Advancing Rehabilitation Therapies through Integrated Stroke Treatment in Virtual Reality (ARTIST): Cognitive and Motor Dual-Task Training for Post-Stroke Recovery
Autori
1Martina Regazzetti, 1Marta Albani Rocchetti, 1Sara Federico, 1Pawel Kiper 1 Healthcare Innovation Technologies Laboratory, IRCCS San Camillo, Venice, Italy
Background and aims
- Upper limb deficits are common and disabling in post-stroke patients, with around 80% experiencing motor impairments during the acute phase. Six months post-stroke, up to 60% still face functional difficulties, negatively impacting autonomy and quality of life. As the population ages and the number of chronic patients rises, the demand for rehabilitation services grows. In this context, innovative organizational models and the integration of advanced technologies such as virtual reality (VR) are emerging to enhance rehabilitation effectiveness and efficiency. Motor-cognitive dual task exercises show promise in promoting neuroplasticity and transferring learned skills to daily activities. The primary objective is to evaluate the clinical effectiveness of a motor-cognitive dual task rehabilitation intervention delivered in VR to post-stroke patients with upper limb deficits, comparing two organizational models (1:1 and 2:1) to conventional therapy.
Secondary objectives include analyzing changes in brain activation and muscle synergies in the experimental groups versus the control group,
Methods
This study is a randomized controlled clinical trial to be conducted at IRCCS San Camillo Hospital in Venice, Italy, enrolling 54 post-stroke patients. Participants will be randomly assigned to three groups: a 1:1 experimental group receiving motor-cognitive VR therapy with one dedicated physiotherapist; a 2:1 experimental group with one therapist supervising two patients simultaneously; and a control group receiving conventional upper limb therapy, matched for intensity and duration. Experimental sessions will occur in the SMART room, a sensor-equipped environment developed in the European HosmartAI project, using VRRS Evo systems (Khymeia S.r.l., Padua, Italy). Each session will last one hour, five days a week for three weeks, including progressively tailored motor and cognitive exercises. Visual and auditory feedback will support learning and motivation. Evaluations will occur at baseline and after the intervention, using the following outcome measures: motor function (Fugl-Meyer Assessment for Upper Extremity, Box and Block Test), cognitive function (Mini-Mental State Examination, Oxford Cognitive Screen), neurophysiology (surface electromyography, electroencephalogram), and user experience (System Usability Scale).
Results
It is expected that patients in the experimental groups will show clinically and statistically significant improvements compared to the control group in both motor function and neurophysiological activation.
Conclusion
The 2:1 organizational model is anticipated to be non-inferior to the 1:1 model, offering a It sustainable and effective approach for post-stroke rehabilitation, particularly in settings with limited professional resources. The analysis of muscle synergies and brain activity will enhance understanding of neuroplastic mechanisms underlying functional recovery and support the development of personalized, technology-enhanced rehabilitation strategies.
REFERENCES
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