Virtual reality exercise improves mobility after stroke: an inpatient randomized controlled trial.
OBJECTIVE
Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients.


METHODS
A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training.


RESULTS
Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (P=0.04) immediately after training.


CONCLUSIONS
This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR.


BACKGROUND
http://www.ANZCTR.org.au/. Unique identifier: ACTRN12613000710729.
From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.).
Daniel
D
McEwen
From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.).
Anne
A
Taillon-Hobson
From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.).
Martin
M
Bilodeau
From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.).
Heidi
H
Sveistrup
From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.). hfinestone@bruyere.org.
Hillel
H
Finestone
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D015444:Exercise; D005260:Female; D006801:Humans; D008124:Locomotion; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D063367:Virtual Reality Exposure Therapy
exercise movement techniques; gait; rehabilitation; virtual reality therapy