Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: a preliminary study.

Only 4 people were studied, and the paper calls it preliminary, so the results cannot show what would happen in a larger group. There was no separate control group of usual therapy or modified constraint-induced movement therapy alone for the whole period; baseline was modified constraint-induced movement therapy alone, then treatment added virtual reality, so the effect of virtual reality cannot be isolated. The inclusion criteria required active wrist extension of at least 20 degrees, active metacarpophalangeal extension of at least 10 degrees, Korean Mini-Mental State Examination scores higher than 24, manual muscle testing higher than Grade 2, and Berg Balance Test scores higher than 40, so the findings may not apply to patients with more severe weakness, balance loss or cognition problems. Patients with visual hemineglect, hemianopsia, visual-perceptual dysfunction, sensory deficits, seizure, hypertension or angina pectoris were excluded. The study lasted 5 weeks and did not report follow-up after the intervention. The authors state that future studies need more participants and comparison of the combined therapy with each therapy used alone.

Do not read the improved test scores as proof that virtual reality training works. The patients received modified constraint-induced movement therapy and virtual reality together, only 4 people were studied, and the paper says more participants and separate comparisons are needed.