Feasibility and Efficacy of a Virtual Reality Game-Based Upper Extremity Motor Function Rehabilitation Therapy in Patients with Chronic Stroke: A Pilot Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Pilot Study
2.1.1. Participants
2.1.2. Procedure
2.2. Design and Protocol
2.2.1. Outcome Measures
- Grip strength. A hydraulic Jamar hand dynamometer was used to measure the maximum grip strength. This was conducted according to the protocol of the American Hand Therapy Association [23]. In a seated position, participants had the arm in adduction, the elbow flexed to 90 degrees, the forearm in neutral position and the wrist between 0 and 30 degrees of extension. Three consecutive trials were carried out with the affected hand, and the mean of the three trials was used for statistical analysis. Clinically, grip strength is an important factor, as in the elderly population, it can inform future development as well as the most appropriate therapeutic approach [24]. Bertrand et al. [24] measured their test-retest reality, concluding that it was excellent (ICC 0.80 to 0.89).
- Action Research Arm Test (ARAT). It is a reliable tool for assessing UE motor deficits after stroke. It is a recommended test for stroke patients with an excellent test-retest reliability for this population (ICC = 0.965) [25]. It consists of 19 tests subdivided into 4 groups (grasp, grip, pinch and gross movement). The higher the score, the better the UE motor skills [26].
- The Box and Blocks Test (BBT). Through this test, gross manual dexterity was measured, both on the more affective and the less affective side. The BBT consists of moving, for one minute and one at a time, the maximum number of blocks from one side of a box to the other. It is an objective, easy to perform, reliable and standardized test and is validated for both acute and chronic stroke patients [27,28]. The minimum detectable change in stroke patients is 1.99 blocks in the most affected hand, and 2.84 blocks in the less affected hand. It has an excellent test-retest reliability for both the most affected hand (r = 0.98) and the least affected hand (r = 0.93) [28].
- Short Form Health Survey-36 Questionnaire (SF-36). The SF-36 is a generic scale on health status, valid both in the general population and in certain groups such as stroke. It consists of 36 questions subdivided into 8 scales: Physical Function, Physical Role, Body Pain, General Health, Vitality, Social Function, Emotional Role and Mental Health. It also adds an item comparing one’s health status with that of the previous year. It is used in descriptive studies as well as in therapeutic interventions [29,30]. In patients with chronic stroke, it has an excellent interrater/intra-rater reality with an ICC = 0.89 [31].
- Patient satisfaction was assessed by means of a questionnaire based on a Likert-type scale, designed by the research group. The questionnaire is made up of 9 items that assess the usefulness of the LMC in their rehabilitation, the degree of motivation, possible technical problems during the intervention, usability, whether they reported pain, the importance of therapist support, experience, frequency of use of electronic devices and the use of new technologies in the rehabilitation process. The range of the questionnaire was from 1 to 4, and the maximum possible score was 36. All questions were directly proportional, i.e., the higher the score, the better the patient’s perception [32,33].
- Attendance rate. Additionally, we recorded the attendance rate (%) for therapy sessions (compliance).
2.2.2. Data Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variable | Pre | Post | p Value |
---|---|---|---|
Grip strength | 16.30 (13.20) | 17.80 (14.90) | 0.005 * |
ARAT total | 48 (30) | 50 (31) | 0.028 * |
ARAT A | 14 (8) | 16 (9) | 0.139 |
ARAT B | 12 (5) | 12 (5) | 0.157 |
ARAT C | 12 (15) | 13 (13) | 0.168 |
ARAT D | 9 (2) | 9 (1) | 0.157 |
BBT | 27 (24) | 20.50 (23) | 0.011 * |
SF-36. Physical function | 45 (37.50) | 50 (40) | 0.655 |
SF36. Physical role | 62.50 (100) | 62.50 (100) | 0.317 |
SF-36. Body ache | 35 (30) | 30 (27.50) | 0.059 |
SF-36. General health | 60 (13.80) | 60 (13.80) | 0.317 |
SF-36. Vitality | 55 (13.80) | 57.50 (13.80) | 0.317 |
SF-36. Social function | 50 (12.50) | 50 (24.90) | 0.083 |
SF-36. Emotional role | 100 (91.80) | 100 (66.90) | 0.317 |
SF-36. Mental health | 62 (11) | 62 (12) | 0.197 |
Item | Media (Standard Deviation) |
---|---|
Motivation | 3.50 (0.527) |
Usability | 3.00 (0.816) |
Use of electronic devices | 2.70 (0.949) |
Pain | 3.80 (0.422) |
Therapist support | 3.70 (0.483) |
Technical problems | 2.60 (0.966) |
Utility | 3.50 (0.527) |
Experience | 3.40 (0.516) |
New technologies | 3.80 (0.422) |
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Aguilera-Rubio, Á.; Cuesta-Gómez, A.; Mallo-López, A.; Jardón-Huete, A.; Oña-Simbaña, E.D.; Alguacil-Diego, I.M. Feasibility and Efficacy of a Virtual Reality Game-Based Upper Extremity Motor Function Rehabilitation Therapy in Patients with Chronic Stroke: A Pilot Study. Int. J. Environ. Res. Public Health 2022, 19, 3381. https://doi.org/10.3390/ijerph19063381
Aguilera-Rubio Á, Cuesta-Gómez A, Mallo-López A, Jardón-Huete A, Oña-Simbaña ED, Alguacil-Diego IM. Feasibility and Efficacy of a Virtual Reality Game-Based Upper Extremity Motor Function Rehabilitation Therapy in Patients with Chronic Stroke: A Pilot Study. International Journal of Environmental Research and Public Health. 2022; 19(6):3381. https://doi.org/10.3390/ijerph19063381
Chicago/Turabian StyleAguilera-Rubio, Ángela, Alicia Cuesta-Gómez, Ana Mallo-López, Alberto Jardón-Huete, Edwin Daniel Oña-Simbaña, and Isabel Mª Alguacil-Diego. 2022. "Feasibility and Efficacy of a Virtual Reality Game-Based Upper Extremity Motor Function Rehabilitation Therapy in Patients with Chronic Stroke: A Pilot Study" International Journal of Environmental Research and Public Health 19, no. 6: 3381. https://doi.org/10.3390/ijerph19063381