The RehabMaster, a task-specific interactive game-based VR rehabilitation system, was developed to facilitate motor recovery after stroke. Our study included the first randomised controlled trial to assess the effects of a depth sensor-based VR gaming system on functional outcomes in patients with stroke; in addition, the testing of usability and clinical efficacy for upper extremity function in patients with stroke yielded favourable responses.
The FMA and MBI improved during the RehabMaster intervention in patients with chronic stroke. As none of the patients with chronic stroke in our clinical trials was receiving any other kind of therapy at the time of recruitment, these improvements appeared to indicate that the RehabMaster intervention was effective in patients with chronic stroke. In addition, the randomised controlled trial in patients with acute/subacute stroke also showed that RehabMaster + OT elicited greater improvement in FMA or MBI compared to OT-only groups, although this trend did not reach statistical significance. Therefore, RehabMaster might be a useful novel tool for rehabilitation of the upper extremities in patients with stroke. We speculated that these functional improvements stemmed from the greater focus of the RehabMaster intervention on the affected upper extremity. As seen in the EXCITE trial (Extremity Constraint Induced Therapy Evaluation), the intensive use of the affected arm may contribute to successful rehabilitation, even in the chronic stage of stroke[32, 33]. The task-specificity of the RehabMaster, which includes more than 40 kinds of training and games with different purposes, might also have been helpful in this regard. This property was created by the design of the RehabMaster specifically for patients with UE functional deficits due to stroke.
Our study has several limitations that must be considered when interpreting the results. We first tested the RehabMaster in patients with chronic stroke, as most previous studies using VR were performed in such patients. Once it was established that the system was safe in patients with chronic stroke, we enrolled patients with acute and subacute stroke in the second trial. Therefore, we intended to demonstrate the effects of the RehabMaster in a non-controlled clinical trial in patients with chronic stroke and in a randomised controlled trial in patients with acute/subacute stroke. The results from two trials, however, showed a slight difference. The different rehabilitation goals and characteristics of each phase of stroke might have influenced the results in these two groups. However, the present study was a pilot study originally designed to test the feasibility of using the RehabMaster in patients with varied degrees and stages of stroke. Different experimental protocols using different intervention times in the two experiments may have caused the inconsistency in their results. We attempted to determine the feasibility of using the RehabMaster for rehabilitation according to the benefit catalogue from the National Health Insurance Services of the Republic of Korea, which includes 20 and 30 minutes of OT. Therefore, both 20- and 30-minute RehabMaster sessions were employed, and the results imply that both durations of RehabMaster intervention are feasible for upper extremity rehabilitation. In the near future, an investigation focused on a specific population with a consistent protocol will be needed in order to establish an appropriate rehabilitation protocol. The differences between the groups of patients with acute/subacute stroke at baseline, despite their statistical non-significance, and the relatively short follow-up period were also limitations of the current study.
Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined.
This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL).
This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation.
Clinical practice guidelines recommend outpatient rehabilitation for stroke survivors who remain disabled after discharge from inpatient rehabilitation . Although these guidelines recommend that the majority of stroke survivors receive at least some outpatient rehabilitation , many cannot access long-term care . Among those individuals who do undergo outpatient rehabilitation, the standard of care for upper extremity rehabilitation is suboptimal.
The primary objective of this trial is to compare the effectiveness of two video game-based models of CI therapy versus traditional clinic-based CI therapy versus standard upper extremity rehabilitation for improving upper extremity motor function. One video gaming group will match the number of total hours spent on the CI therapy transfer package, but will involve fewer days of therapist-client interaction (4 versus 10); the other will match the number of interactions with a therapist to that of clinic-based CI therapy using video consultation between in-person sessions and, as such, will involve more therapist contact hours spent focusing on the transfer package. The secondary objective of this project is to promote personalized medicine by examining individual factors that may differentially influence response to one treatment versus another.
Compare the effectiveness of two technology-based models of in-home CI therapy versus traditional clinic-based CI therapy versus standard upper extremity rehabilitation for improving upper extremity motor function. Therapy-induced changes in performance speed (WMFT), real-world arm use (MAL), and quality of life (NeuroQOL) will be analyzed via mixed effects linear models. Initially, separate models will be constructed for the three primary outcome measures. Each of these models will include treatment and time (as well as their interaction) as fixed effects and participant as a random effect. In these models, the interaction of treatment and time is the primary effect of interest, since it tests the difference in change over time among the four treatment groups. The response variables will be transformed to a natural log scale before model fitting to aid in interpretation such that the coefficient associated with the time effect within a treatment can easily be interpreted as a percentage change in the outcome variable. Demographic measures and initial scores on outcome variables will be compared between groups using t-tests, non-parametric analogues such as Mann-Whitney U, or chi-squared tests. Significant differences will be considered in interpretation of the results. Results will be reported according to the CONSORT guidelines.
Using orthoses for immobilization is an important therapeutic intervention to help support and protect the injured upper extremity after surgery or trauma, and also to offer balance and help position the hand and wrist for enhanced function due to injury or pain. Therapists require core knowledge in upper extremity anatomy, biomechanical principles of orthotic fabrication and hands on practice to be able to fabricate well-fitting and appropriate orthoses for clients requiring immobilization of joints of the upper extremity.
Do you get referrals for patients with the diagnosis of shoulder pain/impingement Do you notice in your practice treating the UE that after prolonged nonuse of the upper extremity due to an elbow/wrist/hand injury, shoulder pain starts when your patient starts using the UE again Do you wonder what is the current evidence available for evaluating these patients Recent biomechanical considerations will be discussed when rehabilitating patients with impingement. Evaluation techniques will be reviewed and demonstrated to allow you to effectively gather the information needed to create an effective treatment plan to return your patient to their ADLs. 153554b96e