Virtual Reality for PostCOVID-19 Stroke: A Case Report
Authors: Kasra Afsahi, Maryam Soheilifar, Noureddin Nakhostin Ansari
COVID-19 has been associated with stroke and neurological complications. The patient was a 59-year-old male presented with sudden left hemiparesis and diplopia due to cavernous sinus thrombosis (CST) on 28/03/2020. The COVID-19 test was positive. Multislice computerized tomography (MSCT) showed ischemic infarction. He underwent surgical sinectomy 9 days after admission. Physiotherapy began for him on August 2020. Our game-based virtual reality (VR) technology developed for stroke patients was based on upper extremity exercises and function for stroke. After 6 weeks of VR therapy plus conventional physiotherapy exercises (18 sessions, three times per week, 60 minutes each session), there were significant improvements in Brunnstrom Motor Recovery Stage (from “4” to “5”), Fugl-Meyer Scale score of upper extremity section (from 49 to 54), and Modified Barthel Index (from 15 to 18). There were no adverse effects. This case with stroke post COVID-19 due to the CST showed the usefulness of VR therapy used as an adjunct to conventional physiotherapy in improving affected upper extremity.
Keywords: COVID-19, stroke, virtual reality, rehabilitation.Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 323
 Reddy ST, Garg T, Shah C, Nascimento FA, Imran R, Kan P, Bowry R, Gonzales N, Barreto A, Kumar A, Volpi J, Misra V, Chiu D, Gadhia R, Savitz SI. Cerebrovascular Disease in Patients with COVID-19: A Review of the Literature and Case Series. Case Rep Neurol. 2020 Jun 11;12(2):199-209.
 Geng B, Wu X, Malhotra A. Septic cavernous sinus thrombosis-Case series and review of the literature. Clin Neurol Neurosurg. 2020 Oct;197:106092.
 van der Poel NA, Mourits MP, de Win MML, Coutinho JM, Dikkers FG. Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review. Eur Arch Otorhinolaryngol. 2018 Sep;275(9):2387-95.
 Bhatia H, Kaur R, Bedi R. MR imaging of cavernous sinus thrombosis. Eur J Radiol Open. 2020 Mar 3;7:100226.
 Weerasinghe D, Lueck CJ. Septic Cavernous Sinus Thrombosis: Case Report and Review of the Literature. Neuroophthalmology. 2016 Oct 19;40(6):263-276.
 Luo Y, Tian X, Wang X. Diagnosis and Treatment of Cerebral Venous Thrombosis: A Review. Front Aging Neurosci. 2018 Jan 30;10:2.
 Hemasian H, Ansari B. First case of Covid-19 presented with cerebral venous thrombosis: A rare and dreaded case. Rev Neurol (Paris). 2020 Jun; 176(6):521-523.
 Hughes C, Nichols T, Pike M, Subbe C, Elghenzai S. Cerebral Venous Sinus Thrombosis as a Presentation of COVID-19. Eur J Case Rep Intern Med. 2020 Apr 29;7(5):001691.
 Tu TM, Goh C, Tan YK, Leow AS, Pang YZ, Chien J, Shafi H, Chan BP, Hui A, Koh J, Tan BY, Umapathi NT, Yeo LL. Cerebral Venous Thrombosis in Patients with COVID-19 Infection: a Case Series and Systematic Review. J Stroke Cerebrovasc Dis. 2020 Dec;29(12):105379.
 Shakibajahromi B, Borhani-Haghighi A, Haseli S, Mowla A. Cerebral venous sinus thrombosis might be under-diagnosed in the COVID-19 era. eNeurologicalSci. 2020 Jul 15;20:100256.
 Liao W, Liu Y, Gu W, Yang J, Chen C, Liu F, Zeng F, Wang X. Cerebral Venous Sinus Thrombosis: Successful Treatment of Two Patients Using the Penumbra System and Review of Endovascular Approaches. Neuroradiol J. 2015 Apr;28(2):177-83.
 Brunnstrom S. Movement therapy in hemiplegia: A neurophysiological approach. New York: Harper & Row; 1970.
 Naghdi S, Ansari NN, Mansouri K, Hasson S. A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke. Brain Inj. 2010;24(11):1372-8.
 Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.
 Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair. 2002 Sep;16(3):232-40.
 McDowell I, Newell C. Measuring Health - A Guide to Rating Scales and Questionnaires Second Edition. Oxford University Press. 1996. pages 56-63
 Lee HS, Park YJ, Park SW. The Effects of Virtual Reality Training on Function in Chronic Stroke Patients: A Systematic Review and Meta-Analysis. Biomed Res Int. 2019 Jun 18;2019:7595639.
 Yamato TP, Pompeu JE, Pompeu SM, Hassett L. Virtual Reality for Stroke Rehabilitation. Phys Ther. 2016;96(10):1508-1513.
 Henderson A, Korner-Bitensky N, Levin M. Virtual reality in stroke rehabilitation: a systematic review of its effectiveness for upper limb motor recovery. Top Stroke Rehabil. 2007;14(2):52-61.
 Shahmoradi L, Almasi S, Ahmadi H, Bashiri A, Azadi T, Mirbagherie A, Ansari NN, Honarpishe R. Virtual Reality Games for Rehabilitation of Upper Extremities in Stroke Patients, J Bodyw Mov The. 2020 In press.
 Page SJ, Fulk GD, Boyne P. Clinically important differences for the upper extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012;92:791-798.