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Schuster C.1,2, Eng K.3, Suica Z.1, Thaler I.4, Signer S.5, Lehmann I.4, McCaskey M.1, Schmid L.6, Hawkins M.3, Verra M.L.7, Kiper D.3
1Reha Rheinfelden, Research Department, Rheinfelden, Switzerland, 2Bern University of Applied Sciences, Institute for Rehabilitation and Performance Technology, Burgdorf, Switzerland, 3University of Zurich and ETH Zurich, Institute for Neuroinformatics, Zurich, Switzerland, 4University Hospital Inselspital Bern, Department of Physiotherapy, Bern, Switzerland, 5Buergersptial Solothurn, Department of Physiotherapy, Solothurn, Switzerland, 6Rehabilitation Centre Clinic Lengg, Physiotherapy Department, Zurich, Switzerland, 7University Hospital Bern, Department of Physiotherapy, Berne, Switzerland
Background: In recent years virtual reality (VR)-based training has been introduced to neurorehabilitation, with the intention to improve upper limb training options and facilitate motor function recovery.
Purpose: The aim of this study was to evaluate an intensive virtual reality training with the YouGrabber system compared to conventional occupational therapy or physiotherapy treatment in a multi-centre setting with three participating centres.
Methods: In a prospective, multi-centre, parallel-group randomised controlled trial, patients at least 6 months after stroke onset were allocated to an experimental group (EG, VR training) or to a control group (CG) that receive conventional therapy (16x45 minutes, 4 weeks). Using custom data gloves, patients´ finger and arm movements are displayed in real-time on a screen and used to manipulate objects in various virtual environments. The VR-based training focused on a task-related upper-limb treatment in sitting or standing position.
In all three centres, blinded assessors tested patients´ motor and cognitive performance twice before, once during, and twice after the intervention for hand dexterity (Box and Block Test, BBT) and ADL function using the Chedoke-McMaster Arm and Hand Activity Inventory (CAHAI). The study was registered with ClinicalTrials.gov: NTC01774669.
Results: Between January 2013 and December 2015, 70 patients were screened for eligibility, of whom 54 were eligible and agreed to participate (16 female, age 62.5±14, time since stroke 3.1±3years). In total, 22 patients were allocated to EG and 32 to CG including 3 drop outs. Patients in both groups improved over time (baseline to follow-up BBT: 21.2±16 to 24.6±17; CAHAI: 65.6±21 to 70.7±20). No between group differences were found. No severe adverse events related to the study were reported.
Conclusion(s): Main functional gains occurred in the first two intervention weeks and remained until follow-up. For BBT 5.5 blocks per minute and for CAHAI 6.3 points would have been necessary to determine a meaningful clinical difference. Overall, an average BBT score of 21.2±16 indicates a study population that is severely affected motor functions at entry.
Implications: VR and conventional training conducted in one-to-one supervised training with experienced therapists seem to have a similar effect on hand dexterity in chronic stroke patients over a 4-week training period.
Funding acknowledgements: The study was funded by the Swiss CTI and the company provided the training systems for all three participating centres.
Topic: Neurology: stroke
Ethics approval: Ethics approval was warranted by the ethics committee of the Canton Aargau (201/065) and the Canton Bern (220/12).
All authors, affiliations and abstracts have been published as submitted.
