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Abstract
Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke.
Method: We evaluated components of the therapeutic intervention, from the patients’ and the therapists’ points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals.
Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted.
Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients.
Computerised Mirror Therapy is feasible for clinical use
Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting
Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation
Implications for Rehabilitation
Acknowledgements
The authors thank the management of the Dunedin Public Hospital, the ISIS Centre Rehabilitation Ward in the Wakari Hospital (Dunedin, New Zealand) and the MEDIAN Klinik Berlin-Kladow (Berlin, Germany) for the provision of the facilities to carry out the studies.
Acknowledgements are given to Dr Wendy Busby, lead stroke physician, Dr Toni Auchinvole and Dr Kellie Perrie, rehabilitation physicians, and the multidisciplinary teams at Dunedin and Wakari hospitals, Southern DHB, for supporting this study.
Disclosure statement
The authors declare no conflict of interest other than listed below.
Dr Simon Hoermann was supported by a Career Development Programme-Postdoctoral Fellowship from the Division of Health Sciences, University of Otago.
Luara Ferreira dos Santos, Nadine Morkisch, Katrin Jettkowski and Henning Schmidt were supported by a regional innovation cluster grant from the Bundesministerium für Bildung und Forschung (BMBF), Germany.
The Royal Society of New Zealand and the BMBF in Germany provided funding to support the international collaboration between the research groups of these two countries.
The studies were approved by the ethics board of the Charité ? University Medicine Berlin, Germany, by the University of Otago Human Ethics Committee ? Health (ethical approval No. HE13/10) and by the Southern District Health Board, Dunedin, New Zealand.