2.5. Intervention
hand pain, seizure, sudden instability
In addition to conventional therapy, the patients in the intervention group received training using the Oculus Quest 2 VR device. In total, there were a minimum of 10 and a maximum of 15 therapy sessions of 20 min per day, 3 times per week for 4 to 5 weeks. The total volume of active VR therapy averaged 270 min for the entire intervention. When determining the 20-min unit of time, we based this on the amount of time the patient spends with a physical or occupational therapist during the exercise unit. The standard therapeutic unit lasts 30 min, but this does not deduce the time the patient takes to talk to the therapist and assess their current condition, remove clothing and shoes, and assume a suitable position for exercise. The first three therapy sessions, which were aimed at familiarising the patient with the functions of the system controls using the First Steps for Quest 2 programme, lasted a maximum of 10 min. The patients were seated for the first two sessions and completed the third and subsequent sessions standing. From the fourth therapy, VITALIS Pro VR 0.4.1 software was used as part of the intervention. All patients completed the exercises in a total of 4 programmes: free painting, 2D tracing, 3D painting, and puzzles. In the “free painting” programme, they were asked to draw specific shapes; in 2D and 3D, they traced the shapes shown. The “puzzle” programme had three levels of difficulty and a hint option. The patients performed each task in three types of environments, namely forest, space, and sea. Each environment also conveyed different sound sensations to the patients. When performing tasks in the forest environment, patients heard birds singing; in the sea environment, it was the sound of waves; and in the space environment, it was computer music. Throughout the exercise, the study coordinator was present in the room and monitored the patient for symptoms indicating sudden instability, seizure, shoulder, arm, or hand pain. If the patient did not feel well at any time during the exercise, the coordinator instructed them to stop the task. Patients enrolled in the study received exercise in VR due to organizational reasons of the rehabilitation facility in the afternoon from 3 h after the completion of all treatments.As a part of conventional therapy, patients were indicated for individual neurophysiological-based physiotherapy 2 times a week for 30 min (total 240–280 min per stay). The other part consisted of occupational therapy aimed at targeted training of self-sufficiency, gross and fine motor skills, monomanual and bimanual activities, and improvement of movement coordination. Occupational therapy was performed twice a week for 30 min (240–280 min in total per stay). Furthermore, patients received twice-weekly bath with iodine–bromine + wrap, oxygen therapy, whirlpool bath, pool exercise, dry hot compresses, classical massage, mechanotherapy, CO