You'll have to ask your doctor what the results of this trial are, and if successful when EXACTLY it will be available in their hospital.
Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial
Trials volume 22, Article number: 91 (2021)
Abstract
Background
The high incidence of cerebral apoplexy makes it one of the most important causes of adult disability. Gait disorder is one of the hallmark symptoms in the sequelae of cerebral apoplexy. The recovery of walking ability is critical for improving patients’ quality of life. Innovative virtual reality technology has been widely used in post-stroke rehabilitation, whose effectiveness and safety have been widely verified. To date, however, there are few studies evaluating the effect of immersive virtual reality on stroke-related gait rehabilitation. This study outlines the application of immersive VR-assisted rehabilitation for gait rehabilitation of stroke patients for comparative evaluation with traditional rehabilitation.
Methods
The study describes a prospective, randomized controlled clinical trial. Thirty-six stroke patients will be screened and enrolled as subjects within 1 month of initial stroke and randomized into two groups. The VRT group (n = 18) will receive VR-assisted training (30 min) 5 days/week for 3 weeks. The non-VRT group (n = 18) will receive functional gait rehabilitation training (30 min) 5 days/week for 3 weeks. The primary outcomes and secondary outcomes will be conducted before intervention, 3 weeks after intervention, and 6 months after intervention. The primary outcomes will include time “up & go” test (TUGT). The secondary outcomes will include MMT muscle strength grading standard (MMT), Fugal-Meyer scale (FMA), motor function assessment scale (MAS), improved Barthel index scale (ADL), step with maximum knee angle, total support time, step frequency, step length, pace, and stride length.
Discussion
Virtual reality is an innovative technology with broad applications, current and prospective. Immersive VR-assisted rehabilitation in patients with vivid treatment scenarios in the form of virtual games will stimulate patients’ interest through active participation. The feedback of VR games can also provide patients with performance awareness and effect feedback, which could be incentivizing. This study may reveal an improved method of stroke rehabilitation which can be helpful for clinical decision-making and future practice.
Trial registration
Chinese Clinical Trial Registry ChiCTR1900025375. Registered on 25 August 2019
Background
Stroke is a serious disease with a high disability rate. Often occurring in elderly populations, stroke-related disability contributes one of the main causes of adult disability [1]. Studies show that stroke survivors experience residual physical dysfunction which has a great impact on their ability to live. Studies have reported that 55–80% of stroke survivors demonstrate continuous motor dysfunction, decreased quality of life, and limited activities in daily life [1,2,3,4]. Other studies have reported that 80% of stroke patients experience movement disorders, including loss of balance and gait ability [1, 3]. The disease-related movement disorders and the subsequent decrease in daily living activity can be a great burden to patients, their families, and society. Gait disorder is one of the most common symptoms in stroke sequelae; thus, the recovery of walking ability is the key to improving patients’ self-care ability and quality of life. Compared with that of the healthy people, the gait of patients with cerebral apoplexy often manifests as slowed, shortened standing time on the paralyzed side, too early toes falling when standing, etc. [5]. As such, gait rehabilitation is often the primary goal of stroke rehabilitation [6,7,8]. As the population continues to age, an increasing number of stroke patients are posed to experience great challenges to disease-related effects. In turn, improving the efficiency of rehabilitation strategies remains of paramount importance.
Virtual reality (VR) is an innovative tool to realize connection, operation, and interaction between human vision and computer-simulated scenarios [9]. Non-immersive VR (for example Xbox Kinect) has been applied in clinical trials of stroke rehabilitation [10, 11]. VR training experience is interesting and enjoyable for the patient, which reduces fatigue, keeps patients in a happy mood, and reduces the boredom of repetitive, conventional rehabilitation. Non-immersive VR-assisted rehabilitation is proposed to provide a more personalized intervention therapy [12]. VR training for stroke patients can therefore improve the participation and autonomy of patients in the rehabilitation process, qualities that have been shown to be more cost and resource effective [13]. Overall, non-immersive VR has been shown to increase limb function learning and improves the quality of life [14].
Recently, immersive VR is a novel VR type. Immersive VR involves a head-mounted display with visual and auditory cues and controllers using haptic (sense of touch) feedback in a 3-dimensional environment [15]. Immersive VR is a technology that provides more realistic environment scene design and object tracking than previous ordinary VR [16], which provides virtual interaction and real-time feedback in vision, touch, hearing, and even motion in realistic scenarios. Patients can experience controllable movement or operation in a simulated virtual environment, so as to achieve the rebuilding or restoring of physical functions.
Immersive VR researches have been reported in the field of pain medicine [17]. In the field of post-stroke rehabilitation, immersive VR has also been reported in upper limb motor function and cognitive ability [16, 18]. However, a few studies have previously explored the application of immersive VR-assisted training in gait rehabilitation after stroke. For example, Biffi et al. found that immersive virtual reality platform enhances the walking ability of children with acquired brain injuries [19] and research by Irene Cortes-Perez has shown that immersive virtual reality improves balance in stroke patients and reduces the risk of falls [20]. Thus, research on immersive VR-assisted training in gait rehabilitation requires its own dedicated investigation. As a VR device of reasonable cost, it has become a powerful research tool for scientific researchers [21, 22]. This study will apply the immersive device to execute VR scenes of rehabilitation training according to clinical practice, so as to systematically evaluate the application of immersive VR technology in the rehabilitation of stroke gait disorders.
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