Content » Vol 52, Issue 11

Original report

Functional changes in the lower extremity after non-immersive virtual reality and physiotherapy following stroke

Pawel Kiper, Carlos Luque-Moreno, Salvatore Pernice, Lorenza Maistrello, Michela Agostini, Andrea Turolla
Azienda ULSS 3 Serenissima, Physical Medicine and Rehabilitation unit, 30126 Venice, Italy. E-mail:
DOI: 10.2340/16501977-2763


Objective: To analyse the effect of virtual reality (VR) ther-apy combined with conventional physiotherapy on balance, gait and motor functional disturbances, and to determine whether there is an influence on motor recovery in the subacute (< 6 months) or chronic (> 6 months) phases after stroke.
Methods: A total of 59 stroke inpatients (mean age 60. 3 years (standard deviation (SD) 14. 8); 14. 0 months (SD 25. 7) post-stroke) were stratified into 2 groups: subacute (n  =  31) and chronic (n  =  28). Clinical scales (Fugl-Meyer lower extremity (FM LE); Functional Independence Measure (FIM); Berg Balance Scale (BBS); Functional Ambulation Category (FAC); modified Ashworth scale (MAS); 10-metre walk test (10MWT); and kinematic parameters during specific motor tasks in sitting and standing position (speed; time; jerk; spatial error; length) were applied before and after treatment. The VR treatment lasted for 15 sessions, 5 days/week, 1 h/day.
Results: The subacute group underwent significant change in all variables, except MAS and length. The chronic group underwent significant improvement in clinical scales, except MAS and kinematics. Motor impairment improved in the severe ≤ 19 FM LE points, moderate 20–28 FM LE points, mild ≥ 29 FM LE points. Neither time since stroke onset nor affected hemisphere differed significantly between groups. The correlations were investigated between the clinical scales and the kinematic parameters of the whole sample. Moreover, FM LE, BBS, MAS, and speed showed high correlations (R2> 0. 70) with independent variables.
Conclusion: VR therapy combined with conventional physiotherapy can contribute to func-tional improvement in the subacute and chronic phases after stroke.

Lay Abstract

Specific treatment, enriched with artificially reinforced feedback, may facilitate physiological activation of the brain areas devoted to motor learning. Based on this rationale it was hypothesized that motor learning could be improved when an enriched environment focused on optimizing the interaction between the human body and the physical environment is used for motor training. The aims of this study were to examine the effect of virtual reality therapy on balance, gait and motor impairment, and to determine whether there is an influence on motor recovery in the subacute (< 6 months) or chronic (> 6 months) phases after stroke. This study was conducted among stroke inpatients, divided into 2 groups (subacute and chronic). Patients improved fower limb function in both subacute and chronic stroke phase. Virtual reality therapy could be a useful tool for specific rehabilitation of the lower limb, which may lead to improved rehabilitation outcomes.


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