Effects of Virtual Reality on the Upper Extremity Spasticity and Motor Function in Patients with Stroke: A Single Blinded Randomized Controlled Trial

Authors: K. Afsahi, M. Soheilifar, S. H. Hosseini, O. S. Esmaeili, R. Kezemi, N. Mehrbod, N. Vahed, T. Hajiahmad, N. N. Ansari

Abstract:

Background: Stroke is a disabling neurological disease. Rehabilitative therapies are important treatment methods. This clinical trial was done to compare the effects of virtual reality (VR) beside conventional rehabilitation versus conventional rehabilitation alone on the spasticity and motor function in stroke patients. Materials and methods: In this open-label randomized controlled clinical trial, 40 consecutive patients with stable first-ever ischemic stroke in the past three to 12 months that were referred to a rehabilitation clinic in Tehran, Iran in 2020 were enrolled. After signing the informed written consent form, subjects were randomly assigned by block randomization of five in each block as cases with 1:1 into two groups of 20 cases; conventional plus VR therapy group: 45-minute conventional therapy session plus 15-minute VR therapy, and conventional group: 60-minute conventional therapy session. VR rehabilitation is designed and developed with different stages. Outcomes were Modified Ashworth scale, Recovery Stage score for motor function, range of motion (ROM) of shoulder abduction/wrist extension, and patients’ satisfaction rate. Data were compared after study termination. Results: The satisfaction rate among the patients was significantly better in combination group (P = 0.003). Only wrist extension was varied between groups and was better in combination group. The variables generally had statistically significant difference (P < 0.05). Conclusion: VR plus conventional rehabilitation therapy is superior versus conventional rehabilitation alone on the wrist and elbow spasticity and motor function in patients with stroke.

Keywords: Stroke, virtual therapy, efficacy, rehabilitation.

References:

[1] Kuklina EV, Tong X, George MG, Bansil P. Epidemiology and prevention of stroke: a worldwide perspective. Expert Rev Neurother. 2012 Feb;12(2):199-208.
[2] Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011 Feb 1;123(4):e18-e209.
[3] Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. Circulation. 2012 Jan 3;125(1):e2-e220.
[4] Venketasubramanian N, Chen CL. Burden of stroke in Singapore. Int J Stroke. 2008 Feb;3(1):51-4.
[5] Virani SS, Alonso A, Benjamin, EJ, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020; E139-E596
[6] Hosseini, A.A., Sobhani-Rad, D., Ghandehari, K. et al. Frequency and clinical patterns of stroke in Iran - Systematic and critical review. BMC Neurol. 2010; 10: 72.
[7] Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and haemorrhagic stroke in 1990–2013: the GBD 2013 study. Neuroepidemiology. 2015;45:161-76.
[8] https://qbi.uq.edu.au/brain/brain-diseases/stroke/stroke-facts
[9] Kwakkel G, Boudewijn J, Jeroen V, et al. Probability of regaining dexterity in the flaccid upper limb impact of severity of paresis and time since onset in acute stroke. Stroke. 2003;34:2181–2186.
[10] Lee KB, Lim SH, Kim KH, et al. Six-month functional recovery of stroke patients: a multi-time-point study. Int J Rehab Res. 2015; 38: 173.
[11] Saposnik G, Levin M; Outcome Research Canada (SORCan) Working Group. Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians. Stroke. 2011;42(5):1380-1386.
[12] Laver KE, George S, Thomas S, Deutsch JE, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2015;2015(2):CD008349.
[13] Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta-analysis. J Adv Nurs. 2021 Epub ahead of print
[14] Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017;11(11):CD008349
[15] Ain QU, Khan S, Ilyas S, et al. Additional Effects of Xbox Kinect Training on Upper Limb Function in Chronic Stroke Patients: A Randomized Control Trial. Healthcare (Basel). 2021;9(3):242.
[16] Ansari NN, Naghdi S, Mashayekhi M, Hasson S, Fakhari Z, Jalaie S. Intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of upper-limb muscle spasticity. NeuroRehabilitation, 2012; 31: 215-22.
[17] Ansari NN, Naghdi S, Forogh B, Hasson S, Atashband M, Lahgari E. Development of the Persian version of the Modified Modified Ashworth Scale: Translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity. Disabil Rehabil. 2012; 34: 1843-7.
[18] Ansari NN, Naghdi S, Hasson S, Fakhari Z, Mashayekhi M, Herasi M. Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia. NeuroRehabilitation. 2009; 25: 235-40.
[19] Naghdi S., Ansari NN., Azarnia S., Kazemnejad A. Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity. Physiother Theory Pract. 2008; 24, 372-9.
[20] Naghdi S, Ansari NN, Mansouri K, Asgari A, Olyaei GR, Kazemnejad A. Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke. Electromyography and Clinical Neurophysiology, 2008;48: 35-41.
[21] Mohammadi R, Semnani AV, Mirmohammadkhani M, Grampurohit N. Effects of Virtual Reality Compared to Conventional Therapy on Balance Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis. 2019;28(7):1787-1798.
[22] Fishbein P, Hutzler Y, Ratmansky M, Treger I, Dunsky A. A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors. J Stroke Cerebrovasc Dis. 2019;28(11):104343.
[23] Wiley E, Khattab S, Tang A. Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol. 2020; 1-11.
[24] Cortés-Pérez I, Nieto-Escamez FA, Obrero-Gaitán E. Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series. Brain Sci. 2020;10(5):296.
[25] Turolla A, Dam M, Ventura L, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil. 2013; 10:85.
[26] Yin CW, Sien NY, Ying LA, Chung SF, Tan May Leng D. Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial. Clin Rehabil. 2014;28(11):1107-1114.
[27] Schuster-Amft C, Eng K, Suica Z, et al. Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial. PLoS One. 2018;13(10):e0204455.
[28] Park M, Ko MH, Oh SW, et al. Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study. J Neuroeng Rehabil. 2019;16(1):122.