Potentials of Virtual Reality-based Post-Stroke Rehabilitation

Mastaneh, Z; Saadat, Z; Kamalzadeh, H; Mouseli, L

Potentials of Virtual Reality-based Post-Stroke Rehabilitation

Authors

Z Mastaneh ¹

Z Saadat ²

H Kamalzadeh ³

L Mouseli ⁴

¹ Associate Professor of Health Information Management, Hormozgan University of Medical Sciences, Social Factors in Health Promotion Research Center, Bandar Abbas

² Assistant Professor of Physiotherapy, Hormozgan University of Medical Sciences, Cardiovascular Research Center, Bandar Abbas

³ Associate Professor of Information Technology, Hormozgan University of Medical Sciences, Health Information Technology Department, Bandar Abbas

⁴ Associate Professor of Health Services Administration, Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Abstract

Introduction & Objective: Post-stroke rehabilitation plays a crucial role in helping individuals regain motor functions and improve their quality of life. Recent advancements in technology, particularly the emergence of virtual reality (VR), have shown significant potential in enhancing the effectiveness of post-stroke rehabilitation programs. This study aims to explore the potentials and opportunities created by VR-based interventions in the post-stroke rehabilitation. Materials & Methods: In this review study, a total of 349 articles related to the study objectives were obtained by searching databases including Web of Science, PubMed, Science Direct, and Google Scholar using the keywords "Rehabilitation," "Post-stroke," "Motion Disability," and "Virtual Reality" from 2015 to 2023. After conducting refinement steps, eliminating non-relevant studies, and aligning with the objectives of the present study, 67 articles were selected. The findings were analyzed, and the results were formulated in the current article. Results: The findings highlighted the potential of designing interactive multidimensional environments tailored to daily activities, and free from constraints and risks of real-world environments. Personalizing exercises according to each patient's specific condition, addressing psychological barriers, empowering and facilitating rapid patient adaptation to the virtual environment, providing tele-rehabilitation services and monitoring by specialized centers, as well as the ability to record and display progress in rehabilitation treatments were among the potential benefits of utilizing VR in rehabilitation settings. Conclusions: Post-stroke rehabilitation utilizing VR as a treatment option, in line with technological advancements, offers an effective platform for the recovery of stroke patients. It allows each patient to choose their personalized treatment option in an engaging and motivating environment. By specifying the type, number, and intensity of exercises, receiving feedback on performance, and monitoring progress, patients can pursue the optimal path towards achieving their functional goals.

Keywords

Motor Rehabilitation

Virtual Reality

Stroke

Personalized Treatment

Exercises

1. Stroke Association. What is stroke and different types of stroke? Cited: 29 Oct 2022. Available at: https://www.stroke.org.uk/what-is-stroke / types-of
stroke.

2. Fiouji H, Namayandeh SM, Barsang S, Erfani M. Epidemiologic study of the main risk factors for
one year ischemic stroke and surivial in patients admitted to the neurology department of Ghayim hospital in Mashhad. Tolooe behdasht J. 2020; 19(2): 33-42.

3. Feigin VL. Global and regional burden of stroke during 1990-2010: findings from the global
burden of disease study. The Lancet. 2014; 383(9913): 245-55.

4. World Stroke Organization. WSO global stroke fact sheet. Cited: 11 Jun 2022. Available at: https://www.world-stroke.org / news- and
blog/news/wso-global-stroke-fact-sheet-2022.

5. Ghandehari K. Epidemiology of stroke in Iran. Galen Med J.2016; 5(1): 3-9.

6. Ahmadabadi S, Alavian F, Sedaghati P .Effectiveness of motor interventions in improving the motor abilities of post-stroke patients: a systematic review. J Rehabil Med. 2022; 10(6): 1140-55. doi:10.32598/SJRM.10.6.2.

7. Dorsch S Ada L, Canning CG. Lower limb strength is significantly impaired in all muscle groups in ambulatory people with chronic stroke: a
cross-sectional study. Arch Phys Med Rehabil. 2016; 97(4): 522-7.

8. Darak V, Karthikbabu S. Lower limb motor function and hip muscle weakness in stroke survivors and their relationship with pelvic tilt, weight-bearing asymmetry, and gait speed: A cross-sectional study. Curr J Neurol 2020; 19(1): 1-7.

9. Kao PC, Dingwell JB, Higginson JS, Binder-Macleod S. Dynamic instability during post-stroke hemiparetic walking. Gait Posture. 2014; 40(3), 457-463. doi:10.1016/j.gaitpost.2014.05.014.

10. Wevers L, Van De Port I, Vermue M,
Mead G, Kwakkel G. Effects of task-oriented
circuit class training on walking competency
after stroke: A systematic review. Stroke. 2009; 40(7): 2450-9. doi: 10.1161/STROKEAHA. 108.541946.

11. Lohse KR, Lang CE, Boyd LA. Is better?
Using metadata to explore dose-response relationships in stroke rehabilitation. Stroke.
2014; 45(7): 2053-58. doi: 10.1161/STROKEAHA. 114.004695.

12. Miclaus RS, Roman N, Henter R, Caloian S. Lower extremity rehabilitation in patients with
post-stroke sequelae through virtual reality
associated with mirror therapy. Int. J. Environ.
Res. Public Health 2021, 18, 2654. https://doi.org/10.3390/ijerph. 18052654.

13. Huygelier H, Mattheus E, Vanden Abeele V, van Ee R, Gillebert CR. The use of the term virtual reality in post-stroke rehabilitation: a scoping review and commentary. Psychologica Belgica. 2021; 61(1):
145-62. doi: 10.5334/ pb.1033.

14. Kim WS, Cho S, Ku J, Kim Y, Lee K,
Hwang HJ, Paik NJ. Clinical application of
virtual reality for upper limb motor rehabilitation in stroke: review of technologies and clinical evidence. J. Clin. Med. 2020, 9, 3369; doi: 10.3390/jcm9103369.

15. Garcia-Munoz C, Casuso-Holgado M. Effectiveness of Wii Fit balance board in comparison with other interventions for post-stroke
balance rehabilitation. Systematic review and
meta-analysis. Rev Neurol. 2019; 69(7): 271-9. doi: 10.33588/rn.6907.2019091.

16. Dominguez-Tellez P, Moral-Munoz JA,
Casado-Fernandez E, Salazar A, Lucena-Anton D. Effects of virtual reality on balance and gait in
stroke: a systematic review and meta-analysis]. Rev Neurol 2019; 69(6): 223-234. doi: 10.33588/rn.6906. 2019063.

17. Maples-Keller JL, Yasinski C, Manjin N, Rothbaum BO. Virtual reality-enhanced extinction of phobias and post-traumatic stress. Neurotherapeutics. 2017; 14: 554-63. doi: 10.1007/s13311
017-0534-y.

18. Kothgassner OD, Goreis A, Kafka JX,
Van Eickels RL, Plener PL, Felnhofer A.
Virtual reality exposure therapy for
posttraumatic stress disorder: a meta-analysis. Eur. J. Psychotraumatol. 2019; 10:1654782. doi:10.1080/20008198.2019.1654782.

19. Pourmand A, Davis S, Marchak A, Whiteside T, Sikka N. Virtual reality as a clinical tool for
pain management. Curr. Pain Headache Rep. 2018; 22: 1-6. doi: 10.1007/s11916-018-0708-2.

20. Wittkopf PG, Lloyd DM, Coe O, Yacoobali S, Billington J. The effect of interactive virtual reality on pain perception: a systematic review of clinical studies. Disabil. Rehabil. 2020; 42: 3722-33. doi:10.1080/09638288.2019.1610803.

21. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for
stroke rehabilitation. Cochrane Database Syst.
Rev. 2017; 11: CD008349. doi: 10.1002/14651858.CD008349.pub4.

22. Karamians R, Proffitt R, Kline D, Gauthier LV. Effectiveness of virtual reality-and gaming-based interventions for upper extremity rehabilitation poststroke: a meta-analysis. Arch. Phys. Med. Rehabil. 2020; 101: 885-96. doi: 10.1016/j.apmr.2019.10.195.

23. Huygelier H, Schraepen B, Lafosse C, Vaes N, Schillebeeckx F, Michiels K, et al. An immersive virtual reality game to train spatial attention orientation after stroke: A feasibility study. Appl. Neuropsychol. 2020: 1-21. doi: 10.1080/23279095.2020.1821030.

24. Tieri G, Morone G, Paolucci S, Iosa M.
Virtual reality in cognitive and motor rehabilitation: Facts, fiction and fallacies. Expert Rev.
Med. Devices. 2018, 15(2), 107-17. doi:10.1080/17434440.2018.1425613.

25. Massetti T, da Silva TD, Crocetta TB,
Guarnieri R, de Freitas BL, Bianchi Lopes P, et al. The clinical utility of virtual reality in neurorehabilitation: a systematic review. J. Cent. Nerv. Syst. 2018, 10, 1179573518813541. doi:10.1177/1179573518813541.

26. Porras DC, Siemonsma P, Inzelberg R, Zeilig G, Plotnik M. Advantages of virtual reality in the rehabilitation of balance and gait: A systematic review. Neurology. 2018; 90(22): 1017-25. doi:10.1212/ WNL.0000000000005603.

27. Silva SM, Corrêa JCF, Pereira GS, Corrêa FI. Social participation following a stroke:
An assessment in accordance with the international classification of functioning, disability and health. Disabil. Rehabil. 2019, 8, 879-886.

28. Gittins M, Lugo-Palacios D, Vail A, Bowen A, Paley L, Bray B, Tyson S. Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments. Clinicl Rehab. 2021; 35(3): 446-57.

29. Makin SDJ, Turpin S, Dennis MS, Wardlaw JM. Cognitive impairment after lacunar stroke: systematic review and meta-analysis of incidence, prevalence and comparison with other stroke subtypes. J. Neurol. Neurosurg. Psychiatry. 2013; 84(8), 893-900. doi: 10.1136/jnnp-2012-303645.

30. Darak V, Karthikbabu S. Lower limb motor function and hip muscle weakness in stroke survivors and their relationship with pelvic tilt, weight-bearing asymmetry, and gait speed: A cross-sectional study. Curr J Neurol 2020; 19(1): 1-7.

31. Bailey RB. Highlighting hybridization: a case report of virtual reality-augmented interventions to improve chronic post-stroke recovery. Medicine 2022; 101: 25(e29357).

32. Bailey JO, Bailenson JN. When does virtual embodiment change our minds? Presence Teleoperators Virtual Environ. 2016, 25, 222-233.

33. Schiza E, Matsangidou M, Neokleous K, Pattichis CS. Virtual reality applications for neurological disease: a review. Front. Robot AI. 2019; 6:100. doi: 10.3389/frobt.2019.00100.

34. Edemekong PF, Bomgaars DL, Levy SB. Activities of daily living (ADLs); StatPearls: Treasure Island, FL, USA, 2017.

35. Rodríguez ML, García AG, Loureiro JP,
García TP. Personalized virtual reality environments for intervention with people with disability. Electronics 2022, 11, 1586. doi: 10. 3390/electronics11101586.

36. Sramka M, Lacko J, Ruzicky E, Masan J. Combined methods of rehabilitation of patients
after stroke: virtual reality and traditional
approach. Neuroendocrinol Lett 2020; 41(3):
123-33.

37. Cortés-Pérez I, Nieto-Escamez FA, Obrero-Gaitán E. Immersive virtual reality in stroke patients as a new approach for reducing postural disabilities and falls risk: a case series. Brain Sci. 2020, 10, 296; doi:10.3390/brainsci10050296.

38. Montalbán MA, Arrogante O. Rehabilitation through virtual reality therapy after a
stroke: A literature review. Revista Científica de la Sociedad de Enfermería Neurológica (English ed.). 2020; 52: 19-27.

39. Moan ME, Vonstad EK, Su X, Vereijken B, Solbjør M, Skjæret-Maroni N. Experiences of
stroke survivors and clinicians with a fully immersive virtual reality treadmill exergame for stroke rehabilitation: a qualitative pilot study. Front. Aging Neurosci.2021; 13: 735251. doi: 10.3389/fnagi.2021.735251.

40. Huygelier H, Mattheus E, Vanden Abeele V,
van Ee R, Gillebert CR. The use of the term
virtual reality in post-stroke rehabilitation: a scoping review and commentary. Psychologica Belgica, 2021; 61(1), pp. 145-162. doi: https://doi.org/10.
5334/ pb.1033.

41. Lin J, Kelleher CL, Engsberg JR. Developing home-based virtual reality therapy interventions. Games Health J. 2013; 2(1): 34-8. doi: 10.1089/g4h. 2012.0033.

42. Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Yang C, Welch V. Home-based
virtual reality training after discharge from
hospital-based stroke rehabilitation: a parallel randomized feasibility trial. 2019; 20: 333-41. doi:10.1186/s13063-019-3438-9.

43. Hossain A, Kim WS, Cho S, Baek D, Bang H, Paik NJ. Upper extremity functional evaluation by fugl-meyer assessment scoring using depth-sensing camera in hemiplegic stroke patients. PLoS One 2016; 11: e0158640.

44. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil. 2002; 83(8): 1138-44.

45. Patterson KK, Parafianowicz I, Danells CJ, Closson V, Verrier MC, Staines WR, et al. Gait asymmetry in community ambulating stroke survivors. Arch Phys Med Rehabil. 2008; 89(2):
304-10.

46. Maggio MG, Latella D, Maresca G, Sciarrone F, Manuli A, Naro A, De Luca R, Calabrò RS.
Virtual reality and cognitive rehabilitation in people with stroke: An overview. J. Neurosci. Nurs. 2019; 51: 101-5.

47. Schroder J, Van Criekinge T, Embrechts E, Celis X, Van Schuppen J, Truijen S, Et al. Combining the benefits of tele-rehabilitation and virtual reality-based balance training: a systematic review on feasibility and effectiveness. Disabil. Rehabilitation. Assist. Technol, 2019; 14(1): 2-11. doi: 10.1080/17483107.2018.1503738.

48. Ruiz-Gonzalez L, Lucena-Anton D,
Salazar A. Physical therapy in Down
syndrome: Systematic review and
meta-analysis. J Intellect Disabil Res 2019; 68(3):1041-67.