Virtual Reality Reflection Therapy Improves Balance and Gait in Patients with Chronic Stroke: Randomized Controlled Trials

Taesung In, Kyeongjin Lee, Changho Song, Taesung In, Kyeongjin Lee, Changho Song

Abstract

BACKGROUND Virtual reality reflection therapy (VRRT) is a technically enhanced version of the mirror therapy concept. The aim of this study was to investigate whether VRRT could improve the postural balance and gait ability of patients with chronic stroke. MATERIAL AND METHODS Twenty-five patients with chronic stroke were randomly allocated into the VRRT group (n=13) and the control group (n=12). The participants in both groups performed a conventional rehabilitation program for 30 minutes. The VRRT group also performed a VRRT program for 30 minutes, five times a week for 4 weeks. The control group performed conventional rehabilitation program and a placebo VRRT program. Outcome measures included Berg Balance Scale (BBS), the Functional Reaching Test (FRT), and the Timed Up and Go (TUG) test (for dynamic balance ability), postural sway (for static balance ability), and 10 meter walking velocity (10 mWV) for gait ability. RESULTS There were statistically significant improvements in the VRRT group compared with the control group for BBS, FRT, TUG, postural sway (mediolateral sway distance with eyes open and eyes closed, anteroposterior and total sway distance with eyes open but not with eyes closed), and 10 mWV (p<0.05). CONCLUSIONS Applying VRRT (even as a home treatment) along with a conventional rehabilitation program for patients with chronic stroke might be even more beneficial than conventional rehabilitation program alone in improving affected lower limb function. Future studies should investigate the effectiveness of VRRT with optimal patient selection, and duration and intensity of training.

Figures

Figure 1
Figure 1
Flow diagram based on CONSORT.
Figure 2
Figure 2
Setting for virtual reality reflection therapy.

References

    1. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76:27–32.
    1. Daly JJ, Zimbelman J, Roenigk KL, et al. Recovery of coordinated gait: randomized controlled stroke trial of functional electrical stimulation (FES) versus no FES, with weight-supported treadmill and over-ground training. Neurorehabil Neural Repair. 2011;25:588–96.
    1. Yang S, Hwang WH, Tsai YC, et al. Improving balance skills in patients who had stroke through virtual reality treadmill training. Am J Phys Med Rehabil. 2011;90:969–78.
    1. Brogardh C, Flansbjer UB, Lexell J. No specific effect of whole-body vibration training in chronic stroke: A double-blind randomized controlled study. Arch Phys Med Rehabil. 2012;93:253–58.
    1. Hoyer E, Jahnsen R, Stanghelle JK, Strand LI. Body weight supported treadmill training versus traditional training in patients dependent on walking assistance after stroke: A randomized controlled trial. Disabil Rehabil. 2012;34:210–19.
    1. Fisher S, Lucas L, Thrasher TA. Robot-assisted gait training for patients with hemiparesis due to stroke. Top Stroke Rehabil. 2011;18:269–76.
    1. Mehrholz J, Hadrich A, Platz T, et al. Electromechanical and robot-assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2012;6:CD006876.
    1. Hu XL, Tong KY, Song R, Zheng XJ, Leung WW. A comparison between electromyography-driven robot and passive motion device on wrist rehabilitation for chronic stroke. Neurorehabil Neural Repair. 2009;23:837–46.
    1. Yavuzer G, Selles R, Sezer N, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:393–98.
    1. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil. 2003;84:1090–92.
    1. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996;263:377–86.
    1. Altschuler EL, Wisdom SB, Stone L, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet. 1999;353:2035–36.
    1. Stevens JA, Stoykov ME. Simulation of bilateral movement training through mirror reflection: A case report demonstrating an occupational therapy technique for hemiparesis. Top Stroke Rehabil. 2004;11:59–66.
    1. Funase K, Tabira T, Higashi T, et al. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci Lett. 2007;419:108–12.
    1. Small SL, Buccino G, Solodkin A. The mirror neuron system and treatment of stroke. Dev Psychobiol. 2012;54:293–310.
    1. Lee MM, Cho HY, Song CH. The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil. 2012;91:689–96. quiz 697–700.
    1. Michielsen ME, Selles RW, Van Der Geest JN, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25:223–33.
    1. Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2007;88:555–59.
    1. Ikai T, Kamikubo T, Takehara I, Nishi M, Miyano S. Dynamic postural control in patients with hemiparesis. Am J Phys Med Rehabil. 2003;82:463–69. quiz 470–72, 84.
    1. Marque P, Felez A, Puel M, et al. Impairment and recovery of left motor function in patients with right hemiplegia. J Neurol Neurosurg Psychiatry. 1997;62:77–81.
    1. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4:26.
    1. Graham JV, Eustace C, Brock K, et al. The Bobath concept in contemporary clinical practice. Top Stroke Rehabil. 2009;16:57–68.
    1. Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: Reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27–36.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–48.
    1. Laufer Y, Sivan D, Schwarzmann R, Sprecher E. Standing balance and functional recovery of patients with right and left hemiparesis in the early stages of rehabilitation. Neurorehabil Neural Repair. 2003;17:207–13.
    1. Wade DT, Wood VA, Hewer RL. Recovery after stroke – the first 3 months. J Neurol Neurosurg Psychiatry. 1985;48:7–13.
    1. Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: A randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81:409–17.
    1. Mccabe CS, Haigh RC, Ring EF, et al. A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1) Rheumatology (Oxford) 2003;42:97–101.
    1. Carey JR, Bhatt E, Nagpal A. Neuroplasticity promoted by task complexity. Exerc Sport Sci Rev. 2005;33:24–31.
    1. Jeannerod M. Mental imagery in the motor context. Neuropsychologia. 1995;33:1419–32.
    1. Staines WR, Mcilroy WE, Graham SJ, Black SE. Bilateral movement enhances ipsilesional cortical activity in acute stroke: A pilot functional MRI study. Neurology. 2001;56:401–4.
    1. Cauraugh JH, Kim S. Two coupled motor recovery protocols are better than one: Electromyogram-triggered neuromuscular stimulation and bilateral movements. Stroke. 2002;33:1589–94.
    1. Cunningham CL, Stoykov ME, Walter CB. Bilateral facilitation of motor control in chronic hemiplegia. Acta Psychol (Amst) 2002;110:321–37.
    1. Whitall J, Mccombe Waller S, et al. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000;31:2390–95.
    1. Walker C, Brouwer BJ, Culham EG. Use of visual feedback in retraining balance following acute stroke. Phys Ther. 2000;80:886–95.
    1. Hlavackova P, Fristios J, Cuisinier R, et al. Effects of mirror feedback on upright stance control in elderly transfemoral amputees. Arch Phys Med Rehabil. 2009;90:1960–63.
    1. Sousa CO, Barela JA, Prado-Medeiros CL, et al. Gait training with partial body weight support during overground walking for individuals with chronic stroke: A pilot study. J Neuroeng Rehabil. 2011;8:48.
    1. Runge CF, Shupert CL, Horak FB, Zajac FE. Ankle and hip postural strategies defined by joint torques. Gait Posture. 1999;10:161–70.
    1. Daubney ME, Culham EG. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther. 1999;79:1177–85.
    1. Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci. 1995;50(Spec):64–67.

Source: PubMed

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