title: Effectiveness of Virtual Reality Exercises in STroke Rehabilitation (EVREST): rationale, design, and protocol of a pilot randomized clinical trial assessing the Wii gaming system.
abstract: BACKGROUND
  Evidence suggests that increasing intensity of rehabilitation results in better motor recovery. Limited evidence is available on the effectiveness of an interactive virtual reality gaming system for stroke rehabilitation. EVREST was designed to evaluate feasibility, safety and efficacy of using the Nintendo Wii gaming virtual reality (VRWii) technology to improve arm recovery in stroke patients.
  
  
  METHODS
  Pilot randomized study comparing, VRWii versus recreational therapy (RT) in patients receiving standard rehabilitation within six months of stroke with a motor deficit of > or =3 on the Chedoke-McMaster Scale (arm). In this study we expect to randomize 20 patients. All participants (age 18-85) will receive customary rehabilitative treatment consistent of a standardized protocol (eight sessions, 60 min each, over a two-week period).
  
  
  METHODS
  The primary feasibility outcome is the total time receiving the intervention. The primary safety outcome is the proportion of patients experiencing intervention-related adverse events during the study period. Efficacy, a secondary outcome measure, will be measured by the Wolf Motor Function Test, Box and Block Test, and Stroke Impact Scale at the four-week follow-up visit. From November, 2008 to September, 2009 21 patients were randomized to VRWii or RT. Mean age, 61 (range 41-83) years. Mean time from stroke onset 25 (range 10-56) days.
  
  
  CONCLUSIONS
  EVREST is the first randomized parallel controlled trial assessing the feasibility, safety, and efficacy of virtual reality using Wii gaming technology in stroke rehabilitation. The results of this study will serve as the basis for a larger multicentre trial. ClinicalTrials.gov registration# NTC692523.
authors.affiliation: Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario. saposnikg@smh.toronto.on.ca
authors.forename: G
authors.initials: G
authors.lastname: Saposnik
authors.forename: M
authors.initials: M
authors.lastname: Mamdani
authors.forename: M
authors.initials: M
authors.lastname: Bayley
authors.forename: K E
authors.initials: KE
authors.lastname: Thorpe
authors.forename: J
authors.initials: J
authors.lastname: Hall
authors.forename: L G
authors.initials: LG
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Teasell
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D017028:Caregivers; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D018579:Patient Selection; D010865:Pilot Projects; D011597:Psychomotor Performance / Q000502:physiology; D012107:Research Design; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity; D018910:Video Games; D055815:Young Adult