Impact of virtual reality game therapy and task-specific neurodevelopmental treatment on motor recovery in survivors of stroke

2020 ◽  
Vol 27 (8) ◽  
pp. 1-11
Author(s):  
Alisha Kaur ◽  
Gandhi Karunanithi Balaji ◽  
A Sahana ◽  
Suruliraj Karthikbabu
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Upper Limb ◽  
Therapy Group ◽  
Motor Recovery ◽  
Table Tennis ◽  
Trunk Control ◽  
Game Therapy ◽  
The Impact ◽  
And Task

Background/Aims This study aimed to compare the impact of virtual reality game therapy and task-specific neurodevelopmental training on the motor recovery of upper limb and trunk control, as well as physical function, in people who have had a stroke. Methods This randomised, assessor-blinded clinical trial was conducted with 34 patients with post-stroke duration of 135 ± 23 days. Patients with first-onset cortical stroke aged 40–60 years, Mini-Mental State Examination score >20, ability to complete a nine-hole peg test within 120 seconds, ability to lift the affected arm at shoulder level and independent standing were included. Patients were excluded if they had unilateral neglect and musculoskeletal injuries of the affected limb in the past 2 months. Outcome measures used were the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Trunk Impairment Scale and Stroke Impact Scale-16. The virtual reality game therapy group performed interactive table tennis, boxing and discus throwing games. The neurodevelopmental treatment group underwent task-specific movements of the upper limb in sitting and standing. All patients performed 45 minutes of treatment, 5 days a week for 4 weeks. Results Both groups showed improvements in all measures after training (P<0.05). There was a between-group difference of 3.47 points in Fugl-Meyer Upper Extremity Scale in favour of the virtual reality game therapy. Conclusions Both treatment regimens resulted in equal improvements in hand dexterity and trunk control after stroke. Virtual reality game therapy improved the upper limb motor recovery of stroke survivors to a greater extent than neurodevelopmental treatment.

scholarly journals STUDY PROTOCOL The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: A study protocol for the TEAMS pilot randomized controlled trial

2020 ◽  
Author(s):  
Alon Kalron ◽  
Anat Achiron ◽  
Massimiliano Pau ◽  
Eleonora Cocco
Keyword(s):  
Multiple Sclerosis ◽  
Virtual Reality ◽  
Study Protocol ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Home Based ◽  
Custom Made ◽  
The Impact

Abstract Background: Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include: a) evaluating the impact of the programs on quality of life after the intervention and a follow up 1 month later; and b) evaluating the impact of the programs on adherence and satisfaction. Methods: Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy; (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several activities of daily living (ADL) functions associated with self-care, dressing and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting position, indicative of the standard care in MS. Following 8-weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention. Discussion: The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS. Trial registration: ClinicalTrials.gov NCT04032431. Registered on 19 July 2019.

scholarly journals Augmented Efficacy of Intermittent Theta Burst Stimulation on the Virtual Reality-based Cycling Training for Upper Limb Function in Patients With Stroke

2020 ◽  
Author(s):  
Yu-Hsin Chen ◽  
Chia-Ling Chen ◽  
Ying-Zu Huang ◽  
Hsieh-Ching Chen ◽  
Chung-Yao Chen ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Motor Function ◽  
Upper Limb ◽  
Manual Dexterity ◽  
Therapeutic Effects ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Theta Burst ◽  
Cycling Training

Abstract Background: Virtual reality and arm cycling have been reported as effective treatment to improve upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb motor function in patients with stroke.Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures, including Modified Ashworth Scale Upper Extremity (MAS-UE), Fugl-Meyer Assessment Upper Extremity (FMA-UE) for body function, Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL) for activity and Stroke Impact Scale (SIS) for participation were assessed before and after the intervention. Paired t test was performed to evaluate the effectiveness after the intervention and analysis of covariance (ANCOVA) was conducted to compare the therapeutic effects between two groups.Results: At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. ANCOVA revealed that the iTBS group presented greater improvement than the sham group significantly in MAS-UE, NHPT and SIS, and with borderline significance in ARAT, BBT and MAL. There was no significant difference in FMA-UE between groups.Conclusions: Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, improving gross motor function and manual dexterity, and increasing participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb motor function recovery, especially manual dexterity, in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017.

scholarly journals Recent findings from the Upper Limb Consortium Study: new approaches to risk assessment and additional health outcomes

2019 ◽  
Vol 63 (1) ◽  
pp. 948-954
Author(s):  
Carisa Harris ◽  
David Rempel ◽  
Alysha R Meyers ◽  
Stephen Bao ◽  
Jay Kapellusch ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Rotator Cuff ◽  
Health Outcomes ◽  
Upper Extremity ◽  
Musculoskeletal Disorders ◽  
Upper Limb ◽  
Assessment Methods ◽  
Work Related ◽  
Upper Extremity Musculoskeletal Disorders ◽  
The Impact

Historically, work-related upper-extremity musculoskeletal disorders (MSD) have comprised a significant portion of the number and cost of injuries in the workplace. The problem of work-related upper-extremity MSD has been, and continues to be, widespread and costly. This panel will present recent research from the Upper Extremity Musculoskeletal Consortium studies. Presentations will be made on new health outcomes such as wrist tendinosis, epicondylitis and rotator cuff syndrome, as well as provide updates on applying new risk assessment methods to prior analyses. The application of the Revised Strain Index will be presented as will a comparison of results from the 2001 ACGIH TLV for Hand Activity to the 2018 ACGIH TLV for Hand Activity. Additionally, the impact of healthy worker survivor effect on the pooled analyses of incident CTS and CTS related disability will be discussed.

scholarly journals Emergence of Virtual Reality as a Tool for Upper Limb Rehabilitation: Incorporation of Motor Control and Motor Learning Principles

2015 ◽  
Vol 95 (3) ◽  
pp. 415-425 ◽  
Author(s):  
Mindy F. Levin ◽  
Patrice L. Weiss ◽  
Emily A. Keshner
Keyword(s):  
Virtual Reality ◽  
Motor Control ◽  
Motor Learning ◽  
Upper Limb ◽  
Limb Movement ◽  
Motor Recovery ◽  
Upper Limb Rehabilitation ◽  
Wide Range ◽  
Learning Principles ◽  
Limb Rehabilitation

The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality–based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback–based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.

scholarly journals Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 736
Author(s):  
Francisco José Sánchez-Cuesta ◽  
Aida Arroyo-Ferrer ◽  
Yeray González-Zamorano ◽  
Athanasios Vourvopoulos ◽  
Sergi Bermúdez i Badia ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Motor Imagery ◽  
Upper Limb ◽  
Cortical Excitability ◽  
Controlled Trial ◽  
Motor Recovery ◽  
Cortical Inhibition ◽  
Randomized Controlled ◽  
Vr Training

Background and Objectives: The motor sequelae after a stroke are frequently persistent and cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the cortico-spinal pathways are known to cause a reduction of cortical excitability in the lesioned area not only for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action. Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation (rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS have been shown to increase the excitability of the lesioned hemisphere. Mental representation techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind, randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain–Computer Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper limb motor recovery after subacute stroke (>3 months) compared to neuromodulation combined with conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI), dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention, after each intervention and 15 days after the last session. Conclusions: This trial will show the additive value of VR immersive motor imagery as an adjuvant therapy combined with a known effective neuromodulation approach opening new perspectives for clinical rehabilitation protocols.

scholarly journals Simulating the Impact of Glenohumeral Capsulorrhaphy on Movement Kinematics and Muscle Function in Activities of Daily Living

2020 ◽  
Author(s):  
Aaron S. Fox ◽  
Stephen D. Gill ◽  
Jason Bonacci ◽  
Richard S. Page
Keyword(s):  
Range Of Motion ◽  
Task Performance ◽  
Upper Limb ◽  
Axial Rotation ◽  
Shoulder Range Of Motion ◽  
Shoulder Kinematics ◽  
The Impact ◽  
Shoulder Range ◽  
Muscular Effort ◽  
And Task

AbstractThis study aimed to use a predictive simulation framework to examine shoulder kinematics, muscular effort and task performance during functional upper limb movements under simulated selective glenohumeral capsulorrhaphy. A musculoskeletal model of the torso and upper limb was adapted to include passive restraints that simulated the changes in shoulder range of motion stemming from selective glenohumeral capsulorrhaphy procedures (anteroinferior, anterosuperior, posteroinferior, posterosuperior, and total anterior, inferior, posterior and superior). Predictive muscle-driven simulations of three functional movements (upward reach, forward reach and head touch) were generated with each model. Shoulder kinematics (elevation, elevation plane and axial rotation), muscle cost (i.e. muscular effort) and task performance time were compared to a baseline model to assess the impact of the capsulorrhaphy procedures. Minimal differences in shoulder kinematics and task performance times were observed, suggesting that task performance could be maintained across the capsulorrhaphy conditions. Increased muscle cost was observed under the selective capsulorrhaphy conditions, however this was dependent on the task and capsulorrhaphy condition. Larger increases in muscle cost were observed under the capsulorrhaphy conditions that incurred the greatest reductions in shoulder range of motion (i.e. total inferior, total anterior, anteroinferior and total posterior conditions) and during tasks that required shoulder kinematics closer to end range of motion (i.e. upward reach and head touch). The elevated muscle loading observed could present a risk to joint capsule repair. Appropriate rehabilitation following glenohumeral capsulorrhaphy is required to account for the elevated demands placed on muscles, particularly when significant range of motion loss presents.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke

2018 ◽  
Vol 35 (1) ◽  
pp. 25-32 ◽  
Author(s):  
Ayhan Aşkın ◽  
Emel Atar ◽  
Hikmet Koçyiğit ◽  
Aliye Tosun
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Chronic Stroke ◽  
Motor Recovery
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