Virtual reality in the rehabilitation of the upper limb following stroke

Abstract

The main focus of physiotherapy after stroke is to restore motor control of a range of tasks to improve function and everyday life. A prominent feature of dysfunction after stroke is motor impairment of the upper limb. In general recovery of arm function after stroke tends to be poor or limited. It is recommended that in daily clinical practice people with stroke should be offered extensive opportunities to exercise the more affected arm. Thus there exists a challenge of how to deliver more intensive therapy to the large numbers of people with stroke. Virtual reality (VR) is a computer technology that presents simulated information and enables individuals to experience and interact with three-dimensional environments. It is a technology that has the potential to be used as an alternative method of delivery in rehabilitation programmes. This thesis was undertaken to investigate the use of VR as a method of delivering upper limb motor rehabilitation after stroke.

A systematic review was conducted to assess the level of current evidence for the use of VR in stroke rehabilitation. This review identified the level of evidence for VR as moderate, and demonstrated the need for more rigorous controlled studies of sufficient sample size. A focus group analysis (n = 4, with 21 participants) was carried out to ascertain the perceptions of people with stroke of upper limb exercise and the style of tasks practiced, and to incorporate these views into the design of the system. This led to the development of a VR based system for upper limb stroke rehabilitation that supports a range of reach and grasp activities. The components of the system include an upper limb motion-tracking device, a head-mounted display screen and data glove worn on the hand. These are connected to a desktop computer.

User testing was conducted in adults, both healthy (n = 10) and with stroke(n = 10), to assess the user experience of the system. This confirmed that stroke users could engage and interact with a virtual environment and had a comparable experience of such in comparison to healthy adults. Participants with more impaired hand function experienced more difficulty engaging effectively with the virtual environment. Single case studies (n = 2) tested the efficacy of the VR training programme (40-45 minute sessions, three times per week over three weeks) and demonstrated that improvements in impairment and activity could be made.

An exploratory RCT was conducted to compare the effects of VR based therapy to standard therapy on impairment and activity levels in people with stroke (n = 18).Results showed that small improvements were made in both impairment and activity levels in both groups. However, there were no significant between group differences. Small sample size and recruitment issues were a problem. This study demonstrated that ahigh quality trial is feasible and a sample size calculation indicates that 20 participants per group would be needed in a future study.

The thesis provides evidence regarding the inclusion of VR based therapy instroke rehabilitation that may inform future trials. The clinical implication would be that VR might be useful in supporting stroke rehabilitation. Physiotherapists need to harness the potential power of technology to support the delivery of rehabilitation to the large numbers of people after stroke that need and want their skills.

Date of Award	Apr 2008
Original language	English
Sponsors	Northern Ireland Chest Heart & Stroke Association
Supervisor	Suzanne Mc Donough (Supervisor) & Sheila Lennon-Fraser (Supervisor)