Exercise intensity of the upper limb can be enhanced using a virtual rehabilitation system

Abstract

Purpose

Motor recovery of the upper limb (UL) is related to exercise intensity, defined as movement repetitions divided by minutes in active therapy, and task difficulty. However, the degree to which UL training in virtual reality (VR) applications deliver intense and challenging exercise and whether these factors are considered in different centres for people with different sensorimotor impairment levels is not evidenced. We determined if (1) a VR programme can deliver high UL exercise intensity in people with sub-acute stroke across different environments and (2) exercise intensity and difficulty differed among patients with different levels of UL sensorimotor impairment.

Methods

Participants with sub-acute stroke (<6 months) with Fugl-Meyer scores ranging from 14 to 57, completed 10 ∼ 50-min UL training sessions using three unilateral and one bilateral VR activity over 2 weeks in centres located in three countries. Training time, number of movement repetitions, and success rates were extracted from game activity logs. Exercise intensity was calculated for each participant, related to UL impairment, and compared between centres.

Results

Exercise intensity was high and was progressed similarly in all centres. Participants had most difficulty with bilateral and lateral reaching activities. Exercise intensity was not, while success rate of only one unilateral activity was related to UL severity.

Conclusion

The level of intensity attained with this VR exercise programme was higher than that reported in current stroke therapy practice. Although progression through different activity levels was similar between centres, clearer guidelines for exercise progression should be provided by the VR application.

Implications for rehabilitation

• VR rehabilitation systems can be used to deliver intensive exercise programmes.

• VR rehabilitation systems need to be designed with measurable progressions through difficulty levels.

Keywords:

• Stroke
• upper limb
• exercise therapy
• personalized exercise
• virtual reality
• intensity
• difficulty

Acknowledgements

The authors would like to thank Subramanian Durairaj, Apoorva Shankaranarayana., Arel Shasha, and Rejean Prevost for their help in data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This project is supported by the Canada-Israel Health Research Programme (MFL and DGL), a programme that is jointly funded by the Canadian Institutes of Health Research, Azrieli Foundation, International Development Research Centre [grant number 108186-001] and Israel Science Foundation [grant number 2392]. MCB was partially supported by the Zavalkoff Family Foundation’s Brain@McGill and Tel Aviv University Collaboration for Neurodevelopmental, Neurodegenerative and Neuropsychiatric Diseases: Prevention, Diagnosis and Treatment.