Virtual Reality for Stroke Rehabilitation

Summary

A Cochrane review [Abstract] 1 included 72 studies with a total of 2470 post-stroke subjects. Thirteen trials recruited patients within 3 months of stroke and 31 trials more than 6 months post stroke. Most studies reported that people with significant cognitive impairment would be excluded; however, this criterion was often poorly defined. Five intervention approaches were used: activity retraining; upper limb training; lower limb, balance and gait training; global motor function training; and cognitive/perceptual training. Twenty-two (31%) of the studies used commercially available gaming consoles: one study used the Playstation EyeToy, 15 used the Nintendo Wii and 4 studies used the Microsoft Kinect. Two studies used a mix of gaming consoles and 8 studies used GestureTek IREX. One study used the Armeo, one used the CAREN system and one used the Lokomat. The remaining studies used customised virtual reality programs. Control groups usually received no intervention or therapy based on a standard-care approach. A wide range of outcome measures were used. Only 5 studies involved longer-term follow-up: four 6 months and one at both 6 months and 5 years. The results were not statistically significant for upper limb function (SMD 0.07, 95% CI -0.05 to 0.20; 22 studies, n=1038) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77; 10 studies, n=210). When compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43; 10 studies, n=466); however, it was not possible to pool results for cognitive function, participation restriction, or quality of life.