Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study

• Published in: Journal of neuroengineering and rehabilitation Vol. 16; no. 1; p. 56
• Main Authors: Rogers, Jeffrey M, Duckworth, Jonathan, Middleton, Sandy, Steenbergen, Bert, Wilson, Peter H
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-05-2019; BioMed Central; BMC
• Subjects: Adult; Adults; Aged; Aged, 80 and over; Brain; Brain injuries; Brain research; Care and treatment; Cognition; Cognition & reasoning; Cognition - physiology; Cognitive ability; Cognitive therapy; Computer & video games; Computer applications; Executive function; Feasibility studies; Female; Head injuries; Health aspects; Humans; Information processing; Interfaces; Male; Methods; Middle Aged; Motor activity; Motor Activity - physiology; Neurorehabilitation; Physical therapy; Physical Therapy Modalities - instrumentation; Pilot Projects; Randomization; Recovery; Recovery of Function; Rehabilitation; Stroke; Stroke - physiopathology; Stroke patients; Stroke Rehabilitation - methods; Systematic review; Technology; Technology application; Traumatic brain injury; Upper extremity; Virtual Reality; Stroke; Cognition; Rehabilitation; Upper extremity; Motor activity; Virtual reality
• ISSN: 1743-0003; 1743-0003
• DOI: 10.1186/s12984-019-0531-y

Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors.
Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.
Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.
A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.
this pilot study was not registered.