4. Discussion
stroke, comorbidity, post-stroke, ’ illness
EVENTS, STROKE
New sophisticated virtual reality technologies implemented in the therapy of post-stroke patients have gained importance in recent years and are promising forms of technology that have been shown to increase patient satisfaction with post-stroke rehabilitation [In the studied patient group, statistically significant changes occurred in all domains of the quality of life and self-sufficiency questionnaire after VR-assisted therapy, and this change persisted four weeks after the end of therapy. Although all patients subjectively rated VR therapy as beneficial, motivating, and enjoyable, and the experimental group experienced improvements in their self-sufficiency, quality of life, and stability, statistical significance was not demonstrated when the test results were compared with those in the control group. Patients perceived and described VR exercise as effective, as immersion increased their motivation to complete meaningful activities, while completion of tasks allowed them to increase the intensity of purposeful repetitive movements. Self-sufficiency in activities that require coordinated hand and arm actions, such as dressing, shoeing, and showering, improved for all patients. After therapy, patients persisted with deficits in fine manipulative activities such as grasping and manipulating keys, coins, and buttons, which require good finger–thumb coordination, which may have been influenced by the programme and controllers not allowing repeated finger involvement in fine motor functional activities during the activity. Virtual reality programmes are designed to simulate objects and events in the real world [The patient’s ability to adapt to his/her new situation is also related to age, gender, education, and social class. Mobility and activities of daily living are the basis of the quality of life in patients after stroke. Performance in ADL becomes automated over the course of life, as activities are performed daily from a very early age, while the repertoire of ADL performance is shaped over the course of life, which also affects different cognitive and physical demands [The level of education, the level of comorbidity, as well as socioeconomic situation, occupational status, and potential return to work are also related to the quality of life. In our study, most patients were living in a relationship with a partner and all patients planned to return to their home environment. Hayes et al. (2003) reported in their study that up to 25% of patients after stroke remain in institutional care, and in their analyses, women were more dependent for ADL, less likely to go unassisted, and lived in nursing homes [However, as new VR technologies are increasingly being implemented in patient rehabilitation programmes and studies report that the use of VR in stroke rehabilitation contributes to improved motor function, self-sufficiency, muscle strength, and balance, further studies are needed to ensure that VR programmes are appropriately selected, properly timed, and produce a targeted treatment effect [The advantage of this study was the fact that the study had follow-up trials to monitor longer-term effects. Even after 4 weeks of therapy, the patients continued to experience a positive effect of therapy. The patients subjectively rated the therapy as motivating and effective. One limitation for our study is that some patients found VR tasks easy to perform after a certain period and would need incorporation of more challenging tasks into their therapy. Furthermore, the small sample size, which became even smaller due to the patients’ illness and the positivity of COVID-19, may also have affected the study results. The time since the stroke was not the same in all patients. The appropriate timing of physical activity is a topic of ongoing debate. Some patients prefer to remain temporarily at home after the stroke and postpone subsequent rehabilitation. This is a natural reaction of the patient who is forced to react to the change in his/her life situation, and his/her reaction depends on many factors, the degree of impairment of physical and mental functions, life experiences, personality, and attitude. Even spare capacity in subsequent rehabilitation facilities plays a role in early rehabilitation.