Motor Retraining in Virtual Reality: A Feasibility Study for Upper-Extremity Rehabilitation in Individuals With Chronic Stroke

Abstract

Background and Purpose. 

Individuals with stroke can improve upper-extremity function in the chronic phase, providing rehabilitation is intensive, attended, and of sufficient duration. Virtual reality has been used in motor retraining; however, off-the-shelf game consoles may not be appropriate for those with marked motor impairment and high finger or arm spasticity. The objective of this study was to investigate the feasibility and effects of training in individuals with chronic stroke who are either high-functioning or low-functioning, and also spastic.

Case Descriptions. 

Four volunteers, 3 men and 1 woman, were recruited from a local aphasia support group. All individuals were chronic post stroke with right-side hemiplegia. Training took place at the Tele-Rehabilitation Institute at Rutgers University. The intervention was performed on the Rutgers Arm II, a prototype training table that senses supported arm movement and grasp strength and tilts to resist or assist reach. Participants played games that adapted automatically to each individual's motor abilities. The games were practiced over 6 weeks, 3 sessions every week, with sessions lasting up to 1 hour. The 4 participants were evaluated by a senior physical therapist before, immediately following, and 6 weeks after the intervention. No occupational or physical therapist was present during the training sessions.

Outcomes. 

The primary outcomes were changes in the affected upper-extremity subset of the Fugl-Meyer test and self-reported changes in the participants' activities of daily living. Improvements in active range of motion and grasp strength were secondary outcomes. All individuals improved in Fugl-Meyer scores and retained these gains (participant 1, 45 to 50; participant 2, 16 to 22; participant 3, 12 to 20; participant 4, 42 to 51). Participants 2 and 3, who presented with severe motor impairment, began using their affected arms in daily activities subsequent to training. All participants improved in their shoulder, elbow, and finger flexion active range of motion. Remarkably, participants 2 and 3, who were unable to exert force in grasping or pinching pre-training, could now do so and retained these gains at 6 weeks following the intervention. Well-being and mood seemed to improve in all participants.

Discussion and Conclusion. 

Results show that motor retraining in virtual reality is feasible, well-tolerated by participants, and benefitting them. The Rutgers Arm II system was able to train participants, who varied greatly in their degree of motor impairment, but without a clinician being present. The present study contributes to the body of knowledge on novel virtual rehabilitation interventions for the upper extremity.