Abstract
An individual may face many challenges to recovery after stroke, particularly with regaining use of their upper extremity. Although repetitive task-oriented training is considered an optimal intervention in stroke rehabilitation, there is limited research using this type of treatment in a virtual context. The purpose of the study was to provide two virtual-reality interventions over four weeks to adults who were poststroke and measure their change in function in their affected upper extremity.
Primary Author and Speaker: Tamara Mills
Additional Authors and Speakers: Sara Buggelli
Contributing Authors: Evan Brooks, Rayyan Bukhari, Veronika Marikovska, Emily McClean, Alyssa Sellers, Arrah Thomas
The purpose of the study was to investigate if the use of two virtual reality (VR) interventions could improve upper extremity (UE) motor function in adult stroke survivors. The VR program known as SaeboVR (Ellington et al., 2015) was classified in this study as a functional activity-based (FAB) intervention, and a VR program known as VirtualRehab was classified as a game-based (GB) intervention. The research question was “does the use of two combined VR interventions improve UE motor function in adults after stroke”? Physical limitations are common after experiencing a stroke, especially UE impairments related to strength and range of motion. Although there is research evidence available on typically used stroke interventions such as CIMT, repetitive task-oriented training, and modalities (Nilsen et al., 2015), the use of VR interventions in stroke rehabilitation consists of various types of VR technologies and there is limited availability of VR research in the literature (Saposnik, & Levin, 2011). Additionally, there are no known studies that examine the effectiveness of VR interventions that combine both the application of functional activities (e.g., cooking, shopping) and game-based activities (e.g., hitting targets, rowing). Investigators conducted a case series design, and participants were recruited using convenience sampling from local stroke support groups and therapy clinics in the area. The inclusion criteria were adults over the age of 21, who were at least six months post stroke, and who had not received any type of UE treatment in the last 30 days. Participants needed to be able to understand and follow verbal directions and have at least ¼ active range of motion (AROM) at the elbow and shoulder of the affected UE. Participants received the two VR interventions in two-hour sessions, three times a week for four weeks. Pre-post change scores were used to assess change in UE motor function using the following measures (1) the Wolf Motor Function Test (WMFT) – a timed, performance-based measure with scores ranging from 0-5 with higher scores indicating normal movement; (2) AROM in the affected UE; and (3) grip strength. One 73 year old male 13 months post stroke, and one 74 year old female 19 months post stroke completed the study. Participant 1 showed no change in WMFT pre and post scores (both were 4.25), and participant 2 showed an increase from 3.87 to 4.50. However, both participants completed all the WMFT items quicker (on average) at the end of the study than they did at baseline. For AROM of the affected UE, both participants showed significant gains ranging from 5° to 48° of motion across 7 of the 12 measured UE motions. Mean scores for grip strength in the affected hand resulted in an increase of 3.73 lbs and 8.00 lbs for participants 1 and 2, respectively. Based on the results of this study, adult stroke survivors may improve UE motor function with the combined use of GB and FAB VR interventions. One implication of the study is that the use of co-interventions for UE recovery in stroke rehabilitation may lead to increased function that can impact the functional performance of a person post stroke. Research has shown that stroke survivors who actively participate in real-life tasks are more inclined to regain a skill (Wolf et al., 2006). Also, the study supported the use of multiple interventions, which represents typical practice, in which practitioners often use a variety of treatment methods. There is an imperative need for practitioners to learn more about VR to further establish the effectiveness of GB and FAB VR interventions as well as develop protocols to guide the frequency, duration, and intensity of these types of interventions to improve the lives of individuals after stroke.
Ellington A., Adams, R. J., White, M., & Diamond, P. T. (2015). Behavioral intention to use a virtual instrumental activities of daily living system among people with stroke. The American Journal of Occupational Therapy, 69(3), 1-8.
Nilsen, D. M., Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T. (2015). Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: An evidence-based review. American Journal of Occupational Therapy, 69, 6901180030. http://dx.doi.org/10.5014/ajot.2015.011965
Saposnik, G., & Levin, M. (2011). Virtual reality in stroke rehabilitation: A meta-analysis and implications for clinicians. Stroke, 42(5), 1380-1386.
Wolf, S., Winstein, C., Miller, J., Taub, E., Uswatte, G., Morris, D., Giuliani, C., & Light, K. (2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The EXCITE randomized clinical trial. The Journal of the American Medical Association, 296(17), 2095-2104. doi:10.1001/jama.296.17.2095