Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study.
Jigna Patel, Gerard Fluet, Qinyin Qiu and 4 others
PMID 31315612WHAT IT FOUND
In people with recent stroke, adding intensive virtual reality and robotic arm training to usual inpatient therapy was associated with larger 6-month gains in arm impairment and wrist movement, but not in task performance or pinch.
Key findings
01The additional virtual reality and robotic training was tolerated without reported adverse incidents.
02The virtual reality group showed significantly greater change over time on the Upper Extremity Fugl-Meyer Assessment and wrist active range of motion.
03There were no significant group differences over time on the Wolf Motor Function Test or maximum pinch force.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was a small feasibility pilot, with 13 participants, and was designed to inform a larger randomized trial rather than prove effectiveness. Participants were alternately assigned, and the paper describes the design as non-randomized. The virtual reality group also received usual physical, occupational, and speech therapy, and some participants received electrical stimulation, so the contribution of virtual reality or robotic training alone cannot be separated. The reliability of the pinch force and wrist range-of-motion measurement methods was not formally assessed. Transcranial magnetic stimulation maps for more proximal arm muscles were not obtained for the first few subjects. Statistical correlations between transcranial magnetic stimulation map changes and clinical outcomes were not possible because of the small sample size.
Declared interests
Funding was provided by the National Institutes of Health and NIDILRR.
The easy way to misread this
Do not read the Fugl-Meyer and wrist range-of-motion results as proof that virtual reality and robotic training causes better stroke recovery. This was a small non-randomized feasibility pilot, and the behavioral and pinch outcomes were not significant.