scholarly journals Effects of Virtual Reality-based Motor Control Training on Inflammation, Oxidative Stress and Neuroplasticity in Patients with Chronic Stroke: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Chien-Yu Huang ◽  
Wei-Chi Chiang ◽  
Ya-Chin Yeh ◽  
Shih-Chen Fan ◽  
Wan-Hsien Yang ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Virtual Reality ◽  
Motor Control ◽  
Upper Limb ◽  
Motor Performance ◽  
Controlled Trial ◽  
Controlled Study ◽  
Heme Oxygenase 1 ◽  
Randomized Controlled ◽  
Vr Training

Abstract Background: Virtual reality (VR)-based rehabilitation is the innovative approach in motor control training in individuals with stroke. Currently, most outcome assessments of motor performance in stroke were based on subjective functional scales and instruments. Detecting serum biomarkers related to inflammation, oxidative stress and neuroplasticity, might provide precise and subtle changes after motor control training in patients with stroke.Objectives: This study aims to identify the effects of immersive VR-based intervention of motor control training on motor function improvement, inflammation, oxidative stress and neuroplasticity in patients with stroke.Methods: This is an assessor-blinded, randomized controlled study. Patients with stroke will be randomly assigned to VR training (VRT) group or the conventional occupational therapy (COT) group. Clinical assessments will include motor performance and active range of motion (AROM) of the upper limb. Serum concentrations of inflammation, oxidative stress and neuroplasticity will be assessed, including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF).Expected outcomes: After the intervention, both groups will show improvements in motor performance and the changes of inflammation, oxidative stress and neuroplasticity. As compared to the COT group, the VRT group will show greater improvements in motor performance and AROM of the upper limb, greater induction of HO-1 and BDNF levels, and greater reductions in 8-OHdG.The trial registration number for this study is ChiCTR2100047853.

scholarly journals Clinical Effects of Immersive Multimodal BCI-VR Training after Bilateral Neuromodulation with rTMS on Upper Limb Motor Recovery after Stroke. A Study Protocol for a Randomized Controlled Trial

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 736
Author(s):  
Francisco José Sánchez-Cuesta ◽  
Aida Arroyo-Ferrer ◽  
Yeray González-Zamorano ◽  
Athanasios Vourvopoulos ◽  
Sergi Bermúdez i Badia ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Motor Imagery ◽  
Upper Limb ◽  
Cortical Excitability ◽  
Controlled Trial ◽  
Motor Recovery ◽  
Cortical Inhibition ◽  
Randomized Controlled ◽  
Vr Training

Background and Objectives: The motor sequelae after a stroke are frequently persistent and cause a high degree of disability. Cortical ischemic or hemorrhagic strokes affecting the cortico-spinal pathways are known to cause a reduction of cortical excitability in the lesioned area not only for the local connectivity impairment but also due to a contralateral hemisphere inhibitory action. Non-invasive brain stimulation using high frequency repetitive magnetic transcranial stimulation (rTMS) over the lesioned hemisphere and contralateral cortical inhibition using low-frequency rTMS have been shown to increase the excitability of the lesioned hemisphere. Mental representation techniques, neurofeedback, and virtual reality have also been shown to increase cortical excitability and complement conventional rehabilitation. Materials and Methods: We aim to carry out a single-blind, randomized, controlled trial aiming to study the efficacy of immersive multimodal Brain–Computer Interfacing-Virtual Reality (BCI-VR) training after bilateral neuromodulation with rTMS on upper limb motor recovery after subacute stroke (>3 months) compared to neuromodulation combined with conventional motor imagery tasks. This study will include 42 subjects in a randomized controlled trial design. The main expected outcomes are changes in the Motricity Index of the Arm (MI), dynamometry of the upper limb, score according to Fugl-Meyer for upper limb (FMA-UE), and changes in the Stroke Impact Scale (SIS). The evaluation will be carried out before the intervention, after each intervention and 15 days after the last session. Conclusions: This trial will show the additive value of VR immersive motor imagery as an adjuvant therapy combined with a known effective neuromodulation approach opening new perspectives for clinical rehabilitation protocols.

scholarly journals Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial

BMC Neurology ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chien-Yu Huang ◽  
Wei-Chi Chiang ◽  
Ya-Chin Yeh ◽  
Shih-Chen Fan ◽  
Wan-Hsien Yang ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Virtual Reality ◽  
Motor Control ◽  
Outcome Measures ◽  
Motor Function ◽  
Upper Limb ◽  
Serum Biomarkers ◽  
Chronic Stroke ◽  
Heme Oxygenase 1 ◽  
Clinical Assessments

Abstract Background Immersive virtual reality (VR)-based motor control training (VRT) is an innovative approach to improve motor function in patients with stroke. Currently, outcome measures for immersive VRT mainly focus on motor function. However, serum biomarkers help detect precise and subtle physiological changes. Therefore, this study aimed to identify the effects of immersive VRT on inflammation, oxidative stress, neuroplasticity and upper limb motor function in stroke patients. Methods Thirty patients with chronic stroke were randomized to the VRT or conventional occupational therapy (COT) groups. Serum biomarkers including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF) were assessed to reflect inflammation, oxidative stress and neuroplasticity. Clinical assessments including active range of motion of the upper limb and the Fugl-Meyer Assessment for upper extremity (FMA-UE) were also used. Two-way mixed analyses of variance (ANOVAs) were used to examine the effects of the intervention (VRT and COT) and time on serum biomarkers and upper limb motor function. Results We found significant time effects in serum IL-6 (p = 0.010), HO-1 (p = 0.002), 8-OHdG (p = 0.045), and all items/subscales of the clinical assessments (ps < 0.05), except FMA-UE-Coordination/Speed (p = 0.055). However, significant group effects existed only in items of the AROM-Elbow Extension (p = 0.007) and AROM-Forearm Pronation (p = 0.048). Moreover, significant interactions between time and group existed in item/subscales of FMA-UE-Shoulder/Elbow/Forearm (p = 0.004), FMA-UE-Total score (p = 0.008), and AROM-Shoulder Flexion (p = 0.001). Conclusion This was the first study to combine the effectiveness of immersive VRT using serum biomarkers as outcome measures. Our study demonstrated promising results that support the further application of commercial and immersive VR technologies in patients with chronic stroke.

Virtual reality training improves trainee performance in total hip arthroplasty: a randomized controlled trial

2019 ◽  
Vol 101-B (12) ◽  
pp. 1585-1592 ◽  
Author(s):  
Kartik Logishetty ◽  
Branavan Rudran ◽  
Justin P. Cobb
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Controlled Trial ◽  
Total Hip ◽  
Randomized Controlled ◽  
Surgical Trainees ◽  
Vr Training ◽  
Component Orientation

Aims Arthroplasty skills need to be acquired safely during training, yet operative experience is increasingly hard to acquire by trainees. Virtual reality (VR) training using headsets and motion-tracked controllers can simulate complex open procedures in a fully immersive operating theatre. The present study aimed to determine if trainees trained using VR perform better than those using conventional preparation for performing total hip arthroplasty (THA). Patients and Methods A total of 24 surgical trainees (seven female, 17 male; mean age 29 years (28 to 31)) volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience of anterior approach THA. Of these 24 trainees, 12 completed a six-week VR training programme in a simulation laboratory, while the other 12 received only conventional preparatory materials for learning THA. All trainees then performed a cadaveric THA, assessed independently by two hip surgeons. The primary outcome was technical and non-technical surgical performance measured by a THA-specific procedure-based assessment (PBA). Secondary outcomes were step completion measured by a task-specific checklist, error in acetabular component orientation, and procedure duration. Results VR-trained surgeons performed at a higher level than controls, with a median PBA of Level 3a (procedure performed with minimal guidance or intervention) versus Level 2a (guidance required for most/all of the procedure or part performed). VR-trained surgeons completed 33% more key steps than controls (mean 22 (sd 3) vs 12 (sd 3)), were 12° more accurate in component orientation (mean error 4° (sd 6°) vs 16° (sd 17°)), and were 18% faster (mean 42 minutes (sd 7) vs 51 minutes (sd 9)). Conclusion Procedural knowledge and psychomotor skills for THA learned in VR were transferred to cadaveric performance. Basic preparatory materials had limited value for trainees learning a new technique. VR training advanced trainees further up the learning curve, enabling highly precise component orientation and more efficient surgery. VR could augment traditional surgical training to improve how surgeons learn complex open procedures. Cite this article: Bone Joint J 2019;101-B:1585–1592

scholarly journals Effects of virtual reality associated with serious games for upper limb rehabilitation in patients with multiple sclerosis: randomized controlled trial

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Alicia Cuesta-Gómez ◽  
Patricia Sánchez-Herrera-Baeza ◽  
Edwin Daniel Oña-Simbaña ◽  
Alicia Martínez-Medina ◽  
Carmen Ortiz-Comino ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Upper Limb ◽  
Serious Games ◽  
Controlled Trial ◽  
Upper Limb Rehabilitation ◽  
Randomized Controlled ◽  
Limb Rehabilitation

scholarly journals Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke: a randomized controlled trial

2020 ◽  
Author(s):  
Yi Long ◽  
Rangge Ouyang ◽  
Jiaqi Zhang
Keyword(s):  
Virtual Reality ◽  
Upper Extremity ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Performance Measure ◽  
Group Differences ◽  
Occupational Performance ◽  
Randomized Controlled ◽  
Canadian Occupational Performance Measure ◽  
Vr Training

Abstract Background—Virtual reality (VR) has been broadly applied in post-stroke rehabilitation. However, studies on occupational performance and self-efficacy as primary outcomes of stroke rehabilitation using VR are lacking. Thus, this study aims to investigate the effects of VR training on occupational performance and self-efficacy in patients with stroke.Methods—This was an assessor-blinded, randomized controlled trial. Sixty participants with first-ever stroke (< 1-year onset) underwent rehabilitation in a single acute hospital. Participants were randomly assigned to either the VR group (n = 30) or control group (n = 30). Both groups received dose-matched conventional rehabilitation (i.e., 45 min, five times per week over 3 weeks). The VR group received additional 45-min VR training for five weekdays over 3 weeks. The primary outcome measures were the Canadian Occupational Performance Measure and Stroke Self-Efficacy Questionnaire. Secondary outcome measures included Modified Barthel Index, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity. The assessment was conducted at baseline and after the 3-week intervention.Results—A total of 52 participants (86.7%) completed the trial. Significant between-group differences in Stroke Self-Efficacy Questionnaire (Median Difference = 8, P = 0.043) and Modified Barthel Index (Median Difference = 10, P = 0.030) were found; however, no significant between-group differences in Canadian Occupational Performance Measure, Fugl-Meyer Assessment-Upper Extremity, and Functional Test for the Hemiplegic Upper Extremity were noted. No serious adverse reactions related to the program were reported.Conclusions—Additional VR training could help improve the self-efficacy and activities of daily living of patients with stroke; however, it was not superior to conventional training in the improvement of upper limb functions, occupational performance, and satisfaction. Nevertheless, VR could be integrated into conventional rehabilitation programs to enhance self-efficacy of patients after stroke.Trial Registration—This study was successfully registered under the title “Effects of virtual reality training on occupational performance and self-efficacy of patients with stroke” on October 13 2019 and could be located in http://www.chictr.org with the study identifier ChiCTR1900026550.

scholarly journals Can virtual reality improve traditional anatomical education?: A randomized controlled trial on use of 3D skull model

2020 ◽  
Author(s):  
Shi Chen ◽  
Jiawei Zhu ◽  
Cheng Cheng ◽  
Zhouxian Pan ◽  
Lingshan Liu ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Controlled Trial ◽  
Controlled Study ◽  
Post Intervention ◽  
Positive Feedbacks ◽  
Randomized Controlled ◽  
Skull Model ◽  
Complex Anatomy ◽  
Identification Test ◽  
Theory Test

Abstract Background Anatomy teaching is trending towards a mixture of lectures, cadaveric models, 2D atlas and computer simulations. This paper presents a study which compare the educational effectiveness of virtual reality (VR) skull model with that of cadaveric skulls and atlas. Methods A randomized controlled study with 73 medical students was carried out with three different groups: VR skull (N = 25), cadaveric skull (N = 25) and atlas (N = 23). Anatomical structures were taught through an introductory lecture and a model-based learning. All students completed the pre- and post-intervention test, which is composed of a theory test and an identification test. Results Participants in all three groups gained significantly higher total scores at post-intervention test than at pre-intervention test; the post-identification test score of VR group was non-statistically higher than the other group (VR 30 [22-33.5], cadaver 26 [20-31.5], atlas 28[20-33]). Participants in VR and cadaver group provided more positive feedbacks on their learning models (VR 26 [19-30] vs. 25 [19.5-29.5] vs. 12 [9-20], p<0.05). Conclusions VR skull model showed equivalent efficiency in teaching anatomy structure as cadaver skull and atlas. In addition, VR can assist participants in understanding complex anatomy structures with higher motivation and tolerable adverse effects.

scholarly journals Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

2021 ◽  
Author(s):  
Yu-Hsin Chen ◽  
Chia-Ling Chen ◽  
Ying-Zu Huang ◽  
Hsieh-Ching Chen ◽  
Chung-Yao Chen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Virtual Reality ◽  
Outcome Measures ◽  
Upper Limb ◽  
Controlled Trial ◽  
Theta Burst Stimulation ◽  
Burst Stimulation ◽  
Randomized Controlled ◽  
Theta Burst ◽  
Cycling Training

Abstract Background: Virtual reality and arm cycling have been reported as effective treatment to improve upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb motor function in patients with stroke.Methods: In this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Co-primary outcome measures for body function were Modified Ashworth Scale Upper Extremity (MAS-UE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Paired t test was performed to evaluate the effectiveness after the intervention and analysis of covariance (ANCOVA) was conducted to compare the therapeutic effects between two groups.Results: At post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. ANCOVA revealed that the iTBS group presented greater improvement than the sham group significantly in MAS-UE, NHPT and SIS. However, there were no significant differences in the changes of the FMA-UE, ARAT, BBT, and MAL between groups.Conclusions: Intermittent TBS showed augmented efficacy on VCT for reducing spasticity, improving manual dexterity, and increasing participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb motor function recovery, especially manual dexterity, in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration: This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017.

scholarly journals Virtual Reality Simulation in Peritoneal Dialysis Training: The Beginning of a New Era

2018 ◽  
Vol 47 (1-3) ◽  
pp. 265-269
Author(s):  
Panagiota Zgoura ◽  
Daniel Hettich ◽  
Jonathan Natzel ◽  
Fedai Özcan ◽  
Boris Kantzow
Keyword(s):  
Virtual Reality ◽  
Peritoneal Dialysis ◽  
Controlled Trial ◽  
Virtual Reality Simulation ◽  
Infection Rates ◽  
New Era ◽  
Randomized Controlled ◽  
Traditional Training ◽  
Vr Training ◽  
The Individual

Background/Aim: Peritonitis rates in peritoneal dialysis (PD) vary considerably not only across countries but also between centers in the same country. Patient education has been shown to significantly reduce infection rates but up till now training lacks standardization with patients being trained using different methods and media (e.g., illustrations, videos). As a result, patients may be insufficiently experienced in performing PD, which might be one of the causes for high peritonitis rates. To address these issues, we developed a PD training program based on virtual reality (VR). Methods: To become acquainted with the PD procedure, patients are equipped with a VR headset and controllers. They are presented with a virtual PD set, which simulates the feeling of sitting in front of a real PD set. The patient is enabled to run through the program as often as necessary to become familiarized with the whole PD procedure. The aim is to standardize, facilitate, and accelerate the individual learning process. To compare the effect of the applied training method to traditional training, a randomized controlled trial is underway. Conclusion: Previous studies on the effectiveness of learning showed that VR training applications are superior to traditional methods, such as text- or video-based training. However, no study has been undertaken in the context of dialysis. We believe that the implementation of VR training programs in clinical practice will be beneficial in improving the patient’s proficiency, and thereby the quality and safety of PD.

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