Virtual reality interventions to enhance upper limb motor improvement after a stroke: commonly used types of platform and outcomes

Abstract

Introduction

Virtual Reality (VR) based platforms are useful in enhancing post-stroke sub-optimal upper limb (UL) motor improvement. A variety of options are available from expensive highly customizable platforms to low cost turnkey solutions. Clinical outcomes primarily help assess the effects of VR-based platforms. These outcomes mainly quantify how much improvement has occurred. Very few outcomes characterize the type (i.e. how) of recovery. We categorized the types of VR-based platforms and outcome measures commonly used for post-stroke UL motor improvement.

Methods

We reviewed the published literature in English from 2000-2019. Different types of VR-based platforms were grouped into those available commercially and those developed by the various research groups. We initially classified outcomes from the retrieved studies under the appropriate International Classification of Functioning categories. Then, we divided the outcomes as those quantifying the type or extent of improvement.

Results

We found a total of 125 studies. Majority of the studies used commercially available platforms. A total of 42 different outcome measures were used. Seventeen different outcomes were used to assess body structure and functions as well as in activity limitations. Eight outcomes assessed the effects of contextual factors and participation restrictions. The Fugl Meyer Assessment, Wolf Motor Function Test and Stroke Impact Scale were most often used across the three categories. Of the 125 studies, 52 used outcomes characterizing the type of recovery. Although a smaller proportion, 24 studies included movement patterns outcomes.

Conclusion

A standardized set of outcomes can promote better comparisons between studies using different VR-based platforms for post-stroke UL motor improvement.

Implications for Rehabilitation

• A wide variety of commercially available systems are present from expensive customizable systems to low-cost turnkey systems.

• The Fugl-Meyer Assessment and Wolf Motor Function Test along with the Stroke Impact Scale-Social Participation subscale were used most often across all studies as assessments of body structure and function, activity limitations and participation restriction.

• It is essential to include movement pattern outcomes addressing whether recovery of compensation occurs with the use of VR-based platforms.

Keywords:

• Clinical assessments
• Wii
• recovery
• arm
• kinematics
• cerebrovascular accident

Acknowledgements

The authors would like to acknowledge the UT Health Science Briscoe Library for electronic access to all studies.

Disclosure statement

The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.