Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis

Quadruple uselessness:

1. No protocols were written on this.

2. Your hospital will never expend the money on virtual reality.

3. Your hospital doesn't even know about this research.

4. Further research suggested, so the research was not planned correctly
   

Examining the effectiveness of virtual, augmented, and mixed reality (VAMR) therapy for upper limb recovery and activities of daily living in stroke patients: a systematic review and meta-analysis

• Sze Chit Leong,
• Yuk Ming Tang,
• Fong Mei Toh &
• Kenneth N. K. Fong 

Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 93 (2022) Cite this article

• Metrics details

Abstract

Introduction

Virtual reality (VR), augmented reality (AR), and mixed reality (MR) are emerging technologies in the field of stroke rehabilitation that have the potential to overcome the limitations of conventional treatment. Enhancing upper limb (UL) function is critical in stroke impairments because the upper limb is involved in the majority of activities of daily living (ADL).

Methods

This study reviewed the use of virtual, augmented and mixed reality (VAMR) methods for improving UL recovery and ADL, and compared the effectiveness of VAMR treatment to conventional rehabilitation therapy. The databases ScienceDirect, PubMed, IEEE Xplore, and Web of Science were examined, and 50 randomized control trials comparing VAMR treatment to standard therapy were determined. The random effect model and fixed effect model are applied based on heterogeneity.

Results

The most often used outcomes of UL recovery and ADL in stroke rehabilitation were the Fugl-Meyer Assessment for Upper Extremities (FMA-UE), followed by the Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), and the Functional Independence Measure (FIM). According to the meta-analysis, VR, AR, and MR all have a significant positive effect on improving FMA-UE for UL impairment (36 studies, MD = 3.91, 95 percent CI = 1.70–6.12, P = 0.0005) and FIM for ADL (10 studies, MD = 4.25, 95 percent CI = 1.47–7.03, P = 0.003), but not on BBT and WMFT for the UL function tests (16 studies, MD = 2.07, 95 percent CI = − 0.58–4.72, P = 0.13),

Conclusions

VAMR therapy was superior to conventional treatment in UL impairment and daily function outcomes, but not UL function measures. Future studies might include further high-quality trials examining the effect of VR, AR, and MR on UL function measures, with an emphasis on subgroup meta-analysis by stroke type and recovery stage.

Background

Stroke is the world’s second greatest cause of death and the third-leading cause of disability in adults, and 80 million people worldwide suffer from the effect of a stroke [1]. Many stroke survivors suffer from a series of neurological sequelae, including physical, cognitive, and communication disorders. After a stroke, upper limb (UL) motor impairments are common, affecting approximately 80% of stroke survivors [2]. Full recovery of the hemiplegic upper limb function is difficult for most stroke survivors/patients, and this severely impairs their activities of daily living (ADL) and social involvement [3]. Enhancing the functional use of the upper limb after a stroke is important [4] because most tasks in everyday life involve the use of the upper limbs.

Despite the fact that conventional rehabilitation treatment has been shown to provide long-term benefits, patients are usually required to participate in very long-term treatments, and the results may vary depending on the experience of the individual therapists [5]. Patients, on the other hand, can lose motivation for treatment adherence since the treatment movements become tiresome and monotonous with time [6]. The emergence of innovative technologies, including virtual reality (VR), augmented reality (AR) and mixed reality (MR), has improved the conventional rehabilitation environment [7]. These new ways of treatment are valuable and provide substantial benefits not only to motivate patients to participate in long-term treatments but also to standardize the quality of treatment for stroke survivors [8, 9].

For VR therapy, a virtual environment resembling a human is constructed utilizing computer technology. Virtual reality is evolving tremendously, providing increasingly realistic virtual settings, which the user simply accepts while employing these therapies to induce recovery [10], while AR enables individuals to interact with virtual models with the use of a smart device such as a smartphone or tablet. The integration of the actual and virtual worlds enabled by augmented reality has the potential to enable humans to uncover abstract theories, phenomena, processes, and behaviors, as well as characteristics that are generally unavailable in a conventional clinical setting [11]. AR has been recognized as an emerging technology that, due to its ability to facilitate intense, repetitive and context-specific rehabilitation, can improve recovery after stroke [12]. For MR therapy, new digital technology in smart healthcare refers to a new type of environmental visualization created by fusing the actual world and the virtual digital world, in which physical entities and digital things can coexist and interact in real-time [13]. The MR system’s interactive media-based feedback provides an engaging medium for intuitively communicating performance and supporting the stroke survivor’s self-assessment [14].

For the early stages of recovery after stroke, virtual reality-based rehabilitation has received attention as a way to fill the gap between the real and ideal world due to its ability to provide high-intensity, repetitive and task-oriented training, as referenced by Kleim et al. [15]. In addition, Cho et al. [16] showed that the developed VR system can improve the motor control of stroke patients after VR proprioception feedback training. Virtual reality-based rehabilitation has shown similar progress to traditional physical therapy and occupational therapy [17]. Furthermore, this technology is an effective, feasible, and safe approach that simplifies rehabilitation compared to conventional rehabilitation, and creates a flexible and user-friendly interactive technique for demonstrating complicated and perplexing concepts [18]. With high-resolution medical consultation procedures and therapies, VR technology in medical applications can also help improve today’s healthcare systems [19]. Furthermore, a VAMR rehabilitation system provides a close collaborative system with high creativity, enhancing motor movements and minimizing the risk of patients feeling that the treatment is becoming tiresome and monotonous with time [20, 21]. The MR system’s evaluation and customizable feedback capabilities also allow clinicians to provide effective personalized training to patients [14].

As such, numerous systematic reviews have been undertaken to investigate the effectiveness of virtual reality on stroke rehabilitation. Wiley et al. [22] reviewed the use of VR technology that focused on the improvement of cognition and function, including global cognition, attention, memory, and language tests, however with a small number of studies covered, the meta-analysis results were highly affected by studies with a large population, causing lower accuracy. Another review conducted by Lee et al. [23], mainly investigated the effects of function in stroke patients. In their study, most of the cases included used game programs in VR intervention groups, which is less diverse. In addition to a review by Chen et al. [24], it analyzed the effects of balance control in stroke. Only nine studies were used, and most of the study groups had a relatively small sample size. Since it lacked external validity, the recorded results may not be relevant to a broader population. Moreno et al. [25] provided another overview of the literature on describing VR technology information for stroke rehabilitation. However, no quantitative analysis of the impacts was conducted, and the instruments and measures employed in the intervention were not been described. Therefore, we review the VAMR training that has effects on the recovery of upper limb function and ADL in order to generalize the findings. Our research is not only focused on the use of general virtual and augmented realities in rehabilitation treatment, but also includes the application of MR in order to investigate the impact of treatments using immersive technologies.

VR therapy is proven to be a worthwhile treatment for stroke patients, and our review aimed to address the following key research questions:

• RQ1: How virtual, augmented and mixed realities are used as interventions to improve hemiparetic UL function and ADL after stroke;

• RQ2: How does the effectiveness of VAMR therapies compare with conventional rehabilitation treatment for UL function after a stroke by meta-analysis.

This review has significant contributions: (1) not only in the review of VR and AR stroke rehabilitation, but also in investigating how MR can be used for rehabilitation; and (2) identification of the stroke outcome measurement scales used for the VAMR interventions. This study investigates VAMR on upper limb stroke rehabilitation, while fewer MR studies have been investigated in previous studies. More MR studies are included in the paper, examining the effects of the use of MR, identifying their significance and limitations, thus enhancing more future ideas for using MR for upper limb stroke rehabilitation. Furthermore, it is important to identify the most commonly used measures having high reliability for VAMR studies, so further research can focus on their advantages and limitations.

Blood gushes from virtual leg injury to help train combat medics

With any decent programmers from our fucking failures of stroke associations it would be easy to simulate a hemorrhagic or ischemic stroke so doctors could objectively determine exactly how far the damage goes. And from that map stroke protocols that recover from such damage.  But this will never occur.
https://www.youtube.com/watch?v=E_KbtzRcE1c&feature=youtu.be
Full story: https://www.newscientist.com/article/...
Researchers have created the first detailed simulation of a serious leg injury by solving equations to show how blood really flows

Artificial intelligence system created to provide therapy for people who have suffered a cerebral stroke

I bet this doesn't make it to the United States because it was not invented here(Mexico). But ask your doctor about it anyway.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=151870&CultureCode=en
The product is patented and aims to be commercialized. It has been successfully tested at the National Institutes of Pediatrics, Neurology and Neurosurgery.
Artificial intelligence, virtual worlds and interaction with video games, are the elements of a new therapy designed by several Mexican institutions to help people who have had a stroke and children with cerebral palsy to recover mobility of their upper extremities quickly.
The purpose of developing the computational system called Gesture Therapy (Terapia de Gestos) is to offer a low cost and more effective alternative than traditional methods, said the research leader, Luis Enrique Sucar Succar, researcher at the National Institute of Astrophysics, Optics and Electronics (INAOE) in Mexico.
The technology has been proven clinically successful at the National Institute of Neurology and Neurosurgery (INNN) and Pediatrics (INP), it encompasses a computer with a webcam and a special handle with a color sphere and force sensors, which detects the exercises performed by the patient.
The idea is that a virtual agent instructs the patient to perform tasks through different games designed to exercise important parts of the arm for rehabilitation, such as the shoulder, elbow, wrist, fingers and using different types of movement as flexion, extension and pressing. This allows the patient to perform their rehabilitation at home, without the need for a therapist to be present at all time.
On the other hand, the virtual environments in which the person does the therapy simulate daily activities to give present a normal lifestyle . For example, some of these tasks are cleaning a window, painting a room, cooking an egg, grocery shopping, added Enrique Sucar, PhD in Computer Science from the Imperial College in Britain.
An important part of the system is based on artificial intelligence, since it is responsible for monitoring and evaluating user’s performance, while he or she exercises as indicated by the virtual agent. With these results the difficulty level of the game is set, based on the movements recorded by the camera and pressure sensors of the handle, it increases or decreases the level of hardness.
The INAOE researcher, who is also an active member of the Mexico Academy of Engineering, said another utility of artificial intelligence is detection of "compensation" for the patient, which happens when he or she moves the whole body instead of just the affected arm.
While the visual tracking software analyzes images obtained from the camera, tracking the position of the hand in three space dimensions is performed. For this, a color ball at the side of the handle is used, its position estimated using computer vision techniques that combine color and texture information of the object.
The system maps the coordinates of the patient's hand in "real" space, and transfers them to the virtual space, where it interacts with an imaginary world, which is observed through the computer screen, Sucar Succar added.
The researcher, who is currently on a sabbatical stay in Italy, said that to achieve the development of Therapy Gestures collaboration of researchers and physicians at the from several institutes and universities were required.
The evaluation was carried out at the Rehabilitation Unit of the INNN where the results showed an improvement in the movement of the affected limb, increasing motivation and adherence to treatment.
Now, the next step is to simultaneously begin a series of clinical trials with about a hundred patients from various hospitals like INNN, the National Institute of Rehabilitation, the University Hospital of Puebla and CRIT (Children Rehabilitation Center) of the same federal entity; to provide the Therapy of Gestures as a commercial product.
Finally, the teacher in electrical engineering by Stanford University, added that he already has a patent in Mexico for the concept called "3D therapy system with monocular visual tracking for the rehabilitation of the upper limb in humans". (Agencia ID)