Improve Upper Limb Activity
Target Population
Target Population
Population
- Stroke phase: a range of stroke phases (acute, subacute – including early subacute, late subacute, and chronic)
- Stroke type: ischemic and hemorrhagic
- Prevalent population: chronic ischemic stroke patients
Intervention
Intervention
Type of Intervention:
- Virtual Reality (VR) Interventions:
- NeuroR augmented reality system with virtual shoulder exercises.
- Semi-immersive table-top workbench with haptic device and 3D computer games.
- Use of virtual games (bowling, boxing, ladder climbing).
- Passive (non-robotic arm) support for arm with hand grasp and movement tracking.
- 3D environment system with computer, sensors, and motion tracking for reaching and grasping.
- Data gloves with an avatar for capturing finger flexure and mimicking user’s movements.
- Cognitive stimulation with Serious Games mobile technology.
- Reinforced feedback in VR to improve sense of position in space and movement parameters.
- Computerized/Commercial Gaming Interventions:
- Nintendo Wii and other console games (e.g., table tennis, soccer, boxing).
- Commercial products such as Sony PlayStation, Xbox Kinect, and SeeMe VR systems.
Equipment Used:
- Virtual Reality (VR) Interventions Equipment:
- Video capture (e.g., Reinforced Feedback in Virtual Environment system).
- Tabletop systems.
- RehabMaster game-based system.
- NeuroR augmented reality system.
- Motion tracking through video cameras, depth sensors, data gloves, and Kinect.
- Various VR environments on screens.
- Computerized/Commercial Gaming Equipment:
- Nintendo Wii.
- Microsoft Xbox Kinect.
- Sony PlayStation EyeToy.
Key Points:
- Virtual environment interventions were used more frequently than computerized/commercial gaming interventions (N=19 vs. N=14).
- Specific virtual reality systems (SVR) were more common than non-specific ones (NSVR).
- SVR interventions focused on 6 neurorehabilitation principles, while NSVR interventions mainly targeted 3 principles.
- Both SVR and NSVR interventions were combined with conventional therapy or physiotherapy/occupational therapy treatments.
- VR interventions aimed to improve upper limb (UL) function, activity, and participation.
- Commercial gaming VR focused on arm, hand, trunk, and standing movements, while VR environments targeted various UL functions and task-based activities.
- Various equipment and motion tracking systems were used, including video cameras, depth sensors, data gloves, Kinect, and VR-specific devices like Wiimotes and MusicGlove.
Mode of Delivery
Mode of Delivery
The mode of delivery for the interventions in the studies varies, with some common patterns emerging:
Duration:
- On average, interventions lasted approximately 4.9 weeks.
- The daily duration of intervention sessions ranged from 43 to 84.3 minutes, with an average of around 63 minutes per day.
- Weekly intervention duration ranged from 12.54 to 153.9 minutes, with an average of approximately 71.64 minutes per week.
Frequency:
- The frequency of sessions was not consistently reported, but it averaged around 4.2 sessions per week.
Training, Support, and Feedback:
- Details regarding training, support, and feedback mechanisms were generally not specified (NR). However, in some cases, interventions were supervised with various levels of contact, such as weekly visits, daily contact in the first week, or at least once a week.
In summary, the interventions typically lasted around 4.9 weeks, involved approximately 4.2 sessions per week, and each session had an average daily duration of 63 minutes. The specific details of training, support, and feedback were often not provided in the available information.
Costs
Costs
- Nintendo Wii: $65.00
- Nintendo Wii Fit (including game + platform): $50.00
- Sony PlayStation 2 EyeToy: $15.00
- Sony PlayStation 3 MOVE: $50.00
- Microsoft Xbox Kinect: $113 – $280
- SeeMe VR systems: $397.00 – $417.00
Feasibility & Adherence
Feasibility & Adherence
Feasibility for Individuals with profound Disabilities: One study suggests that VR-based exergaming is feasible for individuals with profound disabilities. It can be utilized even in a sitting position for wheelchair-dependent users, offering exercise options. However, this study did not provide specific information on potential harm. (Mat Rosly, M., Mat Rosly, H., Davis OAM, G. M., Husain, R., & Hasnan, N. (2017). Exergaming for individuals with neurological disability: a systematic review. Disability and Rehabilitation, 39(8), 727–735. https://doi.org/10.3109/09638288.2016.1161086)
Safety and Acceptability: Another study indicates that time-dose-matched VR rehabilitation is generally safe and acceptable for most patients. The study reported adverse events in both the experimental and control groups, but there was no significant difference in the incidence of adverse reactions between the groups. This suggests that VR interventions do not appear to pose a significantly higher risk of harm compared to control groups. However, the nature and severity of the adverse events were not detailed in the provided information.
It’s important to note that the limited information available does not provide a comprehensive assessment of potential harm associated with VR interventions for individuals with stroke. To assess the safety and potential risks of VR-based interventions more comprehensively, further research and detailed reporting of adverse events is needed.
Additionally, individualized assessment and monitoring of participants during VR sessions should be part of any VR rehabilitation program to ensure safety.