title: Virtual reality in stroke rehabilitation: a meta-analysis and implications for clinicians.
abstract: OBJECTIVE
  Approximately two thirds of stroke survivors continue to experience motor deficits of the arm resulting in diminished quality of life. Conventional rehabilitation provides modest and sometimes delayed effects. Virtual reality (VR) technology is a novel adjunctive therapy that could be applied in neurorehabilitation. We performed a meta-analysis to determine the added benefit of VR technology on arm motor recovery after stroke.
  
  
  METHODS
  We searched Medline, EMBASE, and Cochrane literature from 1966 to July 2010 with the terms "stroke," "virtual reality," and "upper arm/extremity." We evaluated the effect of VR on motor function improvement after stroke.
  
  
  RESULTS
  From the 35 studies identified, 12 met the inclusion/exclusion criteria totaling 195 participants. Among them, there were 5 randomized clinical trials and 7 observational studies with a pre-/postintervention design. Interventions were delivered within 4 to 6 weeks in 9 of the studies and within 2 to 3 weeks in the remaining 3. Eleven of 12 studies showed a significant benefit toward VR for the selected outcomes. In the pooled analysis of all 5 randomized controlled trials, the effect of VR on motor impairment (Fugl-Meyer) was OR=4.89 (95% CI, 1.31 to 18.3). No significant difference was observed for Box and Block Test or motor function. Among observational studies, there was a 14.7% (95% CI, 8.7%-23.6%) improvement in motor impairment and a 20.1% (95% CI, 11.0%-33.8%) improvement in motor function after VR.
  
  
  CONCLUSIONS
  VR and video game applications are novel and potentially useful technologies that can be combined with conventional rehabilitation for upper arm improvement after stroke.
authors.affiliation: Stroke Outcomes Research Unit, Department of Medicine, 55 Queen Street East, Suite 931, St Michael's Hospital, University of Toronto, Toronto, M5C 1R6, Canada. saposnikg@smh.ca
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Mindy
authors.initials: M
authors.lastname: Levin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface; D018910:Video Games