While a number of studies have looked into using virtual reality (VR) to aid in stroke rehabilitation, few have directly compared it to conventional therapy, often consisting of physical therapy (PT) and occupational therapy (OT). However, a large, randomized-controlled trial of standard therapy versus VR therapy was recently published in the journal Neurology.
Titled the VIRTUES trial (Virtual Reality Training for Upper Extremity in Subacute Stroke), researchers from Norway, Denmark, and Belgium investigated what, if any, difference there was in using conventional therapy in stroke rehabilitation compared to non-immersive VR therapy. They randomized 120 stroke-survivors (within 12 weeks-post stroke) with upper limb impairment at 5 different rehabilitation institutes to either group. Each group still received standard rehabilitation but differed in either getting extra conventional upper limb therapy or extra VR therapy. The VR therapy consisted of the YouGrabber hand therapy system – a wearable sensor glove connected to a display monitor and training software. The software consists of hand therapy games, with reaching and grabbing movements utilized to interact in the non-immersive VR environment. The conventional therapy involved a self-training program under the supervision of a therapist with standardized limb exercises done while seated. Each group took part in at least sixteen 60-minute sessions over a period of 4 weeks. A variety of functional outcomes were utilized to measure improvement, including action research arm test (ARAT), box and block Test, and functional independence measure (FIM). These were measured immediately following intervention and later at 3 months.
Both groups improved in all outcome measurements, without a statistically significant difference between them. When a subgroup analysis was performed, both participants with mild-moderate weakness and those with severe weakness had similar improvements. The authors concluded that while VR therapy wasn’t more efficacious than conventional therapy, it was at least equally as effective, and potentially could be an alternative for patients who would find it more motivating.
These findings are consistent with prior guidelines recommending the use of VR in stroke rehabilitation, including the latest (as of 2017) Guidelines for Adult Stroke Rehabilitation and Recovery. VR hasn’t been proven to be superior for therapy, as of yet, but continues to demonstrate efficacy in rehabilitation after a stroke. The authors of the study noted that truly immersive VR might even be more helpful for patients than the non-immersive VR utilized in the study – certainly an area ripe for additional research!
