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Virtual Reality–Augmented Rehabilitation for Patients Following Stroke

AS Merians, PT, PhD, is Professor and Chairperson, Department of Developmental and Rehabilitative Sciences, University of Medicine and Dentistry of New Jersey, 65 Bergen St, Newark, NJ 07103 (USA) (merians{at}umdnj.edu). Address all correspondence to Dr Merians
D Jack was a doctoral student in the College of Computer Science, New Jersey Institute of Technology, Newark, NJ
R Boian is a doctoral student in the School of Engineering, Rutgers University, Piscataway, NJ
M Tremaine, PhD, is Professor of Information Systems and Director, Human-Computer Interaction Program, College of Computer Science, New Jersey Institute of Technology
GC Burdea, PhD, is Associate Professor of Computer Engineering, School of Engineering, and Director, Human-Machine Interface Laboratory, Center for Advanced Information Processing, Rutgers University
SV Adamovich, PhD, is Research Scientist, Center for Molecular and Behavioral Neuroscience, Rutgers University
M Recce, PhD, is Director of the Life Sciences Program, Center for Computational Biology, and Associate Professor in Biomedical Engineering, Mathematical Sciences, Computer Sciences, and Biological Sciences, New Jersey Institute of Technology
H Poizner, PhD, is Professor, Center for Molecular and Behavioral Neuroscience, Rutgers University
Dr Merians, Mr Jack, Mr Boian, Dr Tremaine, Dr Burdea, Dr Adamovich, and Dr Poizner provided concept/idea/design. Dr Merians, Dr Tremaine, Dr Burdea, and Dr Poizner provided writing. Dr Merians, Mr Boian, Dr Adamovich, and Dr Poizner provided data collection, and Dr Merians, Dr Tremaine, Dr Adamovich, and Dr Poizner provided data analysis. Dr Merians and Dr Poizner provided subjects. Dr Burdea, Dr Recce, and Dr Poizner provided project management. Dr Burdea and Dr Poizner provided fund procurement. Dr Poizner provided facilities/equipment. Mr Boian and Dr Poizner provided consultation (including review of manuscript before submission). The authors acknowledge Dr Edward Taub at the University of Alabama at Birmingham for his guidance in the implementation of constraint-induced movement therapy concepts into the non-virtual reality tasks. One of the authors (ASM) spent 2 weeks in Dr Taub's laboratory learning the constraint-induced movement therapy techniques. The authors also thank Olga Norstrom for her help on the affective measures and Thea Moore, OTR, for her help supervising the patients

Background and Purpose. Recent evidence indicates that intensive massed practice may be necessary to modify neural organization and effect recovery of motor skills in patients following stroke. Virtual reality (VR) technology has the capability of creating an interactive, motivating environment in which practice intensity and feedback can be manipulated to create individualized treatments to retrain movement. Case Description. Three patients (ML, LE, and DK), who were in the chronic phase following stroke, participated in a 2-week training program (3 hours a day) including dexterity tasks on real objects and VR exercises. The VR simulations were targeted for range of motion, movement speed, fractionation, and force production. Outcomes. ML's function was the most impaired at the beginning of the intervention, but showed improvement in the thumb and fingers in range of motion and speed of movement. LE improved in fractionation and range of motion of his thumb and fingers. DK made the greatest gains, showing improvement in range of motion and strength of the thumb, velocity of the thumb and fingers, and fractionation. Two of the 3 patients improved on the Jebsen Test of Hand Function. Discussion. The outcomes suggest that VR may be useful to augment rehabilitation of the upper limb in patients in the chronic phase following stroke.

Key Words: Motor learning • Recovery • Rehabilitation • Stroke • Virtual reality

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