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Effects of Virtual Reality Rehabilitation Training on Cognitive Function and Activities of Daily Living of Patients With Poststroke Cognitive Impairment: A Systematic Review and Meta-Analysis

Published:April 09, 2022DOI:https://doi.org/10.1016/j.apmr.2022.03.012

      Abstract

      Objective

      To determine the effects of virtual reality (VR) rehabilitation training on the cognitive function and activities of daily living (ADL) of patients with poststroke cognitive impairment (PSCI).

      Data Sources

      Four Chinese databases and 6 English databases were systematically searched for studies published until August 31, 2021, by using Medical Subject Headings of the National Library of Medicine terms such as virtual reality, cognition disorders, cognitive dysfunction, and stroke and free terms such as virtual environment, VR, cognition impairment, cerebrovascular accident, and PSCI.

      Study Selection

      Randomized controlled trials treating PSCI with VR training were included. The control groups received conventional treatments such as conventional rehabilitation training and drug therapy; the experimental groups received VR rehabilitation training. The outcome measures were cognitive function and ADL.

      Data Extraction

      Two researchers independently extracted key information from eligible studies. The methodological quality of the studies was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions v5.1.0. Meta-analysis was performed using RevMan v5.4. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

      Data Synthesis

      Twenty-one studies (1149 participants) were included. Meta-analyses found that compared with the control group, VR rehabilitation training increased Mini-Mental State Examination, Montreal Cognitive Assessment, Loewenstein Occupational Therapy Cognitive Assessment, Rivermead Behavioral Memory Test Second Edition, Barthel Index, Modified Barthel Index, and FIM scores; event-related potential 300 (P300) amplitude; and the N-acetylaspartate/creatinine (Cr) ratio on proton magnetic resonance spectroscopy (1H-MRS) and reduced P300 latency; Trail Making Test scores; and the choline-containing compounds/Cr ratio on 1H-MRS (all P<.05). These results indicated that VR training improved cognitive function and ADL in PSCI.

      Conclusions

      VR rehabilitation training promotes the rehabilitation of cognitive function and recovery of ADL in patients with PSCI and may be a good complementary approach to conventional cognitive interventions.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), BI (Barthel Index), Cho (choline-containing compounds), Cr (creatinine), 1H-MRS (proton magnetic resonance spectroscopy), LOTCA (Loewenstein Occupational Therapy Cognitive Assessment), MBI (Modified Barthel Index), MD (mean difference), MMSE (Mini-Mental State Examination), MoCA (Montreal Cognitive Assessment), NAA (N-acetylaspartate), OR (odds ratio), PSCI (poststroke cognitive impairment), P300 (event-related potential 300), RBMT-II (Rivermead Behavioral Memory Test Second Edition), RCT (randomized controlled trial), TMT (Trail Making Test), VR (virtual reality), WAIS-III (Wechsler Adult Intelligence Scale-Ⅲ)
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      References

        • GBD 2019 Stroke Collaborators
        Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.
        Lancet Neurol. 2021; 20: 795-820
        • Verdelho A
        • Wardlaw J
        • Pavlovic A
        • et al.
        Cognitive impairment in patients with cerebrovascular disease: a white paper from the links between stroke ESO Dementia Committee.
        Eur Stroke J. 2021; 6: 5-17
        • Sexton E
        • McLoughlin A
        • Williams DJ
        • et al.
        Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke.
        Eur Stroke J. 2019; 4: 160-171
        • Delavaran H
        • lónsson AC
        • Lóvkvist H
        • et al.
        Cognitive function in stroke survivors: a 10-year follow-up study.
        Acta Neurol Scand. 2017; 136: 187-194
        • Levine DA
        • Galecki AT
        • Langa KM
        • et al.
        Trajectory of cognitive decline after incident stroke.
        JAMA. 2015; 314: 41-51
        • Fride Y
        • Adamit T
        • Maeir A
        • et al.
        What are the correlates of cognition and participation to return to work after first ever mild stroke?.
        Top Stroke Rehabil. 2015; 22: 317-325
        • Lo Coco D
        • Lopez G
        • Corrao S.
        Cognitive impairment and stroke in elderly patients.
        Vasc Health Risk Manag. 2016; 12: 105-116
        • Stinear CM
        • Lang CE
        • Zeiler S
        • et al.
        Advances and challenges in stroke rehabilitation.
        Lancet Neurol. 2020; 19: 348-360
        • Xu Q
        • Li C
        • Pan Y
        • et al.
        Impact of smart force feedback rehabilitation robot training on upper limb motor function in the subacute stage of stroke.
        NeuroRehabilitation. 2020; 47: 209-215
        • Franz S
        • Muser J
        • Thielhorn U
        • et al.
        Inter-professional communication and interaction in the neurological rehabilitation team: a literature review.
        Disabil Rehabil. 2020; 42: 1607-1615
        • Weiss P
        • Kizony R
        • Feintuch U
        • et al.
        Virtual reality in neurorehabilitation.
        (editors)in: Selzer M Cohen L Gage F Clarke S Duncan P Textbook of neural repair and rehabilitation. Cambridge University Press, Cambridge2006: 182-197
        • Liao YY
        • Tseng HY
        • Lin YJ
        • et al.
        Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment.
        Eur J Phys Rehabil Med. 2020; 56: 47-57
        • Coyle H
        • Traynor V
        • Solowij N.
        Computerized and virtual reality cognitive training for individuals at high risk of cognitive decline: systematic review of the literature.
        Am J Geriatr Psychiatry. 2015; 23: 335-359
        • Gambhir S
        • Narkeesh A
        • Arumozhi R.
        Role of virtual reality in cognitive rehabilitation.
        Int J Ther Rehabil Res. 2017; 6: 125-130
        • Slobounov SM
        • Ray W
        • Johnson B
        • et al.
        Modulation of cortical activity in 2D versus 3D virtual reality environments: an EEG study.
        Int J Psychophysiol. 2015; 95: 254-260
        • Bauer ACM
        • Andringa G.
        The potential of immersive virtual reality for cognitive training in elderly.
        Gerontology. 2020; 66: 614-623
        • Zhang Q
        • Fu Y
        • Lu Y
        • et al.
        Impact of virtual reality-based therapies on cognition and mental health of stroke patients: systematic review and meta-analysis.
        J Med Internet Res. 2021; 23: e31007
        • Wiley E
        • Khattab S
        • Tang A
        Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis.
        Disabil Rehabil Assist Technol. 2022; 17 (50-0)
      1. Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions version 6.2. Available at: www.training.cochrane.org/handbook. Accessed March 27, 2022.

        • Higgins JP
        • Green S.
        Cochrane handbook for systematic reviews of interventions.
        John Wiley & Sons, New York2011
        • Bai L
        • Du CW
        • Wang WC
        • et al.
        The efficacy and evaluation of rTMS combined with VR training in the treatment of post-stroke depression with cognitive impairment.
        Med J Nat Def Forces Southwest China. 2021; 31: 424-427
        • Yang H.
        Effects of breviscapine injection combined with virtual reality rehabilitation training on cognitive function and balance ability of stroke patients.
        Chin J Conval Med. 2020; 29: 755-756
        • Fu KJ.
        Observation on the rehabilitation effect of virtual reality scene interactive training on cognitive dysfunction in patients with cerebral infarction.
        Chengde Medical University, China2020
        • Ren YG
        • Li JY
        • Hu K
        • et al.
        The effect of virtual reality training on the rehabilitation treatment of cognitive dysfunction patients after cerebral infarction.
        J Int Psychiatry. 2020; 47 (200): 1193-1195
        • Guo JQ
        • Dong J.
        Observation on the effect of virtual reality training in the treatment of cognitive impairment after stroke.
        Womens Health Res. 2020; : 111-112
        • Manuli A
        • Maggio MG
        • Latella D
        • et al.
        Can robotic gait rehabilitation plus virtual reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols.
        J Stroke Cerebrovasc Dis. 2020; 29104994
        • Fu KJ
        • Liu YM
        • Sun LN
        • et al.
        Effects of virtual reality training on cognitive function and balance function in convalescent stroke patients.
        Chin Manipulation Rehabil Med. 2020; 11: 34-36
        • Fu KJ
        • Liu XD
        • Fan F
        • et al.
        The effect of virtual reality technology on the cognitive function of stroke patients in recovery period.
        J Chengde Med Coll. 2019; 36: 303-305
        • Fu KJ
        • Sun LN
        • Fan F
        • et al.
        The effect of virtual reality training on the cognitive function of patients with cerebral infarction in recovery period.
        Chin J Phys Med Rehabil. 2019; 41: 682-684
        • Fu KJ
        • Fan F
        • Wang ZB
        • et al.
        Observation on the effect of virtual reality training on the cognitive function of patients with cerebral hemorrhage in recovery period.
        Chin Manipulation Rehabil Med. 2019; : 7-9
        • Zhang HL
        • Che WS
        • Chu NN.
        Effect of scalp acupuncture combined with virtual situational interactive training on functional rehabilitation of stroke patients.
        Chin J Gerontol. 2019; 39: 4902-4906
        • Shi Z.
        A randomized controlled clinical trial on the efficacy of upper limb robot mediated virtual reality training for motor and cognitive dysfunction in sub-acute stroke.
        Gansu University of Traditional Chinese Medicine, China2017
        • Wang H
        • Wu JS.
        The effect of virtual reality training on cognitively impaired stroke patients with hemiplegia.
        Chin J Rehabil. 2017; 32: 299-301
        • Wen HY
        • Li LQ
        • Long JZ.
        Effect of 3D virtual reality technology on the curative effect of stroke patients with memory dysfunction and 1H-MRS.
        Chin J Gerontol. 2017; 37: 100-102
        • Chen JJ
        • Hu JB
        • Zhai HW
        • et al.
        Application of virtual reality technology to treat stroke patients with impaired memory.
        Acta Med Xuzhou. 2016; 36: 307-310
        • Xue H.
        The effect of neuroelectrophysiological monitoring and virtual reality training on the cognitive function and limb motor function of stroke patients in recovery period.
        Mod Pract Med. 2020; 32: 613-615
        • Chen JW.
        Effect of upper-limb robot training assisted by virtual reality on upper limb function and cognitive function of stroke patients.
        Wuhan Sports University, China2020
        • Faria AL
        • Pinho MS
        • Bermúdez I
        • Badia S.
        A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients.
        J Neuroeng Rehabil. 2020; 17: 78
        • Maier M
        • Ballester BR
        • Leiva Bañuelos N
        • et al.
        Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial.
        J Neuroeng Rehabil. 2020; 17: 42
        • Xiao X
        • Liang B.
        The effect of virtual reality training on the cognitive function and P300 of stroke patients in recovery period.
        Chin J Rehabil Med. 2019; 34: 339-341
        • Faria AL
        • Andrade A
        • Soares L
        • et al.
        Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients.
        J Neuroeng Rehabil. 2016; 13: 96
        • Burton L
        • Tyson SF.
        Screening for cognitive impairment after stroke: a systematic review of psychometric properties and clinical utility.
        J Rehabil Med. 2015; 47: 193-203
        • Fang C
        • Zhang Y
        • Zhang M
        • et al.
        P300 measures and drive-related risks: a systematic review and meta-analysis.
        Int J Environ Res Public Health. 2020; 17: 5266
        • Wang SY
        • Gong ZK
        • Sen J
        • et al.
        The usefulness of the Loewenstein Occupational Therapy Cognition Assessment in evaluating cognitive function in patients with stroke.
        Eur Rev Med Pharmacol Sci. 2014; 18: 3665-3672
        • Katz N
        • Itzkovich M
        • Averbuch S
        • et al.
        Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for brain-injured patients: reliability and validity.
        Am J Occup Ther. 1989; 43: 184-192
        • Reitan RM.
        Validity of the trail making test as an Indicator of organic brain damage.
        Percept Mot Skills. 1958; 8: 271-276
        • Wilson B
        • Cockburn J
        • Baddeley A
        • et al.
        The development and validation of a test battery for detecting and monitoring everyday memory problems.
        J Clin Exp Neuropsychol. 1989; 11: 855-870
        • Keith RA
        • Granger CV
        • Hamilton BB
        • et al.
        The functional independence measure: a new tool for rehabilitation.
        Adv Clin Rehabil. 1987; 1: 6-18
        • Rae CD.
        A guide to the metabolic pathways and function of metabolites observed in human brain 1H magnetic resonance spectra.
        Neurochem Res. 2014; 39: 1-36
        • Guenter W
        • Bieliński M
        • Bonek R
        • et al.
        Neurochemical changes in the brain and neuropsychiatric symptoms in clinically isolated syndrome.
        J Clin Med. 2020; 9: 3909
        • Joe E
        • Medina LD
        • Ringman JM
        • et al.
        1H MRS spectroscopy in preclinical autosomal dominant Alzheimer disease.
        Brain Imaging Behav. 2019; 13: 925-932
        • Cheng A
        • Yao R
        • Cao W
        • et al.
        The value of 1H-MRS and MRI in combined methylmalonic aciduria and homocystinuria.
        J Comput Assist Tomogr. 2019; 43: 559-562
        • Ryan JJ
        • Lopez SJ.
        Wechsler Adult Intelligence Scale-III.
        (editors)in: Dorfman WI Hersen M Understanding psychological assessment. Springer, New York, US2001: 19-42
        • Anderson A
        • Klein J
        • White B
        • et al.
        Training and certifying users of the National Institutes of Health Stroke Scale.
        Stroke. 2020; 51: 990-993
        • Jacquin A
        • Binquet C
        • Rouaud O
        • et al.
        Post-stroke cognitive impairment: high prevalence and determining factors in a cohort of mild stroke.
        J Alzheimers Dis. 2014; 40: 1029-1038
        • Nie P
        • Liu F
        • Lin S
        • et al.
        The effects of computer-assisted cognitive rehabilitation on cognitive impairment after stroke: a systematic review and meta-analysis.
        J Clin Nurs. 2022; 31: 1136-1148
        • Riva G
        • Mancuso V
        • Cavedoni S
        • et al.
        Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains.
        Expert Rev Med Devices. 2020; 17: 1035-1061
        • Lopatina OL
        • Morgun AV
        • Gorina YV
        • et al.
        Current approaches to modeling the virtual reality in rodents for the assessment of brain plasticity and behavior.
        J Neurosci Methods. 2020; 335108616
        • Zhang LP
        • Jiang GD
        • Miao YC
        • et al.
        The study of brain proton magnetic resonance spectroscopy (1H-MRS) in patients with mild cognitive impairment.
        J Chin Clin Med Imaging. 2011; 22: 1-5
        • Subramanian SK
        • Prasanna SS.
        Virtual reality and noninvasive brain stimulation in stroke: how effective is their combination for upper limb motor improvement?-A meta-analysis.
        PM R. 2018; 10: 1261-1270
        • Tieri G
        • Morone G
        • Paolucci S
        • et al.
        Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies.
        Expert Rev Med Devices. 2018; 15: 107-117
        • Brassel S
        • Power E
        • Campbell A
        • et al.
        Recommendations for the design and implementation of virtual reality for acquired brain injury rehabilitation: systematic review.
        J Med Internet Res. 2021; 23: e26344
      2. Fisher GG, Chaffee DS, Tetrick LE, et al. Cognitive functioning, aging, and work: A review and recommendations for research and practice. J Occup Health Psychol. 2017;22(3):314–336.

        • Wilson L
        • Horton L
        • Kunzmann K
        • et al.
        Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury.
        J Neurol Neurosurg Psychiatry. 2020 Dec 2; ([Epub ahead of print])