Abstract
Background
motor impairment of the upper limb (UL) after a stroke is common, which negatively impacts patients’ quality of life. Stroke survivors may develop a condition known as learned non-use, resulting in a tendency to avoid using the affected hand due to failure. Previous research has shown that constraint-induced movement therapy (CIMT), where the healthy arm is physically constrained to encourage the use of the stroke-affected arm, is effective in UL rehabilitation. However, some patients find it exhausting and tiring. New technologies have been applied to stroke rehabilitation alongside conventional techniques in recent years. For example, immersive virtual reality (IVR) has emerged as a new treatment approach for stroke rehabilitation, simulating real-life activities to work on self-care skills. Method: in this pilot study, we evaluated the efficacy of the IVR, which incorporates positive reinforcement components in motor coordination as opposed to CIMT using IVR technology. Eighteen participants were randomized to an IVR group to receive VR intervention plus physical therapy (PT) sessions or a control group to receive PT sessions alone. Participants were instructed to reach with either their affected or unaffected hand to a randomly assigned target in the VR. The movement of the virtual image of the UL was reinforced by visual feedback to the participants. Treatment effects on motor recovery were investigated using the Fugl-Meyer (FM) scale for the UL, kinematic dataset, and a questionnaire.
Results
the IVR group exhibited significant improvements in FM scores (p < 0.05) between the first and fifth session, signifying a substantial recovery of UL motor function, with the fifth session showing higher scores. The time to target in the last session reduced compared with that in the first session, suggesting motor learning and recovery (p < 0.05). The patients were highly engaged and motivated during the sessions because they felt like they were in charge of the virtual image of their upper body.
Conclusions
The results suggest that positive reinforcement within the IVR could encourage motor recovery of the affected hand and may facilitate the application of motor learning and neuroplasticity principles during neurological rehabilitation.