Giulia Fregna (Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, Italy)
Andrea Baroni (Department of Neuroscience and Rehabilitation, University of Ferrara, Italy)
Gabriele Perachiotti (Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, Italy)
Chiara Paoluzzi (Department of Neuroscience and Rehabilitation, University of Ferrara, Italy)
Antonino Casile (Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy)
Sofia Straudi (Department of Neuroscience and Rehabilitation, University of Ferrara, Italy)
The use of Virtual Reality (VR) as a therapy complement in the rehabilitation treatment of post-stroke subjects seems useful for improving upper limb (UL) function1. Recently, an increasing scientific interest has been focused on Immersive VR tools, such as Head-Mounted Displays (HMD), for their promising role in ameliorating UL impairment after stroke thanks to greater immersion and presence feelings experienced by the user, instrumental factors in promoting neuroplasticity processes. Clinical use of HMDs in UL rehabilitation treatment has revealed positive effects on motor recovery and arm use in chronic stroke survivors but its application in the subacute phase has been under-investigated so far2.
The present study aims to analyze the clinical effect of an UL rehabilitation program through HMD in subacute stroke subjects on motor impairment, independence and quality of life compared to a conventional treatment. We also explored cybersickness phenomena, satisfaction and embodiment perceived.
We are leading a multicenter randomized controlled trial. Patients within 4 weeks after stroke are enrolled if they present UL impairment (Fugl-Meyer Assessment – Upper Extremity – FMA-UE – score < 55) and are then randomized into the experimental group (EG) and the control one (CG) during their intensive rehabilitation stay; subjects are stratified between groups according to UL impairment severity (FMA-UE score). EG patients undergo HMD sessions 5 days per week for 4 weeks, 1 hour each, into the routine clinical activities. The system used has been previously developed and tested in a stroke sample3. For CG patients only the conventional treatment identified by their clinical needs is administered. Before (T0), after the 4-week treatment (T1), and in a 6-month follow-up (T2), all the subjects are assessed through the FMA-UE, the Barthel Index (BI), and the Stroke Impact Scale 3.0 (SIS). Cybersickness, embodiment and satisfaction perceived are investigated in EG subjects through specific questionnaires.
10 patients have been enrolled so far (5 for each group): 3 females, age range: 51-79, FMA-UE score: 9-47, BI score: 10-85. Considering the clinical changes detected from T0 to T1, EG patients showed greater gains in the FMA-UE, in a statistically significant way (p<0.05). While both groups improved in all the other outcome measures, no other significant between groups differences have been found. The majority of EG patients were fully satisfied with the treatment reporting high embodiment levels, and no cybersickness events occurred. T2 data acquisition is still ongoing, thus, further information will allow a more comprehensive understanding of the clinical effects of the treatment performed, analyzing longitudinal changes in a multi-dimensional way.
These preliminary data suggest a beneficial effect of adding Immersive VR training through HMD to the conventional rehabilitation treatment in improving UL motor recovery in subacute stroke survivors.
