As reported by Reuters on September 8, 2011 video gamers might face some surprising additions to their ranks if preliminary results from stroke rehab studies using virtual reality systems pan out.
Researchers taking a fresh look at past research have found virtual reality could help stroke patients regain some physical function in the short term and perform daily activities better than conventional stroke therapy.
Still, “I’m not sure we’re looking at it replacing conventional therapy,” said Judith Deutsch, one of the authors of the review and a physical therapy researcher at the University of Medicine and Dentistry of New Jersey in Newark. Instead, she suggested that using virtual reality video games could complement other types of rehab.
“You can make it engaging, and you can have somebody potentially work at a high intensity and for longer than they might if they didn’t have the stimulation of the game and the virtual environment,” she told Reuters Health.
Each year, more than 700,000 people in the United States have a stroke. Although most of them survive, they are often left crippled.
With some virtual reality programs, patients can practice dressing themselves, shopping in a supermarket, or driving their car until they improve enough to do those activities in the real world. Or, they can play games that require repeated muscle movements and improve strength.
But some experts say it’s too soon for stroke survivors to start treatment with virtual reality, noting that the research is promising but still limited. And in most of the studies so far, scientists tested customized systems, not off-the-shelf games.
Taking stock of the current medical evidence, Deutsch’s research team pooled the results of 19 studies — including a total of 565 stroke patients — that compared virtual reality rehab with conventional physical and occupational therapy or no treatment.
Those studies showed that patients who used virtual reality had better arm function than after conventional therapy, and also tended to improve more on basic daily activities, such as showering and dressing.
Virtual reality didn’t seem to improve hand strength or walking speed, however, and there wasn’t enough data to examine its effect on thinking and memory skills.
Most people in the studies were on the young side, as far as stroke patients go, and the trials were limited by their small size, Deutsch and colleagues note in their report in The Cochrane Library.
“At the end of the day, what it means is these studies are showing a potential benefit and a trend,” said Dr. Gustavo Saposnik, who heads the Stroke Outcomes Research Unit at St. Michael’s Hospital in Toronto.
However, he said, there’s still the need for bigger studies to get a clearer picture of how virtual reality and conventional stroke treatment compare.
“This is still under research,” Saposnik, who was not involved in the review, told Reuters Health. “We are not recommending any of our patients to undergo or to try virtual reality outside of a clinical study.”
But it’s promising, he added, that virtual reality can fulfill some of the “basic concepts in stroke rehab,” including repetition of specific activities at varying intensity levels.
“Conventional rehabilitation is challenging, it’s time consuming, it’s intensive, it’s tedious. For some patients they don’t appreciate the benefits initially, you have to have several months of very intensive therapy before they can appreciate some benefit,” Saposnik said.
The researchers noticed improvement over conventional therapy starting after about 15 hours of virtual reality, but said it’s unclear if the benefits would hold up over more than a few months.
With investigators increasingly focusing on readily-available gaming systems such as the Wii and Kinect for rehab instead of more expensive custom-made devices, Deutsch said that doctors and physical therapists can expect to know a lot more about virtual reality soon.
“There’s a lot of cool stuff that’s going to happen in the next couple years,” she said.
The ArmTutor and HandTutor have more than a short term success rate with post stroke victims wishing to improve their range of motion and the dexterity of their wrist, fingers, arm and shoulder joints.
The newly developed HandTutor and ArmTutor together with their sister devices ( LegTutor, 3DTutor) have become a key system in neuromuscular rehabilitation and physical therapy for stroke victims. These innovative devices implement an impairment based program with augmented feedback and encourage motor learning through intensive active exercises. These exercises are challenging and motivating and allow for repetitive training tailored to the patient’s performance. The system also includes objective quantitative evaluations that provide the therapist information to customize the most suitable rehabilitation program to the patient’s ability. Currently part of the rehabilitation program of leading U.S. and foreign hospitals the Tutors are also used in clinics and at home through the use of telerehabilitation.
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