Effects of the brain-damaged side after stroke on the learning of a balance task in a non-immersive virtual reality environment.

Background: Post-stroke survivors with right hemisphere injury have more impairments in postural control and balance. However, the impact of the hemisphere injured on the process of balance reacquisition has not been fully explored. We hypothesized that stroke survivors could learn balance tasks (H1), but right hemisphere damaged patients would show poor motor learning if compared to left hemisphere damaged patients (H2)Objective: To investigate whether the brain-damaged side after stroke affects the learning of a balance task. Methods: Three groups were recruited: twenty stroke survivors (ten left and ten right hemisphere damage) and twenty healthy volunteers. The participants practiced a balance task for thirty minutes, four consecutive days. The task was the Table Tilt game (NintendoTM Company), which induces balance demands with a progression of complexity. Motor performance was assessed at baseline, post-practice and after one week (retention test). Accuracy, errors, and complexity of the task achieved during the trial were assessedResults: Participants in all groups improved their performance (p < .001) and maintained it at the retention test. The control group showed better performance if compared to the right and left hemisphere damaged stroke survivors (p < .05). There was no difference between individuals with right and left hemisphere damaged, but the right hemisphere damaged patients demonstrated more errors at higher levels of complexityConclusion: Stroke survivors can learn balance tasks (H1), and the right hemisphere damaged patients demonstrate more errors than those with left hemisphere injury in higher complexity conditions (H2).

Effects of extrinsic feedback on the motor learning after stroke

Aim: This study aims to investigate the effects of the type of extrinsic feedback provided equally in terms of timing and frequency of delivery on the motor learning after stroke. Methods: Twenty post-stroke individuals were distributed randomly into two groups according to the type of feedback provided: knowledge of performance experimental group (KPEG) and knowledge of results experimental group (KREG). Additionally, a control group (CG) was consisted of 20 healthy individuals age- and feedback-matched with the experimental groups. The task was a pointing skill performed in a virtual reality system. The acquisition phase consisted of 3 days/ 75 trials per day. Two retention tests (ret1 and ret2) were run after four days from the acquisition phase. Dependent variable measures were defined by motor performance and movement pattern. Results: The statistical analysis showed interaction effect F(3,108 = 49.13, p = 0.01) among KPEG and KREG. Based on the motor performance parameters (score) the KPEG improved performance significantly from pre to post (p = 0.001), and maintain it from pre to ret1 (p = 0.002), and from the pre to ret2 (p = 0.001). However, the KREG only showed a difference in motor performance from the pre to post (p = 0.003). Compared to the KREG, the KPEG showed improvement on the movement pattern based on the smoothness (p = 0.004), which suggests that the KPEG performed more corrections of movements in relation to the CG and KREG groups. Conclusion: These findings suggest that KP allowed better motor learning in individuals after stroke.(AU)

Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review.

OBJECTIVE: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated. METHOD: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials. RESULTS: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component. DISCUSSION: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.