In the US, stroke is the number five cause of death and a leading cause of disability. Many people who have had a stroke experience hemiparesis – reduced muscle strength on one side of the body – and often compensate by relying more heavily on their healthy limb. Prolonged periods of not using the affected limb can lead to further impairment, but now, researchers say virtual reality could help some stroke patients regain the use of their arm.

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Patients used a Rehabilitation Gaming System to control a virtual body with their own movements.
Image credit: Belén Rubio Ballester

The researchers – led by Belén Rubio, of the Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems at Universitat Pompeu Fabra in Spain – publish their clinical pilot study in the Journal of NeuroEngineering and Rehabilitation.

They note that “learned non-use” of a limb is common in stroke patients and is linked to reduced quality of life.

“There is a need for designing new rehabilitation strategies that promote the use of the affected limb in performing daily activities,” says Rubio. “Often we neglect the remarkable contribution of the patient’s emotional and psychological states to recover, and this included their confidence.”

To increase patient confidence in using their paralyzed arm, Rubio and colleagues conducted a small pilot study with 20 hemiparetic stroke patients.

Using a “Rehabilitation Gaming System” (RGS) with a Microsoft Kinect sensor, the patients were able to control a virtual body with their own movements, from a first-person perspective.

Fast facts about stroke
  • A stroke occurs when a blood vessel is blocked, denying part of the brain the blood and oxygen it needs.
  • Each year, 795,000 Americans suffer a new or recurrent stroke.
  • Americans paid about $73.7 billion in 2010 for stroke-related medical costs and disability.

Learn more about stroke

During the study, the researchers asked the patients to reach targets that appeared in a virtual environment. For some of the trials, the team gradually improved the movement of the paretic limb in the virtual world, making it appear faster, more accurate and easier to use – without alerting the participants that they did so.

After sneaking in the gradual changes, the team then recorded the patients’ performance on trials with the normal settings, including the likelihood of them using their paretic arm.

Results showed that after enhancing the movement, the patients began to use their paretic limb more often. Rubio says this suggests that “changing patients’ beliefs on their capabilities significantly improves the use of their paretic limb.”

In detail, the team found that only 10 minutes of enhancement was needed to produce “significant changes in the amount of spontaneous use of the affected limb.”

And after the enhanced trials, the patients were significantly more likely to select their paretic limb when reaching toward a virtual target, despite having no awareness that the previous trials were enhanced.

Rubio and colleagues note that current stroke therapies involve forcing patients to use the paretic limb by limiting movement of the healthy limb, but this study provides hope of an alternative solution – one in which the patient’s confidence is used in recovery.

Commenting on their technique, Rubio says:

This therapy could create a virtuous circle of recovery, in which positive feedback, spontaneous arm use and motor performance can reinforce each other. Engaging patients in this ongoing cycle of spontaneous arm use, training and learning could produce a remarkable impact on their recovery process.”

She adds that the RGS has demonstrated a “significant impact on recovery of functionality for both acute and chronic patients,” and the system is used in Spanish hospitals and treatment centers.

Next steps for the team are to repeat the study with a larger sample size, to further demonstrate how virtuality reality interventions can be used in therapy.

In August of last year, Medical News Today investigated how surgeons can be trained using gaming technology.