Effects of Virtual Rehabilitation Training on Post-Stroke Executive and Praxis Skills and Depression Symptoms: A Quasi-Randomised Clinical Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Procedures
2.3. Psychometric Measures
2.4. Praxis Abilities Exercise
2.5. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Domain | Objective of Therapy | Activities Carried Out through Traditional Therapy (Control Group) | Activities Carried Out through Therapy with VRRS (Experimental Group) |
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Ideomotor Apraxia | Therapy for ideomotor apraxia aims to improve the ability to perform intentional movements and coordination between thought and action in patients with this condition. |
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Constructive Apraxia | Therapy for constructive apraxia aims to improve drawing, construction, and object manipulation skills in patients with this condition. |
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Domain | Individual Session Duration | VRRS Therapy | Traditional Therapy | ||||
---|---|---|---|---|---|---|---|
Exercise | Description | Aim | Exercise | Description | Aim | ||
Ideomotor apraxia | 3 times a week for 60 min of traditional therapy or virtual reality therapy for 8 weeks | Virtual meal preparation | Simulation of food preparation, such as cutting and mixing. | Coordination and sequencing of complex movements. | Imitation of Movements | The patient imitates the hand and arm movements performed by the therapist. | Helps restore the ability to perform movements on command. |
Virtual money management | Count, manage, and give change in a virtual environment. | Strengthens computational and object manipulation skills. | Sequences of movements | The patient performs a series of movements in a specific sequence (e.g., bring a hand to the mouth, then raise an arm). | Improves the ability to perform sequences of motor actions. | ||
Farm | Simulation of virtual farming activities, such as cultivating and harvesting. | Improves motor sequence and coordination in complex tasks. | Gestures on command | The patient performs symbolic gestures such as waving, pointing, or mimicking the use of objects upon request. | Enhances the ability to perform learned gestures and actions on command. | ||
Virtual dressing | Clothing activities: buttoning shirts, putting on shoes. | Facilitates motor coordination and sequencing of complex movements. | Handling of objects | The patient manipulates everyday objects such as combs, pens or cups, performing appropriate actions with them. | Strengthens the ability to use objects functionally. | ||
Replica of gestures | Perform gestures or actions shown in VR simulations, such as greetings or orders. | Improves learning of symbolic gestures and imitative movements. | Acknowledgment of shares | The patient observes images of people performing actions and must recognise or describe the action. | Stimulates recognition and understanding of motor actions. | ||
Identify the action | Recognise and replicate specific actions shown in VR simulations. | Enhances the ability to understand and perform actions on command. | Dressing in Sequence | The patient performs the complete dressing sequence, from putting on socks and shoes to putting on a jacket and hat. | Strengthens the ability to perform complex, everyday motor sequences. | ||
Virtual supermarket | Simulate the purchase of products: take items from shelves, pay at checkout. | Enhances motor skills and management of daily actions. | Reordering of sequences | The patient must sequentially order pictures representing an action (e.g., washing hands). | Improves understanding of the logical sequence of motor actions. | ||
Constructive apraxia | 3 times a week for 60 min of traditional therapy or virtual reality therapy for 8 weeks | Virtual puzzle | Solve three-dimensional puzzles by fitting virtual pieces into a predefined pattern. | Strengthens spatial perception and hand-eye coordination. | Construction of geometric figures | The patient must construct simple geometric figures using blocks or puzzle pieces. | Improves ability to perceive and organise spatial shapes. |
Design and construction | Draw and build complex objects or structures in a virtual three-dimensional space. | Enhances spatial and motor planning skills. | Copy of drawings | The patient copies simple and complex drawings or shapes, such as squares, triangles, and more articulated objects. | Strengthens drawing accuracy and spatial perception. | ||
Assembly of virtual objects | Assemble parts of a complex object, such as a model or device, following step-by-step instructions. | Strengthens ability to follow assembly and construction sequences. | Cutting and gluing activities | The patient uses scissors, paper and glue to create shapes and compositions, practicing precise manipulation and hand control. | Improves hand–eye coordination and manual dexterity. | ||
Simulation of home environment | Rearrange the decor of a virtual room, choosing and placing furniture and decorations in a functional way. | Improves the ability to visualise and realise spatial configurations. | Block construction | The patient uses physical blocks to build towers or other structures, following a model or freely. | Enhances hand–eye coordination and spatial planning. | ||
Advanced dot connection | Complete figures by joining virtual dots in complex sequences. | Enhances the ability to follow and complete sequences. | Modeling activities | The patient uses plasticine to build three-dimensional models following detailed instructions, such as creating figures or buildings. | Enhances perception and spatial manipulation. | ||
Virtual Pathways | Follow and complete virtual paths that require coordinated movements through complex virtual environments. | Improves ability to orient and perform multiple tasks. | Drawing of maps | The patient creates or completes maps of simple environments, such as a room or neighborhood, by correctly placing key elements. | Strengthens the ability to organise and represent spatial configurations. |
All | EG | CG | p-Value | |
---|---|---|---|---|
Participants | 20 | 10 (50.0) | 10 (50.0) | - |
Male | 10 (50.0) | 4 (40.0) | 6 (60.0) | 0.65 |
Age (years) | 48.30 ± 14.77 | 53.50 ± 8.87 | 43.10 ± 17.93 | 0.29 |
Education (years) | 6.90 ± 4.83 | 11.10 ± 2.96 | 2.70 ± 1.16 | <0.001 |
EG | CG | |||
---|---|---|---|---|
Median (1st Qu.–3rd Qu.) | Median (1st Qu.–3rd Qu.) | p-Value | ||
MMSE | T0 | 16.00 (14.25–17.75) | 22.00 (19.50–23.00) | 0.002 |
T1 | 20.50 (19.00–21.00) | 23.50 (23.00–25.00) | 0.007 | |
p-value | 0.002 | 0.002 | ||
FAB | T0 | 13.53 (12.63–14.00) | 14.03 (12.25–14.50) | 0.306 |
T1 | 14.50 (13.63–16.50) | 15.15 (13.63–13.00) | 0.568 | |
p-value | 0.002 | 0.022 | ||
HRS-D | T0 | 12.00 (10.25–15.50) | 12.00 (8.00–15.00) | 0.761 |
T1 | 11.50 (10.00–13.75) | 12.00 (6.00–13.00) | 0.704 | |
p-value | 0.012 | 0.021 | ||
Constructional Apraxia | T0 | 9.00 (8.25–9.75) | 10.00 (6.75–12.00) | 0.337 |
T1 | 13.00 (12.00–13.75) | 12.00 (10.25–13.00) | 0.512 | |
p-value | 0.002 | 0.042 | ||
Ideomotor Apraxia | T0 | 6.50 (4.25–8.75) | 12.00 (3.75–16.00) | 0.363 |
T1 | 14.50 (12.25–17.75) | 18.50 (14.25–19.00) | 0.383 | |
p-value | 0.002 | 0.009 |
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De Luca, R.; Gangemi, A.; Maggio, M.G.; Bonanno, M.; Calderone, A.; Mazzurco Masi, V.M.; Rifici, C.; Cappadona, I.; Pagano, M.; Cardile, D.; et al. Effects of Virtual Rehabilitation Training on Post-Stroke Executive and Praxis Skills and Depression Symptoms: A Quasi-Randomised Clinical Trial. Diagnostics 2024, 14, 1892. https://doi.org/10.3390/diagnostics14171892
De Luca R, Gangemi A, Maggio MG, Bonanno M, Calderone A, Mazzurco Masi VM, Rifici C, Cappadona I, Pagano M, Cardile D, et al. Effects of Virtual Rehabilitation Training on Post-Stroke Executive and Praxis Skills and Depression Symptoms: A Quasi-Randomised Clinical Trial. Diagnostics. 2024; 14(17):1892. https://doi.org/10.3390/diagnostics14171892
Chicago/Turabian StyleDe Luca, Rosaria, Antonio Gangemi, Maria Grazia Maggio, Mirjam Bonanno, Andrea Calderone, Vincenza Maura Mazzurco Masi, Carmela Rifici, Irene Cappadona, Maria Pagano, Davide Cardile, and et al. 2024. "Effects of Virtual Rehabilitation Training on Post-Stroke Executive and Praxis Skills and Depression Symptoms: A Quasi-Randomised Clinical Trial" Diagnostics 14, no. 17: 1892. https://doi.org/10.3390/diagnostics14171892