Parametri cinematici per il monitoraggio del recupero motorio dell’arto superiore durante un training di realtà virtuale immersiva: analisi esplorativa in pazienti stroke in fase subacuta

Autori

Fregna Giulia (Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy)

Antonioni Annibale (Università di Ferrara, Ferrara, Italy)

Perachiotti Gabriele (Università di Ferrara, Ferrara, Italy)

Baroni Andrea (Università di Ferrara, Ferrara, Italy)

Ledda Lorenzo (Università di Ferrara, Ferrara, Italy)

Tirana Manuel (Università di Ferrara, Ferrara, Italy)

Casile Antonino (Università di Messina, Messina, Italy)

Straudi Sofia (Università di Ferrara, Ferrara, Italy)

Background and aims

Stroke is a leading cause of acquired disability in adults, and upper limb (UL) paresis is one of the most frequent and functionally limiting consequences. Although scientific literature recommends analyzing UL impairment using referenced marker-based motion capture tools [1], their clinical use is often constrained by high costs, required training, and dedicated space. Immersive Virtual Reality (IVR) is a focus of intense research due to its promising effect in increasing rehabilitation effectiveness, but its efficacy as a measurement tool able to quantify and sensitively track kinematic parameters in neurologically impaired subjects is still underinvestigated. This study aims to investigate the clinical reliability of an IVR device as a markerless motion capture instrument for assessing and monitoring UL impairment in subacute stroke survivors during the execution of an UL IVR training [2].

Methods

This is a secondary analysis of an ongoing multicenter randomized controlled trial coordinated by the Ferrara University Hospital. Subacute stroke patients (aged between 18-80 yo) are enrolled in the first 4 weeks after stroke; subjects randomly assigned to the experimental group perform 4 weeks of UL training via Head-Mounted Display (HMD) (5 weekly sessions of 1 hour each for 4 weeks) during the conventional activites of their intensive rehabilitation stay. UL impairment severity is assessed pre (T0) and post-treatment (T1) through the Fugl Meyer Assessment – Upper Extremity (FMA-UE). Additionally, previously validated kinematic indexes have been recorded by HMD during the whole treatment in order to capture clinical changes and potential correlations with the collected clinical outcomes [3].

Results

10 patients completed the experimental protocol and have been analyzed. At T1, the mean FMA-UE score was statistically significantly higher (mean, SD: 40.6±15.2) compared to the T0 one (mean, SD: 22.2±12.1, p<0.01). Comprehensively, a statistically significant reduction in speed difference between arms during treatment has been found in all the virtual tasks: Ball Task (from 1.96±1.62 to 1.44±1.43 s, p=0.002), Cloud Task (from 2.43±2.73 to 1.47±1.62 s, p=0.012), Glasses one (from 1.06±0.69 to 0.71±0.62 s, p=0.006). Moreover, the observed between-arms speed difference proved to be statistically significantly related to the FMA-UE score in all tasks (p<0.05).

Conclusion

The use of a commercial, low-cost IVR-based HMD could provide clinically relevant UL kinematic metrics in the rehabilitation assessment and treatment of subacute stroke survivors. The possibility to quantitatively track UL sensorimotor recovery in a markerless, ecological, and, potentially, remote manner could increase the therapeutic specificity of the rehabilitative intervention.

REFERENCES

[1] Kwakkel G, Van Wegen E, Burridge JH, et al. Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke. 2019;14(8):783-791. doi:10.1177/1747493019873519

[2] Fregna G, Schincaglia N, Baroni A, Straudi S, Casile A. A novel immersive virtual reality environment for the motor rehabilitation of stroke patients: A feasibility study. Front Robot AI. 2022;9:906424. Published 2022 Aug 29. doi:10.3389/frobt.2022.906424

[3] Casile A, Fregna G, Boarini V, et al. Quantitative Comparison of Hand Kinematics Measured with a Markerless Commercial Head-Mounted Display and a Marker-Based Motion Capture System in Stroke Survivors. Sensors (Basel). 2023;23(18):7906. Published 2023 Sep 15. doi:10.3390/s23187906