title: Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial.
abstract: BACKGROUND
  Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients.
  
  
  METHODS
  This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10-12 sessions of 30-45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant's group allocation.
  
  
  CONCLUSIONS
  The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation.
  
  
  BACKGROUND
  https://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014. Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.|Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Sheehy
authors.affiliation: Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Taillon-Hobson
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.|School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Sveistrup
authors.affiliation: School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.|Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.|School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Bilodeau
authors.affiliation: Ottawa Hospital Research Institute, 501 Smyth Rd., Box 201B, Office L1298a, Ottawa, ON, K1H 8L6, Canada.|Department of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada.|Department of Surgery, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Fergusson
authors.affiliation: Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 407-C Robinson Hall, 336 Huntington Ave., Boston, MA, 02115, USA.
authors.forename: D
authors.initials: D
authors.lastname: Levac
authors.affiliation: Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. hfinestone@bruyere.org.|Bruyère Continuing Care, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. hfinestone@bruyere.org.|Faculty of Medicine, University of Ottawa, 505 Smyth Road, Rm. 1200, Ottawa, ON, K1H 8M2, Canada. hfinestone@bruyere.org.
authors.forename: H
authors.initials: H
authors.lastname: Finestone
mesh_terms: D002170:Canada; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D007297:Inpatients; D004856:Postural Balance; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
keywords: Inpatient; Randomized controlled trial; Rehabilitation; Stroke; Therapy; Virtual reality