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Kiper P1, Agostini M1, Maistrello L1, Baba A1, Berlingieri C1, Pregnolato G1, Baldan F1, Turolla A1
1Fondazione Ospedale San Camillo IRCCS, Laboratory of Neurorehabilitation Technologies, Venice, Italy
Background: Recovery process underpinned by rehabilitation modalities could be intended as a learning process exploited by the central nervous system. Innovative technologies have provided the opportunity to enrich the environments in which motor rehabilitation programs are carried out. This enrichment could potentially facilitate the physiological activation of the brain areas devoted to motor learning.
Purpose: To evaluate whether the continuous visualization of on-line teacher in virtual reality (VR) is effective for the improvement of upper limb motor function, in stroke patients.
Methods: Patients affected by stroke within 2 years before enrolment were randomized in two groups: Ever Teacher and Never Teacher group. Both treatments lasted 1h/day, 5 days/week for 20 sessions. The clinical effect of different intervention modalities was assessed before and after treatment with the following scales: Fugl-Meyer Upper Extremity (FM) scale (primary outcome), Functional Independence Measure (FIM) scale, Reaching Performance scale (RPS). Moreover, kinematics were assessed by: Time (seconds), Velocity (cm/s), Smoothness (number of sub-movements) extracted from a sequence of standard motor tasks. Kinematics were evaluated on the basis of reaching movement. In the Ever Teacher group, specific feedback called “virtual teacher” was displayed online during every task repetition. Whereas, in the Never Teacher group, the patients was asked to perform the same motor exercises using the upper limb, but without the enhanced visual feedback provided via the virtual teacher assistance.
Results: 70 patients with an average age of 59.7 ± 15.4 (25 female, 45 male) and 7.1 ± 6.4 months since stroke were enrolled in the study and randomized to Ever Teacher (38 patents) and Never Teacher (32 patients) group.
Statistically significant improvement was observed within Ever Teacher group (FM: V=1 p 0.05; FIM V=11 p 0.05; RPS: V=11 p 0.05; Reaching: Time - V=576 p 0.05, Velocity - V=92 p 0.05, Smoothness - V=198 p 0.05) and Never Teacher group (FM: V=28 p 0.05; FIM V=48 p 0.05; RPS: V=30.5 p 0.05; Reaching: Time - V=217.5 p 0.05, Velocity - V=58 p 0.05, Smoothness - V=65 p=0.190).
Not significant differences emerged between two treatment groups in clinical scales
(FM: U=651.5 p=0.472; FIM: U=564.5 p=0.462; RPS: U=512 p=0.863), and kinematic parameters (Time - U=381.5 p=0.064, Velocity - U=594.5 p=0.342, Smoothness - U=103.5 p=0.338).
Regression model showed that time since stroke affects negatively the FIM scale (R=0.79, p=0.013).
Conclusion(s): The results showed that treatment in VR can induce significant improvements for upper limb recovery following a stroke. However, seems that the facilitation of a single motor learning paradigm (i.e. supervised learning) does not substantially modify the recovery of the motor function, which could instead be favored by the multimodality of the proposed treatment.
Implications: The findings improve the understanding of enhanced feedback provided in VR environment and its impact on motor recovery after stroke. Moreover, provide insights for future technology development in rehabilitation field.
Keywords: Stroke, Virtual Reality, Motor Learning
Funding acknowledgements: Funded by the Società Italiana di Fisioterapia (Bando di Ricerca S.I.F. 2013) and by the Italian Ministry of Health (Grant-GR-2011-02348942).
Purpose: To evaluate whether the continuous visualization of on-line teacher in virtual reality (VR) is effective for the improvement of upper limb motor function, in stroke patients.
Methods: Patients affected by stroke within 2 years before enrolment were randomized in two groups: Ever Teacher and Never Teacher group. Both treatments lasted 1h/day, 5 days/week for 20 sessions. The clinical effect of different intervention modalities was assessed before and after treatment with the following scales: Fugl-Meyer Upper Extremity (FM) scale (primary outcome), Functional Independence Measure (FIM) scale, Reaching Performance scale (RPS). Moreover, kinematics were assessed by: Time (seconds), Velocity (cm/s), Smoothness (number of sub-movements) extracted from a sequence of standard motor tasks. Kinematics were evaluated on the basis of reaching movement. In the Ever Teacher group, specific feedback called “virtual teacher” was displayed online during every task repetition. Whereas, in the Never Teacher group, the patients was asked to perform the same motor exercises using the upper limb, but without the enhanced visual feedback provided via the virtual teacher assistance.
Results: 70 patients with an average age of 59.7 ± 15.4 (25 female, 45 male) and 7.1 ± 6.4 months since stroke were enrolled in the study and randomized to Ever Teacher (38 patents) and Never Teacher (32 patients) group.
Statistically significant improvement was observed within Ever Teacher group (FM: V=1 p 0.05; FIM V=11 p 0.05; RPS: V=11 p 0.05; Reaching: Time - V=576 p 0.05, Velocity - V=92 p 0.05, Smoothness - V=198 p 0.05) and Never Teacher group (FM: V=28 p 0.05; FIM V=48 p 0.05; RPS: V=30.5 p 0.05; Reaching: Time - V=217.5 p 0.05, Velocity - V=58 p 0.05, Smoothness - V=65 p=0.190).
Not significant differences emerged between two treatment groups in clinical scales
(FM: U=651.5 p=0.472; FIM: U=564.5 p=0.462; RPS: U=512 p=0.863), and kinematic parameters (Time - U=381.5 p=0.064, Velocity - U=594.5 p=0.342, Smoothness - U=103.5 p=0.338).
Regression model showed that time since stroke affects negatively the FIM scale (R=0.79, p=0.013).
Conclusion(s): The results showed that treatment in VR can induce significant improvements for upper limb recovery following a stroke. However, seems that the facilitation of a single motor learning paradigm (i.e. supervised learning) does not substantially modify the recovery of the motor function, which could instead be favored by the multimodality of the proposed treatment.
Implications: The findings improve the understanding of enhanced feedback provided in VR environment and its impact on motor recovery after stroke. Moreover, provide insights for future technology development in rehabilitation field.
Keywords: Stroke, Virtual Reality, Motor Learning
Funding acknowledgements: Funded by the Società Italiana di Fisioterapia (Bando di Ricerca S.I.F. 2013) and by the Italian Ministry of Health (Grant-GR-2011-02348942).
Topic: Neurology: stroke; Robotics & technology; Disability & rehabilitation
Ethics approval required: Yes
Institution: Fondazione Ospedale San Camillo IRCCS
Ethics committee: Approved by Ethical committee of the IRCCS San Camillo Hospital
Ethics number: Prot. 2013.11
All authors, affiliations and abstracts have been published as submitted.
