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Ku, Im, and Kang: Upper Extremity Rehabilitation using Virtual Reality after Stroke
Review

Brain & Neurorehabilitation 2014; 7(1): 30-38.

Published online: 31 March 2014

DOI: https://doi.org/10.12786/bn.2014.7.1.30

Upper Extremity Rehabilitation using Virtual Reality after Stroke

Jeonghun Ku, Ph.D., Hyungjun Im, M.D.1, Youn Joo Kang, M.D., Ph.D.1

Department of Biomedical Engineering, Keimyung University, Korea.

1Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Korea.

Correspondence to: Youn Joo Kang, Department of Rehabilitation Medicine, Eulji Hospital, 280-1, Hagye-dong, Nowon-gu, Seoul 139-872, Korea. Tel: 02-970-8315, Fax: 02-979-8268, md52516@hanmail.net

Copyright © 2014 Korean Society for Neurorehabilitation

Abstract

There is limited evidence regarding the use of virtual reality (VR) and interactive video gaming for improving arm function because there are few such commercial devices and little relevant research. However, evidence of the greater effectiveness of upper extremity VR training over that of conventional therapy after stroke has recently grown due to the adoption of various therapeutic devices. VR applications are novel and potent technologies for upper extremity rehabilitation after stroke because the interface technologies, augmented reality technologies, and various sensorimotor feedback techniques are rapidly advancing. Going forward, VR technology should be designed to provide the possibility of intense functional repetitive practice for patients. The combination of VR with robotic devices, neuromodulation, mirror therapy, and telerehabilitation may synergistically improve upper extremity function after stroke. In severely injured patients, robotic interfaces should be considered, the level of difficulty should be fitted appropriately to the severity of the deficits, and the fact that it is difficult to train patients repeatedly and effectively in a real-world environment should be considered. Further research should be conducted on the application of VR programs in larger populations, VR involving various training paradigms, VR at different exercise levels, and the long-term sustained effects of VR. In addition, synergistically enhanced effects of combining other treatments and feedback paradigms with well-designed interfaces should be investigated.

Keywords: virtual reality, rehabilitation, upper extremity, stroke

Figures and Tables

Fig. 1
Examples of interactive three-dimensional virtual reality devices displayedat the 7th World Congress of the International Society of Physical Medicine and Rehabilitation (Beijing, China, June 16-20, 2013).
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Fig. 2
Robotic interface (ArmeoPower, Hocoma, Volketswil, Switzerland) (A), head-mounted displays (xSightHMD: Sensics, Inc. Mayland, USA) (B), and cyber-gloves with force feedback (CyberGrasp system, CA, USA) (C) with virtual reality systems have been rapidly evolving in the field of upper-extremity rehabilitation.
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Fig. 3
Commercial video game for upper-extremity rehabilitation after stroke, IREX (A, GestureTekTechnologies, Toronto, Canada) and Wii (B, Nintendo, Tokyo, Japan).
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Fig. 4
Upper-extremity visuomotor training in the Rehabilitation Gaming System (RGS, SPECS Research Lab, Barcelona, Spain).
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Fig. 5
Intensive repetitive practice for wrist rehabilitation after stroke (Ski game for wrist exercise following stroke, Metasio Asia, Inc., Kyungki-do, Korea).
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Table 1
Virtual Reality in Neurorehabilitation of Upper-extremities after Stroke
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FM: Fugl-Meyer Arm Scale, WMFT: Wolf Motor Function Test, JTHF: Jebsen Test of Hand Function, FIM: Functional Independence Measure, BBT: Box and Blocks Test, MFT: Manual Function Test, AMPS: Assessment of Motor and Process Skills, MAS: Modified Ashworth Scale, SIS: Stroke Impact Scale, MI: Motricity Index, MRC: Medical Research Council Grade, BI: Barthel Index, CAHAI: Chedoke Arm and Hand Activity Inventory, ARAT: Action Research Arm Test, RPSS: Reaching Performance Scale for Stroke, MAL-AS: Motor Activity Log Amount Scale, AROM: active ROM, VR: virtual reality.

Notes

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (2013R1A1A2060973).

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