ARGHHH!!! WHERE ARE THE TWO FUNCTIONING NEURONS AMONGST ALL THE STROKE MEDICAL PERSONS IN THE WORLD? All stroke survivors are still guinea pigs in single case studies run by their doctor. Have you signed a consent agreement for that research?
http://www.jwatch.org/na41889/2016/08/03/virtual-reality-rehabilitation-beneficial-after-stroke
Nonimmersive VR gaming enhances motor performance after stroke but is no better than simple recreational activities.
In
small studies, nonimmersive virtual-reality (VR) video game systems
improved poststroke motor performance when added to conventional
rehabilitation. However, these studies lacked active control
interventions and may have lacked matched amount of therapy time. To
compare the effects of nonimmersive VR and recreational therapy (RT),
researchers conducted a multicenter, single-blind, parallel-group study.
They randomized 141 patients with mild-to-moderate motor disability
within 3 months after a first-time ischemic stroke, to receive
conventional rehabilitation plus either VR training with the Nintendo
Wii gaming system (using commercially available software) or RT (playing
cards, bingo, Jenga, or ball games). Each group completed ten 60-minute
sessions over a 2-week period. Rehabilitation therapists administered
the interventions and provided feedback to avoid inappropriate
compensatory movements. The primary endpoint was improvement from
baseline to end of the intervention in time on an abbreviated Wolf Motor
Function Test (WMFT), with added grip strength and flip-a-card tasks.
Secondary outcomes included activities of daily living, quality-of-life
and global outcome measures, and grip strength. Outcome measures were
also assessed at 4 weeks after baseline.
The median WMFT
performance time improved in both groups, with no significant
between-group differences at 2 or 4 weeks postbaseline. The only
difference between groups was better 2-week performance in the RT group
on the Box and Block test, a secondary outcome.
Comment
This well-executed study is one of several that have failed to
demonstrate superior benefits of novel neurorehabilitation
interventions, with or without technology. Several issues are worth
noting. Supplemental therapy of some type improved short-term motor
function. Whether gains for either group were sustained beyond 4 weeks
was not addressed. The type of VR or the timing, intensity, and duration
of training may not have been optimal, and issues such as patient
preference were not addressed. Nevertheless, the cautionary conclusion
about indiscriminate adaptation of innovative, but costly,
rehabilitation interventions without adequate clinical trials is well
taken.
Dr. Abrams is Director of the Neurorehabilitation Clinic, University of California, San Francisco, Medical Center.
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