title: Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI.
abstract: OBJECTIVE
  To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements.
  
  
  METHODS
  Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU.
  
  
  RESULTS
  P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to -1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU.
  
  
  CONCLUSIONS
  The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns. Implications for Rehabilitation YouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense. The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting. The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical activation patterns.
authors.affiliation: Research Department, Reha Rheinfelden , Rheinfelden , Switzerland .
authors.forename: Corina
authors.initials: C
authors.lastname: Schuster-Amft
authors.forename: Andrea
authors.initials: A
authors.lastname: Henneke
authors.forename: Birgit
authors.initials: B
authors.lastname: Hartog-Keisker
authors.forename: Lisa
authors.initials: L
authors.lastname: Holper
authors.forename: Ewa
authors.initials: E
authors.lastname: Siekierka
authors.forename: Edith
authors.initials: E
authors.lastname: Chevrier
authors.forename: Pawel
authors.initials: P
authors.lastname: Pyk
authors.forename: Spyros
authors.initials: S
authors.lastname: Kollias
authors.forename: Daniel
authors.initials: D
authors.lastname: Kiper
authors.forename: Kynan
authors.initials: K
authors.lastname: Eng
mesh_terms: D000203:Activities of Daily Living; D002908:Chronic Disease; D003198:Computer Simulation; D005240:Feasibility Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D034941:Upper Extremity; D014584:User-Computer Interface
keywords: Motor function; stroke; upper limb; virtual reality