The Impact of Virtual Reality on Upper Extremity Function In Stroke Patients: A Pilot Study

Main Article Content

K. Kamatchi
Jibi Paul
Jagatheesan Alagesan
N. Harikrishnan

Keywords

Stroke, Virtual Reality, Fugl Meyer Upper Extremity scale ,Electromyogram, cerebrovascular accident

Abstract

Background and Objectives: A stroke, also known as a CVA (cerebrovascular accident), happens when blood flow to a portion of the brain is interrupted. When a blood vessel is blocked or ruptured, this occurs. It can result in permanent brain damage because brain cells die if they are not supplied with oxygenated blood on a regular basis. Because the majority of activities of daily living (ADL) require upper and lower limbs, and only a small percentage of patients will restore function, it is critical to enhance functional capabilities in post-stroke patients. Thus, the study focuses on the effectiveness of virtual reality in the rehabilitation of the Stroke patients to improve the upper extremity function.
Materials and Methods: 8 subjects was selected based on the selection criteria with age group between 45-70 years, people who had stroke for the first time with the onset of 2-6 months, 1st unilateral cerebral infarction, both gender (male & female), people who scored4-5 in Brunnstrom stage of recovery and people who scored between level 3 & 4 in functional test for hemiplegic upper extremity scale was included in the study. People with recent fracture & recent surgery, with cognitive or communication impairments, Parkinson’s disease, severe cardiovascular disease, with severe pain and muscleweakness, with vision and hearing problems was excluded from the study. Pre-test was done by using Fugl-Meyer Upper Extremity scale, EMG (Electromyogram).The VR treatment was conducted for 2 months (3 days / week, 45 minutes a day with the rest period of 2 minutes, between each set of games.).Statistics were done based on the data collected.
Result: On comparing the pre and post test values shows highly significance difference between Pre-test and Post-test mean values at P ≤ 0.001. The result of the study showed that Virtual Reality (VR) was effective in improving the upper limb function among MCA Stroke patients.
Conclusion: The conclusion of the study showed that Virtual Reality (VR) was effective in improving the upper limb function among Stroke patients. The intensive and repetitive use of the affected upper limb by using Immersive Virtual reality showed positive effects on improving the motor function and skills in stroke patients.

Abstract 291 | pdf Downloads 203

References

1. Suelen Santos Alves, Patricia Silva De Camargo, Gabriela Nagai Ocamoto., Effects of Virtual Reality and Motor Imagery Techniques using Fugl Meyer Assessment scale in post-stroke patients. International Journal of Therapy and Rehabilitation, November 2018, Vol 25, No 11.
2. Roshini Rajappan, Kartikeyan Selvaganapathy, Syed Abudaheer., Effect of Mirror Therapy on Hemiparetic Upper Extremity in Subacute Stroke patients. Int J Physiother. Dec 2017, Vol 2 (6), 1041-1046.
3. Navina Shrestha, K. Vadivelan, V.P.R. Sivakumar., A Comparative study on Task - Specific Training with trunk restrain versus Constraint Induced Movement Therapy on upper extremity function in sub-acute stroke conducted in a physiotherapy hospital in Nepal., International Journal of Scientific and Research, Volume 6, Issue 9, ISSN 2250-3153.
4. Anselmo de Silva, AT Viana, Tatiana G C Pinho Barroso., Positive Balance Recovery in Ischemic Post-Stroke patients with delayed access to Physical Therapy. BioMed Research International, Vol 2020, doi.org/10.1155/9153174.
5. Sung Ho Jang, Min Cheol Chang., Motor Outcomes of Patients with a complete Middle Cerebral Artery territory Infarct. Neural Regenerative Research, 2013; Vol 8(20):1892-1897.
6. Seong-Sin Kim, Byoung Hee Lee. Motor imagery training improves upper extremity performance in stroke patients. J. Phys. Ther. Sci. Vol 27, No 7, 27: 2289-2291.
7. Chien‑Yu Huang, Wei‑Chi Chiang, Ya‑Chin Yeh, Shih‑Chen Fan, Wan‑Hsien Yang, Ho‑Chang Kuo, Ping‑Chia Li.,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. https://doi.org/10.1186/s12883-021-02547-4.
8. Cristina Russo, Laura Veronelli, Carlotta Casati, Alessia Monti, Laura Perucca, Francesco Ferraro, Massimo Corbo, Nadia Bolognini., Explicit motorsequence learning after stroke: a neuropsychological study. Experimental Brain Research (2021) 239, 2303-2316.
9. Naoyuki Takeuchi, Shin-Ichi Izumi., Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity. Volume 2013, Article ID 128641, http://dx.doi.org/10.1155/2013/128641
10. Riva G, Baños RM, Botella C, Mantovani F, Gaggioli A., Transforming experience : the potential of augmented reality and virtual reality for enhancing personal and clinical change.Front Psychiatry. 2016;7:164.
11. Mohammed Abd El Kafy, Mansour Abdullah Alshehri, Amir Abdel Raouf El-Fiky., The Effect of Virtual Reality-Based Therapy on improving upper limb functions in individuals with Stroke: A Randomized Control Trial. Front Aging Neurosci. 2021; 13: 731343.
12. Irene Cortés-Pérez, Francisco Antonio Nieto-Escamez, Esteban Obrero-Gaitán., Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series. Brain Sci. 2020, 10, 296.
13. Willliam E Clark, Manoj Sivan, Rory JO’Connor., Evaluating the use of robotic and virtual reality rehabilitation technologies to improve function in stroke survivors: A narrative review. J Rehabil Assist Technol Eng,. doi: 10.1177/2055668319863557.
14. Madhumanti Mukherjee, Nilima Bedekar, Parag K. Sancheti, Ashok Shyam., ,Immediate and Short-Term Effect of Virtual Reality Training on Pain, Range of Motion, and Kinesiophobia in Patients with Cervical Spondylosis. Indian J Phys Ther Res 2020;2:55-60.
15. Ho-Hee Son., The Effects of Virtual Reality Games in Posture Correction Exercise on the Posture and Balance of Patients with Forward Head Posture. J Korean Soc PhysMed, 2020; 15(2):11-21.
16. David Morales Tejera, Hector Beltran Alacreu, Roberto Cano-de-la-Cuerda, Jose Vicente Leon Hernandez, Aitor Martin, Cesar Calvo-Lobo, Alfonso Gil-Martinez.,Effects of Virtual Reality versus Exercise on Pain, Functional, Somatosensory and Psychosocial Outcomes in Patients with Non-specific Chronic Neck Pain: A Randomized Clinical Trial. Int. J. Environ. Res. Public Health 2020, 17, 5950.
17. Rezaei I, Razeghi M, Ebrahimi S, Kayedi S, Rezaeian Zadeh A., A Novel Virtual Reality Technique compared to Conventional Proprioceptive Training to treat Neck Pain: A Randomized Controlled Trial. J Biomed Phys Eng 2019; 9(3).
18. Steele KM, Papazian C and Feldner HA., Muscle Activity After Stroke: Perspectives on Deploying Surface Electromyography in Acute Care. Front. Neurol. 11:576757. doi: 10.3389/fneur.2020.576757.
19. Rubana H Chowdhury, Mamun B Reaz, Mohd Alauddin Bin Mohd Ali, Ashrif A Bakar, K Chellappan, Chang.,Surface electromyography signal processing and classification techniques. Sensors (Basel). 2013 Sep 17;13(9):12431-66. doi: 10.3390/s130912431.
20. David J Gladstone, Cynthia J Danells, Sandra E Black., The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of its Measurement Properties Neurorehabilitation and neural Repair. 2002;16(3):232-40.
21. Shogo Hiragami, Yu Inoue, Kazuhiro Harada.,Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis. J. Phys. Ther. Sci. 31: 917–921.
22. Frank Behrendt, Julia Charlotte Rizza, Fabian Blum, Zorica Suica, Corina Schuster-Amft., German version of the Chedoke McMaster arm and hand activity inventory (CAHAI-G): intra-rater reliability and responsiveness. Health and Quality of Life Outcomes (2020) 18:247.
23. Hmingsangi Zaucha, Annie Thomas., Utility of Chedoke arm hand activity inventory in the Indian population: mixed method research sequential explanatoryInt J Res Med Sci. 2019 Jun;7(6):2273-2277.
24. Barreca SR, Stratford PW, Lambert CL, Masters LM, Streiner DL., Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil. 2005;86:1616–22.
25. Masters LM, Lambert CL, Griffiths J, McBay C., Validation of three shortened versions of the Chedoke arm and hand activity inventory. Physiother Can. 2006;58:148–56
26. Han Suk Lee, Yoo Junk Park, Sun Wook Park., The Effects of Virtual Reality Training on function in Chronic Stroke patients: A Systematic Review and Meta-Analysis. BioMed Research International, Volume 2019, https://doi.org/10.1155/2019/7595639.
27. Ksenija Sevcenko, Ingrid Lindgren., The effects of virtual reality training in stroke and Parkinson’s disease rehabilitation: a systematic review and a perspective on usability. Eur Rev Aging Phys Act 19, 4 (2022). https://doi.org/10.1186/s11556-022-00283-3.