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      Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke

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          Abstract

          Background

          Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors.

          Methods

          Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory).

          Results

          Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test ( p < 0.01) and finger dexterity measured by the Box and Blocks Test ( p < 0.01) and the Nine Hole Peg Test ( p < 0.01); and participation ( p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating.

          Conclusions

          Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.

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          Most cited references41

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          Assessing Wolf motor function test as outcome measure for research in patients after stroke.

          The Wolf Motor Function Test (WMFT) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements. This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population. Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment. Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment (FMA) on 2 occasions (12 to 16 days apart), with scoring performed independently by 2 random raters. The WMFT and FMA demonstrated agreement (P 0.05) from the dominant and nondominant extremities of individuals without impairment. The WMFT and FMA scores were related (P<0.02) for the more affected extremity in individuals after stroke. The interrater reliability, construct validity, and criterion validity of the WMFT, as used in these subject samples, are supported.
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            What do motor "recovery" and "compensation" mean in patients following stroke?

            There is a lack of consistency among researchers and clinicians in the use of terminology that describes changes in motor ability following neurological injury. Specifically, the terms and definitions of motor compensation and motor recovery have been used in different ways, which is a potential barrier to interdisciplinary communication. This Point of View describes the problem and offers a solution in the form of definitions of compensation and recovery at the neuronal, motor performance, and functional levels within the framework of the International Classification of Functioning model.
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              Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident.

              This study establishes intratester reliability for all components of physical performance and intertester reliability for the total scores of upper and lower extremity motor performance in a cumulative numerical scoring system devised by Fugl-Meyer et al. Intertester reliability was found to be high for the total scores of upper and lower extremity motor performance. All intratester and intertester reliability coefficients were high and statistically significant. Establishing the reliability of the Fugl-Meyer method of assessing recovery of function following cerebrovascular accident has increased the usefulness of this method for clinical assessment and as a tool for the comparative analysis of the effectiveness of various therapeutic interventions.
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                Author and article information

                Contributors
                rllorens@labhuman.com
                Journal
                J Neuroeng Rehabil
                J Neuroeng Rehabil
                Journal of NeuroEngineering and Rehabilitation
                BioMed Central (London )
                1743-0003
                11 May 2016
                11 May 2016
                2016
                : 13
                : 45
                Affiliations
                [ ]Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
                [ ]Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022 Spain
                [ ]Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Av. Sos Baynat s/n, Univesity of Jaume I, Castellón, 12071 Spain
                Article
                153
                10.1186/s12984-016-0153-6
                4864937
                27169462
                7ca38d45-efe8-48cb-82d5-0a0d27aeca9e
                © Colomer et al. 2016

                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.

                History
                : 9 July 2015
                : 3 May 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003329, Ministerio de Economía y Competitividad (ES);
                Award ID: IDI-20110844
                Funded by: Ministerio de Educación y Ciencia (ES)
                Award ID: SEJ2006-14301/PSIC
                Funded by: Conselleria de Educació de la Generalitat Valenciana
                Award ID: 2008-157
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Neurosciences
                stroke,upper limb,hemiparesis,physical therapy,virtual reality,augmented reality,tabletop systems

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