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Impact of virtual reality-based rehabilitation on functional outcomes in patients with acute stroke: a retrospective case-matched study

  • Tsung-Han Ho
  • Fu-Chi Yang
  • Ruei-Ching Lin
  • Wu-Chien Chien
  • Chi-Hsiang Chung
  • Shang-Lin Chiang
  • Chung-Hsing Chou
  • Chia-Kuang Tsai
  • Chia-Lin Tsai
  • Yu-Kai Lin
  • Jiunn-Tay LeeEmail author
Original Communication

Abstract

Background and objectives

To date, the efficacy of the virtual reality (VR) application for acute stroke compared with conventional therapy (CT) remains unclear. This retrospective study aims to assess the impact of adjuvant VR technology on multidimensional therapy for patients with acute-stage stroke.

Methods

100 acute ischemic stroke patients with onset within 7 days who underwent combined adjuvant VR-based rehabilitation program and CT (intervention group–VR + CT) were compared to an equal number of cross-matched patients who received CT alone. While the intervention group received 40-min CT plus 20-min VR program (seven times for 1 week), the comparison group received time-matched CT alone. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), medical cost-effectiveness, and shortening of hospital stay were used as outcome measures.

Results

Posttreatment, the VR + CT group revealed significantly improved NIHSS and mRS (P < 0.001), whereas only the mRS improvement was remarkable in the CT group. In between-group comparisons, the intervention group had better improvements of symptom severity (NIHSS percentage improvement from the baseline; 20.18% vs. 4.59%, P < 0.005), functional outcomes (mRS improvement from the baseline; − 0.58 vs. − 0.23, P < 0.001), and reduced medical cost (Taiwan dollar; 49474 vs. 66306, P < 0.005). Furthermore, the VR + CT group reached markedly higher proportion of functional independence in activities of daily living (mRS, 0–2) at discharge compared with the CT group (68% vs. 60%, P < 0.001).

Conclusions

This study suggests that the combination of VR-based rehabilitation and traditional therapy could be more effective for neurorehabilitation than CT alone in the early improvement of symptom severity, functional outcomes, and lower medical expenditure in acute stroke patients.

Keywords

Virtual reality Neurorehabilitation Acute stroke National Institutes of Health Stroke Scale Modified Rankin Scale Activities of daily living Lower medical expenditure 

Notes

Acknowledgements

The authors wish to acknowledge Mr. Ray Chen and the Long Good team for developing the software programs for acute stroke rehabilitation.

Author contributions

J-TL and F-CY designed the study and prepared the ethics application documents. T-HH compiled the majority of the manuscript. R-CL, S-LC, C-HC, C-KT, C-LT, and Y-KL participated in study design meetings. W-CC and C-HC carried out the data analysis; All authors read and approve the final manuscript.

Funding

This study was supported in part by grants from the Ministry of Science and Technology (MOST 106-2314-B-016-007- MY2; MOST 107-2314-B-016 -017), Ministry of National Defense Medical Affairs Bureau (MAB-106-041; MAB-106-042; MAB-107-025), Tri-Service General Hospital (TSGH-C107-073; TSGH-C107-072), Teh-Tzer Study Group for Human Medical Research Foundation (A1061038), and Cheng Hsin General Hospital (CH-NDMC-106-13). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Ethical approval

The study was approved by the Institutional Review Board on Human Subjects Research and Ethics Committees of Tri-Service General Hospital, National Defense Medical Center, Taiwan. (TSGHIRB No. 1-106-05-041).

Conflicts of interest

The authors declar no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

  1. 1.
    Pedreira da Fonseca E, Ribeiro da Silva NM, Pinto EB (2017) Therapeutic effect of virtual reality on post-stroke patients: randomized clinical trial. J Stroke Cerebrovasc Dis 26:94–100CrossRefGoogle Scholar
  2. 2.
    Lee HC, Huang CL, Ho SH, Sung WH (2017) The effect of a virtual reality game intervention on balance for patients with stroke: a randomized controlled trial. Games Health J 6:303–311CrossRefGoogle Scholar
  3. 3.
    Li Z, Han XG, Sheng J, Ma SJ (2016) Virtual reality for improving balance in patients after stroke: a systematic review and meta-analysis. Clin Rehabil 30:432–440CrossRefGoogle Scholar
  4. 4.
    Lee KH (2015) Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1. J Phys Ther Sci 27:1637–1640CrossRefGoogle Scholar
  5. 5.
    Choi JH, Han EY, Kim BR et al (2014) Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients. Ann Rehabil Med 38:485–493CrossRefGoogle Scholar
  6. 6.
    Vanbellingen T, Filius SJ, Nyffeler T, van Wegen EEH (2017) Usability of videogame-based dexterity training in the early rehabilitation phase of stroke patients: a pilot study. Front Neurol 8:654CrossRefGoogle Scholar
  7. 7.
    de Rooij IJ, van de Port IG, Meijer JG (2016) Effect of virtual reality training on balance and gait ability in patients with stroke: systematic review and meta-analysis. Phys Ther 96:1905–1918CrossRefGoogle Scholar
  8. 8.
    Carregosa AA, Aguiar Dos Santos LR, Masruha MR et al (2018) Virtual rehabilitation through Nintendo Wii in poststroke patients: follow-up. J Stroke Cerebrovasc Dis 27:494–498CrossRefGoogle Scholar
  9. 9.
    Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M (2017) Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev 11:CD008349Google Scholar
  10. 10.
    da Silva Cameirão M, Bermúdez I, Badia S, Duarte E, Verschure PF (2011) Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restor Neurol Neurosci 29:287–298Google Scholar
  11. 11.
    Ji EK, Lee SH (2016) Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: A preliminary study. J Phys Ther Sci 28:3168–3172CrossRefGoogle Scholar
  12. 12.
    Lohse KR, Hilderman CG, Cheung KL, Tatla S, Van der Loos HF (2014) Virtual reality therapy for adults post-stroke: a systematic review and meta-analysis exploring virtual environments and commercial games in therapy. PLoS One 9:e93318CrossRefGoogle Scholar
  13. 13.
    Lee SJ, Chun MH (2014) Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Arch Phys Med Rehabil 95:431–438CrossRefGoogle Scholar
  14. 14.
    Bergmann J, Krewer C, Bauer P, Koenig A, Riener R, Müller F (2018) Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. Eur J Phys Rehabil Med 54:397–407Google Scholar
  15. 15.
    Kwon JS, Park MJ, Yoon IJ, Park SH (2012) Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial. NeuroRehabilitation 31:379–385Google Scholar
  16. 16.
    Corbetta D, Imeri F, Gatti R (2015) Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. J Physiother 61:117–124CrossRefGoogle Scholar
  17. 17.
    Schuster-Amft C, Eng K, Lehmann I et al (2014) Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial. Trials 15:350CrossRefGoogle Scholar
  18. 18.
    Newcommon NJ, Green TL, Haley E, Cooke T, Hill MD (2003) Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin Scale. Stroke 34:377–378CrossRefGoogle Scholar
  19. 19.
    Muir KW, Weir CJ, Murray GD, Povey C, Lees KR (1996) Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke 27:1817–1820CrossRefGoogle Scholar
  20. 20.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607CrossRefGoogle Scholar
  21. 21.
    Saver JL, Filip B, Hamilton S et al (2010) FAST-MAG Investigators and Coordinators. Improving the reliability of stroke disability grading in clinical trials and clinical practice: the Rankin Focused Assessment (RFA). Stroke 41:992–995CrossRefGoogle Scholar
  22. 22.
    Quinn TJ, Taylor-Rowan M, Coyte A et al (2017) Pre-stroke modified rankin scale: evaluation of validity, prognostic accuracy, and association with treatment. Front Neurol 8:275CrossRefGoogle Scholar
  23. 23.
    Palma GC, Freitas TB, Bonuzzi GM et al (2017) Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review. Top Stroke Rehabil 24:269–278CrossRefGoogle Scholar
  24. 24.
    Kiper P, Agostini M, Luque-Moreno C, Tonin P, Turolla A (2014) Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial. Biomed Res Int 2014:752128CrossRefGoogle Scholar
  25. 25.
    Turolla A, Dam M, Ventura L et al (2013) Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil 10:85CrossRefGoogle Scholar
  26. 26.
    Yong Joo L, Soon Yin T, Xu D et al (2010) A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke. J Rehabil Med 42:437–441CrossRefGoogle Scholar
  27. 27.
    Dos Santos LR, Carregosa AA, Masruha MR et al (2015) The use of nintendo Wii in the rehabilitation of poststroke patients: a systematic review. J Stroke Cerebrovasc Dis 24:2298–2305CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tsung-Han Ho
    • 1
  • Fu-Chi Yang
    • 1
  • Ruei-Ching Lin
    • 2
  • Wu-Chien Chien
    • 3
  • Chi-Hsiang Chung
    • 4
  • Shang-Lin Chiang
    • 5
  • Chung-Hsing Chou
    • 1
    • 6
  • Chia-Kuang Tsai
    • 1
    • 6
  • Chia-Lin Tsai
    • 1
    • 6
  • Yu-Kai Lin
    • 1
  • Jiunn-Tay Lee
    • 1
    • 6
    Email author
  1. 1.Department of NeurologyTri-Service General Hospital, National Defense Medical CenterTaipeiTaiwan
  2. 2.Department of Nursing, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan
  3. 3.Department of Medical Research, Tri-Service General HospitalNational Defense Medical CenterTaipeiTaiwan
  4. 4.School of Public HealthNational Defense Medical CenterTaipeiTaiwan
  5. 5.Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of MedicineNational Defense Medical CenterTaipeiTaiwan
  6. 6.Graduate Institute of Medical SciencesNational Defense Medical CenterTaipeiTaiwan

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