Can VR make stroke rehabilitation more accessible?
Developing a Virtual Reality rehabilitation program in collaboration with the University of Manitoba
Stroke rehabilitation is a lengthy and intensive process, but it is also necessary for stroke survivors. Repetitive and task-oriented training over several months has shown to be the way to go for an efficient recovery. The thing is, rehabilitation is also tedious, costly, labor-intensive, and requires strict adherence, all while being scarcely accessible to some patients due to barriers such as distance, cost, logistics, or background. This creates a need for accessible rehabilitation services that can be delivered equitably to all stroke survivors. 👩🏽⚕️
So… why not go remote?
Telerehabilitation (TR) has already been somewhat explored via technologies such as smartphones, computers, tablets, and video conferencing. While having proved their efficiency in a lot of ways, these programs still come with a few drawbacks; the loss of human contact, or the inability to emulate realistically what would be performed during in-person therapy, for example.
Now… How about immersive technologies? They are becoming an essential tool in many areas of modern medicine, and expand the possibilities of what can be done through a simple screen. Virtual Reality, for one, could answer a lot of the aforementioned pain points quite easily. It has also been shown to increase motivation and engagement in various fields thanks to its level of immersion. So… Could immersive technologies expand the success of telerehabilitation programs, leading to both better therapy, and better access to therapy?
As such, The University of Manitoba partnered up with the StellarX team to develop a Virtual Reality rehabilitation program. This “Active at Home Post-Stroke Program” (or Home PSP), developed in collaboration with Dr. Amine Choukou, combines VR-enabled cognitive training with tablet-led physical activity. First, an interactive mobile app, installed on a mobile tablet, enables a virtual coach to deliver a follow-along exercise program. Then, a simulated VR environment enables activities for participants to complete, resembling scenarios they would encounter on the daily inside their home — but with the possibility of tracking results. 🏠
Program parameters
The entire program consists of 24 VR sessions, and 24 tablet sessions to be completed over a 12-week period, for a total of 48 sessions. Each week, the participant would complete two sessions for each technology, resulting in four sessions per week.
The tablet program features physical exercises such as resistance training, balance training, and stretching. The follow-along videos provide different exercises that target gross and fine motor skills, strength, and range of motion.
Then, the VR program transports the user into a virtual apartment, where they can perform activities that emulate daily-life scenarios. Activities are based on tools used to allocate autonomy assistance, which divide them into two main categories: activities of daily living (ADL), and domestic activities (DA). ADLs concern basic personal care, while DAs encompass more elaborate actions one must perform independently.
The VR program is divided into a total of five training modules:
As the sessions progress, the complexity of each session gradually increases, along with the total number of tasks to perform.
Testing the hypothesis
Here, the participant is a 55-year-old woman who lives rurally, and experienced a stroke in March of 2021. The stroke has affected her right arm and leg mobility, as well as her speech.
Since the participant was already attending in-person stroke rehabilitation when the study took place, our program was here considered as complementary therapy to conventional rehabilitation services.
The setup we put together for her consisted of a HTC Vive Pro headset, two hand-held controllers, and two base stations on a tripod.
Results
The participant was assessed in a few different ways throughout the experiment. These included:
- the FuglMeyer assessment (FMA)
- the Modified Ashworth Scale (MAS)
- the 10 Meter Walk Test (10MWT)
- the Mini-Mental Status Exam (MMSE)
- the BORG rating of perceived exertion
These assessments were completed 3 times; on day 1, at week 6, and at week 12. The results are as follows:
Some stats improved slightly, while some worsened. 3 questionnaires were also completed 3 times:
- the Motor Activity Log (MAL)
- the Stroke Impact Scale (SIS)
- the Treatment Self-Regulation Questionnaire
These show that the willingness of the participant in partaking in the program decreased over time. This is due to several factors, such as a momentary illness, physical limitations in using the VR hardware (mainly, pressing a button with their mobility problems), and lack of motivation due to being self-directed. Some test results also point towards mild dementia.
Overall, the participant was not able to finish the entirety of the program, having completed 16 VR home training sessions within 6 weeks, and 10 tablet training sessions within 12 weeks; which obviously affected the final results shown above.
Despite the participant not partaking in the entirety of the program, these results still show that VR can effectively engage patients in telerehabilitation, and is a safe virtual space for stroke survivors to regain neurocognitive skills.
While the VR experience presented some challenges for the participant due to personal limitations, it was still overall very well received, and contributed to some degree of improvement. If it worked while not being assiduously followed, imagine what a diligent use could achieve! If anything, this only highlights the need for immersive hardware that is adapted for people with neurological conditions. Plus, home-based interventions allow people to perform exercises when it is most suitable for them, which is an undeniable asset. 🙌
Let’s keep in mind that our study is the first to introduce VR to practice daily living activities in an objective of post-stroke rehabilitation. Now that we have gathered preliminary data on the program’s feasibility, safety, and efficacy, further research is needed to evaluate it as a standalone intervention!
If you’d like to read more about this research study, you can check out our website, or consult Dr. Choukou and his collaborator’s Open Access paper.
Lastly, here’s the full infographic summarizing everything you just read. Feel free to share if it captivated your interest (and don’t forget to tag us)!
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