMFT (p = 0.001), Lawton IADL (p = 0.01), and SIS domains; strength, ADL and stroke recovery (p < 0.05). These results indicated an improvement in UL motor ability, sensory function, instrumental ADL, and quality of life in both groups after eight weeks of intervention. However, no significant (p > 0.05) group effect on all the outcome measures was demonstrated. Thus, replacing a portion of standard physiotherapy time with VR games was equally effective in improving UL function and general health compared to receiving only standard physiotherapy among stroke survivors.

1. Introduction

Stroke is a leading cause of significant disability among adults globally [1]. Rehabilitation is of utmost importance with an increase in the number of stroke survivors [2]. Stroke rehabilitation requires a multidisciplinary approach, is long-term and challenging due to its complexity [3]. Recent evidence suggests that the extension of a stroke rehabilitation programme may lead to further improvement in function and quality of life among stroke survivors [3].

Persistent upper limb (UL) dysfunction after a stroke is one of the most challenging issues in rehabilitation [4]. Increasing the dose of rehabilitation among stroke survivors may improve outcomes, and one of the strategies includes performing self-administered exercises using VR games technology [4]. VR is a computer-assisted technology that can provide users with experiences of a simulated “real” environment [5]. VR technology has been used in rehabilitation in addition to standard physiotherapy, or as a preventive therapy [5]. VR-based rehabilitation also offers the capacity to individualise treatment needs while providing the standardisation of assessment and training protocols [5].

Earlier evidence suggested that VR technology can provide a unique medium whereby rehabilitation can be delivered in a functional and purposeful manner [6]. Moreover, VR technology-based rehabilitation can be readily graded and documented [6]. Other than that, stroke survivors can perform VR training at their home and the therapist can monitor from a distance, known as tele-rehabilitation [7]. Compliance towards treatment and rehabilitation is a vital factor to consider in stroke management [8]. Hence, VR rehabilitation has the potential to improve patient participation, enable intensive therapy and reduce demand on health care professionals [5,6,7].

In previous studies, VR games were shown to be effective in improving physical function among stroke survivors [9], balance and functional mobility in older adults [10,11], and upper limb reaction time in adults with physical disabilities [12]. However, balance and mobility issues were examined rather than upper limb function [9,11]. There is also limited information on VR games as an adjunct to standard physiotherapy. Moreover, previous evidence mainly demonstrates the effects of VR as a standalone intervention among stroke survivors [13,14]. For example, in a pilot crossover design study involving 14 participants with chronic stroke, VR game-assisted intervention was performed for 45–60 min for a duration of 2.5 weeks [14]. The results showed improved UL motor performance using the Fugl-Meyer assessment for upper extremities (FMA-UE) as the primary outcome measure. In our present study, we aimed to examine the effectiveness of VR games as an adjunct to standard physiotherapy in improving upper limb (UL) function and general health among stroke survivors.[…]

Continue —->  Virtual Reality Games as an Adjunct in Improving Upper Limb Function and General Health among Stroke Survivors

[Abstract] Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial

Abstract

Background. Abnormal muscle co-activation contributes to impairment after stroke. We developed a myoelectric computer interface (MyoCI) training paradigm to reduce abnormal co-activation. MyoCI provides intuitive feedback about muscle activation patterns, enabling decoupling of these muscles.

Objective. To investigate tolerability and effects of MyoCI training of 3 muscle pairs on arm motor recovery after stroke, including effects of training dose and isometric versus movement-based training.

Methods. We randomized chronic stroke survivors with moderate-to-severe arm impairment to 3 groups. Two groups tested different doses of isometric MyoCI (60 vs 90 minutes), and one group tested MyoCI without arm restraint (90 minutes), over 6 weeks. Primary outcome was arm impairment (Fugl-Meyer Assessment). Secondary outcomes included function, spasticity, and elbow range-of-motion at weeks 6 and 10.

Results. Over all 32 subjects, MyoCI training of 3 muscle pairs significantly reduced impairment (Fugl-Meyer Assessment) by 3.3 ± 0.6 and 3.1 ± 0.7 (P < 10⁻⁴) at weeks 6 and 10, respectively. Each group improved significantly from baseline; no significant differences were seen between groups. Participants’ lab-based and home-based function also improved at weeks 6 and 10 (P ≤ .01). Spasticity also decreased over all subjects, and elbow range-of-motion improved. Both moderately and severely impaired patients showed significant improvement. No participants had training-related adverse events. MyoCI reduced abnormal co-activation, which appeared to transfer to reaching in the movement group.

Conclusions. MyoCI is a well-tolerated, novel rehabilitation tool that enables stroke survivors to reduce abnormal co-activation. It may reduce impairment and spasticity and improve arm function, even in severely impaired patients.

 

via Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial – Emily M. Mugler, Goran Tomic, Aparna Singh, Saad Hameed, Eric W. Lindberg, Jon Gaide, Murad Alqadi, Elizabeth Robinson, Katherine Dalzotto, Camila Limoli, Tyler Jacobson, Jungwha Lee, Marc W. Slutzky, 2019