Elements  virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study

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Abstract

Background

Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors.

Methods

Twenty-one adults (42–94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30–40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.

Results

Effect sizes for the experimental group ( d = 1.05–2.51) were larger compared with controls ( d = 0.11–0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand ( p = 0.008), and general intellectual status and executive function ( p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.

Conclusion

A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.

Trial registration

this pilot study was not registered.

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Most cited references 74

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Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing

Yoav Benjamini, Yosef Hochberg (1995)

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Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.

Gustavo Saposnik, Robert Teasell, Muhammad Mamdani … (2010)

Hemiparesis resulting in functional limitation of an upper extremity is common among stroke survivors. Although existing evidence suggests that increasing intensity of stroke rehabilitation therapy results in better motor recovery, limited evidence is available on the efficacy of virtual reality for stroke rehabilitation. In this pilot, randomized, single-blinded clinical trial with 2 parallel groups involving stroke patients within 2 months, we compared the feasibility, safety, and efficacy of virtual reality using the Nintendo Wii gaming system (VRWii) versus recreational therapy (playing cards, bingo, or "Jenga") among those receiving standard rehabilitation to evaluate arm motor improvement. The primary feasibility outcome was the total time receiving the intervention. The primary safety outcome was the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, was evaluated with the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at 4 weeks after intervention. Overall, 22 of 110 (20%) of screened patients were randomized. The mean age (range) was 61.3 (41 to 83) years. Two participants dropped out after a training session. The interventions were successfully delivered in 9 of 10 participants in the VRWii and 8 of 10 in the recreational therapy arm. The mean total session time was 388 minutes in the recreational therapy group compared with 364 minutes in the VRWii group (P=0.75). There were no serious adverse events in any group. Relative to the recreational therapy group, participants in the VRWii arm had a significant improvement in mean motor function of 7 seconds (Wolf Motor Function Test, 7.4 seconds; 95% CI, -14.5, -0.2) after adjustment for age, baseline functional status (Wolf Motor Function Test), and stroke severity. VRWii gaming technology represents a safe, feasible, and potentially effective alternative to facilitate rehabilitation therapy and promote motor recovery after stroke.

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Is Open Access

Stroke injury, cognitive impairment and vascular dementia☆

Raj Kalaria, Rufus Akinyemi, Masafumi Ihara (2016)

The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.

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Author and article information

Contributors

Jeffrey M. Rogers: +61 2 9351 9261 , jeffrey.rogers@sydney.edu.au

Jonathan Duckworth: jonathan.duckworth@rmit.edu.au

Sandy Middleton: sandy.middleton@acu.edu.au

Bert Steenbergen:

ORCID: http://orcid.org/0000-0001-8863-2624

b.steenbergen@pwo.ru.nl

Peter H. Wilson:

ORCID: http://orcid.org/0000-0003-3747-0287

peterH.wislon@acu.edu.au

Journal

Journal ID (nlm-ta): J Neuroeng Rehabil

Journal ID (iso-abbrev): J Neuroeng Rehabil

Title: Journal of NeuroEngineering and Rehabilitation

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-0003

Publication date (Electronic): 15 May 2019

Publication date PMC-release: 15 May 2019

Publication date Collection: 2019

Volume: 16

Affiliations

[1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, The University of Sydney, , Faculty of Health Sciences, ; Sydney, NSW Australia

[2 ]School of Design, RMIT, Melbourne, VIC Australia

[3 ]Nursing Research Institute, St Vincent’s Health Australia and Australian Catholic University, Sydney, NSW Australia

[4 ]ISNI 0000000122931605, GRID grid.5590.9, Behavioural Science Institute, , Radboud University, ; Nijmegen, The Netherlands

[5 ]ISNI 0000 0001 2194 1270, GRID grid.411958.0, Centre for Disability and Development Research (CeDDR) and School of Behavioural and Health Science, , Australian Catholic University, ; Melbourne, VIC Australia

Article

Publisher ID: 531

DOI: 10.1186/s12984-019-0531-y

PMC ID: 6518680

PubMed ID: 31092252

SO-VID: 040f02d7-713f-4bb2-b253-7760c349eb95

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Funding

Funded by: Prince of Wales Hospital Foundation

Award ID: Research Award

Award Recipient : Jeffrey M. Rogers

Funded by: Australian Catholic University

Award ID: Research Fund Program Grant

Award Recipient : Peter H. Wilson

Custom metadata

ScienceOpen disciplines: Neurosciences

Keywords: cognition,motor activity,rehabilitation,stroke,upper extremity,virtual reality

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ScienceOpen disciplines: Neurosciences

Keywords: cognition, motor activity, rehabilitation, stroke, upper extremity, virtual reality

Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study

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Abstract

Background

Methods

Results

Conclusion

Trial registration

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Functional role of amyloid

Most cited references 74

Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing

Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle.

Stroke injury, cognitive impairment and vascular dementia☆

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