The effectiveness of reinforced feedback in virtual environment in the first 12 months after stroke

• Published in: Neurologia i neurochirurgia polska 2011, Vol.45 (5), p.436-444
• Main Authors: Kiper, Paweł, Piron, Lamberto, Turolla, Andrea, Stożek, Joanna, Tonin, Paolo
• Format: Article
• Language: English
• Subjects: Aged; Combined Modality Therapy; Computer Simulation - utilization; Disability Evaluation; Exercise Therapy - instrumentation; Exercise Therapy - methods; Feedback, Psychological; Female; Follow-Up Studies; Humans; Male; Middle Aged; motor learning; nauka motoryki; Neuromuscular Agents - therapeutic use; Outcome Assessment (Health Care); Paresis - etiology; Paresis - rehabilitation; Poland; Recovery of Function; rehabilitacja; rehabilitation; rzeczywistość wirtualna; Stroke; Stroke - complications; Stroke - physiopathology; Stroke Rehabilitation; Treatment Outcome; udar mózgu; Upper Extremity - physiopathology; virtual reality
• ISSN: 0028-3843; 1897-4260
• DOI: 10.1016/S0028-3843(14)60311-X

Reinforced feedback in virtual environment (RFVE) therapy is emerging as an innovative method in rehabilitation, which may be advantageous in the treatment of the affected arm after stroke. The purpose of this study was to investigate the impact of assisted motor training in a virtual environment for the treatment of the upper extremity (UE) after stroke compared to traditional neuromotor rehabilitation (TNR), studying also if differences exist related to the type of stroke (haemorrhagic or ischaemic). Eighty patients affected by a stroke (48 ischaemic and 32 haemorrhagic) that occurred at least 1 year before were enrolled. The clinical assessment comprising the Fugl-Meyer UE (F-M UE), modified Ashworth (Bohannon & Smith) and Functional Independence Measure scale (FIM) was administered before and after the treatment. A statistically significant difference between RFVE and TNR groups (Mann-Whitney U-test) was observed in the clinical outcomes of F-M UE and FIM (both p < 0.001), but not Ashworth (p = 0.053). The outcomes of F-M UE and FIM improved in the RFVE haemorrhagic group and in the TNR haemorrhagic group with a significant difference between groups (both p < 0.001), but not for Ashworth (p = 0.651). Comparing the RFVE ischaemic group to the TNR ischaemic group, statistically significant differences emerged in F-M UE (p < 0.001), FIM (p < 0.001), and Ashworth (p = 0.036). The RFVE therapy in combination with TNR showed better improvements compared to the TNR treatment only. The RFVE therapy combined with the TNR treatment was more effective than the TNR double training, in both post-ischaemic and post-haemorrhagic groups. We observed improvements in both groups of patients: post-haemorrhagic and post-ischaemic stroke after RFVE training. Terapia w środowisku wirtualnym (reinforced feedback in virtual environment – RFVE) staje się nowatorską metodą w rehabilitacji, której zastosowanie może mieć korzystny wpływ w leczeniu porażonej kończyny górnej u chorych po udarze mózgu. Celem pracy było zbadanie wpływu terapii RFVE w leczeniu kończyny górnej po udarze mózgu w stosunku do tradycyjnej rehabilitacji neurologicznej (TRN) oraz określenie występowania różnic zależnych od rodzaju udaru mózgu (krwotoczny, niedokrwienny). Badaniom poddano 80 chorych (48 pacjentów po udarze niedokrwiennym i 32 pacjentów po krwotocznym udarze mózgu) z niedowładem połowiczym w okresie do roku po przebytym udarze mózgu. Funkcje kończyny górnej oceniano na początku i po zakończeni