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Neurology and Therapy
Published in: Neurology and Therapy 1/2012

Open Access 01-12-2012 | ORIGINAL RESEARCH

Virtual Reality Versus Conventional Treatment of Reaching Ability in Chronic Stroke: Clinical Feasibility Study

Authors: Mindy F. Levin, Osnat Snir, Dario G. Liebermann, Harold Weingarden, Patrice L. Weiss

Published in: Neurology and Therapy | Issue 1/2012

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Abstract

Introduction

The objective of this study was to evaluate the potential of exercises performed in a 2D video-capture virtual reality (VR) training environment to improve upper limb motor ability in stroke patients compared to those performed in conventional therapy.

Methods

A small sample randomized control trial, in an outpatient rehabilitation center with 12 patients with chronic stroke, aged 33–80 years, who were randomly allocated to video-capture VR therapy and conventional therapy groups. All patients participated in four clinical evaluation sessions (pre-test 1, pre-test 2, post-test, follow-up) and nine 45-minute intervention sessions over a 3-week period. Main outcomes assessed were Body Structure and Function (impairment: Fugl–Meyer Assessment [FMA]; Composite Spasticity Index [CSI]; Reaching Performance Scale for Stroke), Activity (Box and Blocks; Wolf Motor Function Test [WMFT]), and Participation (Motor Activity Log) levels of the International Classification of Functioning.

Results

Improvements occurred in both groups, but more patients in the VR group improved upper limb clinical impairment (FMA, CSI) and activity scores (WMFT) and improvements occurred earlier. Patients in the VR group also reported satisfaction with the novel treatment.

Conclusions

The modest advantage of VR over conventional training supports further investigation of the effect of video-capture VR or VR combined with conventional therapy in larger-scale randomized, more intense controlled studies.
Literature
1.
Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:2181–6.PubMedCrossRef
2.
Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J. Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil. 2002;83:1035–42.PubMedCrossRef
3.
Maldonado MA, Allred RP, Felthauser EL, Jones TA. Motor skill training, but not voluntary exercise, improves skilled reaching after unilateral ischemic lesions of the sensorimotor cortex in rats. Neurorehabil Neural Repair. 2008;22:250–61.PubMedCrossRef
4.
Proteau L, Blandin Y, Alain C, Dorion A. The effects of the amount and variability of practice on the learning of a multi-segmented motor task. Acta Psychol. 1994;85:61–74.CrossRef
5.
Winstein CJ, Merians AS, Sullivan KJ. Motor learning after unilateral brain damage. Neuropsychologia. 1999;37:975–87.PubMedCrossRef
6.
Kantak SS, Sullivan KJ, Fisher BE, Knowlton BJ, Winstein CJ. Neural substrates of motor memory consolidation depend on practice structure. Nat Neurosci. 2010;13:923–5.PubMedCrossRef
7.
Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GJ, Koetsier JC. Effects of intensity of rehabilitation after stroke. A research synthesis. Stroke. 1997;28:1550–6.PubMedCrossRef
8.
Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51:S225–39.PubMedCrossRef
9.
Cirstea CM, Ptito A, Levin MF. Feedback and cognition in arm motor skill reacquisition after stroke. Stroke. 2006;37:1237–42.PubMedCrossRef
10.
Nudo RJ, Milliken GW. Reorganization of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. J Neurophysiol. 1996;75:2144–9.PubMed
11.
Rizzo A. Virtual reality and disability: emergence and challenge. Disabil Rehabil. 2002;24:567–9.CrossRef
12.
Rizzo AA, Kim GJ. A SWOT analysis of the field of VR rehabilitation and therapy. Presence-TeleopVirt. 2005;14:119–46.CrossRef
13.
Weiss PL, Ring H. Commentary on virtual reality in stroke rehabilitation: still more virtual than real. Disabil Rehabil. 2007;29:1147–9.CrossRef
14.
You SH, Jang SH, Kim YH, et al. Virtual reality-induced cortical reorganization and associated locomotor recovery in chronic stroke: an experimenter-blind randomized study. Stroke. 2005;36:1166–71.PubMedCrossRef
15.
Holden MK. Virtual environments for motor rehabilitation: review. Cyberpsychol Behav. 2005;8:187–211.PubMedCrossRef
16.
Henderson AK, Korner-Bitensky N, Levin MF. Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Top Stroke Rehabil. 2007;14:52–61.PubMedCrossRef
17.
Adamovich SV, Fluet GG, Tunik E, Merians AS. Sensorimotor training in virtual reality: a review. Neurorehabilitation. 2009;25:29–44.PubMed
18.
Lucca LF. Virtual reality and motor rehabilitation of the upper limb after stroke: a generation of progress? J Rehabil Med. 2009;41:1003–6.PubMedCrossRef
19.
Weiss PL, Sveistrup H, Rand D, Kizony R. Video capture virtual reality: a decade of rehabilitation assessment and intervention. Phys Ther Rev. 2009;14:307–21.CrossRef
20.
Crosbie JH, Lennon S, Basford JR, McDonough SM. Virtual reality in stroke rehabilitation: still more virtual than real. Disabil Rehabil. 2007;29:1139–46.PubMedCrossRef
21.
Mumford N, Wilson PH. Virtual reality in acquired brain injury upper limb rehabilitation: evidence-based evaluation of clinical research. Brain Inj. 2009;23:179–91.PubMedCrossRef
22.
Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2011;9:CD008349.PubMed
23.
Saposnik G, Levin MF. Virtual reality in stroke rehabilitation: a metanalysis and implications for clinicians. Stroke. 2011;42:1380–6.PubMedCrossRef
24.
Creem-Regeh SH, Willemsen P, Gooch AA, Thompson WB. The influence of restricted viewing conditions on egocentric distance perception: implications for real and virtual environments. Perception. 2005;34:191–204.CrossRef
25.
Magdalon EC, Michaelsen SM, Quevedo AAF, Levin MF. Comparison of grasping movements made by healthy subjects in a 3-dimentional immersive virtual versus physical environment. Acta Psychol (Amst). 2011;138:126–34.CrossRef
26.
Liebermann DG, Berman S, Weiss PL, Levin MF. Kinematics of reaching movements in a 2D virtual environment in adults with and without stroke. IEEE Trans Neural Syst Rehab Eng. 2012. (In press).
27.
Knaut LA, Subramanian S, McFadyen BJ, Bourbonnais D, Levin MF. Kinematics of pointing movements made in a virtual versus a physical 3D environment in stroke. Arch Phys Med Rehabil. 2009;90:793–802.PubMedCrossRef
28.
IOM: Institute of Medicine. Small Clinical Trials: Issues and Challenges. Washington: National Academies; 2001.
29.
Jack D, Boian R, Merians AS, et al. Virtual reality-enhanced stroke rehabilitation. IEEE Trans Neural Syst Rehab Eng. 2011;9:308–18.CrossRef
30.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRef
31.
Rand D, Katz N, Weiss PL. Evaluation of virtual shopping in the VMall: comparison of post-stroke participants to healthy control groups. Disabil Rehabil. 2007;29:1710–9.PubMedCrossRef
32.
World Health Organization. ICF: International Classification of Functioning, Disability and Health. Geneva: World Health Organization; 2001.
33.
Fugl-Meyer AR, Jääsko L, Leyman L, Olsson S, Steglind S. The post-stroke hemiparetic patient. I. A method for evaluation of physical performance. Scand J Rehab Med. 1975;7:13–31.
34.
Levin MF, Hui-Chan CW. Relief of hemiparetic spasticity by TENS is associated with improvement in reflex and voluntary motor functions. Electroencephalogr Clin Neurophysiol. 1992;85:131–42.PubMedCrossRef
35.
Levin MF, Desrosiers J, Beauchemin D, Bergeron N, Rochette A. Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale. Phys Ther. 2004;84:8–22.PubMed
36.
Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther. 1985;39:386–91.PubMedCrossRef
37.
Wolf SL, Catlin PA, Ellis M, Archer AL, Morgan B, Piacentino A. Assessing Wolf motor function test as outcome measure for research in patients after stroke. Stroke. 2001;32:1635–9.PubMedCrossRef
38.
Uswatte G, Taub E, Morris D, Light K, Thompson PA. The Motor Activity Log-28: assessing daily use of the hemiparetic arm after stroke. Neurology. 2006;67:1189–94.PubMedCrossRef
39.
Schwartz IS, Baer DM. Social validity assessments: is current practice state of the art? J Appl Behav Anal. 1991;24:189–204.PubMedCrossRef
40.
Barlow DH, Nock MK, Hersen M. Single case experimental designs—strategies for studying behavior change. Boston: Pearson Education; 2009.
41.
Trahan J, Malouin F. Intermittent intensive physiotherapy in children with cerebral palsy: a pilot study. Dev Med Child Neurol. 2002;44:233–9.PubMedCrossRef
42.
Schneiberg S, Mckinley P, Sveistrup H, Gisel E, Mayo NE, Levin MF. Task-oriented intervention and trunk restraint on upper limb movement quality in children with cerebral palsy. Dev Med Child Neurol. 2010;52:e245–53.PubMedCrossRef
43.
Saposnik G, Mamdani M, Bayley M, Thorpe KE, Hall J, Cohen LG, Teasell R, EVREST Steering Committee, EVREST Study Group for the Stroke Outcome Research Canada Working Group. Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system. Int J Stroke. 2010;5:47–51.PubMedCrossRef
44.
Scruggs TE, Mastropieri MA. Summarizing single-subject research: issues and applications. Behav Modif. 1994;22:221–42.CrossRef
45.
Campbell JM. Statistical comparison of four effect sizes for single-subject designs. Behav Modif. 2004;28:234–46.PubMedCrossRef
46.
Bingham GP, Pagano C. The necessity of a perception/action approach to definite distance perception: monocular distance perception to guide reaching. J Exp Psych Human Perc Perf. 1998;24:145–68.CrossRef
47.
Bernstein NA. The Co-ordination and Regulation of Movements. Chapter II. The problem of the interrelation of co-ordination and localization, Oxford: Pergamon Press; 1967:15–60.
48.
Levin MF, Kleim JF, Wolf S. What do motor ‘recovery’ and ‘compensation’ mean in patients following stroke? Neurorehabil Neural Repair. 2009;23:313–9.PubMed
49.
Subramanian SK, Massie CL, Malcolm MP, Levin MF. Does provision of extrinsic feedback result in improved motor learning in the upper limb poststroke? A systematic review of the evidence. Neurorehabil Neural Repair. 2010;24:113–24.PubMedCrossRef
50.
Subramanian SK, Lourenco CB, Chilingaryan G, Sveistrup H, Levin MF. Arm motor recovery using virtual reality intervention in chronic stroke: randomized control trial. Neurorehabil Neural Repair. 2012. [Epub ahead of print].
51.
Grezes J, Decety J. Functional anatomy of execution, mental simulation, observation, and verb generation of actions: a meta-analysis. Hum Brain Mapp. 2001;12:1–19.PubMedCrossRef
52.
Anquetil T, Jeannerod M. Simulated actions in the first and in the third person perspectives share common representations. Brain Res. 2007;1130:125–9.PubMedCrossRef
53.
Newport R, Brown L, Husain M, Mort D, Jackson SR. The role of the posterior parietal lobe in prism adaptation: failure to adapt to optical prisms in patients with bilateral damage to posterior parietal cortex. Cortex. 2006;42:720–9.PubMedCrossRef
Metadata
Title
Virtual Reality Versus Conventional Treatment of Reaching Ability in Chronic Stroke: Clinical Feasibility Study
Authors
Mindy F. Levin
Osnat Snir
Dario G. Liebermann
Harold Weingarden
Patrice L. Weiss
Publication date
01-12-2012
Publisher
Springer Healthcare Communications
Published in
Neurology and Therapy / Issue 1/2012
Print ISSN: 2193-8253
Electronic ISSN: 2193-6536
DOI
https://doi.org/10.1007/s40120-012-0003-9

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