Is Virtual-Reality Rehabilitation Beneficial After Stroke?

FUCK this has to be one of the stupidest questions that should never be asked. Our fucking failures of stroke associations don't have a database of stroke protocols with efficacy ratings that are updated each time new research comes out.  That is what a great stroke association would be doing.
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 

Gary M. Abrams, MD reviewing Saposnik G et al. Lancet Neurol 2016 Jun 27.

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.

Citation(s):

1. Saposnik G et al. Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): A randomised, multicentre, single-blind, controlled trial. Lancet Neurol 2016 Jun 27; [e-pub]. (http://dx.doi.org/10.1016/S1474-4422(16)30121-1)