A combined aerobic exercise and virtual reality-based upper extremity rehabilitation intervention for chronic stroke – feasibility and preliminary effects on physical function and quality of life

This doesn't do a damn bit of good unless you write this in a protocol and distribute it to all 10 million yearly stroke survivors now, and for past  and future survivors also.

A combined aerobic exercise and virtual reality-based upper extremity rehabilitation intervention for chronic stroke – feasibility and preliminary effects on physical function and quality of life

Author links open overlay panelRyan E.RossPh.D.¹²

EmersonHartOTR/L¹²Ewan R.WilliamsPh.D., MPT¹²Chris M.GregoryPh.D., PT¹²Patrick A.FlumeM.D.³Christina M.MingoraM.D.³Michelle L.WoodburyPh.D., OTR/L²⁴

https://doi.org/10.1016/j.arrct.2022.100244Get rights and content

Under a Creative Commons license

Open access

Abstract

Objectives

To examine the feasibility of combining lower extremity aerobic exercise (AEx) with a virtual reality (VR) upper extremity (UE) rehabilitation intervention; and 2) provide an estimate of effect size for the combined intervention on UE function, aerobic capacity, and health-related quality of life.

Design

Single group feasibility trial

Setting

Research laboratory

Participants

Community dwelling individuals with mild to moderate impairment of the upper extremity at least 6 months post-stroke (male, n=6; female n=4; mean age = 54 years)

Intervention

All participants received 18 sessions over a nominal 2-3 sessions per week schedule of a combined AEx and VR-UE rehabilitation intervention. During each session participants completed 15 minutes of lower extremity AEx followed by playing a VR-UE rehabilitation game for approximately 20 minutes.

Main Outcome Measures

Feasibility was evaluated by metrics of adherence, retention, treatment acceptability, data completeness, and adverse events. UE function, aerobic capacity (VO_2peak), and quality of life were assessed with the Fugl-Meyer Upper Extremity Assessment (FMA-UE), expired gas exchange analysis, and Stroke Impact Scale (SIS), respectively.

Results

Adherence was 100% and there were no withdrawals or losses to follow-up to report. Participants completed the intervention in 49 ± 14 days. Cohen's d_z effect size calculations indicated the intervention elicited medium effects on FMA-UE (d_z = 0.50), SIS memory domain (d_z = 0.46); and large effects on absolute VO_2peak (d_z = 1.46), relative VO_2peak (d_z = 1.21), SIS strength (d_z = 1.18) and SIS overall recovery domains (d_z = 0.81).

Conclusions

Combining lower extremity AEx and VR-UE rehabilitation appears feasible in the clinical research setting. Fifteen minutes of lower extremity AEx performed at vigorous intensity appears to elicit clinically meaningful benefits in chronic stroke. Further examination of the combining lower extremity AEx and VR-UE rehabilitation and its effects on physical function and quality of life is warranted.