Virtual reality for upper limb rehabilitation in sub-acute and chronic stroke: a randomized controlled trial

Publication date: Available online 14 February 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Pawel Kiper, Andrzej Szczudlik, Michela Agostini, Jozef Opara, Roman Nowobilski, Laura Ventura, Paolo Tonin, Andrea Turolla
ObjectiveTo evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke aetiology (i.e. ischemic or hemorrhagic).DesignRandomized controlled trial.SettingInpatients in a hospital facility for intensive rehabilitation.Participants136 patients within one year from onset of a single stroke.InterventionsThe experimental treatment was based on the combination of RFVE with CR, while control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5 days a week, for 4 weeks.Main Outcome MeasuresFugl-Meyer upper extremity (F-M UE) scale (primary outcome), Functional Independence Measure (FIM), National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements: duration (Time), mean linear velocity (Speed), number of submovements (Peak) (secondary outcomes).Results136 patients (ischemic=78, hemorrhagic=58) were randomized in two groups (RFVE=68, CR=68) and stratified by stroke aetiology (ischemic, hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) at: F-M UE (p<0.001), FIM (p<0.001), NIHSS (p≤0.014), ESAS (p≤0.022), Time (p<0.001), Speed (p<0.001), Peak (p<0.001). Stroke aetiology did not have significant effects on patient outcomes.ConclusionThe RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke aetiology (Clinical Trial Registration – NCT01955291).



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