Virtual reality (VR) and other video games led to significant improvement in arm strength following stroke and could provide an affordable, enjoyable, and effective way to intensify treatment, according to research reported in Stroke: Journal of the American Heart Association, Dallas.
Researchers analyzed seven observational and five randomized trials, representing a total of 195 patients, ages 26 to 88, who had suffered mild to moderate strokes. Each study had investigated the effects of electronic games on upper arm strength and function.
In the observational studies, there was an average 14.7% improvement in motor strength after virtual reality sessions. There was a 20% average improvement in motor function, or the ability to perform standard tasks. In the randomized clinical trials, patients who played virtual reality games showed a statistically significant 4.89 times higher chance of improvement in motor strength compared to those who got standard therapy.
"Virtual reality gaming is a promising and potentially useful alternative to enhance motor improvement after stroke," said Gustavo Saposnik, MD, MSc, lead author of the study and director of the Stroke Outcomes Research Unit at St Michael’s Hospital at the University of Toronto. "Virtual reality gaming therapy may provide an affordable, enjoyable, and effective alternative to intensify treatment and promote motor recovery after stroke."
Between 55% and 75% of stroke survivors continue to experience motor deficits that reduce their quality of life, yet conventional therapy provides "modest and sometimes delayed effects," said Saposnik, also an assistant professor in the hospital’s department of medicine.
Recent research indicates the brain has a remarkable potential for remodelling because after injury it shows neuroplasticity, the ability to create new nerve cell connections. Those studies indicate that training designed to maximize the brain’s remodelling potential should be challenging, repetitive, task-specific, motivating, and novel. All of those are qualities of video-gaming, especially virtual reality systems in which players interact with a multisensory simulated environment via a wireless controller and receive real-time feedback on their performance.
Saposnik said advantages of virtual reality systems include:
- real-time feedback providing immediate positive reinforcement;
- multisensorial feedback, including vision, hearing, and sensory perception;
- computer-assisted movement;
- simple graphics; and
- potential for modifiable speed that enables participation over a wide range of patients including those with a cognitive impairment.
Although treatment varied by study, most patients played 20 to 30 hours during 4 to 6 weeks of therapy on one of several computer-based technology systems: three traditional video game systems (ie, Glasstron, IREX, Playstation Eye Toy) and nine virtual reality systems (eg, Virtual Teacher, CyberGlove, VR Motion, PneuGlove, Wii).
The observational studies followed patients in treatment to monitor changes over time. The randomized trials–considered more scientifically rigorous–randomly assigned two groups of patients to get either standard or virtual reality therapy.
Some of the smaller studies added virtual reality or video gaming on top of conventional therapy, which Saposnik said could limit this pooled analysis by skewing results for those who received more therapy. So far, there have been no large (more than 100 patients), randomized, controlled trials that compared the combination of virtual reality with conventional physical and occupational therapy to conventional treatment alone. That kind of study is needed, Saposnik said.
Co-author is Mindy Levin, PT, MSc, PhD, for the Stroke Outcome Research Canada working group.