Interactive Virtual Reality Based Task-specific Rehabilitation System for Upper Extremity Training in Patients with Chronic Stroke

Abstract

A functional deficit of the upper extremity occurs in up to 70% of post-stroke patients in the acute phase and persists in about a half the patients. Task-specific high intensity repetitive training has been postulated to be most effective for upper extremity training of the post-stroke patient, but it has some limitations when applied to patients in the chronic phase.

We compared the effectiveness of virtual reality-based rehabilitation training (VT) with a conditioning or fitness exercise program (CE) in post-stroke patients assigned to two groups, each receiving both VT and CE with a cross-over design (VT-CE for group A and CE-VT for group B). Training was for four weeks, 30 minutes a day, three times a week. Fugl-Meyer Assessment (FMA) and modified Barthel index (MBI) were employed as primary outcome measures, and the Short Form 36 Health Survey (SF-36) was evaluated for quality of life (QOL). The participants were also evaluated for motor power, spasticity, and cognitive function using the Medical Research Council scale, modified Ashworth scale, and mini mental status exam, respectively. All outcome measurements were performed at the baseline, at four weeks, and at eight weeks.

Ninety-eight participants completed both interventions, and the drop-out rate was 20.3%. There were significant improvements in both FMA and MBI scores, and the former was improved more by VT than by CE. The improvement in MBI score was also greater with VT, but not significantly so. SF-36 and MMSE scores improved similarly in response to the two interventions, as did motor power and spasticity.

The results demonstrated the effectiveness of task-specific repetitive training using the newly developed VR-based interactive rehabilitation system for upper extremity motor rehabilitation in chronic post-stroke patients.