To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.
A pilot, randomized, single-blind, controlled trial.
Stroke rehabilitation inpatient unit.
Participants (N=48) with hemiplegia secondary to a unilateral stroke for >3 months and with a hemiplegic wrist extensor Medical Research Council scale score ranging from 1 to 3.
FES was applied to the wrist extensors and finger extensors. A VR-based wearable rehabilitation device was used combined with FES and virtual activity–based training for the intervention group. The control group received cyclic FES only. Both groups completed 20 sessions over a 4-week period.
Main Outcome Measures
Primary outcome measures were changes in Fugl-Meyer Assessment–Upper Extremity and Wolf Motor Function Test scores. Secondary outcome measures were changes in Box and Block Test, Jebsen-Taylor Hand Function Test, and Stroke Impact Scale scores. Assessments were performed at baseline (t0) and at 2 weeks (t1), 4 weeks (t4), and 8 weeks (t8). Between-group comparisons were evaluated using a repeated-measures analysis of variance.
Forty-one participants were included in the analysis. Compared with FES alone, VR-FES produced a substantial increase in Fugl-Meyer Assessment–distal score (P=.011) and marginal improvement in Jebsen-Taylor Hand Function Test–gross score (P=.057). VR-FES produced greater, although nonsignificant, improvements in all other outcome measures, except in the Stroke Impact Scale–activities of daily living/instrumental activities of daily living score.
FES with VR-based rehabilitation may be more effective than cyclic FES in improving distal upper extremity gross motor performance poststroke.
List of abbreviations:ADL (activities of daily living), BB (Box and Block Test), FAS (Functional Ability Scale), FES (functional electrical stimulation), FMA (Fugl-Meyer Assessment), JTHFT (Jebsen-Taylor Hand Function Test), MRC (Medical Research Council), SIS (Stroke Impact Scale), VR (virtual reality), WMFT (Wolf Motor Function Test)
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Published online: March 02, 2018
Supported by the Institute for Information and Communications Technology Promotion funded by the Korean government (Ministry of Science, ICT and Future Planning) (grant no. 2015-0-00728).
Clinical Trial Registration No.: NCT02772510.
© 2018 by the American Congress of Rehabilitation Medicine