Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.
Gerard G Fluet, Jigna Patel, Qinyin Qiu and 5 others
PMID 27669997WHAT IT FOUND
A person with subacute stroke completed eight one-hour VR hand training sessions over two weeks while continuing occupational, physical, and speech therapy.
She gained pinch force, hand scores, and brain map changes, but this case cannot show the training caused them.
Key findings
01The primary outcome, motor map area, changed: lesioned-hemisphere first dorsal interossei map area expanded more than 100% from pretest to posttest and continued to expand at retention.
02Finger pinch force increased almost 50% during training, and pinch tracing improved 25% from pretest to posttest and another 30% from posttest to retention.
03Total Fugl-Meyer increased 12 points from pretest to posttest and 6 more points at retention; Box and Blocks went from no blocks to eight blocks at posttest and 23 blocks at retention.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
A case report describes what happened to a single person; it is not evidence that the treatment works. The person received standard inpatient occupational, physical, and speech therapy during the study, and she had outpatient occupational therapy before retention, so the contribution of the VR component alone cannot be separated. The authors state they could not distinguish improvements caused by training from spontaneous recovery. The person began the intervention 37 days after stroke, a time when the authors note spontaneous recovery and motor map expansion have typically levelled off, but confounding remains. She had non-fluent aphasia and dysphagia, and the authors note motor performance tests can be affected by communication, visual perception, arousal, attention, and working memory. The primary outcome was motor map area, but the paper does not show that map changes caused clinical improvement.
Declared interests
The authors state that they have no conflicts of interest.
The easy way to misread this
Do not conclude that VR hand training caused the improvements. The person also received standard inpatient occupational, physical, and speech therapy, and she had outpatient occupational therapy before retention. The authors state they could not distinguish training effects from spontaneous recovery.