Introduction: Early intensive and goal-oriented rehabilitation is critical to improve disability after stroke, but conventional rehabilitation is limited by poor patient compliance due to lack of motivation or fatigue. Virtual Reality (VR) based rehabilitation offers a unique adjunct to conventional therapy utilizing gaming software to make goal-oriented tasks enjoyable and motivating, but current literature excludes patients in the acute phase of recovery where neuroplasticity is highest. Here we test the feasibility and safety of early use of immersive VR-based rehabilitation on patients hospitalized for acute ischemic stroke. Methods: This is a prospective observational study of 13 patients, > 18 years old hospitalized with acute ischemic stroke, who receive a single 20-minute VR session using the REAL immersive VR device. The device consists of a headset and 6 body sensors (torso, arm, wrist). During the session, a physical or occupational therapist guides the patient through various virtual activities targeting stroke-related impairments. Patients were excluded if they were unable to follow commands, had paralysis of the upper extremity, unable to begin therapy, reported prior history of vertigo or inner ear dysfunction, and reported prior history of epilepsy. Feasibility was measured by an ease-of-use survey, User Satisfaction Evaluation Questionnaire (USEQ). Safety and tolerability were assessed by Simulator Sickness Questionnaire (SSQ). USEQ and SSQ were graded on a five and four-point Likert scale, respectively, administered at the conclusion of the VR session. Results: A total of 13 patients completed 1 VR session with a median session duration of 50 minutes, with a median of 22 minutes spent using VR. See Table 1 for demographics. VR sessions were administered in a median time of 62 hrs. from hospital arrival and a median time of 65 hrs. from last known well. Patients experienced a median improvement of NIHSS of –1 on discharge. Mean USEQ score was 25 suggestive of high user satisfaction with the system. Figure 1 displays scoring breakdown. Mean total SSQ score was 8.1 suggestive of minimal simulator sickness symptoms (Table 2). Conclusions: Early use of immersive VR-based rehabilitation in patients hospitalized with acute stroke is feasible and safe. This study lays the groundwork for future trials that can leverage the engaging and motivating features of VR during a period of high neuroplastic potential to improve disability after stroke.
Tian et al. (Thu,) studied this question.
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