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Task-specific virtual reality training on hemiparetic upper extremity in patients with stroke

Abstract

Task-specific training has been proven to be effective in promoting recovery of the hemiparetic upper extremities after a stroke. This study was to develop a task-specific VR (TS-VR) program using a leap motion controller device and the Unity3D game engine to promote recovery of the hemiparetic upper extremity in patients with stroke based on a hierarchy of seven functional tasks in the functional test for the hemiplegic upper extremity (FTHUE). The final version of the TS-VR was tested on 20 patients suffering from chronic stroke with upper-extremity hemiparesis over 2 weeks, 5 sessions per week, 30 min per session. Outcomes were assessed using the Fugl-Meyer assessment-upper extremity score (FMA-UE), the Wolf motor function test (WMFT), and the motor activity log (MAL) at the first (week 0), last (week 2), and follow-up sessions (week 5). Patients’ arm impairments were stratified into lower (levels 1–4) and higher (levels 5–7) functioning groups according to the FTHUE. Significant improvements were found after TS-VR training in FMA-UE total score and its subscores, and WFMT score among the three time occasions (p = 0.000), but no significant effect on grip strength was found. The higher-functioning group benefited more from the TS-VR, as indicated in outcome measures as well as amount of use score in MAL, but this was not the case for those in the lower-functioning group. Our findings show the TS-VR training was useful for upper-extremity recovery in patients with chronic stroke. It has potential to be applied in clinical settings in future.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding authors on reasonable request.

Abbreviations

AR:

Augmented reality

FMA-UE Total:

Fugl-Meyer assessment-upper-extremity total score

FMA-UL:

Fugl-Meyer assessment-upper limb subscore

FMA-Hand:

Fugl-Meyer assessment hand subscore

FTHUE:

Functional test for the hemiplegic upper extremity

Group 1:

Higher-functioning group

Group 2:

Lower-functioning group

LMC:

Leap motion controller

MAL-AOU:

Motor activity log-amount of use scale (AOU)

MAL-QOM:

Motor activity log-quality of movement scale (QOM)

TS-VR:

Task-specific virtual reality program

WMFT:

Wolf motor function test

VR:

Virtual reality

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Acknowledgements

The authors would like to express their appreciation to the Hong Kong Stroke Association for coordinating the data collection.

Funding

The study received no funding from any source.

Author information

Authors and Affiliations

Authors

Contributions

KNKF designed the study. YMT and KS were responsible for the technical parts, including modeling the virtual content, computer programming, and development of the TS-VR program. KS, AKHY, CCWL, and YWTM were primarily responsible for the data collection, and data analysis. KNKF, YMT, KS, AKHY, CCWL, and YWTM drafted the manuscript. All authors made substantial contributions to the manuscript, and all read and approved the final version.

Corresponding author

Correspondence to Yuk Ming Tang.

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Conflict of interest

The authors declare that they have no competing interests with respect to the research, authorship, and/or publication of this article.

Ethics approval

The study was carried out in accordance with the principles of the Declaration of Helsinki. Ethical approval was sought and obtained from the Human Ethics Committee of the Hong Kong Polytechnic University (HSEARS20180503002).

Consent to participate

Written and informed consent was obtained from all patients before the study commenced.

Consent for publication

Use of data and materials for purposes of reporting was included in the informed consent procedures and all patients gave their written consent for this publication.

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Fong, K.N.K., Tang, Y.M., Sie, K. et al. Task-specific virtual reality training on hemiparetic upper extremity in patients with stroke. Virtual Reality 26, 453–464 (2022). https://doi.org/10.1007/s10055-021-00583-6

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  • DOI: https://doi.org/10.1007/s10055-021-00583-6

Keywords

  • Rehabilitation
  • Training stroke
  • Virtual reality
  • Evaluation
  • Upper limb
  • Task-specific training
  • Leap motion controller