Safety and Potential Usability of Immersive Virtual Reality for Brain Rehabilitation: A Pilot Study.

Objective: This study was conducted to demonstrate the safety and usability of an immersive virtual reality (VR) game as a rehabilitative training by assessing adverse events (AEs), adherence, and satisfaction in patients with brain injury who had free optional opportunities. Materials and Methods: The results were analyzed retrospectively. Seventy-eight patients with brain injury, undergoing rehabilitation treatment for motor impairment, were recruited. Among them, 51 were available for postintervention survey. The immersive type of VR training was programmed to facilitate use of the paralyzed upper extremity through a fishing simulation game. The Oculus Rift was used as head-mounted display device. Patients were observed for any AEs as defined in the Common Terminology Criteria for AEs during and after each VR training session. A postintervention telephone survey was done to investigate adherence-related factors and safety. Results: The results were analyzed after dividing the patients into nonadherence (patients participated <3 times) and high-adherence (≥3 times) groups. No serious AEs were reported during and after the VR training, and several patients reported other AEs, predominantly dizziness, with one case requiring cessation of VR training. Overall, the satisfaction rate was 54%. Compared with the nonadherence group, the high-adherence group expressed higher satisfaction with VR training, regarded it as effective for recovery from upper limb paralysis, accepted VR as comprehensible, and considered the level of difficulty to be appropriate (P < 0.05). Conclusion: Immersive VR training appeared to be safe for patients with brain injury.

Effects of virtual reality immersive training with computerized cognitive training on cognitive function and activities of daily living performance in patients with acute stage stroke: A preliminary randomized controlled trial.

OBJECTIVE: The purpose of this study was to investigate the impact of virtual reality immersive training with computerized cognitive training on the cognitive function and activity of daily living in patients with acute stroke. METHOD: We included 42 patients with acute stage stroke from C hospital in Sungnam from May, 2017 to September, 2017. The patients were randomly selected and divided into the experimental (n = 21) and control (n = 21) group. The experimental group performed virtual reality training, including Head Mount Display with computerized cognitive therapy, and the control group performed computerized cognitive therapy. Both groups trained for 30 minutes a day 5 times a week; the intervention lasted 4 weeks. To evaluate the improvement in each group, pre-post-test evaluation was conducted using the Loewenstein Occupational Therapy Cognitive Assessment and Computerized Neurocognitive Function Test for cognitive function, and Functional Independent Measure for activities of daily living. RESULTS: Attention and memory in cognitive function and activity of daily living performance were improved in the both groups. CONCLUSION: Virtual reality immersive training might be an affordable approach for cognitive function and activity of daily living performance recovery for patients with acute stroke.

Clinical Applicability and Psychometric Properties of Manual Function Test for Patients with Stroke.

The Manual Function Test (MFT) is a tool to assess upper extremity motor impairment associated with stroke. This study investigated psychometric properties of the Korean version of the MFT and to establish normative data. Eighty-one patients were enrolled to evaluate MFT, Fugl-Meyer Assessment (FMA) and manual muscle test (MMT). MFT was completed by eight raters on two occasions separated by 6 weeks. Absolute and relative reliability and validity were examined. Additionally, MFT was assessed on 75 healthy controls of different ages. Intraclass correlation coefficient (ICC) (2,1) values for total and each dimension of Korean MFT ranged from 0.984 to 0.998 in the affected side of hemiplegic patients, indicating inter-rater reliability. Percentage values of standard error of measurement (SEM) and smallest real difference (SRD) ranged 3.10-10.57% and 8.58-29.29% respectively. Test-retest reliability ICCs for all raters were above 0.98. Effect size (ES) and standardized response mean (SRM) were larger in the acute-subacute group (onset to initial evaluation ≤ 4 months) (ES = 0.12; SRM = 0.41) than those in the chronic group (onset to evaluation > 4 months) (ES = 0.01; SRM = 0.11). MFT score was significantly correlated with FMA score (p < 0.001) and MMT score (p < 0.001). In healthy controls, regression analysis indicated that age significantly predicts manual function scores on both dominant and non-dominant. The Korean MFT showed good reliability and validity. Modest responsiveness was observed in patients evaluated early after stroke onset. The Korean MFT is useful in evaluating upper extremity motor deficits for clinical and research purposes.