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Immersive virtual reality mirror therapy for upper limb recovery following stroke

A pilot study

Weber, Lynne M., MA, OTR/L; Nilsen, Dawn M., EdD, OTR/L, FAOTA; Gillen, Glen, EdD, OTR, FAOTA; Yoon, Jin, BS; Stein, Joel, MD

American Journal of Physical Medicine & Rehabilitation: April 5, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001190
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Objective This study was designed to examine the feasibility of immersive virtual reality (VR) mirror therapy for upper limb paresis after stroke using a head-mounted display, and provide preliminary evidence of efficacy.

Design Ten outpatients with chronic stroke, upper limb hemiparesis, and a low predisposition for motion sickness completed a 12-session program of 30 minutes each of immersive VR mirror therapy. The VR system provided the illusion of movement in the hemiparetic upper limb while suppressing the visual representation of the non-paretic side. Feasibility was assessed via patient compliance, adverse event tracking, the System Usability Scale, and the Simulator Sickness Questionnaire. Preliminary efficacy was evaluated using the Fugl-Meyer Upper Extremity (FM-UE) and Action Research Arm Test.

Results Immersive VR mirror therapy for patients with chronic stroke was safe, well-tolerated, and without adverse events, such as simulator sickness. Motor outcomes revealed a small improvement for the FM-UE from 21.7 (SD= 8.68) to 22.8 (SD= 9.19) that did not achieve statistical significance (p=0.084).

Conclusion Four weeks of immersive virtual reality mirror therapy was well-tolerated by chronic stroke patients. Our findings support further clinical trials of immersive VR technologies and visually-enhanced mirror therapies for stroke survivors.

Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center

Associate Professor of Rehabilitation and Regenerative Medicine at Columbia University Medical Center

Professor and Director, Programs in Occupational Therapy, Vice Chair, Department of Rehabilitation and Regenerative Medicine, Assistant Dean, Vagelos College of Physicians and Surgeons, Columbia University

Columbia University Vagelos College of Physicians and Surgeons

Simon Baruch Professor and Chair Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, Chair, Department of Rehabilitation Medicine, Weill Cornell Medical College, Physiatrist-in-Chief, New York Presbyterian Hospital

Correspondence: Joel Stein, MD, Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, HP 1-165, New York, New York 10032, USA. Telephone: 1-212-305-4818; Fax 1-212-342-3138; Email: js1165@cumc.columbia.edu

Author disclosures: Realiteer, Inc. – Loan of research equipment; Grant funding: T35 AG044303. Related Presentations: “Virtual Reality Mirror Therapy for Stroke: Let’s Turn it Around!” American Academy of Physical Medicine and Rehabilitation Annual Assembly, October 2018.

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