Discussion
spasticity, stroke, hand motor function, poststroke, subacute stroke
STROKE, DISEASE
The main purpose of this clinical trial was to test whether conventional rehabilitation combined with SVR technology is more effective than an intervention based exclusively on occupational therapy and physiotherapy for improving hand motor function in adults with subacute stroke.Previous studies [In this study of patients with a poststroke interval of less than 6 months (EG mean: 55.3 days at baseline), patients randomly allocated to the EG followed a motor training protocol with SVR technology designed for improving hand motor function; interventions were delivered over the course of three weeks, five consecutive days a week, with each session lasting 50 min. In addition, patients in this group a received 100-min session of conventional treatment (occupational therapy and physiotherapy) along with each SVR training session. This combined treatment regimen yielded promising functional results regarding distal motor control of the upper limb, as resistance to movement decreased (spasticity), while the functionality and motion of the hand and wrist increased. In light of the functional results, it is important to highlight that the HandTutorThe introduction of SVR systems into conventional rehabilitation processes offers new models of simulation that provide participants with the experience of motivating, stimulating, realistic environments, allowing safe practice of techniques based on meaningful, entertaining daily tasks [Ikbali et al., in their intervention, chose the Kinect sensor in combination with the commercial console Xbox 360 by MicrosoftThe results of this study suggest that VRBT using MeditouchThe differences in Ashworth Scale scores for the wrist found in our study coincide with the results published by Young-Bin et al. [Our study revealed positive results in terms of hand function after the combination of SVR and conventional physiotherapy and occupational therapy. The difference between baseline and follow-up measurements reflected functional improvements after the experimental intervention: 5.6 points on the wrist scale of the FMA-UE, 8.9 points on the hand scale of the same instrument (p = 0.000 for each), and 32.8 points on the ARAT. In this respect, it is important to note the proximity of the three-week postintervention differences to the minimum detectable change on the Spanish version of the FMA-UE, which corresponds to 7.3 points six weeks after intervention. The effect size of the intervention (hIncreased practice results in greater ability as long as the exercises are challenging, progressive and skill-based [A noteworthy feature that likely contributes to the utility of the HandTutorFor our study, we designed a daily intervention plan, devoting 50 min per session to motor training with SVR technology devices.High-quality upper-limb training focusing on the motion quality of the injured segment is difficult to achieve in the time allowed in standard rehabilitation programs, in which patients are encouraged to carry out tasks through compensation [Similar results have been found in studies that combined conventional techniques with the use of robotics [The use of VRBT in treatments aimed at functional recovery of the upper limb in stroke patients brings about an enriched, interactive environment that positively influences neuroplasticity, especially in the subacute phase of the disease, in which the level of brain reorganization is at a maximum [The above results suggest that SVR-facilitated exercise-based intervention programs benefit the recovery of hand motor function in people with stroke.Recent studies on stroke patients observed significant changes and great improvements in ARAT and FMA-UE results when patients received upper-limb therapy 5 days a week over 3 , 6 and 12 weeks; the declared intention in those studies was to make motion practice as realistic as possible, with increasing progress in joint movement culminating in full practice of the actual physical task [The SVR technology devices used for our study focused on the joints and body segments damaged by stroke, differentiating and isolating the movements and the active range of joint motion if necessary. The HandTutorEvidence from this study reveals that virtual reality has the potential to create effective environments for rehabilitation with safe, multimodal, individualized simulations while providing feedback and options regarding repetition, intensity, and training in specific tasks; these features are not common among conventional physical therapies but are useful for promoting the recovery of upper limbs after stroke [