Friday, April 8, 2011

Virtual Reality in Stroke Rehab: Meta-Analysis (study)

The current study is one specific to upper-body (arm) rehabilitation post-stroke and therefore was limited to only 12 studies totaling 195 patients, of which only 5 were randomized-controlled studies (RCT). So to generalize these findings to all stroke patients would not be recommended, however, the findings do indicate that almost all studies demonstrated improved motor function by using VR. As we've advocated for a long time, virtual reality/exergames/active gaming technology can be used to improve expected outcomes especially if it is incorporated with other forms of modalities and regiments. 
XaviX EyeHand

Virtual Reality in Stroke Rehabilitation: A Meta-Analysis and Implications for Clinicians -- Saposnik et al., 10.1161/STROKEAHA.110.605451 -- Stroke

doi: 10.1161/STROKEAHA.110.605451

Using games and virtual reality to assist patients recovering from stroke, traumatic brain injury (TBI) and other neurological disorders and conditions is not a new field. In fact for many years, pioneers like Skip Rizzo (USC) have been cranking away at merging and modifying technologies and therapeutic modalities to best service their patients.  At last year's NIH sponsored workshop on using Virtual Reality to impact obesity and diabetes, Skip, Belinda Lange and Sheryl Flynn presented their work, research and demonstrations of new software related to balance rehabilitation.

Saposnik, G., & Levin, M. (2011). Virtual Reality in Stroke Rehabilitation: A Meta-Analysis and Implications for Clinicians Stroke DOI: 10.1161/STROKEAHA.110.605451

Background and Purpose—Approximately two thirds of stroke survivors continue to experience motor deficits of the arm resulting in diminished quality of life. Conventional rehabilitation provides modest and sometimes delayed effects. Virtual reality (VR) technology is a novel adjunctive therapy that could be applied in neurorehabilitation. We performed a meta-analysis to determine the added benefit of VR technology on arm motor recovery after stroke.

Results—From the 35 studies identified, 12 met the inclusion/exclusion criteria totaling 195 participants. Among them, there were 5 randomized clinical trials and 7 observational studies with a pre-/postintervention design. Interventions were delivered within 4 to 6 weeks in 9 of the studies and within 2 to 3 weeks in the remaining 3. Eleven of 12 studies showed a significant benefit toward VR for the selected outcomes. In the pooled analysis of all 5 randomized controlled trials, the effect of VR on motor impairment (Fugl-Meyer) was OR=4.89 (95% CI, 1.31 to 18.3). No significant difference was observed for Box and Block Test or motor function. Among observational studies, there was a 14.7% (95% CI, 8.7%–23.6%) improvement in motor impairment and a 20.1% (95% CI, 11.0%–33.8%) improvement in motor function after VR.

Conclusions—VR and video game applications are novel and potentially useful technologies that can be combined with conventional rehabilitation for upper arm improvement after stroke.
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