''Playstation eyetoy games'' improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. Effect of Virtual Reality on Cognition in Stroke Patients Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke Reinforced Feedback in Virtual Environment for Rehabilitation of Upper Extremity Dysfunction after Stroke: Preliminary Data from a Randomized Controlled Trial Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. Virtual Reality–Induced Cortical Reorganization and Associated Locomotor Recovery in Chronic Stroke: An Experimenter-Blind Randomized Study The Effect of Virtual Reality and Tetra-Ataxiometric Posturography Programs on Stroke Patients With Impaired Standing Balance Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): Rationale, Design, and Protocol of a Pilot Randomized Clinical Trial Assessing the Wii Gaming System Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke Cognitive training on stroke patients via virtual reality-based serious games Effects of game-based virtual reality on health-related quality of life in chronic stroke patients: A randomized, controlled study Clinical usefulness of the virtual reality-based postural control training on the gait ability in patients with stroke Visual Biofeedback Balance Training Using Wii Fit after Stroke: A Randomized Controlled Trial A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology — a randomized controlled, single-blinded, pilot clinical trial study Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial Effects of Training With a Robot-Virtual Reality System Compared With a Robot Alone on the Gait of Individuals After Stroke Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial. The Effect of Virtual Reality Training on Unilateral Spatial Neglect in Stroke Patients Does the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke? Virtual reality training for stroke rehabilitation. Asymmetric training using virtual reality reflection equipment and the enhancement of upper limb function in stroke patients: a randomized controlled trial. Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke Motor Learning Principles for Rehabilitation: A Pilot Randomized Controlled Study in Poststroke Patients A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments Facilitation of corticospinal excitability by virtual reality exercise following anodal transcranial direct current stimulation in healthy volunteers and subacute stroke subjects Virtual Immersion for Post-Stroke Hand Rehabilitation Therapy Virtual Reality Exercise Improves Mobility After Stroke: An Inpatient Randomized Controlled Trial Improving Balance Skills in Patients Who Had Stroke Through Virtual Reality Treadmill Training Exercises for paretic upper limb after stroke: a combined virtual-reality and telemedicine approach. Chronic stroke survivors achieve comparable outcomes following virtual task specific repetitive training guided by a wearable robotic orthosis (UL-EXO7) and actual task specific repetitive training guided by a physical therapist. Cortical reorganization and associated functional motor recovery after virtual reality in patients with chronic stroke: an experimenter-blind preliminary study. Effects of virtual reality on upper extremity function and activities of daily living performance in acute stroke: a double-blind randomized clinical trial. Virtual reality in the rehabilitation of the arm after hemiplegic stroke: a randomized controlled pilot study The Effect of Arm Support Combined With Rehabilitation Games on Upper-Extremity Function in Subacute Stroke Virtual reality for upper extremity rehabilitation in early stroke: a pilot randomized controlled trial Additional Virtual Reality Training Using Xbox Kinect in Stroke Survivors with Hemiplegia Arm Motor Recovery Using a Virtual Reality Intervention in Chronic Stroke Use of Virtual Reality to Enhance Balance and Ambulation in Chronic Stroke: A Double-Blind, Randomized Controlled Study Eliciting Upper Extremity Purposeful Movements Using Video Games
AIM To evaluate the effects of ' ' Playstation EyeToy Games ' ' on upper extremity motor recovery and upper extremity-related motor functioning of patients with subacute stroke . METHODS The authors design ed a r and omized , controlled , assessor-blinded , 4-week trial , with follow-up at 3 months . A total of 20 hemiparetic in patients ( mean age 61.1 years ) , all within 12 months post-stroke , received 30 minutes of treatment with ' ' Playstation EyeToy Games ' ' per day , consisting of flexion and extension of the paretic shoulder , elbow and wrist as well as abduction of the paretic shoulder or placebo therapy ( watching the games for the same duration without physical involvement into the games ) in addition to conventional program , 5 days a week , 2 - 5 hours/day for 4 weeks . Brunnstrom 's staging and self-care sub-items of the functional independence measure ( FIM ) were performed at 0 month ( baseline ) , 4 weeks ( post-treatment ) , and 3 months ( follow-up ) after the treatment . RESULTS The mean change score ( 95 % confidence interval ) of the FIM self-care score ( 5.5 [ 2.9 - 8.0 ] vs 1.8 [ 0.1 - 3.7 ] , P=0.018 ) showed significantly more improvement in the EyeToy group compared to the control group . No significant differences were found between the groups for the Brunnstrom stages for h and and upper extremity . CONCLUSION ' ' Playstation EyeToy Games ' ' combined with a conventional stroke rehabilitation program have a potential to enhance upper extremity-related motor functioning in subacute stroke patients Objective To investigate the effect of virtual reality on the recovery of cognitive impairment in stroke patients . Method Twenty-eight patients ( 11 males and 17 females , mean age 64.2 ) with cognitive impairment following stroke were recruited for this study . All patients were r and omly assigned to one of two groups , the virtual reality ( VR ) group ( n=15 ) or the control group ( n=13 ) . The VR group received both virtual reality training and computer-based cognitive rehabilitation , whereas the control group received only computer-based cognitive rehabilitation . To measure , activity of daily living cognitive and motor functions , the following assessment tools were used : computerized neuropsychological test and the Tower of London ( TOL ) test for cognitive function assessment , Korean-Modified Barthel index ( K-MBI ) for functional status evaluation , and the motricity index ( MI ) for motor function assessment . All recruited patients underwent these evaluations before rehabilitation and four weeks after rehabilitation . Results The VR group showed significant improvement in the K-MMSE , visual and auditory continuous performance tests ( CPT ) , forward digit span test ( DST ) , forward and backward visual span tests ( VST ) , visual and verbal learning tests , TOL , K-MBI , and MI scores , while the control group showed significant improvement in the K-MMSE , forward DST , visual and verbal learning tests , trail-making test-type A , TOL , K-MBI , and MI scores after rehabilitation . The changes in the visual CPT and backward VST in the VR group after rehabilitation were significantly higher than those in the control group . Conclusion Our findings suggest that virtual reality training combined with computer-based cognitive rehabilitation may be of additional benefit for treating cognitive impairment in stroke patients Background Acquired brain injury ( ABI ) is the main cause of death and disability among young adults . In most cases , survivors can experience balance instability , result ing in functional impairments that are associated with diminished health-related quality of life . Traditional rehabilitation therapy may be tedious . This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders . We present eBaViR ( easy Balance Virtual Rehabilitation ) , a system based on the Nintendo ® Wii Balance Board ® ( WBB ) , which has been design ed by clinical therapists to improve st and ing balance in patients with ABI through motivational and adaptative exercises . We hypothesize that eBaViR , is feasible , safe and potentially effective in enhancing st and ing balance . Methods In this contribution , we present a r and omized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients . This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation ( n = 9 ) versus st and ard rehabilitation ( n = 8) . Effectiveness was evaluated by means of traditional static and dynamic balance scales . Results The final sample consisted of 11 men and 6 women . Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days . Patients using eBaViR had a significant improvement in static balance ( p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test ) compared to patients who underwent traditional therapy . Regarding dynamic balance , the results showed significant improvement over time in all these measures , but no significant group effect or group-by-time interaction was detected for any of them , which suggests that both groups improved in the same way . There were no serious adverse events during treatment in either group . Conclusions The results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population . These results have encouraged us to reinforce the virtual treatment with new exercises , so an evolution of the system is currently being developed This exploratory study was undertaken to investigate the mechanisms that contributed to improvements in upper limb function following a novel training program . Surface electromyography ( EMG ) was used to examine training-induced changes in the pattern of triceps and biceps activation during reaching tasks in stroke survivors with severe paresis in the chronic stage of recovery . The EMG data were obtained in the context of a single blind r and omised clinical trial conducted with 42 stroke survivors with minimal upper limb muscle activity and who were more than 6 months post-stroke . Of the 33 participants who completed the study , 10 received training of reaching using a non-robotic upper limb training device , the SMART Arm , with EMG triggered functional electrical stimulation ( EMG-stim ) , 13 received training of reaching using the SMART Arm alone , and 10 received no intervention . Each intervention group engaged in 12 1-h training sessions over a 4-week period . Clinical and laboratory measures of upper limb function were administered prior to training ( 0 weeks ) , at completion ( 4 weeks ) and 2 months ( 12 weeks ) after training . The primary outcome measure was ‘ upper arm function ’ which is Item 6 of the Motor Assessment Scale ( MAS ) . Laboratory measures consisted of two multijoint reaching tasks to assess ‘ maximum isometric force ’ and ‘ maximum distance reached ’ . Surface EMG  was used to monitor triceps brachii and biceps brachii during the two reaching tasks . To provide a comparison with normal values , seven healthy adults were tested on one of the reaching tasks according to the same procedure . Study findings demonstrated a statistically significant improvement in upper limb function for stroke participants in the two training groups compared to those who received no training however no difference was found between the two training groups . For the reaching tasks , all stroke participants , when compared to normal healthy adults , exhibited lower triceps and biceps activation and a lower ratio of triceps to biceps activation . Following training , stroke participants demonstrated increased triceps activation and an increased ratio of triceps to biceps activation for the task that was trained . Better performance was associated with greater triceps activation and a higher ratio of triceps to biceps activation . The findings suggest that increased activation of triceps as an agonist and an improved coordination between triceps and biceps could have mediated the observed changes in arm function . The changes in EMG activity were small relative to the changes in arm function indicating that factors , such as the contribution of other muscles of reaching , may also be implicated Objectives . To study whether the reinforced feedback in virtual environment ( RFVE ) is more effective than traditional rehabilitation ( TR ) for the treatment of upper limb motor function after stroke , regardless of stroke etiology ( i.e. , ischemic , hemorrhagic ) . Design . R and omized controlled trial . Participants . Forty-four patients affected by stroke . Intervention . The patients were r and omized into two groups : RFVE ( N = 23 ) and TR ( N = 21 ) , and stratified according to stroke etiology . The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality , while in the TR treatment the same exercises were provided without augmented feedbacks . Outcome Measures . Fugl-Meyer upper extremity scale ( F-M UE ) , Functional Independence Measure scale ( FIM ) , and kinematics parameters ( speed , time , and peak ) . Results . The F-M UE ( P = 0.030 ) , FIM ( P = 0.021 ) , time ( P = 0.008 ) , and peak ( P = 0.018 ) , were significantly higher in the RFVE group after treatment , but not speed ( P = 0.140 ) . The patients affected by hemorrhagic stroke significantly improved FIM ( P = 0.031 ) , time ( P = 0.011 ) , and peak ( P = 0.020 ) after treatment , whereas the patients affected by ischemic stroke improved significantly only speed ( P = 0.005 ) when treated by RFVE . Conclusion . These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function . This trial is registered with NCT01955291 OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke Background and Purpose — Virtual reality ( VR ) is a new promising computer-assisted technology to promote motor recovery in stroke patients .  VR-induced neuroplasticity supporting locomotor recovery is not known . We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients . Methods — Ten chronic stroke patients were assigned r and omly to either the control group or the  VR  group . VR was design ed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning . Laterality index ( LI ) in the regions of interests ( ROIs ) and locomotor recovery were measured before and after VR using functional MRI ( fMRI ) and st and ardized locomotor tests , respectively . The t test and nonparametric test were performed to compare the mean differences at P<0.05 . Results — There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex ( SMC ) between the groups ( P<0.05 ) , indicating that VR practice produced a greater increase in LI for the control group . However , the interval changes in the other ROIs were not significantly different ( P>0.05 ) . Motor function was significantly improved after VR ( P<0.05 ) . Conclusions — Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation . This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke . This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR Objective To investigate the effect of virtual reality ( VR ) and a tetra-ataxiometric posturography ( Tetrax ) program on stroke patients with impaired st and ing balance . Methods Thirty acute stroke patients with impaired st and ing balance were recruited and r and omly assigned to a VR , Tetrax , or control group . All patients received conventional balance training as a baseline ; and VR and Tetrax patients received VR or Tetrax treatment , in addition . The primary outcome measures to evaluate the overall st and ing balance were the Berg Balance Scale ( BBS ) and the falling index ( FI ) . The secondary outcome measures were the stability index ( SI ) and the weight distribution index ( WDI ) , which were used to evaluate the balance status according to specific body positions . The FI , SI , and WDI were measured using the Tetrax instrument . Results The BBS and FI scores were improved in all groups , with no significant differences between groups . In open-eyed positions , the VR group showed significantly greater improvement in SI and WDI scores than the control group ( p<0.017 ) . In closed-eyed positions , the Tetrax group showed significantly greater improvement in SI and WDI scores than the control group ( p<0.017 ) . Conclusion The inclusion of VR and Tetrax programs did not lead to an overall benefit in balance . VR and Tetrax did , however , demonstrate a benefit in specific positions . A Tetrax program may benefit patients with abnormal proprioceptive function , whereas a VR program may benefit patients with normal sensory function Background Evidence suggests that increasing intensity of rehabilitation results in better motor recovery . Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation . EVREST was design ed to evaluate feasibility , safety and efficacy of using the Nintendo Wii gaming virtual reality ( VRWii ) technology to improve arm recovery in stroke patients . Methods Pilot r and omized study comparing , VRWii versus recreational therapy ( RT ) in patients receiving st and ard rehabilitation within six months of stroke with a motor deficit of ≥3 on the Chedoke-McMaster Scale ( arm ) . In this study we expect to r and omize 20 patients . All participants ( age 18–85 ) will receive customary rehabilitative treatment consistent of a st and ardized protocol ( eight sessions , 60 min each , over a two-week period ) . Outcome measures The primary feasibility outcome is the total time receiving the intervention . The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period . Efficacy , a secondary outcome measure , will be measured by the Wolf Motor Function Test , Box and Block Test , and Stroke Impact Scale at the four-week follow-up visit . From November , 2008 to September , 2009 21 patients were r and omized to VRWii or RT . Mean age , 61 ( range 41–83 ) years .  Mean time from stroke onset 25 ( range 10–56 ) days . Conclusions EVREST is the first r and omized parallel controlled trial assessing the feasibility , safety , and efficacy  of virtual reality using Wii gaming technology in stroke rehabilitation . The results of this study will serve as the basis for a larger multicentre trial . Clinical Trials.gov registration # Objective : To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke . Design : R and omized controlled trial . Setting : Outpatient neurorehabilitation unit . Participants : A total of 20 individuals with chronic stroke . Interventions : The intervention consisted of 20 one-hour sessions , five sessions per week . The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training . The control group underwent one hour conventional therapy . Main measures : Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale , the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment , the Brunel Balance Assessment , and the 10-m Walking Test . Subjective data of the virtual reality-based intervention were collected from the experimental group , with a feedback question naire at the end of the trial . Results : The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale ( p < 0.05 ) and in the 10-m Walking Test ( p < 0.05 ) . Post-hoc analyses showed greater improvement in the experimental group : 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale , –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test , and also in the number of participants who increased level in the Brunel Balance Assessment ( χ2 = 2.5 , p < 0.01 ) . Conclusions : Virtual reality interventions can be an effective re source to enhance the improvement of balance in individuals with chronic stroke Abstract Purpose : Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages . In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation , a cognitive training program using virtual reality was applied to stroke patients . Methods : A virtual reality-based serious games application for cognitive training was developed , with attention and memory tasks consisting of daily life activities . Twenty stroke patients were r and omly assigned to two conditions : exposure to the intervention , and waiting list control . Results : The results showed significant improvements in attention and memory functions in the intervention group , but not in the controls . Conclusions : Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation . Implication s for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention . Training of daily-life activities using a virtual reality application .  Accessibility to training contents In the present study , we aim ed to determine whether game-based virtual reality ( VR ) rehabilitation , combined with occupational therapy ( OT ) , could improve health-related quality of life , depression , and upper extremity function . We recruited 35 patients with chronic hemiparetic stroke , and these participants were r and omized into groups that underwent VR rehabilitation plus conventional OT , or the same amount of conventional OT alone , for 20 sessions over 4 weeks . Compared to baseline , the VR rehabilitation plus OT group exhibited significantly improved role limitation due to emotional problems ( p=0.047 ) . Compared to baseline , both groups also exhibited significantly improved depression ( p=0.017 ) and upper extremity function ( p=0.001 ) , although the inter-group differences were not significant . However , a significant inter-group difference was observed for role limitation due to physical problems ( p=0.031 ) . Our results indicate that game-based VR rehabilitation has specific effects on health-related quality of life , depression , and upper extremity function among patients with chronic hemiparetic stroke This study is a single blind r and omized controlled trial to determine the effect of virtual reality-based postural control training on the gait ability in patients with chronic stroke . Sixteen subjects were r and omly assigned to either experimental group ( VR , n= 8) or control group ( CPT , n= 8) . Subjects in both groups received conventional physical therapy for 60 min per day , five days per week during a period of four weeks . Subjects in the VR group received additional augmented reality-based training for 30 min per day , three days per week during a period of four weeks . The subjects were evaluated one week before and after participating in a four week training and follow-up at one month post-training . Data derived from the gait analyses included spatiotemporal gait parameters , 10 meters walking test ( 10 mWT ) . In the gait parameters , subjects in the VR group showed significant improvement , except for cadence at post-training and follow-up within the experimental group . However , no obvious significant improvement was observed within the control group . In between group comparisons , the experimental group ( VR group ) showed significantly greater improvement only in stride length compared with the control group ( P < 0.05 ) , however , no significant difference was observed in other gait parameters . In conclusion , we demonstrate significant improvement in gait ability in chronic stroke patients who received virtual reality based postural control training . These findings suggest that virtual reality ( VR ) postural control training using real-time information may be a useful approach for enhancement of gait ability in patients with chronic stroke [ Purpose ] The aim of the present study was to investigate the effect of balance training with visual biofeedback on balance , body symmetry , and function among individuals with hemiplegia following a stroke . [ Subjects and Methods ] The present study was performed using a r and omized controlled clinical trial with a blinded evaluator . The subjects were twenty adults with hemiplegia following a stroke . The experimental group performed balance training with visual biofeedback using Wii Fit ® together with conventional physical therapy . The control group underwent conventional physical therapy alone . The intervention lasted five weeks , with two sessions per week . Body symmetry ( baropodometry ) , static balance ( stabilometry ) , functional balance ( Berg Balance Scale ) , functional mobility ( Timed Up and Go test ) , and independence in activities of daily living ( Functional Independence Measure ) were assessed before and after the intervention . [ Results ] No statistically significant differences were found between the experimental and control groups . In the intragroup analysis , both groups demonstrated a significant improvement in all variables studied . [ Conclusion ] The physical therapy program combined with balance training involving visual biofeedback ( Wii Fit ® ) led to an improvement in body symmetry , balance , and function among stroke victims . However , the improvement was similar to that achieved with conventional physical therapy alone Objective : To assess the effectiveness of a computerized visual perception rehabilitation programme using motion tracking technology for visual perception impairment . Design : R and omized controlled , single-blinded , pilot clinical trial study . Setting : Inpatient rehabilitation hospital . Subjects : Sixteen left hemiplegic patients with visual perceptional impairment . Intervention : Subjects were r and omly assigned to receive either ( 1 ) participation in a computerized visual perception rehabilitation programme with an interactive patient — computer interface applying motion tracking technology based on the CAMSHIFT algorithm or ( 2 ) use of the PSS CogRehab program for three sessions per week , 30 minutes per session for four weeks . There were eight patients in each group . Main measures : Mini-Mental Status Examination , Motor-free Visual Perception Test and Modified Barthel Index were assessed at the beginning and end of the training . A survey was conducted to evaluate the degree of patients ' interest using an interest scale . Results : After training , the mean ( SD ) Motor-free Visual Perception Test score increased significantly in both experimental group ( from 65.8 ( 19.5 ) to 77.8 ( 28.7 ) ) and control group ( from 68.3 ( 11.4 ) to 74.1 ( 14.8 ) ) ( P<0.01 ) . Modified Barthel Index score increased significantly in both groups , with the experimental group recording a higher increase . Mean ( SD ) interest scale score was greater in the experimental group ( 2.2 ( 0.8 ) ) than in the control group ( 1.3 ( 0.7 ) ) ( P<0.01 ) . Conclusions : A computerized visual perception rehabilitation programme with interactive computer interface using motion tracking technology could be considered as a treatment option for stroke patients with visual perception impairment Background Recent evidence has demonstrated the efficacy of Virtual Reality ( VR ) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied . Objectives To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients . Methods A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital . We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale ( It-NIHSS ) between 1 and 3 and without severe neuropsychological impairments interfering with recovery . Patients were allocated to two treatments groups , receiving combined VR and upper limb conventional ( ULC ) therapy or ULC therapy alone . The treatment programs consisted of 2 hours of daily therapy , delivered 5 days per week , for 4 weeks . The outcome measures were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scales . Results Both treatments significantly improved F-M UE and FIM scores , but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone . The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 ( P < 0.001 ) pts and 3.2 ± 1.2 ( P = 0.007 ) pts , respectively . Conclusions VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities . Trial registration Italian Ministry of Health IRCCS Research Programme Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with the robot virtual reality ( VR ) system and the other group trained with the robot alone . Outcome measures were temporal features of gait measured in a laboratory setting and the community . Results — Greater changes in velocity and distance walked were demonstrated for the group trained with the robotic device coupled with the VR than training with the robot alone . Similarly , significantly greater improvements in the distance walked and number of steps taken in the community were measured for the group that trained with robot coupled with the VR . These differences were maintained at 3 months ’ follow-up . Conclusions — The study is the first to demonstrate that LE training of individuals with chronic hemiparesis using a robotic device coupled with VR improved walking ability in the laboratory and the community better than robot training alone BACKGROUND Upper limb ( UL ) impairment is the most common disabling deficit following a stroke . Previous studies have suggested that transcranial direct current stimulation ( tDCS ) enhances the effect of conventional therapies . OBJECTIVE This pilot double-blind r and omized control trial aim ed to determine whether or not tDCS , combined with Wii virtual reality therapy ( VRT ) , would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals . METHODS Twenty participants were r and omly assigned either to an experimental group that received VRT and tDCS , or a control group that received VRT and sham tDCS . The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS , and one hour of virtual reality therapy . The outcomes included were determined using the Fugl-Meyer scale , the Wolf motor function test , the modified Ashworth scale ( MAS ) , grip strength , and the stroke specific quality of life scale ( SSQOL ) . Minimal clinical ly important differences ( MCID ) were observed when assessing outcome data . RESULTS Both groups demonstrated gains in all evaluated areas , except for the SSQOL-UL domain . Differences between groups were only observed in wrist spasticity levels in the experimental group , where more than 50 % of the participants achieved the MCID . CONCLUSIONS These findings support that tDCS , combined with VRT therapy , should be investigated and clarified further Objective To investigate the effect of virtual reality training on unilateral spatial neglect in stroke patients . Method Twenty-four stroke patients ( 14 males and 10 females , mean age=64.7 ) who had unilateral spatial neglect as a result of right hemisphere stroke were recruited . All patients were r and omly assigned to either the virtual reality ( VR ) group ( n=12 ) or the control group ( n=12 ) . The VR group received VR training , which stimulated the left side of their bodies . The control group received conventional neglect therapy such as visual scanning training . Both groups received therapy for 30 minutes a day , five days per week for three weeks . Outcome measurements included star cancellation test , line bisection test , Catherine Bergego scale ( CBS ) , and the Korean version of modified Barthel index ( K-MBI ) . These measurements were taken before and after treatment . Results There were no significant differences in the baseline characteristics and initial values between the two groups . The changes in star cancellation test results and CBS in the VR group were significantly higher than those of the control group after treatment . The changes in line bisection test score and the K-MBI in the VR group were not statistically significant . Conclusion This study suggests that virtual reality training may be a beneficial therapeutic technique on unilateral spatial neglect in stroke patients This r and omised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions result ed in more superior retraining of dynamic balance compared to CR after stroke . 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and r and omly assigned to either a control or an experimental group . Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation .  Functional Reach Test , Timed Up and Go , Modified Barthel Index , Berg Balance Scale , and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions . Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower OBJECTIVE To evaluate the effectiveness of a 2-D virtual reality ( 2DVR ) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway ( MTR ) . METHOD A flat-screen 2DVR based training programme and a corresponding , typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a r and omised control group pre-test and post-test . RESULTS Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme .  An additional 22 subjects formed the control group . They were assessed by using a behavioural checklist of MTR skills and a newly vali date d MTR self-efficacy scale . The subjects of both training groups showed a significant improvement in their knowledge , skills and self-efficacy in using the MTR ( p<0.01 ) , whereas , the MTR skills and self-efficacy of the control group remained stable over a four-week interval . CONCLUSION Though both training programmes were effective in training the patients with stroke , they demonstrated differential improvements in MTR skills and related self-efficacy . Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke BACKGROUND Asymmetric movements with both h and s contributed to the improvement of spatially coupled motion . Thus , the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients . METHODS Twenty-four stroke patients were r and omly allocated to an experimental group ( n=12 ) or a control group ( n=12 ) . Both groups participated in conventional physical therapy for 2 × 30 min/d , 5 d/wk , for 4 weeks . The experimental group also participated in an asymmetric training program using virtual reality reflection equipment , and the control group participated in a symmetric training program . Both asymmetric and symmetric programs were conducted for 30 min/d , 5 d/wk , for 4 weeks . To compare upper limb function before and after intervention , the Fugl-Meyer Assessment ( FMA ) , the Box and Block Test ( BBT ) , grip strength , range of motion ( ROM ) , and spasticity were assessed . RESULTS Both groups showed significant increases in upper limb function , excepting spasticity , after intervention ( P<.05 , 1-way repeated- measures analysis of variance [ ANOVA ] ) . A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA , BBT , grip strength , and ROM of wrist flexion , extension , and ulnar deviation ( P<.05 , 2-way repeated- measures ANOVA ) . CONCLUSIONS This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients . We consider that an additional study based on a program using virtual reflection , which is more functional than performing simple tasks , and consisting of tasks relevant to the activities of daily living be conducted Background Dexterous manipulation of the h and , one of the features of human motor control , is often compromised after stroke , to the detriment of basic functions . Despite the importance of independent movement of the digits to activities of daily living , relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on h and rehabilitation . The purpose of this study was to investigate the impact of such finger individuation training , by means of a novel mechatronic-virtual reality system , on fine motor control after stroke . Methods An actuated virtual keypad ( AVK ) system was developed in which the impaired h and controls a virtual h and playing a set of keys . Creation of individuated digit movements is assisted by a pneumatically actuated glove , the PneuGlove . A study examining efficacy of the AVK system was subsequently performed . Participants had chronic , moderate h and impairment result ing from a single stroke incurred at least 6 months prior . Each subject underwent 18 hour-long sessions of extensive therapy ( 3x per week for 6 weeks ) targeted at finger individuation . Subjects were r and omly divided into two groups : the first group ( Keypad : N = 7 ) utilized the AVK system  while the other group ( OT : N = 7 ) received a similarly intensive dose of occupational therapy ; both groups worked directly with a licensed occupational therapist . Outcome measures such as the Jebsen-Taylor H and Function Test ( JTHFT ) , Action research Arm Test ( ARAT ) , Fugl-Meyer Upper Extremity Motor Assessment /H and subcomponent ( FMUE/FMH ) , grip and pinch strengths were collected at baseline , post-treatment and one-month post-treatment . Results While both groups exhibited some signs of change after the training sessions , only the Keypad group displayed statistically significant improvement both for measures of impairment ( FMH : p = 0.048 ) and measures of task performance ( JTHFT : p = 0.021 ) . Additionally , the finger individuation index – a measure of finger independence – improved only for the Keypad group after training ( p = 0.05 ) in the subset ( Keypad : N = 4 ; OT : N = 5 ) of these participants for which it was measured . Conclusions Actively assisted individuation therapy comprised of non task-specific modalities , such as can be achieved with virtual platforms like the AVK described here , may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke Background . Six months after a stroke , the hemiplegic arm often remains compromised . More innovative approaches to motor rehabilitation are needed . Objective . The authors compared a motor learning — based approach in a virtual environment with more conventional upper extremity therapy in a pilot trial . Methods . This prospect i ve , single-blinded , r and omized controlled trial compared reinforced feedback in a virtual environment ( RFVE ; n = 27 ) with a control intervention ( n = 20 ) of progressive therapy for the affected upper extremity . Both treatments were provided for 4 weeks , 5 days per week , with 1-hour treatment sessions daily . The primary outcomes were the Fugl-Meyer Upper Extremity ( F-M UE ) and Functional Independence Measure ( FIM ) scores . Kinematic outcomes included mean duration ( MD ) , mean linear velocity ( MLV ) , and number of submovements to measure the motor performance . Analyses of the primary outcomes were performed per protocol and by intention to treat . Results . F-M UE scores improved significantly in the RFVE group compared with the conventional therapy group ( “ intention to treat ” = 5.10 points , P = .004 ; ANCOVA = 4.26 points , P < .01 ) . Several of the kinematic parameters improved in the RFVE group ( MD , P < .01 ; MLV , P < .01 ) . FIM improvements did not differ . Conclusions . Both rehabilitation therapies improved arm motor performance and functional activity , but the RFVE therapy induced more robust results in patients exposed to late rehabilitation treatment Background Virtual reality ( VR ) is not commonly used in clinical rehabilitation , and commercial VR gaming systems may have mixed effects in patients with stroke . Therefore , we developed RehabMaster ™ , a task-specific interactive game-based VR system for post-stroke rehabilitation of the upper extremities , and assessed its usability and clinical efficacy . Methods A participatory design and usability tests were carried out for development of RehabMaster with representative user groups . Two clinical trials were then performed . The first was an observational study in which seven patients with chronic stroke received 30 minutes of  RehabMaster intervention per day for two weeks . The second was a r and omised controlled trial of 16 patients with acute or subacute stroke who received 10 sessions of conventional occupational therapy only ( OT-only group ) or conventional occupational therapy plus 20 minutes of RehabMaster intervention ( RehabMaster + OT group ) . The Fugl-Meyer Assessment score ( FMA ) , modified Barthel Index ( MBI ) , adverse effects , and drop-out rate were recorded . Results The requirements of a VR system for stroke rehabilitation were established and incorporated into RehabMaster . The reported advantages from the usability tests were improved attention , the immersive flow experience , and individualised intervention . The first clinical trial showed that the RehabMaster intervention improved the FMA ( P = .03 ) and MBI ( P = .04 ) across evaluation times . The second trial revealed that the addition of RehabMaster intervention tended to enhance the improvement in the FMA ( P = .07 ) but did not affect the improvement in the MBI . One patient with chronic stroke left the trial , and no adverse effects were reported . Conclusions The RehabMaster is a feasible and safe VR system for enhancing upper extremity function in patients with stroke Background There is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation . We investigated the beneficial effects of the application of transcranial direct current stimulation ( tDCS ) combined with virtual reality ( VR ) motor training . Methods In total , 15 healthy , right-h and ed volunteers and 15 patients with stroke in the subacute stage participated . Four different conditions ( A : active wrist exercise , B : VR wrist exercise , C : VR wrist exercise following anodal tDCS ( 1 mV , 20 min ) on the left ( healthy volunteer ) or affected ( stroke patient ) primary motor cortex , and D : anodal tDCS without exercise ) were provided in r and om order on separate days . We compared during and post-exercise corticospinal excitability under different conditions in healthy volunteers ( A , B , C , D ) and stroke patients ( B , C , D ) by measuring the changes in amplitudes of motor evoked potentials in the extensor carpi radialis muscle , elicited with single-pulse transcranial magnetic stimulation . For statistical analyses , a linear mixed model for a repeated- measures covariance pattern model with unstructured covariance within groups ( healthy or stroke groups ) was used . Results The VR wrist exercise ( B ) facilitated post-exercise corticospinal excitability more than the active wrist exercise ( A ) or anodal tDCS without exercise ( D ) in healthy volunteers . Moreover , the post-exercise corticospinal facilitation after tDCS  and VR exercise ( C ) was greater and was sustained for 20 min after exercise versus the other conditions in healthy volunteers ( A , B , D ) and in subacute stroke patients ( B , D ) . Conclusions The combined effect of VR motor training following tDCS was synergistic and short-term corticospinal facilitation was superior to the application of VR training , active motor training , or tDCS without exercise condition . These results support the concept of combining brain stimulation with VR motor training to promote recovery after a stroke Stroke is the leading cause of serious , long-term disability in the United States . Impairment of upper extremity function is a common outcome following stroke , often to the detriment of lifestyle and employment opportunities . While the upper extremity is a natural target for therapy , treatment may be hampered by limitations in baseline capability as lack of success may discourage arm and h and use . We developeda virtual reality ( VR ) system in order to encourage repetitive task practice . This system combined an assistive glove with a novel VR environment . A set of exercises for this system was developed to encourage specific movements . Six stroke survivors with chronic upper extremity hemiparesis volunteered to participate in a pilot study in which they completed 18 one-hour training sessions with the VR system .  Performance with the system was recorded across the 18 training sessions . Clinical evaluations of motor control were conducted at three time points : prior to initiation of training , following the end of training , and 1 month later . Subjects displayed significant improvement on performance of the virtual tasks over the course of the training , although for the clinical outcome measures only lateral pinch showed significant improvement . Future expansion to multi-user virtual environments may extend the benefits of this system for stroke survivors with hemiparesis by furthering engagement in the rehabilitation exercises Background and Purpose — Exercise using virtual reality ( VR ) has improved balance in adults with traumatic brain injury and community-dwelling older adults . Rigorous r and omized studies regarding its efficacy , safety , and applicability with individuals after stroke are lacking . The purpose of this study was to determine whether an adjunct VR therapy improves balance , mobility , and gait in stroke rehabilitation in patients . Methods — A blinded r and omized controlled trial study ing 59 stroke survivors on an inpatient stroke rehabilitation unit was performed . The treatment group ( n=30 ) received st and ard stroke rehabilitation therapy plus a program of VR exercises that challenged balance ( eg , soccer goal tending , snowboarding ) performed while st and ing . The control group ( n=29 ) received st and ard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance ( performed in sitting ) . VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period . Objective outcome measures of balance and mobility were assessed before , immediately after , and 1 month after training . Results — Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test , with both groups meeting minimal clinical important differences after training . More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain ( P=0.04 ) immediately after training . Conclusions — This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes . Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR . Clinical Trial Registration — URL : http://www.ANZCTR.org.au/. Unique identifier : ACTRN12613000710729 Objective : The aim of this study was to evaluate the effects of virtual reality ( VR ) treadmill training on the balance skills of patients who have had a stroke . Design : A total of 14 patients with strokes were recruited and r and omly assigned to receive VR treadmill or traditional treadmill training . The outcome measures that were included for the study were center of pressure ( COP ) sway excursion , COP maximum sway in anterior-posterior direction , COP maximum sway in medial-lateral direction , COP sway area , bilateral limb-loading symmetric index , the sway excursion values for the paretic foot ( sway excursion/P ) , paretic limb stance time ( stance time/P ) , number of steps of the paretic limb ( number of steps/P ) , and contact area of the paretic foot ( contact A/P ) during quiet stance , sit-to-st and transfer , and level walking . Results : There were no significant improvements in COP-related measures and symmetric index during the quiet stance , either in the VR treadmill or traditional treadmill training group ( P > 0.05 ) . However , the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant ( P = 0.038 ) . Traditional treadmill training failed to improve sit-to-st and performance , whereas VR treadmill training improved symmetric index ( P = 0.028 ) and sway excursion ( P = 0.046 ) significantly during sit-to-st and transfer . The changes of symmetric index between groups were markedly different ( P = 0.045 ) . Finally , both groups improved significantly in stance time/P , but only VR treadmill training increased contact A/P ( P = 0.034 ) after training during level walking . The difference between groups during level walking was not significant . Conclusions : Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance , but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did . VR treadmill training also improved balance skill during sit-to-st and transfers and the involvement of paretic limb in level walking more than the traditional one did OBJECTIVE Telerehabilitation enables a remotely controlled programme to be used to treat motor deficits in post-stroke patients . The effects of this telerehabilitation approach were compared with traditional motor rehabilitation methods . DESIGN R and omized single-blind controlled trial . PATIENTS A total of 36 patients with mild arm motor impairments due to ischaemic stroke in the region of the middle cerebral artery . METHODS The experimental treatment was a virtual reality-based system delivered via the Internet , which provided motor tasks to the patients from a remote rehabilitation facility . The control group underwent traditional physical therapy for the upper limb . Both treatments were of 4 weeks duration . All patients were assessed one month prior to therapy , at the commencement and termination of therapies and one month post-therapy , with the Fugl-Meyer Upper Extremity , the ABILH AND and the Ashworth scales . RESULTS Both rehabilitative therapies significantly improved all outcome scores after treatment , but only the Fugl-Meyer Upper Extremity scale showed differences in the comparison between groups . CONCLUSION Both strategies were effective , but the experimental approach induced better outcomes in motor performance . These results may favour early discharge from hospital sustained by a telerehabilitation programme , with potential beneficial effects on the use of available re sources Survivors post stroke commonly have upper limb impairments . Patients can drive neural reorganization , brain recovery and return of function with task specific repetitive training ( TSRT ) .  Fifteen community independent stroke survivors ( 25 - 75 years , > 6 months post stroke , Upper Limb Fugl Meyer [ ULFM ] scores 16 - 39 ) participated in this r and omized feasibility study to compare outcomes of upper limb TSRT guided by a robotic orthosis ( bilateral or unilateral ) or a physical therapist . After 6 weeks of training ( 18 h ) , across all subjects , there were significant improvements in depression , flexibility , strength , tone , pain and voluntary movement ( ULFM ) ( p < 0.05 ; effect sizes 0.49 - 3.53 ) . Each training group significantly improved ULFM scores and range of motion without significant group differences . Virtual or actual TSRT performed with a robotic orthosis or a physical therapist significantly reduced arm impairments around the shoulder and elbow without significant gains in fine motor h and control , activities of daily living or independence OBJECTIVE To investigate the effects of virtual reality ( VR ) on cortical reorganization and motor recovery . DESIGN Nonparametric pre- and posttest design with experimenter blinded . SETTING University medical center . PARTICIPANTS Five patients with hemiparesis ( age , 59.8+/-3.4y ) were recruited . INTERVENTION Five patients received VR for 60 minutes a day , 5 times a week for 4 weeks . VR was design ed to provide a virtual rehabilitation scene where the intensity of practice and sensory feedback could be systematic ally manipulated to provide the most appropriate , individualized motor retraining program . MAIN OUTCOME MEASURES Cortical activation and associated motor recovery were measured before and after VR using functional magnetic resonance imaging and st and ardized motor tests , respectively . Nonparametric tests were used at P less than .05 . RESULTS Prior to VR , the bilateral primary sensorimotor cortices ( SM1s ) , contralesional premotor cortex , and contralesional or ipsilesional supplementary motor area were activated . After VR , the altered activations disappeared and predominantly the ipsilesional SM1 was activated ( P<.05 ) . Motor function was improved ( P<.05 ) . CONCLUSIONS This is a novel demonstration of  VR-induced neuroplastic changes and associated motor recovery in chronic stroke AIM To examine the effects of conventional therapy ( CT ) combined with intensive virtual reality ( VR ) program on upper extremity function and activities of daily living ( ADL ) in individuals in the acute stage of stroke . METHOD Twenty-six individuals were r and omly assigned to the control or experimental group . The control group received CT , while the experimental group received VR training in addition to CT on same day . The Fugl-Meyer Assessment ( FMA ) and the Manual Function Test ( MFT ) were used to measure improvement of functioning in the affected limb and the Korean version of the Modified Barthel Index ( K-MBI ) was conducted to evaluate ADL . RESULT In tests of upper extremity functioning , VR group showed significant improvement on FMA and MFT ( p < 0.05 ) . In the CT group , only FMA score showed significant change ( p < 0.05 ) . ADL performance improved significantly in both groups ( p < 0.05 ) . However , there were no significant differences between the two groups in upper extremity function and ADL performance ( p > 0.05 ) . CONCLUSION This study observed that VR training has the advantage of improving intended arm function during intensive training for individuals in the acute stage of stroke Objective : To assess the feasibility of a trial to investigate the effectiveness of virtual reality-mediated therapy compared to conventional physiotherapy in the motor rehabilitation of the arm following stroke , and to provide data for a power analysis to determine numbers for a future main trial . Design : Pilot r and omized controlled trial . Setting : Clinical research facility . Participants : Eighteen people with a first stroke , 10 males and 8 females , 7 right and 2 left side most affected . Mean time since stroke 10.8 months . Interventions : Participants were r and omized to a virtual reality group or a conventional arm therapy group for nine sessions over three weeks . Main measures : The upper limb Motricity Index and the Action Research Arm Test were completed at baseline , post intervention and six weeks follow-up . Results : Outcome data were obtained from 95 % of participants at the end of treatment and at follow-up : one participant withdrew . Compliance was high ; only two people reported side-effects from virtual reality exposure . Both groups demonstrated small ( 7–8 points on upper limb Motricity Index and 4 points on the Action Research Arm Test ) , but non-significant , changes to their arm impairment and activity levels . Conclusion : A r and omized controlled trial of virtual reality-mediated therapy comparable to conventional therapy would be feasible , with some suggested improvements in recruitment and outcome measures . Seventy-eight participants ( 39 per group ) would be required for a main trial Background . Use of rehabilitation technology , such as (electro)mechanical devices or robotics , could partly relieve the increasing strain on stroke rehabilitation caused by an increasing prevalence of stroke . Arm support ( AS ) training showed improvement of unsupported arm function in chronic stroke . Objective . To examine the effect of weight-supported arm training combined with computerized exercises on arm function and capacity , compared with dose-matched conventional reach training in subacute stroke patients . Methods . In a single-blind , multicenter , r and omized controlled trial , 70 subacute stroke patients received 6 weeks of training with either an AS device combined with computerized exercises or dose-matched conventional training ( CON ) .  Arm function was evaluated pretraining and posttraining by Fugl-Meyer assessment ( FM ) , maximal reach distance , Stroke Upper Limb Capacity Scale ( SULCS ) , and arm pain via Visual Analogue Scale , in addition to perceived motivation by Intrinsic Motivation Inventory posttraining . Results . FM and SULCS scores and reach distance improved significantly within both groups . These improvements and experienced pain did not differ between groups . The AS group reported higher interest/enjoyment during training than the CON group . Conclusions . AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation , when applied at the same dose Objectives : To investigate the effect of virtual reality ( VR ) rehabilitation on upper extremity motor performance of patients with early stroke . Design : Pilot r and omized controlled trial . Setting : Rehabilitation wards . Participants : Twenty three adults with stroke ( mean age ( SD ) = 58.35 ( 13.45 ) years and mean time since stroke ( SD ) = 16.30 ( 7.44 ) days ) . Interventions : Participants were r and omly assigned to VR group ( n=11 ) or control group ( n=12 ) . VR group received nine 30 minutes upper extremity VR therapy in st and ing ( five weekdays in two weeks ) plus conventional therapy , which included physical and occupational therapy . Control group received only conventional therapy , which was comparable to total training time received by VR group ( mean training hours (SD):VR = 17.07 ( 2.86 ) ; control = 15.50 ( 2.79 ) ) . Main outcome measures : The main outcome measure was the Fugl-Meyer Assessment ( FMA ) . Secondary outcomes included Action Research Arm Test , Motor Activity Log and Functional Independence Measure . Results were taken at baseline , post intervention and 1-month post intervention . Participants ’ feedback and adverse effects were recorded . Results : All participants improved in FMA scores ( mean change ( SD ) = 11.65 ( 8.56 ) , P<.001 ) . These effects were sustained at one month after intervention ( mean ( SD ) change from baseline = 18.67 ( 13.26 ) , P<.001 ) . All other outcome measures showed similar patterns . There were no significant differences in improvement between both groups . Majority of the participants found VR training  useful and enjoyable , with no serious adverse effects reported . Conclusion : Although additional VR training was not superior to conventional therapy alone , this study demonstrates the feasibility of VR training in early stroke Objective The aim of this study was to investigate the effects of additional virtual reality training using Xbox Kinect on upper extremity function , including range of motion , motor function , and gross manual dexterity , in stroke survivors with hemiplegia . Design This study is a r and omized controlled trial . Forty participants were r and omly allocated to either the experimental or control groups ; the experimental group ( n = 20 ) underwent virtual reality training using Xbox Kinect and conventional occupational therapy , and the control group ( n = 20 ) underwent conventional occupational therapy alone . The mean time since the onset of stroke was 7.22 mos in the experimental group and 8.47 mos in the control group . At baseline and after 6 wks of intervention , range of motion of the upper extremity was measured , and the Fugl-Meyer Assessment and the Box and Block Test were performed . Results After intervention , significant improvements from baseline values in range of motion of the upper extremity , Fugl-Meyer Assessment scores , and Box and Block Test scores were observed in the experimental and control groups ( P < 0.05 ) . At follow-up , there were significant differences between the two groups in range of motion ( except for the wrist ) , Fugl-Meyer Assessment scores , and Box and Block Test scores ( P < 0.05 ) . Conclusions The hemiplegic stroke survivors who received additional virtual reality training using Xbox Kinect showed significantly improved function of the upper extremity . However , the effects of the virtual reality training using Xbox Kinect may have been a result of the greater total intervention time in the training group compared with the control group . Thus , the potential efficacy of Xbox Kinect in the rehabilitation of post-stroke survivors needs to be investigated in greater depth Introduction . Despite interest in virtual environments ( VEs ) for poststroke arm motor rehabilitation , advantages over physical environment ( PE ) training have not been established . Objective . The authors compared kinematic and clinical outcomes of dose-matched upper-limb training between a 3D VE and a PE in chronic stroke . Methods : Participants ( n = 32 ) were r and omized to a 3D VE or PE for training . They pointed to 6 workspace targets ( 72 trials , 12 trials/target , r and omized ) for 12 sessions over 4 weeks with similar feedback on precision , movement speed , and trunk displacement . Primary ( kinematics , clinical arm motor impairment ) and secondary ( activity level , arm use ) outcomes were compared by time ( PRE , POST , and follow-up , RET ) , training environment , and impairment severity ( mild , moderate-to-severe ) using mixed-model analyses of variance ( ANOVAs ) . Results . Endpoint speed , overall performance on a reach-to-grasp task , and activity levels increased in both groups . Only participants in the VE group improved shoulder horizontal adduction at POST ( 9.5 ° ) and flexion at both POST ( 6.3 ° ) and RET ( 13 ° ) . Impairment level affected outcomes . After VE training , the mild group increased elbow extension ( RET , 25.5 ° ) . The moderate-to-severe group in VE increased arm use at POST ( 0.5 points ) and reaching ability at RET ( 2.2 points ) . The moderate-to-severe group training in PE  increased reaching ability earlier ( POST , 1.7 points ) and both elbow extension ( 10.7 ° ) and arm use ( 0.4 points ) at RET , but these changes were accompanied by increased compensatory trunk displacement ( RET , 30.2 mm ) . Conclusion . VE training led to more changes in the mild group and a motor recovery pattern in the moderate-to-severe group indicative of less compensation , possibly because of a better use of feedback Kim JH , Jang SH , Kim CS , Jung JH , You JH : Use of virtual reality to enhance balance and ambulation in chronic stroke : A double-blind , r and omized controlled study . Objective : To examine an additive effect of virtual reality on balance and gait function in patients with chronic hemiparetic stroke . Design : Twenty-four adults with hemiparetic stroke were r and omly assigned to either an experimental group ( n = 12 ) or a control group . Both groups underwent conventional physical therapy , 40 mins a day , 4 days a week for 4 wks . The experimental group received an additional 30 mins of virtual reality therapy each session . Balance performance was determined by the Balance Performance Monitor and Berg Balance Scale tests . Gait performance was determined by the 10-m walking test and Modified Motor Assessment Scale , and spatiotemporal parameters were obtained using GAITRite . Analysis of variance and correlation statistics were performed at P < 0.05 . Results : In the balance test , the experimental group had improved Berg Balance Scale scores , balance and dynamic balance angles ( ability to control weight shifting ) compared with the controls ( P < 0.05 ) . In the gait performance test , the experimental group showed significant improvements in velocity , Modified Motor Assessment Scale scores , cadence , step time , step length , and stride length ( P < 0.05 ) . Improvement in dynamic balance angles was correlated with velocity and cadence ( P < 0.01 ) . Conclusions : This study demonstrates that virtual reality has an augmented effect on balance and associated locomotor recovery in adults with hemiparetic stroke when added to conventional therapy Background . Video games have become popular in stroke rehabilitation ; however , the nature of this intervention is not fully understood . Objectives . To compare the number of ( a ) purpose ful and non purpose ful repetitions of the weaker upper extremity ( UE ) and ( b ) movement accelerations as assessed by accelerometer activity counts of the weaker and stronger UEs of individuals with chronic stroke while playing video games or participating in traditional therapy .  Methods . Twenty-nine individuals ( mean age 59 years , 1 - 7 years poststroke ) took part in a group intervention of  video -games ( n = 15 ) or traditional therapy ( n = 14 ) as part of a r and omized controlled trial . During 1 - 2 sessions , participants were video-taped while wearing wrist accelerometers . Assessors counted the number of repetitions and classified movements as purpose ful or non purpose ful using videotapes . The weaker UE motor impairments were correlated to movement accelerations , to determine if participants were using their potential during the sessions . Results . Participants in the video game group performed a median of 271 purpose ful movements and 37 970 activity counts compared to 48 purpose ful movements and 14 872 activity counts in the traditional group ( z = −3.0 , P = .001 and z = −1.9 , P = .05 , respectively ) . Participants in the traditional group performed a median of 26 non purpose ful ( exercises ) compared with 0 in the video game group ( z = −4.2 , P = .000 ) . Strong significant correlations were found between the motor ability of the weak UE to repetitions of participants in both groups ( r = .86 , P < .01 ) . Participants with higher motor ability performed more repetitions .  Conclusions . Video games elicited more UE purpose ful repetitions and higher acceleration of movement compared with traditional therapy in individuals with chronic stroke
Abstract Objective : This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning , Disability , and Health ( ICF ) framework .
Virtual reality is a promising tool for therapy for stroke rehabilitation , but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains ( Body Structures , Body Functions , Activity , and Participation ) have not been investigated .