Combining Virtual Reality Motor Rehabilitation With Cognitive Strategy Use in Chronic Stroke

Abstract

Abstract Importance: Rehabilitation interventions for chronic stroke are largely impairment based, with results confined to the level of impairment instead of function. In contrast, cognitive strategy training interventions have demonstrated clinically meaningful improvements in functional outcomes. Integration of these approaches has yet to be explored. Objective: To evaluate acceptability, recruitment, and retention rate and determine which outcome measures best capture the effect of the intervention. Design: Single-group, pre–post design. Setting: Research laboratory. Participants: Adults with chronic stroke and hemiparesis (N = 10). Intervention: A 12-wk intervention integrating cognitive strategy training with upper extremity motor training. Two weekly sessions used Kinect-based virtual reality to encourage high numbers of upper extremity movement repetitions. The third weekly session focused on the use of cognitive strategies with practice of client-centered goals. Outcomes and Measures: Upper extremity motor performance was measured with the Fugl–Meyer Assessment. Occupational performance on trained and untrained goals was measured via the Performance Quality Rating Scale and the Canadian Occupational Performance Measure. Outcome data were gathered preintervention, postintervention, and at 3-mo follow-up. Results: The intervention was perceived as acceptable. Recruitment rate was 15%, and retention rate was 100%. Large effects were found on outcomes of upper extremity motor performance, occupational performance, and participation at follow-up. Conclusion and Relevance: MetacogVR is feasible for adults with chronic stroke. The effect of MetacogVR is best captured through measures of upper extremity motor performance, occupational performance, and participation. What This Articles Adds: Traditional, impairment-based approaches to chronic stroke rehabilitation may require integration with cognitive-strategy training to affect performance on meaningful goals.