Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke
Free accessOtherFirst published online March, 2007
Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke
Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs).
Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later.
Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs.
Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.
Sveistrup H.Motor rehabilitation using virtual reality. J Neuroengineering Rehabil2004;1(1): 10-10.
2.
Holden MK.Virtual environments for motor rehabilitation: review. Cyberpsychol Behav2005;8(3): 187-211.
3.
Rose FD, Brooks BM, Rizzo AA.Virtual reality in brain damage rehabilitation: review. Cyberpsychol Behav2005;8(3): 241-262.
4.
Weiss P, Rand D, Katz N, Kizony R.Video capture virtual reality as a flexible and effective rehabilitation tool. J Neuroengineering Rehabil2004;1(1): 12-12.
5.
Bardorfer A, Munih M, Zupan A, Primozic A.Upper limb motion analysis using haptic interface. IEEE Trans Mechatron2001;6(3): 253-260.
6.
Conner BB, Wing AM, Humphreys G, Bracewell RM, Harvey DA.Errorless learning using haptic guidance: research in cognitive rehabilitation following stroke. Paper presented at Proc 4th Intl Conf Disabil, Virtual Reality & Assoc Tech, September 2002, Veszprém, Hungary.
7.
Broeren J, Rydmark M, Sunnerhagen KS.Virtual reality and haptics as a training device for movement rehabilitation after stroke: a single-case study. Arch Phys Med Rehabil2004;85(8): 1247-1250.
8.
Deutsch JE, Merians AS, Adamovich S, Poizner H, Burdea GC.Development and application of virtual reality technology to improve hand use and gait of individuals post-stroke. Restor Neurol Neurosci2004;22(3-5): 371-386.
9.
Viau A, Feldman AG, McFadyen BJ, Levin MF.Reaching in reality and virtual reality: a comparison of movement kinematics in healthy subjects and in adults with hemiparesis. J Neuroengineering Rehabil2004;1(1): 11-11.
Beer RF, Dewald JP, Rymer WZ.Deficits in the coordination of multijoint arm movements in patients with hemiparesis: evidence for disturbed control of limb dynamics. Exp Brain Res2000;131(3): 305-319.
12.
Viitanen M, Fugl-Meyer KS, Bernspang B, Fugl-Meyer AR.Life satisfaction in long-term survivors after stroke. Scand J Rehabil Med1988;20(1): 17-24.
13.
Dijkerman HC, Wood VA, Hewer RL.Long-term outcome after discharge from a stroke rehabilitation unit. J R Coll Physicians Lond1996;30(6): 538-546.
14.
Bach-y-Rita P.Late postacute neurologic rehabilitation: neuro-science, engineering, and clinical programs. Arch Phys Med Rehabil2003;84(8): 1100-1108.
15.
Stein J.Motor recovery strategies after stroke. Top Stroke Rehabil2004;11(2): 12-22.
16.
Dobkin BH.Strategies for stroke rehabilitation. Lancet Neurol2004;3(9): 528-536.
17.
Bach-y-Rita P, Wood S, Leder R, et al.Computer-assisted motivating rehabilitation (CAMR) for institutional, home, and educational late stroke programs. Top Stroke Rehabil2002;8(4): 1-10.
18.
Wood SR, Murillo N, Bach-y-Rita P, Leder RS, Marks JT, Page SJ.Motivating, game-based stroke rehabilitation: a brief report. Top Stroke Rehabil2003;10(2): 134-140.
19.
Mathiowetz V, Volland G, Kashman N, Weber K.Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther1985;39(6): 386-391.
20.
Desrosiers J, Bravo G, Hebert R, Dutil E, Mercier L.Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch Phys Med Rehabil1994;75(7): 751-755.
21.
Kazdin A.Single-case research designs: methods for clinical and applied settings. New York: Oxford University Press; 1982.
22.
Ottenbacher K.Evaluating clinical change: strategies for occupational and physical therapists. Baltimore: Wiliams & Wilkins; 1986.
23.
Alon G, Sunnerhagen KS, Geurts AC, Ohry A.A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke. Neurorehabilitation2003;18(3): 215-225.
24.
Fisher A.AMPS, Assessment of Motor and Process Skills: development, standardization, and administration manual. Vol 1. 5th ed.Fort Collins (CO): Three Star; 2003.
Fisher AG.The assessment of IADL motor skills: an application of many-faceted Rasch analysis. Am J Occup Ther1993;47(4): 319-329.
27.
Kirkley KN, Fisher AG.Alternate forms reliability of the assessment of motor and process skills. J Outcome Meas1999;3(1): 53-70.
28.
Bernspang B, Fisher A.Validation of the Assessment of Motor and Process Skills for use in Sweden. Scand J Occup Ther1995;1: 3-9.
29.
Fisher AG, Liu Y, Velozo CA, Pan AW.Cross-cultural assessment of process skills. Am J Occup Ther1992;46(10): 876-885.
30.
Dickerson AE, Fisher AG.Age differences in functional performance. Am J Occup Ther1993;47(8): 686-692.
31.
Doble SE, Fisk JD, Fisher AG, Ritvo PG, Murray TJ.Functional competence of community-dwelling persons with multiple sclerosis using the assessment of motor and process skills. Arch Phys Med Rehabil1994;75(8): 843-851.
32.
Park S, Fisher AG, Velozo CA.Using the assessment of motor and process skills to compare occupational performance between clinic and home settings. Am J Occup Ther1994;48(8): 697-709.
33.
Dromerick AW, Edwards DF, Diringer MN.Sensitivity to changes in disability after stroke: a comparison of four scales useful in clinical trials. J Rehabil Res Dev2003;40(1): 1-8.
34.
Robey RR, Schultz M, Crawford A, Sinner C.Single-subject clinical-outcome research: designs, data, effect sizes, and analyses. Aphasiology1999;13(6): 445-473.
35.
Zhan S, Ottenbacher KJ.Single subject research designs for disability research. Disabil Rehabil2001;23(1): 1-8.
36.
Ottenbacher KJ.Reliability and accuracy of visually analyzing graphed data from single-subject designs. Am J Occup Ther1986;40(7): 464-469.
37.
Bengali MK, Ottenbacher KJ.The effect of autocorrelation on the results of visually analyzing data from single-subject designs. Am J Occup Ther1998;52(8): 650-655.
38.
Roby-Brami A, Feydy A, Combeaud M, Biryukova EV, Bussel B, Levin MF.Motor compensation and recovery for reaching in stroke patients. Acta Neurol Scand2003;107(5): 369-381.
39.
Kusoffsky A, Apel I, Hirschfeld H.Reaching-lifting-placing task during standing after stroke: coordination among ground forces, ankle muscle activity, and hand movement. Arch Phys Med Rehabil2001;82(5): 650-660.
40.
Rizzo AA, Kim GJ.A SWOT analysis of the field of virtual rehabilitation and therapy. Presence: Teleoperators and Virtual Environments2005;14(2): 119-146.
41.
Rizzo AA, Strickland D, Bouchard S.The challenge of using virtual reality in telerehabilitation. Telemed J E Health2004; 10(2): 184-195.
