Use the labels in the right column to find what you want. Or you can go thru them one by one, there are only 14615 posts. Searching is done in the search box in upper left corner. I blog on anything to do with stroke.DO NOT DO ANYTHING SUGGESTED HERE AS I AM NOT MEDICALLY TRAINED, YOUR DOCTOR IS, LISTEN TO THEM. BUT I BET THEY DON'T KNOW HOW TO GET YOU 100% RECOVERED. I DON'T EITHER, BUT HAVE PLENTY OF QUESTIONS FOR YOUR DOCTOR TO ANSWER.
Deans' stroke musings
Changing stroke rehab and research worldwide now.Time is Brain!Just think of all thetrillions and trillions of neuronsthateach daybecause there areeffective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.
What this blog is for:
Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group. My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html
Monday, April 10, 2017
Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients
Stroke is one of the most
common causes of acquired disability, leaving numerous adults with
cognitive and motor impairments, and affecting patients’ capability to
live independently. There is substancial evidence on post-stroke
cognitive rehabilitation benefits, but its implementation is generally
limited by the use of paper-and-pencil methods, insufficient
personalization, and suboptimal intensity. Virtual reality tools have
shown potential for improving cognitive rehabilitation by supporting
carefully personalized, ecologically valid tasks through accessible
technologies. Notwithstanding important progress in VR-based cognitive
rehabilitation systems, specially with Activities of Daily Living
(ADL’s) simulations, there is still a need of more clinical trials for
its validation. In this work we present a one-month randomized
controlled trial with 18 stroke in and outpatients from two
rehabilitation units: 9 performing a VR-based intervention and 9
performing conventional rehabilitation.
The VR-based intervention
involved a virtual simulation of a city – Reh@City - where memory,
attention, visuo-spatial abilities and executive functions tasks are
integrated in the performance of several daily routines. The
intervention had levels of difficulty progression through a method of
fading cues. There was a pre and post-intervention assessment in both
groups with the Addenbrooke Cognitive Examination (primary outcome) and
the Trail Making Test A and B, Picture Arrangement from WAIS III and
Stroke Impact Scale 3.0 (secondary outcomes).
A within groups analysis
revealed significant improvements in global cognitive functioning,
attention, memory, visuo-spatial abilities, executive functions, emotion
and overall recovery in the VR group. The control group only improved
in self-reported memory and social participation. A between groups
analysis, showed significantly greater improvements in global cognitive
functioning, attention and executive functions when comparing VR to
Our results suggest that
cognitive rehabilitation through the Reh@City, an ecologically valid VR
system for the training of ADL’s, has more impact than conventional
This trial was not registered
because it is a small sample study that evaluates the clinical validity
of a prototype virtual reality system.
In most countries, stroke is among most common causes of death and one of the main causes of acquired adult disability .
Because most patients with stroke survive the initial illness, the
greatest impact is usually caused by the long term consequences for
patients and their families .
It is estimated that 33 to 42 % of stroke survivors require assistance
for daily living activities three to six months post stroke, and of
these, 36 % continue to be disabled five years later [3, 4].
Although remarkable developments have been made in the medical
treatment of stroke, it continues to heavily rely on rehabilitation
interventions. In addition to motor disabilities, more than 40 % of
stroke survivors are left with cognitive impairment after the event and
almost two thirds are affected by mild cognitive impairment, and
therefore are at risk of developing dementia .
Besides having a direct influence on the quality of life of patients
and their caregivers, cognitive impairment after stroke is also
associated with higher mortality  and greater rates of institutionalization .
Cognition is important for overall recovery since its impairment
reduces a person’s ability to plan and initiate self-directed
activities, to solve problems, to sustain and divide attention, to
memorize information and to understand task instructions. It has been
shown that recovery of cognitive function of stroke patients in
inpatient rehabilitation is directly related to their level of
participation in rehabilitation activities .
Thus, reducing the impact of post stroke cognitive impairment through
appropriate rehabilitation programs is an essential goal.
cognitive rehabilitation practice tends to be directed towards isolated
cognitive domains including attention (focusing, shifting, dividing or
sustaining), executive functions (planning, inhibition, control),
visuo-spatial ability (visual search, drawing, construction), memory
(recall and recognition of visual and verbal information) and language
(expressive and receptive) . Although there is evidence on the efficacy of current methods ,
an important concern is how effectively the improvements of these
abilities that are trained separately generalize, leading to sustained
improvement in everyday functioning [11, 12].
When we consider the cognitive domains required for activities of daily
living (ADL’s) such as a successful meal preparation – the patient must
define a menu, identify the needed ingredients, write a shopping list,
organize the time for shopping and preparing the meal – we acknowledge
that multiple dimensions of cognition are engaged and, thereby,
suggesting that need to be rehabilitated as a whole as opposed to
Unfortunately, there is insufficient evidence to determine if and how
the ecological validity of current cognitive rehabilitation methods
impacts recovery [14, 15].
cognitive rehabilitation methodologies suffer other limitations besides
the generalization of improvements to functional activities, social
participation and life satisfaction. For instance, it is known that an
intensive and individualized training is preferable .
Personalized rehabilitation involves an assessment of each patient’s
impairments, a definition of attainable goals for improvement, an
intervention to assist in the achievement of goals and, finally, a
reassessment to measure improvements .
However, in-depth patient assessment is expensive and time consuming,
and currently impracticable due to the scarcity of professionals and
resources, resulting in a suboptimal intensity, personalization and
duration of rehabilitation interventions .
Further, although there is growing evidence that patients may achieve
improvements on functional tasks even many months after having a stroke , most rehabilitation therapies are only guaranteed within three to 6 months post stroke . Additionally, a James Lind Alliance study 
interviewed 799 chronic stroke patients who reported that cognitive
problems had not been addressed appropriately, especially when compared
with mobility, confirming that it is essential to find adaptable and
accessible tools that can be used frequently and intensively by patients
at the clinic or at home after discharge, in order to maximize
rehabilitation outcomes. Caregivers and health professionals were also
interviewed and indicated that investigating ways to improve cognition
after stroke should be a research priority .
Reality (VR) and interactive technologies have emerged as a valuable
approach in stroke rehabilitation by providing the opportunity to
practice cognitive and motor activities that are not or cannot be
usually practiced within the clinical environment, such as training
attention abilities in street crossing situations , executive functions by visiting a supermarket , or performing simulations of real-life scenarios and activities in urban virtual environments [24, 25].
Yet, the advantages of VR to address stroke impairments go beyond
ecological validity of training, with a growing body of evidence
especially in the motor rehabilitation domain .
Virtual environments are designed to be more enjoyable than
conventional rehabilitation methods. The introduction of gaming elements
and immediate feedback on performance enhance motivation, thereby
encouraging higher numbers of repetitions .
Additionally, it enables the systematic presentation of stimulus and
challenges in a hierarchical fashion, which can be varied from simple to
complex upon success ,
making it progressively challenging according to patients abilities.
Further, when stroke survivors suffer of hemiparesis in their dominant
arm, this interferes with their ability to perform paper-and-pencil
tasks, which in turn may impede cognitive training. Thus, another
central advantage of VR is the possibility to be integrated with
accessible interfaces such as adapted joysticks, natural user interfaces
or robotic systems .