Exercise as it relates to Disease/Virtual reality: rehabilitation for stroke patients

This wiki page created by u3085734 is a fact sheet of the journal article "Effect of a virtual reality exercise program accompanied by cognitive tasks on the balance and gait of stroke patients" by Lee IW et al. (2015).

Background
Stroke

A stroke is a blockage of blood to the brain. There are several ways in which this can happen, the most common being an ischemic stroke where part of the brain looses blood supply by a blood clot blocking a blood vessel. Stroke is a chronic condition that can severely impact ones daily living by increasing risk of falls, impair movement, sensation, perception, cognition, and/or language.

Virtual Reality

Virtual reality is a combination of hardware and software that allows users to immerse themselves in a world which provides real world like feedback. It has a wide range of applications such as oil and gas industry, manufacturing industry, military and medical care. Although virtual reality programs require a high level of specificity to the individual in order to be effective, they are able to provide visual, auditory, tactile feedback and motivation.

Context

Strokes cost the Australian economy $5 billion in 2012 alone, was the underlying cause of death for 11 220 Austrlaians in 2010 and of the 381 400 Australians who suffered a stroke in 2009, 133 490 had an impairment lasting for longer than 6 months. Modifiable lifestyle factors can influence the risk of stroke, particularly ischemic stroke.

Where is the research from?
The study was conducted by researchers from the Department of Physical Therapy in Nambu University and the Department of Rehabilitation Science in Daegu University, all in the Republic of Korea.

The authors of the research

Lee IW, Kim YN and Lee DK have been involved in 109, 339 and 987 published studies on PubMed respectively as of 06/09/2016.

What kind of research was this?
This is a quantitative randomised controlled study that reported no conflict of interest nor did they report where they received funding from.

What did the research involve?
20 patients were selected, all of which had been diagnosed with stroke 6 months before the study. They were then randomly divided into two groups. the experimental group consisted of 6 males and 4 females, who participated in a virtual reality program while performing cognitive tasks. The virtual reality exercise program used the city walking (left-right weight shift), hot air balloon (up-down weight shift), and bubble (total weight shift) activities available in BioRescue. This was accompanied by addition and subtraction by tens and backward reading of two or three words or numbers for their cognition training. The control group contained 5 males and 5 females, who participated in a proprioceptive neuromuscular facilitation (PNF - see second paragraph under Introduction) exercise program. Both groups performed their activities 45 minutes a day, 3 times a week, for 6 weeks. Balance and gait were measured using the Berg Balance Scale (BBS) and Timed Up and Go Test (TUGT) respectively.

Was the methodology the best approach?

Several large flaws exist within the study. The small sample size of 20 means a large generalisation of stroke patients would occur, although the researchers acknowledge this. Methodology between the groups are vastly different: more groups should have been added to the study, such as a group where only cognitive training is done, another where only the virtual reality program is used. No follow-up occurred in the study, another limitation acknowledged by the researchers, which could provide information on the length of effect of the interventions used.

What were the basic results?
Comparison of the results of the BBS and TUGT between the experimental and control groups aMean±SD. *p<0.05 (paired t-test). # p<0.05 (independent t-test). D-value: difference value; EG: experimental group; CG: control group; BBS: Berg Balance Scale; TUGT: Timed Up and Go Test

Those who participated in the virtual reality training program showed greater increase in both the TUGT and BBS when compared to the control group. It is important to note that both groups performed better post intervention, although virtual reality and PNF  stretching has been shown to aid with the rehabilitation of stroke patients, while dual tasks (which requires cognition) can impair gait.

How did the researchers interpret the results?
The researchers interpretation of the results was that their study supported the findings of other literature that a virtual reality program combined with cognitive training had a positive effect on balance and gait of stroke patients.

What conclusions can we take from this research?
The thing to take away from this study is that more research needs to be done in this area. The results look promising; the experimental group saw greater increases in measured outcomes when compared with the control group, however all of the methods used are current techniques for stroke patients and an overall increase in measured outcomes would not be uncommon. The flaws within the study means that it is not conclusive information, but rather that this is an area where there is a lot of potential for further research.

Further information/resources
For more general information regarding stroke: https://strokefoundation.com.au/

For support groups within Australia: https://strokefoundation.com.au/About-Stroke/Help-after-stroke/Local-stroke-support-groups-and-choirs

For more information regarding virtual reality: http://www.vrs.org.uk/virtual-reality/what-is-virtual-reality.html

For more information regarding gait, balance and fall prevention: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116773/