[New perspectives of locomotor rehabilitation after stroke]

An Exploratory Study on the use of Virtual Reality in Balance Rehabilitation

Studies have shown the potential of Virtual Reality and motion tracking devices in physical rehabilitation. This paper addresses the topic of using non-immersive Virtual Reality therapeutic games with motion tracking in physical rehabilitation and describes an exploratory study performed in collaboration with a national public Rehabilitation Center about their use to motivate patients to perform exercises relevant for balance rehabilitation. The work involved developing and adapting mini-games to track patients posture; tests with patients recovering from Spinal Cord Injury suggest that this type of games can be helpful in the recovery process namely in patients' motivation for performing the therapeutic gestures.

Progressive treadmill cognitive dual-task gait training on the gait ability in patients with chronic stroke

The purpose of this study was to investigate the effects of progressive treadmill cognitive dual-task training on gait performance in individuals with chronic stroke patients. Twenty-six participants with chronic hemiparesis were recruited to this study and randomly distributed into two groups: progressive treadmill cognitive dual-task gait training (PTCDG group, 13 patients), conventional treadmill gait training (CTG group, 13 patients). All patients underwent 20 sessions of treadmill gait training with a harness (5 times per week, for a total of 4 weeks). The GAITRite was used to analyze gait kinematics, and 10-m walking test (10MWT) wear used as the clinical evaluation indicators. After training, PTCDG group showed significant improvement in gait velocity, cadence, single support time, and 10MWT compared to the control group. However there was no significant difference between the groups in the stride lengths in the affected and unaffected sides. The study verified that progressive treadmill cognitive dual-task gait training had a positive influence on the gait and clinical gait index in chronic stroke patients.

Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review

QUESTION

In people after stroke, does virtual reality based rehabilitation (VRBR) improve walking speed, balance and mobility more than the same duration of standard rehabilitation? In people after stroke, does adding extra VRBR to standard rehabilitation improve the effects on gait, balance and mobility?

DESIGN

Systematic review with meta-analysis of randomised trials.

PARTICIPANTS

Adults with a clinical diagnosis of stroke.

INTERVENTION

Eligible trials had to include one these comparisons: VRBR replacing some or all of standard rehabilitation or VRBR used as extra rehabilitation time added to a standard rehabilitation regimen.

OUTCOME MEASURES

Walking speed, balance, mobility and adverse events.

RESULTS

In total, 15 trials involving 341 participants were included. When VRBR replaced some or all of the standard rehabilitation, there were statistically significant benefits in walking speed (MD 0.15 m/s, 95% CI 0.10 to 0.19), balance (MD 2.1 points on the Berg Balance Scale, 95% CI 1.8 to 2.5) and mobility (MD 2.3 seconds on the Timed Up and Go test, 95% CI 1.2 to 3.4). When VRBR was added to standard rehabilitation, mobility showed a significant benefit (0.7 seconds on the Timed Up and Go test, 95% CI 0.4 to 1.1), but insufficient evidence was found to comment about walking speed (one trial) and balance (high heterogeneity).

CONCLUSION

Substituting some or all of a standard rehabilitation regimen with VRBR elicits greater benefits in walking speed, balance and mobility in people with stroke. Although the benefits are small, the extra cost of applying virtual reality to standard rehabilitation is also small, especially when spread over many patients in a clinic. Adding extra VRBR time to standard rehabilitation also has some benefits; further research is needed to determine if these benefits are clinically worthwhile.

Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation

BACKGROUND AND PURPOSE

The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA).

METHOD

Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale.

RESULTS

The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation.

DISCUSSION AND CONCLUSION

The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.

On the role of auditory feedback in robot-assisted movement training after stroke: review of the literature

The goal of this paper is to address a topic that is rarely investigated in the literature of technology-assisted motor rehabilitation, that is, the integration of auditory feedback in the rehabilitation device. After a brief introduction on rehabilitation robotics, the main concepts of auditory feedback are presented, together with relevant approaches, techniques, and technologies available in this domain. Current uses of auditory feedback in the context of technology-assisted rehabilitation are then reviewed. In particular, a comparative quantitative analysis over a large corpus of the recent literature suggests that the potential of auditory feedback in rehabilitation systems is currently and largely underexploited. Finally, several scenarios are proposed in which the use of auditory feedback may contribute to overcome some of the main limitations of current rehabilitation systems, in terms of user engagement, development of acute-phase and home rehabilitation devices, learning of more complex motor tasks, and improving activities of daily living.

Motor rehabilitation using virtual reality

Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications.