Effect of Virtual Reality on Balance and Cognitive Function in Acute and Subacute Stroke Patients: A Randomized Clinical Trial VR Impact on Balance and Cognition in Stroke
Main Article Content
Abstract
Background: Stroke is a leading cause of disability worldwide, often resulting in impaired balance and cognitive function. Virtual reality (VR) has emerged as a novel intervention in stroke rehabilitation, offering immersive environments to enhance motor recovery.
Objective: To evaluate the effect of VR-based rehabilitation on balance and cognitive function in acute and subacute stroke patients compared to conventional physical therapy.
Methods: A single-blinded randomized clinical trial was conducted at Allied Hospital Faisalabad from February to April 2024, involving 50 stroke patients. Participants were randomly assigned to either a VR intervention group or a control group receiving conventional therapy. Both groups underwent therapy three times weekly for six weeks. Balance was assessed using the Berg Balance Scale, and cognitive function was evaluated with the Mini-Mental State Examination. Data were analyzed using SPSS version 27 with non-parametric tests.
Results: The VR group showed significant improvements in balance (mean rank post-treatment 27.95) compared to the control group (mean rank post-treatment 11.06), with a p-value of 0.030. Cognitive function also improved significantly in the VR group (p = 0.001).
Conclusion: VR interventions significantly enhance balance and cognitive function in stroke rehabilitation, particularly in acute phases, suggesting its integration into standard care.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Malik A, Rusly H, Gondo AA. Comparison of Post-Stroke Patient Coordination Level Between Frequency Exercise of Proprioceptive Neuromuscular Facilitation (PNF). Journal of Physics: Conference Series. 2020.
Katan M, Luft A. Global Burden of Stroke. Seminars in Neurology. 2018.
Zhang S, Zhang W, Zhou G. Extended Risk Factors for Stroke Prevention. Journal of the National Medical Association. 2019;111(4):447-56.
Venketasubramanian N, Yoon BW, Pandian J, Navarro JC. Stroke Epidemiology in South, East, and South-East Asia: A Review. Journal of Stroke. 2017;19(3):286.
Owolabi MO, Thrift AG, Mahal A, Ishida M, Martins S, Johnson WD, et al. Primary Stroke Prevention Worldwide: Translating Evidence into Action. The Lancet Public Health. 2022;7(1).
Singh V, Roth S, Llovera G, Sadler R, Garzetti D, Stecher B, et al. Microbiota Dysbiosis Controls the Neuroinflammatory Response After Stroke. Journal of Neuroscience. 2016;36(28):7428-40.
Demaerschalk BM. Literature-Searching Strategies to Improve the Application of Evidence-Based Clinical Practice Principles to Stroke Care. Mayo Clinic Proceedings. 2004.
Tuo QZ, Zhang ST, Lei P. Mechanisms of Neuronal Cell Death in Ischemic Stroke and Their Therapeutic Implications. Medicinal Research Reviews. 2022;42(1):259-305.
Byl N, Roderick J, Mohamed O, Hanny M, Kotler J, Smith A, et al. Effectiveness of Sensory and Motor Rehabilitation of the Upper Limb Following the Principles of Neuroplasticity: Patients Stable Poststroke. Neurorehabilitation and Neural Repair. 2003;17(3):176-91.
Sharma V, Kaur J. Effect of Core Strengthening with Pelvic Proprioceptive Neuromuscular Facilitation on Trunk, Balance, Gait, and Function in Chronic Stroke. Journal of Exercise Rehabilitation. 2017;13(2):200.
Bowman T, Gervasoni E, Arienti C, Lazzarini SG, Negrini S, Crea S, et al. Wearable Devices for Biofeedback Rehabilitation: A Systematic Review and Meta-Analysis to Design Application Rules and Estimate the Effectiveness on Balance and Gait Outcomes in Neurological Diseases. Sensors. 2021;21(10):3444.
Laxmidas GT. The Effect of Lower Limb Progressive Resistance Exercise on Balance in Subacute and Chronic Stroke Patients. Indian Journal of Physical Therapy.
Levin MF, Kleim JA, Wolf SL. What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke? Neurorehabilitation and Neural Repair. 2009;23(4):313-9.
Proffitt R, Lange B. Considerations in the Efficacy and Effectiveness of Virtual Reality Interventions for Stroke Rehabilitation: Moving the Field Forward. Physical Therapy. 2015;95(3):441-8.
Cortés-Pérez I, Nieto-Escamez FA, Obrero-Gaitán E. Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series. Brain Sciences. 2020;10(5):296.
Maier M, Ballester BR, Verschure PF. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Frontiers in Systems Neuroscience. 2019;13:74.
Levin MF, Demers M. Motor Learning in Neurological Rehabilitation. Disability and Rehabilitation. 2021;43(24):3445-53.
Miehlbradt J, Cuturi LF, Zanchi S, Gori M, Micera S. Immersive Virtual Reality Interferes with Default Head–Trunk Coordination Strategies in Young Children. Scientific Reports. 2021;11(1):17959.
Saposnik G, Levin M, Group SORCW. Virtual Reality in Stroke Rehabilitation: A Meta-Analysis and Implications for Clinicians. Stroke. 2011;42(5):1380-6.
Daghsen L, Fleury L, Bouvier J, Zavanone C, Dupont S, Hummel FC, et al. Evaluation of a Shortened Version of the Action Research Arm Test (ARAT) for Upper Extremity Function After Stroke: The Mini-ARAT. Clinical Rehabilitation. 2022;36(9):1257-66.
Morone G, Tramontano M, Iosa M, Shofany J, Iemma A, Musicco M, et al. The Efficacy of Balance Training with Video Game-Based Therapy in Subacute Stroke Patients: A Randomized Controlled Trial. BioMed Research International. 2014.
Lloréns R, Gil-Gómez JA, Alcañiz M, Colomer C, Noé E. Improvement in Balance Using a Virtual Reality-Based Stepping Exercise: A Randomized Controlled Trial Involving Individuals with Chronic Stroke. Clinical Rehabilitation. 2015;29(3):261-8.