A study by Kristina Fiore, Staff Writer for ”MedPage Today” and published September 08, 2011 and with a review by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
notes that virtual reality and interactive video gaming might potentially offer some advantages over traditional therapy for patients rehabilitating after a stroke including improved motivation and increased involvement in therapeutic activities.
In addition she notes that in this review of a number of relatively small and limited studies, there was some evidence that the use of virtual reality programs was associated with improved arm function and improved management of everyday activities, but it could not be determined if these effects were longlasting.
Virtual reality may help stroke patients regain arm function and recover some ability to perform daily activities, researchers found.
In a meta-analysis, seven studies involving 205 patients found that gaming in the computer-simulated world improved arm function significantly better than standard therapy, Kate Laver, MD, of Flinders University in Daw Park, Adelaide, Australia, and colleagues reported in Cochrane Reviews.
It also offered greater improvements in activities of daily living, in a smaller number of studies, they reported.
“Virtual reality looks as if it could be a promising therapeutic tool, but we need a lot more data before we can assess which aspects of virtual reality are the most important, and assess how long the effects last,” Laver said in a statement.
Virtual reality — an interface that allows users to become immersed in a computer-generated environment — as well as interactive video gaming, such as the Nintendo Wii, have emerged as new treatment approaches in stroke rehabilitation, yet there’s little information on their therapeutic effectiveness.
The researchers conducted a review of 19 studies totaling 565 patients on the effects of virtual reality and interactive video gaming on upper limb, lower limb, and global motor function after a stroke.
They noted that the overall sample was relatively young, with mean ages of 51 to 73. As well, a wide range of outcome measures were used, they said.
Based on results of seven studies totaling 205 patients, Laver and colleagues found that virtual reality significantly improved arm function compared with conventional therapy (standardized mean difference [SMD] 0.53, 95% CI 0.25 to 0.81).
One trial looking at longer-term effects found significantly better improvement in arm function with virtual reality compared with regular therapy, the researchers said (P=0.045).
In terms of secondary outcomes, the researchers also saw significant improvement compared with standard therapy for activities of daily living in three studies totaling 101 patients (SMD 0.81, 95% CI 0.39 to 1.22).
Yet in two trials there were no significant effects on grip strength, and in three trials there were no benefits on gait speed compared with regular therapy.
Laver and colleagues wrote that they couldn’t determine any effects on global motor function because there wasn’t a sufficient number of comparable studies.
For other secondary outcomes, the researchers weren’t able to pool results for cognitive function, participation restriction, and quality of life or imaging studies. Nor could they pool results on driving evaluations.
There were few adverse events across all studies, and those that were reported were relatively mild, Laver and colleagues wrote.
Only one study looked at an interactive gaming console, so they couldn’t assess effects of systems such as the Nintendo Wii. They said future research is needed to examine the effects of therapy done with this tool rather than virtual reality.
The researchers added that it’s also unclear which characteristics of virtual reality are most important in therapy, and it’s not known whether the beneficial effects on arm function or activities of daily living are sustained in the long term.
More randomized controlled trials are needed to determine which types of virtual reality interventions are most effective as well, they said.
Enter the HandTutor system together with its sister devices the ArmTutor, LegTutor and 3DTutor. This new innovative device uses interactive games to improve movement and agility in patients that have suffered a stroke,brain or spinal injuries, Parkinson’s , MS, CP and many other diseases.
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