Useless, since they don't tell us where the protocol is so survivors can do this themselves. For chronic survivors who aren't seeing doctors or therapists anymore, don't researchers realize that simple fact and produce usable research that survivors can directly use? I'd fire the mentors and senior researchers that don't understand this simple fact!
Use of low-cost virtual reality in the treatment of the upper extremity in chronic stroke: a randomized clinical trial
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 12 (2024)
Abstract
Background
Chronicity and lack of motivation often go together during the upper limb rehabilitation process in stroke. Virtual reality is a useful tool in this context, providing safe, intensive, individualised treatments in a playful environment. B-cost, easy-to-use devices with personalised and motivating games for a specific population seem to be the most effective option in the treatment of the upper limbs.
Methods
A randomised clinical study with follow-up was carried out to assess the effectiveness of the Leap Motion Controller® device in improving the functionality of the upper limb in patients with chronic stroke. Patients (n = 36) were randomised into a control group that performed conventional therapy and an experimental group that combined the virtual reality protocol(Where is it?) with conventional therapy. The outcome measures used were grip strength; the Block and Box Test; the Action Research Arm Test; the Disabilities of the Arm, Shoulder and Hand; as well as a Technology Satisfaction Questionnaire and adherence to treatment.
Results
Inter-group statistical analysis showed no significant differences except in subsection D of the Action Research Arm Test. Intra-group analysis showed significant differences in both groups, but the experimental group reached significance in all long-term variables. Satisfaction and adherence levels were very high.
Conclusions
The Leap Motion Controller® system, as a complementary tool, produces improvements in grip strength, dexterity and motor function in patients with chronic stroke. It is perceived as a safe, motivating, and easy-to-use device.
Clinical Registration: NCT04166617 Clinical Trials.
Introduction
The chronicity of the upper limb (UL) rehabilitation process in stroke leads to an inherent loss of motivation in the long term, resulting in the need for new treatment approaches that combine both the recovery of functionality and the motivation to continue to achieve functional goals [1, 2].
The use of virtual reality (VR) in neurorehabilitation arose with the aim of creating new, more efficient options for functional recovery by generating environments in which to carry out different tasks and is currently a potential treatment tool [3]. VR is a promising tool in neurorehabilitation, as it promotes neuroplasticity by enabling treatments with a high number of repetitions, allowing changes in task difficulty, and keeping patients motivated and involved during the rehabilitation session [4, 5].
The development of portable and affordable VR devices is making VR therapy accessible to the chronic population [6]. A recent review on the design of serious games in the field of neurorehabilitation [7] outlines three necessary concepts when developing this technology: the game genre, the nature of the game, and the game development strategy. The authors concluded that casual games (any game that involves the completion of single, simple tasks, not tied to a story or extensive development) designed specifically for one type of patient, with a first-person perspective, played in single-player mode, and using non-immersive VR had better clinical outcomes. In contrast to this, they also stated that commercial games are perceived as more engaging and motivating, emphasising the need for future work in this area. Therefore, perhaps the trend should be to use inexpensive, easy-to-use devices, but with games that are personalised and motivating for a specific population.
The Leap Motion Controller® (LMC®) system is a small, portable, low-cost, and commercially available tracking device that can capture UL movements in 3D, without the need for motion markers. It is a part of semi-immersive VR and allows the development of customised applications thanks to its software development kit [8, 9]. Its use has been investigated both as a single therapy and in combination with conventional treatment in stroke patients, mainly in the acute and subacute phases. In both cases, the ultimate goal has been to assess its effectiveness on parameters of grip strength, dexterity, or motor function [10]. After a review of the current literature on the use of this device in the stroke population [10], we deduce that studies with a larger sample size, with higher methodological quality, and with follow-up evaluations are needed to assess its effectiveness with greater precision.
Prior to this research, a pilot study of the feasibility of the device was developed together with a VR protocol with games created ad hoc for the chronic stroke population [11]. The results were very positive, which generated the need to verify these results with a study of higher methodological quality.
Despite the amount of scientific literature on the use of virtual reality in the field of neurorehabilitation, and the constant changes in devices, there is a lack of clear detailed protocols, reproducible through low-cost devices.
Therefore, the aim of the present research was to assess the effectiveness of the LMC® system through games designed specifically for chronic stroke patients, and whether the potential benefit, if any, would be sustained over time. A semi-immersive VR protocol was developed as an adjunct to conventional rehabilitation treatment in improving the functionality of the UL compared to a conventional treatment group, in addition to assessing motivation and adherence to treatment.
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