Effects of Virtual Reality Training on Mobility in Stroke

Abstract

BACKGROUND Stroke is the prominent source of disability and patients experience impaired balance, motor control and mobility. Virtual reality training through exer-gaming is emerging technology in stroke training. The interactive session of virtual reality enhances the functional status by improving motivation and active participation. PURPOSE OF STUDY The objective of study was to determine effects of additional virtual reality training versus task-oriented training alone on physical performance, mobility and balance in chronic stroke patients. METHODOLOGY A single blind randomized control trial was conducted from January 2016- March 2017 at Physical Rehabilitation department of Pakistan Railway General Hospital, Rawalpindi Pakistan. Non-probability purposive sampling was used to collect a sample of 52 chronic stroke patients; both ischemic and hemorrhagic, with minimum age of 40 years and symptoms lasting for at least 3 months with standing ability, while patients having cognitive or visual impairments and with joints pain were excluded. Sealed envelope method was used for random assignment into two groups: Virtual reality training (VRT) group (n=26) and Task oriented training (TOT) group (n=26). Task oriented training was provided to both groups while additional 10-20 minutes of exer-gaming was provided to only virtual reality training group for 03 days per week for 8 weeks. Data was collected using standardized assessment tools including; Fugl-Meyer Assessment- Lower Extremity (FMA-LE), Berg Balance Scale, Timed Up and Go test (TUG), Dynamic Gait Index (GDI). Fatigue Impact Scale (FIS) and Quality Of Life (QOL). The assessment was done at baseline and after every two weeks until end of training. The data was analyzed through SPSS-21 and repeated measures ANOVA with Bonferroni was used for within-group analysis and independent samples t test for between-group comparisons. RESULTS The mean age of VRT and TOT group was 50.20±8.76 and 55.46±11.57 years respectively. VRT group showed significantly better scores in FMA-LE and BBS after 04 weeks of training as compared to TOT group (P<0.05). Timed Up and Go score was significantly better in VRT group after 06 weeks than TOT group (P<0.05). Both groups have similar effects in Dynamic Gait Index after 08 weeks of training. (p>0.05) FIS showed significant reduction in VRT group (P<0.05) while no significant difference was observed in quality of life of stroke patients in both groups. (p>0.05) CONCLUSION It can be concluded that additional virtual reality with task oriented training is significantly better than task oriented training alone in improving physical performance, mobility and balance outcome in chronic stroke. Additional virtual reality and task oriented training have similar effects on gait performance of stroke patients.