Posts Tagged UL

[ARTICLE] Active rehabilitation training system for upper limb based on virtual reality – Full Text

 

In this article, an active rehabilitation training system based on the virtual reality technology is designed for patients with the upper-limb hemiparesis. The six-axis inertial measurement unit sensors are used to acquire the range of motion of both shoulder and elbow joints. In order to enhance the effect of rehabilitation training, several virtual rehabilitation training games based on the Unity3D engine are designed to complete different tasks from simple level to complicated level. The purpose is to increase the patients’ interest during the rehabilitation training. The basic functions of the virtual rehabilitation task scenes are tested and verified through the single-joint training and the multi-joint compounding training experiments. The experimental results show that the ranges of motion of both shoulder and elbow joints can reach the required ranges of a normal human in the rehabilitation training games. Therefore, the system which is easy to wear, low cost, wireless communication, real-time data acquisition, and interesting virtual rehabilitation task games can provide an effective rehabilitation training process for the upper-limb hemiparesis at home.

The upper limb has many degrees of freedom, and it is also a complex part of the human body by which people can accomplish fine movements during their activities in daily life. With the intensification of the aging problem in the world, the amount of stroke hemiparesis has shown a growing trend, especially in China, which has an enormous population.1 Approximately 30%–50% of these stroke survivors will suffer from chronic hemiparesis, especially involving their hands. In addition, spinal cord injury (SCI) and traffic accident survivors may also find limb movements’ disorder. Injury within the cervical region of the cord leads to tetraplegia, which leads to impairment of all four limbs. An estimated result shows that 55% of new cases will result in tetraplegia, while the other 45% will experience paraplegia due to injury below the cervical level.2Limb hemiparesis which is caused by stroke, SCI, or traffic accidents not only gives the patient’s daily life a great deal of inconvenience and even more makes the patient suffer from great mental pain but also brings a heavy stress and medical burden for the patient’s family and society. Technology has been developed in an effort to facilitate rehabilitation for the patient. Upper-limb rehabilitation is one of the fastest growing areas in modern neurorehabilitation. Quality of life can be improved with efficient therapy.3 At present, rehabilitation therapy of upper limb with traditional rehabilitation therapy is commonly used, that is, rehabilitation therapists perform rehabilitation trainings on individuals. Now with the development of robot technology, the rehabilitation of robot-assisted training is also rising up. The MIT-Manus4 is an example of end-effector-based and arm-rehabilitation robotic device, while the ARMin device5 is an example of arm-rehabilitation exoskeletons which also allows pronation/supination of the lower arm and wrist flexion/extension. It could be operated in three modes: passive mobilization, active game-supported arm therapy, and active training of activities of daily living (ADLs). The end-effector-based robots have practical advantages (usability, simplicity, and cost-effectiveness), and exoskeleton robots have biomechanical advantages (better guidance). Currently, the automatic rehabilitation devices on market as mentioned above are mostly complex and expensive, which are often used in the hospitals and clinics are not affordable to ordinary patients. Therefore, one of the research objectives aims to develop the upper-limb rehabilitation training system with minimal structure and low cost and can be used in patient’s home. But in China, it can be seen that patients with upper-limb orthosis in home is only for fixing the arm and just move autonomously according to the setting angle. The researches on intelligent domestic rehabilitation device just begins, most of which are in the experimental stage and not yet market oriented.6,7

Another problem is that the patients are treated with low initiative and dull training process which does not motivate them, while the treatment effect is not obvious.8,9 Computer games based on virtual reality (VR) are a good way to mobilize the patients’ initiative in the training, so the rehabilitation effect on a particular movement task will be greatly improved.10 VR environments provide an excellent method to manipulate task conditions in training. The effects and the intensity of training can be enhanced and designed more challenging, since the implementation of VR can build a channel both visual and haptic communication can be involved in. The research on VR system which is applied to rehabilitation training was initiated a few years ago. Mazzone et al.11 made a study on the effect of rehabilitation training for patients with shoulder joints training using VR technology. This study aimed to determine whether performance of shoulder exercises in virtual reality gaming (VRG) results in similar muscle activation as non-VRG exercise. The conclusion was drawn that exercise with VRG should be effective to reduce shoulder pain caused by spinal injury. Fischer et al.12 conducted a preliminary study claim that stroke patients could assist themselves in training their hands in the virtual environment. The purpose of this pilot study was to investigate the impact of assisted motor training in a virtual environment on hand function for the stroke survivors. Participants had 6 weeks of training in reach-to-grasp of both virtual and actual objects. After the training period, participants in all three groups demonstrated a decrease in time to perform some of the functional tasks. These designs based on VR have achieved some success and then the second research objective is to add the VR technology to the intelligent domestic rehabilitation device. These studies are mainly designed for the single joint of the upper-limb rehabilitation training. Therefore, it is necessary to carry out the research on multi-joint combined training device for patients who can just stay home by training with VR tasks of adjustable game levels.

Another important element which needs to be considered as an ultimate success using at home is its ease of use. Therefore, simple active rehabilitation device should be developed. The setup time of such device should be fast, besides measurement, treatment approaches, and incorporating gaming, and should provide intuitive interfaces that can be directly utilized by the individuals. This study will introduce an active rehabilitation training system for upper limb based on VR technology, which has some advantages such as simple structure, easy to manipulate, and portable for household. It also mobilizes patients’ initiative with adjustable difficulty level of VR tasks so that the individuals’ rehabilitation effect of the upper limb is obviously improved.

The active rehabilitation training system for upper limb based on VR is designed for the pronation/supination and flexion movement trainings of the elbow joint and the extension/flexion and abduction exercises of the shoulder joint. By adding the games in training processes, the patients may actively participate in rehabilitation trainings, while the efficiency will be greatly improved. The portable and easy-to-use design of this system can effectively reduce the problem of the medical resources shortage in the rehabilitation field.

Overall scheme of the system

The system is composed of two parts: the upper-limb posture detection system and the virtual rehabilitation training task scene, as shown in Figure 1.

figure

Figure 1. Schematic diagram of an active rehabilitation training system for upper limb based on VR.

 

Continue —> Active rehabilitation training system for upper limb based on virtual realityAdvances in Mechanical Engineering – Jianhai Han, Shujun Lian, Bingjing Guo, Xiangpan Li, Aimin You, 2017

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[ARTICLE] Mapping upper-limb motor performance after stroke – a novel method with utility for individualized motor training – Full Text

Abstract

Background

Chronic upper limb motor impairment is a common outcome of stroke. Therapeutic training can reduce motor impairment. Recently, a growing interest in evaluating motor training provided by robotic assistive devices has emerged. Robot-assisted therapy is attractive because it provides a means of increasing practice intensity without increasing the workload of physical therapists. However, movements practised through robotic assistive devices are commonly pre-defined and fixed across individuals. More optimal training may result from individualizing the selection of the trained movements based on the individual’s impairment profile. This requires quantitative assessment of the degree of the motor impairment prior to training, in relevant movement tasks. However, standard clinical measures for profiling motor impairment after stroke are often subjective and lack precision. We have developed a novel robot-mediated method for systematic and fine-grained mapping (or profiling) of individual performance across a wide range of planar arm reaching movements. Here we describe and demonstrate this mapping method and its utilization for individualized training. We also present a novel principle for the individualized selection of training movements based on the performance maps.

Methods and Results

To demonstrate the utility of our method we present examples of 2D performance maps produced from the kinetic and kinematics data of two individuals with stroke-related upper limb hemiparesis. The maps outline distinct regions of high motor impairment. The procedure of map-based selection of training movements and the change in motor performance following training is demonstrated for one participant.

Conclusions

The performance mapping method is feasible to produce (online or offline). The 2D maps are easy to interpret and to be utilized for selecting individual performance-based training. Different performance maps can be easily compared within and between individuals, which potentially has diagnostic utility.

Background

Impaired upper-limb (UL) function is one of the most common consequences of stroke [123], which can severely hamper activities of daily living and reduce quality of life. Certain intervention methods can promote some recovery of UL motor function though their outcome shows high variability and depends on the intensity (repetition) of the intervention [456789].

Robotic assistive technologies can be beneficial for improving clinical scores of UL motor impairment [910], by allowing intensive training [911121314]. However, currently there is no consistent evidence for the effectiveness of robot-assisted UL therapy for improving daily living activity [15]. One possibility is that the tasks performed with robotic assistance do not generalise to everyday tasks. Another possibility is that the tasks are not optimised for the trained individuals. Currently, in robot-assisted therapy the set of practiced movements are usually pre-determined, with limited regard to the motor profile of the individual (e.g. ‘centre-out’ point-to-point reaches, or forearm pronation/supination, wrist extension/flexion [161718]). However, the effectiveness of training for motor recovery is likely to depend on the difficulty to perform the task due to motor impairment [19]. For example, training focused on unimpaired movements or on tasks that are either too easy or too difficult is likely to contribute relatively little to motor learning and recovery [192021]. An advantage of the robot-mediated approach is that it allows the collection of various accurate and real-time data about motor performance that would be potentially useful for individualized adjustments of the therapy; e.g. selection of training tasks based on the profile of motor performance. Yet, prescribing training conditions based on a motor performance profile requires characterising motor performance across a range of movement conditions for each individual. Here we present a novel computerised method for systematically mapping individuals’ UL motor performance (or impairment) across a wide range of robot-mediated reaching movements. The map can then serve as a basis for individualised and performance-based selection of training movements.

For optimal utilization of a motor performance map, the mapped metrics should reflect basic components of sensorimotor control, so that the map can be directly linked to processes underlying the movements (e.g. muscle activity and movement representation). Continuous metrics, allowing smoothing and interpolation from tested movements to neighbouring untested regions are also valuable. Accordingly, our mapping of reaching performance is done across the two dimensions of target location (in angular coordinates relative to a central position) and of prescribed starting location (again in angular coordinates relative to the selected target, which indicates the dictated movement direction). The range of target and start locations tests both postural and movement-related aspects of motor control, respectively. Importantly, muscle activation patterns and population neural activity in the motor-related cortices show tuning to one or both task dimensions [22232425], and behavioural studies support the essential underlying role of these parameters in planning of reaching movements [2627].

Of course, the usefulness of a motor performance map for prescribing performance-based training also depends on an appropriate principle for the selection of movements to be practiced. Here we demonstrate the utility of our mapping method for individualized task selection based on a principle which we term “steepest gradients” (SG), although the motor performance map can be the basis for alternative task selection principles. The SG principle is founded on the idea that training with tasks performed with an intermediate range of difficulty would allow more improvement and learning-induced plasticity, compared to training with very difficult or easy tasks [1928] .

Here we report the details of the mapping methods, and show its efficacy in portraying relevant motor impairment patterns for individual subjects. We also briefly demonstrate its utility for individually-tailored selection of practiced movement using the SG principle. However, our evidence for the utility and benefit of the mapping method for individualizing UL robot-mediated rehabilitation after stroke will be reported in subsequent publications.[…]

 

Continue —> Mapping upper-limb motor performance after stroke – a novel method with utility for individualized motor training | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1Schematic description of the experimental setting (top view). a The participant held the handle of a robotic manipulandum (indicated onscreen by a red disc; not shown), which allowed planar reaching movements from a start position (white onscreen disc (here gray) to a target position (blue onscreen disc; here black) and provided assisting and guiding forces as needed. Hand’s grip was maintained via a special glove and the forearm was supported against gravity (not shown). The participant leaned his/her head against a headrest, maintaining upright seating posture (ensured using a harness). The horizontal display occluded the hand and the manipulandum from vision. The start-to-target axis (y) and its perpendicular axis (x) correspond to the axes of the assisting and guiding forces, respectively, which were provided during the arm movement as needed by the robot. Adapted from Howard et al. (2009). b The reaching workspace used for mapping performance. The locations of the 8 targets, used in the mapping sessions, are indicated by small open circles. An example of the arm posture when the hand located at the 90o target is shown. Participants were tested with 5cm reaches to each target from 8 start locations (indicated, for the example target, by small black dots). The dashed circle indicates the extent of the mapped workspace. The drawing reflects the actual relationship of target and start locations and arm posture, based on a photograph taken with a healthy participant

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[WEB SITE] Post-Stroke Rehab Benefits From Virtual Reality

Patients from 5 rehabilitation centers were enrolled within 12 weeks after a stroke.

Patients from 5 rehabilitation centers were enrolled within 12 weeks after a stroke.

HealthDay News — Virtual reality (VR) training is as effective as conventional training for upper extremity rehabilitation after stroke, according to a study published in Neurology.

Iris Brunner, PhD, from the University of Bergen in Norway, and colleagues randomized 120 patients with upper extremity motor impairment within 12 weeks after stroke to receive VR or CT as an adjunct to standard rehabilitation. Participants underwent at least 16 60-minute training sessions over a four-week period.

The researchers found that there were no between-group differences for any of the outcome measures.

Improvement of upper extremity motor function assessed with the Action Research Arm Test was similar between the groups at the post-intervention (P=.714) and follow-up (P=.777) assessments. Improvements were seen in patients from both groups from baseline to the post-intervention assessment and from baseline to follow-up. Improvements were similar in subgroup analysis of mild to moderate versus severe upper extremity paresis.

“Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation,” conclude the authors.

Reference

Brunner I, Skouen JS, Hofstad H, et al. Virtual reality training for upper extremity in subacute stroke (VIRTUES): A multicenter RCT [published online November 15, 2017]. Neurology. doi:10.1212/WNL.0000000000004744.

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[Abstract+References] Cortical and functional responses to an early protocol of sensory re-education of the hand using audio–tactile interaction.

Early sensory re-education techniques are important strategies associated with cortical hand area preservation. The aim of this study was to investigate early cortical responses, sensory function outcomes and disability in patients treated with an early protocol of sensory re-education of the hand using an audio-tactile interaction device with a sensor glove model.

After surgical repair of median and/or ulnar nerves, participants received either early sensory re-education twice a week with the sensor glove during three months or no specific sensory training. Both groups underwent standard rehabilitation. Patients were assessed at one, three and six months after surgery on training-related cortical responses by functional magnetic resonance imaging, sensory thresholds, discriminative touch and disability using the Disabilities of the Arm, Shoulder and Hand patient-reported questionnaire.

At six-months, there were no statistically significant differences in sensory function between groups. During functional magnetic resonance imaging, trained patients presented complex cortical responses to auditory stimulation indicating an effective connectivity between the cortical hand map and associative areas.

Training with the sensor glove model seems to provide some type of early cortical audio-tactile interaction in patients with sensory impairment at the hand after nerve injury. Although no differences were observed between groups related to sensory function and disability at the intermediate phase of peripheral reinnervation, this study suggests that an early sensory intervention by sensory substitution could be an option to enhance the response on cortical reorganization after nerve repair in the hand. Longer follow-up and an adequately powered trial is needed to confirm our findings.

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via Cortical and functional responses to an early protocol of sensory re-education of the hand using audio–tactile interactionHand Therapy – Raquel Metzker Mendes, Carlo Rondinoni, Marisa de Cássia Registro Fonseca, Rafael Inácio Barbosa, Carlos Ernesto Garrido Salmón, Cláudio Henrique Barbieri, Nilton Mazzer, 2017

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[BOOK Chapter] Biomechanics of the Upper Limb – Google Books

The BOOK —> Atlas of Orthoses and Assistive Devices E-Book – Joseph Webster, Douglas Murphy – Google Books

 Go to Chapter 11: Biomechanics of the Upper Limb

 

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[Abstract+References] Finite element analysis of the wrist in stroke patients: the effects of hand grip.

Abstract

The provision of the most suitable rehabilitation treatment for stroke patient remains an ongoing challenge for clinicians. Fully understanding the pathomechanics of the upper limb will allow doctors to assist patients with physiotherapy treatment that will aid in full arm recovery. A biomechanical study was therefore conducted using the finite element (FE) method. A three-dimensional (3D) model of the human wrist was reconstructed using computed tomography (CT)-scanned images. A stroke model was constructed based on pathological problems, i.e. bone density reductions, cartilage wane, and spasticity. The cartilages were reconstructed as per the articulation shapes in the joint, while the ligaments were modelled using linear links. The hand grip condition was mimicked, and the resulting biomechanical characteristics of the stroke and healthy models were compared. Due to the lower thickness of the cartilages, the stroke model reported a higher contact pressure (305 MPa), specifically at the MC1-trapezium. Contrarily, a healthy model reported a contact pressure of 228 MPa. In the context of wrist extension and displacement, the stroke model (0.68° and 5.54 mm, respectively) reported a lower magnitude than the healthy model (0.98° and 9.43 mm, respectively), which agrees with previously reported works. It was therefore concluded that clinicians should take extra care in rehabilitation treatment of wrist movement in order to prevent the occurrence of other complications.

Graphical abstract

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[ARTICLE] EMG based FES for post-stroke rehabilitation – Full Text

Abstract.

Annually, 15 million in world population experiences stroke. Nearly 9 million stroke
survivors every year experience mild to severe disability. The loss of upper extremity function in stroke survivors still remains a major rehabilitation challenge. The proposed EMG based FES system can be used for effective upper limb motor re-education in post stroke upper limb rehabilitation. The  governing feature of the designed system is its synchronous activation, in which the FES stimulation is dependent on the amplitude of the EMG signal acquired from the unaffected upper limb muscle of the hemiplegic patient. This proportionate operation eliminates the undesirable  damage to the patient’s skin by generating stimulus in proportion to voluntary EMG signals. This feature overcomes the disadvantages of currently available manual motor re-education systems. This model can be used in home-based post stroke rehabilitation, to effectively improve the upper limb functions.

[…]

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Available from: https://www.researchgate.net/publication/321478935_EMG_based_FES_for_post-stroke_rehabilitation [accessed Dec 09 2017].

 

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[ARTICLE] Arm rehabilitation in post stroke subjects: A randomized controlled trial on the efficacy of myoelectrically driven FES applied in a task-oriented approach – Full Text

Abstract

Purpose

Motor recovery of persons after stroke may be enhanced by a novel approach where residual muscle activity is facilitated by patient-controlled electrical muscle activation. Myoelectric activity from hemiparetic muscles is then used for continuous control of functional electrical stimulation (MeCFES) of same or synergic muscles to promote restoration of movements during task-oriented therapy (TOT). Use of MeCFES during TOT may help to obtain a larger functional and neurological recovery than otherwise possible.

Study design

Multicenter randomized controlled trial.

Methods

Eighty two acute and chronic stroke victims were recruited through the collaborating facilities and after signing an informed consent were randomized to receive either the experimental (MeCFES assisted TOT (M-TOT) or conventional rehabilitation care including TOT (C-TOT). Both groups received 45 minutes of rehabilitation over 25 sessions. Outcomes were Action Research Arm Test (ARAT), Upper Extremity Fugl-Meyer Assessment (FMA-UE) scores and Disability of the Arm Shoulder and Hand questionnaire.

Results

Sixty eight subjects completed the protocol (Mean age 66.2, range 36.5–88.7, onset months 12.7, range 0.8–19.1) of which 45 were seen at follow up 5 weeks later. There were significant improvements in both groups on ARAT (median improvement: MeCFES TOT group 3.0; C-TOT group 2.0) and FMA-UE (median improvement: M-TOT 4.5; C-TOT 3.5). Considering subacute subjects (time since stroke < 6 months), there was a trend for a larger proportion of improved patients in the M-TOT group following rehabilitation (57.9%) than in the C-TOT group (33.2%) (difference in proportion improved 24.7%; 95% CI -4.0; 48.6), though the study did not meet the planned sample size.

Conclusion

This is the first large multicentre RCT to compare MeCFES assisted TOT with conventional care TOT for the upper extremity. No adverse events or negative outcomes were encountered, thus we conclude that MeCFES can be a safe adjunct to rehabilitation that could promote recovery of upper limb function in persons after stroke, particularly when applied in the subacute phase.

 

Introduction

Stroke is the leading cause of disability in adults in the world and can result in highly complex clinical situations. The insult often involves the sensory-motor system leading to hemiparesis and impairment of the upper limb in over 50% of survivors [1,2]. Although some structural recovery is possible, especially in the first months after stroke, only a small percentage of persons recover pre-morbid movement patterns and functionality [3].

Limitations in reaching and grasping have an important role in determining the level of independence of the person in their daily activities and the subsequent impact on their quality of life. Tailored goal oriented rehabilitation is therefore an essential factor in reducing impairment and augmenting functionality of a hemiplegic arm. A plurality of interventions may help the subject to restore participation and adapt to the new clinical status including task oriented therapy (TOT) that has been shown to be effective for motor recovery [4,5], as well as constraint induced movement therapy (CIMT) [6], biofeedback and robot assisted therapy [79]. Moreover, electrostimulation has been applied to improve muscle recruitment and aid motor recovery. Since resources and time in rehabilitation are limited it is important to identify and employ effective interventions [10].

The inability to use the arm in an efficient way may lead to non use of the arm and hand that can lead to changes also at the neural level [11]. It is therefore essential that arm use is facilitated in meaningful activities. Approaches that assist the person during purposeful voluntarily activated movement could be important for inducing neuroplasticity and increasing function. Neuromuscular electrical stimulation (NMES) has been employed in rehabilitation of stroke patients either to generate muscle contraction or be a support during movements; however, with inconsistent results [1120]. A prerequisite for neuroplasticity through training is the volitional intent and attention of the person and it therefore follows that the user should participate consciously in the rehabilitative intervention [21,22].

Through the use of EMG it is technically possible to register the myoelectric activity from voluntary contraction of a muscle while its motor nerve is being stimulated by electrical impulses [23]. MeCFES is a method where the FES is directly controlled by volitional EMG activity. In contrast to EMG triggered FES, the controlling muscle is continuously controlling the stimulation intensity. Thus the resulting movement and intrinsic multisensory activation is synchronized with the active attention and intention of the subject and the muscle contraction can be gradually modulated by the subject himself facilitating motor learning and recovery of function. This has been demonstrated to be possible in spinal cord injured subjects [24,25] and a pilot study has shown that when the controlling and stimulated muscles are homologous or they are synergistic it may lead to a marked increase in motor function of the hemiparetic forearm of selected stroke patients [26]. Motor learning principles required for CNS-activity-dependent plasticity, in fact, include task-oriented movements, muscle activation driving practice of movement, focused attention, repetition of desired movements, and training specificity [21,22,27]. The use of MeCFES during active challenging goal oriented movements should help the patient and the therapist overcome the effect of learned non use by turning attempts to move the arm into successful movements.

We hypothesize that applying MeCFES in a task oriented paradigm to assist normal arm movements during rehabilitation of the upper limb in persons with stroke will improve the movement quality and success and thus induce recovery at the body functions level (impairment) and the activity level (disability) of the International Classification of Function, Disability and Health (ICF) [28] superior to that induced by usual care task-oriented rehabilitation.[…]

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[WEB SITE] Virtual Reality As Effective As Standard Training for Post-Stroke Rehabilitation.

Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis.

Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis

HealthDay News — Virtual reality (VR) training is as effective as conventional training for upper extremity rehabilitation after stroke, according to a study published online in Neurology.

Iris Brunner, PhD, from the University of Bergen in Norway, and colleagues randomized 120 patients with upper extremity motor impairment within 12 weeks after stroke to receive VR or CT as an adjunct to standard rehabilitation. Participants underwent at least 16 60-minute training sessions over a 4-week period.

The researchers found that there were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with the Action Research Arm Test was similar between the groups at the post-intervention (=.714) and follow-up (=.777) assessments.

Improvements were seen in patients from both groups from baseline to the post-intervention assessment and from baseline to follow-up. Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis.

“Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation,” concluded the authors.

Reference

Brunner I, Skouen JS, Hofstad H, et al. Virtual reality training for upper extremity in subacute stroke (VIRTUES): a multicenter RCT [published online November 15, 2017]. Neurology. doi:10.1212/WNL.0000000000004744

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[WEB SITE] Games, Gloves, and Grip: PTs Rehab Arms and Hands Post-Stroke With YouGrabber

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Playing virtual reality games could be as effective as adding extra physical therapy sessions to a stroke patient’s rehab regimen, according to researchers.

“It is not a question of choosing one thing over the other, rather of having different training alternatives to provide variation,” says Iris Brunner, author of a study, published recently in Neurology, that explored a variety of medical uses for virtual reality.

“Virtual reality cannot replace physical therapy. But it can be experienced as a game, motivating patients to do an extra treatment session,” adds Brunner, associate professor with the University of Aarhus and Hammel Neurocenter, in Denmark.

Brunner and her team’s study included 120 stroke patients with mild to severe hand weakness, all of whom were randomly assigned to add 16 hour-long therapy sessions to their routine rehabilitation over a month. One group performed physical therapy, while the other group played a virtual reality game called YouGrabber, notes a media release from HealthDay.

In the game, Brunner explains, “the patients wear gloves with sensors, and their movements are tracked by an infrared camera and transferred to a virtual arm on screen.”

“In different scenarios, they can grasp objects that come toward them or pick carrots. In other games, patients steer a plane or a car with their movement. The therapist chooses the movements to be trained and the level of difficulty.”

Fifty patients in the physical therapy group and 52 in the virtual reality group completed the study and were evaluated after 3 months.

The researchers found no difference between the two groups with regard to the improvement in their hand and arm function.

“Patients who started out with moderately to mildly impaired arm and hand motor function achieved, on average, a level of good motor function,” Brunner states, while those with severe weakness were able to use their arms to make movements.

Patients with severe hand weakness appreciated how even small movements translated to the virtual arms on screen, she adds. And even the older patients liked the virtual reality game, she notes, possibly because the graphics are simpler than those in commercial video games.

Brunner concludes by noting that larger studies are needed to understand the potential value of virtual reality as a stroke recovery treatment.

[Source: HealthDay]

 

via Games, Gloves, and Grip: PTs Rehab Arms and Hands Post-Stroke With YouGrabber – Rehab Managment

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