Effectiveness of Commercial Gaming-Based Virtual Reality Movement Therapy on Functional Recovery of Upper Extremity in Subacute Stroke Patients

Introduction Upper limb motor impairment after a stroke is an important sequela. Constraint-induced movement therapy is a rehabilitation approach that has strong evidence. The incorporation of transcranial direct-current stimulation has been proposed; however, there is a lack of studies that confirm its benefits. The principal aim is to compare the effectiveness of 7 days of active versus sham bi-hemispheric transcranial direct-current stimulation, combined with modified constraint-induced movement therapy, for motor and functional recovery of the hemiparetic upper limb in subacute stroke patients. Method/design Randomized, double blind, sham-controlled, parallel group clinical trial in two stroke units. Participants: adults over 18 years, at least 2 days post unihemispheric stroke event, with hemiparesis, and without severe pain, aphasia or cognitive impairment. Intervention: Patients will receive 7 days of continuous therapy and be assigned to one of the treatment groups: active bi-hemispheric transcranial direct-current stimulation or sham bi-hemispheric transcranial direct-current stimulation. Measurement: Evaluations will take place at days 0, 5, 7 and 10, and at 3rd months. The Fugl-Meyer Assessment – Upper Extremity, Wolf Motor Function Test, Functional Independence Measure and Stroke Impact Scale are considered. Discussion Modified constraint-induced movement therapy plus transcranial direct-current stimulation in subacute stroke patients with hemiparesis could maximize motor and functional recovery. Trial registration: ClinicalTrials.gov identifier NCT03452254.

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Effects of mirror therapy vs modified constraint induced movement therapy on upper extremity in subacute stroke patients

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v20i2.51542 ◽

2021 ◽

Vol 20 (2) ◽

pp. 323-329

Author(s):

Kamatchi Kaviraja ◽

G Tharani ◽

G Yuvarani ◽

N Kaviraja ◽

Jenifer Augustina S ◽

...

Keyword(s):

Upper Extremity ◽

Upper Limb ◽

Movement Therapy ◽

Systemic Hypertension ◽

Mirror Therapy ◽

Stroke Patients ◽

Functional Index ◽

Constraint Induced Movement Therapy ◽

Subacute Stroke ◽

The Brain

Objective: To compare and to examine the effectiveness of mirror therapy and modified constraint induced movement therapy (mCIMT) on upper extremity in subacute stroke patients. Background: Stroke or cerebral vascular accident is sudden dead of the brain cells due to inadequate blood flow. The WHO defines stroke as rapidly developing clinical signs of focal disturbance of cerebral function, with symptoms lasting for 24hrs or longer or leading to death, with no apparent cause other than of vascular origin. The most common consequence of stroke is loss of upper limb function. The protocol planned for improving the function of upper limb are mirror therapy and modified constraint induced movement therapy (mCIMT). Mirror therapy is a simple and inexpensive treatment which uses the visual information activating the premotor and motor cortex of the brain. This is explained by activation of so called mirrorneuron system. Whereas mCIMT utilises the redundant pathway in brain through neuro plasticity. Methodology: A total of 30 participants with subacute stroke were selected. The inclusion criteria are both gender of age 55-70 years and duration of 2-12 months of post stroke. Participants with mini mental state examination score<24, uncontrolled systemic hypertension, severe shoulder subluxation, previous stroke and severe cardiac failure were excluded. The outcome measures were measured using Upper Extremity Functional Index (UEFI) and Fugl Meyer Upper Extremity Scale. Procedure: All 30 participants with sub-acute stroke were divided into two groups. Both the group individuals were assessed for pre test using Fugl Meyer Upper Extremity Scale and Upper Extremity Functional Index Scale. Group A (15) was assigned to mirror therapy for 5 days a week, for 4 weeks and rest intervals was given. Similarly group B (15) was assigned to modified constraint induced movement therapy for 5 days a week, for 4 weeks. Both the groups were given conventional therapy for 20 mins. At the end of study subjects were assessed for post test using UEFI and Fugl Meyer upper extremity scale. Results: The Modified Constraint Induced Movement (mCIMT) is more effective than Mirror Therapy in improving the hemiparetic upper extremity in subacute stroke patients. Bangladesh Journal of Medical Science Vol.20(2) 2021 p.323-329

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Postural Control Disturbances Induced by Virtual Reality in Stroke Patients

Applied Sciences ◽

10.3390/app11041510 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1510

Author(s):

Charles Morizio ◽

Maxime Billot ◽

Jean-Christophe Daviet ◽

Stéphane Baudry ◽

Christophe Barbanchon ◽

...

Keyword(s):

Virtual Reality ◽

Postural Control ◽

Virtual Environments ◽

Center Of Pressure ◽

Dynamic Condition ◽

Static Condition ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

People who survive a stroke are often left with long-term neurologic deficits that induce, among other impairments, balance disorders. While virtual reality (VR) is growing in popularity for postural control rehabilitation in post-stroke patients, studies on the effect of challenging virtual environments, simulating common daily situations on postural control in post-stroke patients, are scarce. This study is a first step to document the postural response of stroke patients to different challenging virtual environments. Five subacute stroke patients and fifteen age-matched healthy adults were included. All participants underwent posturographic tests in control conditions (open and closed eyes) and virtual environment without (one static condition) and with avatars (four dynamic conditions) using a head-mounted device for VR. In dynamic environments, we modulated the density of the virtual crowd (dense and light crowd) and the avoidance space with the avatars (near or far). Center of pressure velocity was collected by trial throughout randomized 30-s periods. Results showed that more challenging conditions (dynamic condition) induced greater postural disturbances in stroke patients than in healthy counterparts. Our study suggests that virtual reality environments should be adjusted in light of obtaining more or less challenging conditions.

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