MD Conference Express ISC 2013 - (Page 34)
OTHER NEWS
Virtual Reality in Stroke Rehabilitation
Written By Emma Hitt, PhD
Peer-Reviewed
Highlights From
Stroke is a leading cause of adult disability, and around two thirds of stroke survivors continue
to experience motor deficits in their arms and hands that are associated with diminished quality
of life [Saposnik G et al. Stroke 2011]. The current paradigm in stroke rehabilitation involves
repetitive, high-intensity, task-specific stimulation to improve motor recovery [Luft AR, Hanley
DF. JAMA 2006; Kalra L, Ratan R. Stroke 2007]. However, only a few of the current techniques
have effectively shown a significant improvement in arm function after stroke [Langhorne P et al.
Lancet Neurol 2009]. Gustavo Saposnik, MD, MSc, St. Michael’s Hospital, University of Toronto,
Toronto, Ontario, Canada, presented the benefits of using virtual reality (VR) gaming technology
in stroke rehabilitation and how VR may engage the brain reward system.
Conventional stroke rehabilitation has several limitations [Langhorne P et al. Lancet Neurol
2009]. It is time consuming, and labor and resource intensive. It provides modest effects that are
initially underappreciated by stroke survivors, and compliance problems and high dropout rates
can limit recovery. In addition, in certain regions the availability and conventional rehabilitation
may be costly.
VR allows a user to interact with a multisensory computer-simulated environment and receive
instant feedback on performance. Neuroplasticity and the reorganization of cerebral activity are the
basis of stroke rehabilitation, and VR has the potential to affect neuroplasticity through repetition,
intensity, and task-oriented training [Kalra L, Ratan R. Stroke 2007; Saposnik G et al. Stroke 2011].
The availability of VR video game systems for home use has made this technology less expensive,
and more accessible to clinicians and patients.
A meta-analysis of the available data on VR in stroke rehabilitation revealed that 11 of 12
studies showed a significant benefit of VR in stroke rehabilitation [Saposnik G et al. Stroke 2011].
Five small clinical trials showed that patients randomized to VR were nearly 5 times more likely
to benefit compared with controls. Among observational studies, there was a 20.1% (95% CI, 11.0
to 33.8) improvement in motor function and a 14.7% (95% CI, 8.7 to 23.6) improvement in motor
impairment after several 30- to 60-minute VR sessions in a 4- to 6-week time period (Figure 1).
Figure 1. Meta-Analysis of Observational Studies Using Virtual Reality Systems in Upper Limb
Stroke Rehabilitation
A. Motor Impairment
Study Name
Statistics for Each Study
% Improve
% Improvement and 95% CI
Upper
Limit
0.524
p Value
0.150
Lower
Limit
0.028
z Value
Holden
-1.858
0.063
Piron
Merians
Kamper
Yong
0.150
0.150
0.165
0.122
0.075
0.025
0.026
0.030
0.277
0.551
0.592
0.383
-4.380
-1.752
-1.592
-2.584
0.000
0.080
0.111
0.010
Total
0.147
0.087
0.236
-5.900
0.000
-1.00
Heterogeneity: X2=0.102; df=4 (p=0.99); I2=0%
-0.50
0.00
0.50
1.00
B. Motor Function
Study Name
Statistics for Each Study
% Improve
Holden
Boian
Merians
Broeren
Kamper
Yong
Total
0.240
0.250
0.150
0.110
0.207
0.206
0.201
Lower
Limit
0.064
0.034
0.025
0.007
0.040
0.072
0.110
Upper
Limit
0.593
0.762
0.551
0.671
0.619
0.466
0.338
Heterogeneity: X2=0.52; df=5 (p=0.99); I2=0%
% Improvement and 95% CI
z Value
p Value
-1.477
-0.951
-1.752
-1.463
-1.440
-2.183
-3.822
0.140
0.341
0.080
0.144
0.150
0.029
0.000
-1.00
-0.50
0.00
0.50
1.00
Adapted from Saposnik et al. Stroke 2011.
34
April 2013
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Table of Contents for the Digital Edition of MD Conference Express ISC 2013
MD Conference Express ISC 2013
Contents
Defending the Stroke Guidelines
Stroke Update: An Overview of What Is Going on in the Area of Stroke
Brain Imaging Does Not Help Identify Patients Who May Benefit From Endovascular Treatments for Acute Ischemic Stroke
MISTIE II Trial: 365-Day Results Demonstrate Improved Outcomes and Cost Benefit
Addition of AMPLATZER PFO Occluder to Medical Therapy Is Beneficial in Patients With Cryptogenic Stroke and PFO
Intraoperative CT-Guided Endoscopic Surgery for ICH [ICES]
The EMBRACE Trial: Prolonged Ambulatory Cardiac Monitoring Improves the Detection and Treatment of Atrial Fibrillation in Patients With Cryptogenic Stroke
DP-b99 Does Not Improve Recovery Following Acute Ischemic Stroke
The Secondary Prevention of Small Subcortical Strokes Trial: Blood Pressure Intervention Results
Final Results of the Solitaire FR Thrombectomy for Acute Revascularization: The STAR Trial
Clopidogrel Plus Aspirin Reduces Risk of Recurrent Stroke: The CHANCE Trial
Reversal of Chronic Hypoperfusion to Improve Cognitive Function: The RECON Trial
Cardioembolic Stroke
IMS III
Novel Anticoagulants in Vascular Neurology Practice
Wake-Up Stroke
Virtual Reality in Stroke Rehabilitation
Reward Improves Long-Term Retention of a Motor Memory Through Induction of Offline Memory Gains
MD Conference Express ISC 2013
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