Virtual Reality Training Gets Similar Results for Stroke Rehab

December 19, 2017

Using a new virtual reality approach to rehabilitation training had similar benefits to conventional therapy for arm motor function in patients in the subacute phase of stroke in a new study.

The VIRTUES study, published in the December 12 issue of Neurology, was conducted by a team led by Iris Brunner, PhD, University of Bergen, Norway.

"We had hoped that the virtual reality approach would lead to better functional improvement than the conventional approach as previous studies have suggested the virtual reality training allows more intensive exercise as patients appear to be active for a larger part of each session," Dr Brunner commented to Medscape Medical News.  

"But having the same outcome as conventional training is still a good result," she said. "Therapists can supervise several different patients on these devices at the same time in a hospital setting and so should be able to deliver more treatment." 

The researchers note that most patients in both groups, even those with initially severe distal paresis, showed substantial increases in arm motor function. "This implies that different training modalities can contribute to improvement and may be applied according to patient preference," they say.

Dr Brunner added: "In future there will be more opportunity for patients to be able to do this virtual reality training at home supported by a remote therapist, which will further increase the amount of therapy able to be delivered. This is the primary aim as we know that more intensive therapy gets better outcomes. This is most crucial in the first few weeks after a stroke — where we have a golden opportunity to exploit the recovery potential. And this virtual reality technology will help us do that."

The current study compared virtual reality training with conventional training for arm function on top of standard rehabilitation.

Dr Brunner explained that standard rehabilitation varies but normally entails some physiotherapy, some occupational therapy, and some speech and language therapy according to individual needs.

Conventional training for upper arm function encompasses more specific physiotherapy and occupational therapy conducted on a one-to-one basis. 

The virtual reality approach involved using a custom-made training device, which Dr Brunner described as "similar to a Wii but much more sophisticated."

"The patient wears gloves and maneuvers a tracer with an infrared camera to engage in certain exercises — these are mainly in the form of games, such as driving a car or steering a plane," she said. The therapist chooses specific exercises tailored to each patient's needs. "It is a very useful aid in that in motivates patients to do their exercises in an entertaining way," Dr Brunner notes. "For the current study patients were in the hospital and the therapist was present, but it would also be possible for patients to do this at home after receiving initial training."

For the current study, 120 patients with upper extremity motor impairment within 12 weeks (mean, 35 days) after stroke were randomly assigned to virtual reality or conventional therapy as an adjunct to standard rehabilitation.

The training comprised a minimum of 16 sessions of 60 minutes over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after the intervention, and at the 3-month follow-up.

Results showed no between-group differences for any of the outcome measures. Patients in the virtual reality group improved by 12 points on the ARAT scale from baseline to the postintervention assessment and 17 points from baseline to follow-up, while patients in the conventional therapy group improved by 13 and 17 points, respectively.

Improvement was also similar between groups for patients with different degrees of paralysis.

The researchers point out that the virtual reality approach in this study was not immersive in the sense of providing a real experience of being in another reality.

"We can only speculate whether a more immersive experience would have made a difference. New developments, e.g., the application of VR [virtual reality] goggles, may possibly add another dimension and may increase the effect of motor training," they suggest.

The study was funded by the Norwegian Research Council, Regional Hospital Central Jutland Research Fund, Western Norway Regional Health Authority, Norwegian Fund for Post-Graduate Training in Physiotherapy, and Danish Physiotherapists ' Research Fund. The authors have disclosed no relevant financial relationships.

Neurology. Published online December 12, 2017. Abstract

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