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      Does body shadow improve the efficacy of virtual reality-based training with BTS NIRVANA? : A pilot study

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          Abstract

          Background:

          Aim of the present study was to evaluate whether the presence of body shadows during virtual reality (VR) training with BTS NIRVANA (BTs-N) may lead to a better functional recovery.

          Methods:

          We enrolled 20 poststroke rehabilitation inpatients, who underwent a neurocognitive-rehabilitative training consisting of 24 sessions (3 times a week for 8 weeks) of BTs-N. All the patients were randomized into 2 groups: semi-immersive virtual training with (S-IVT S group) or without (S-IVT group) body shadows. Each participant was evaluated before (T0) and immediately (T1) after the end of the training (Trial Registration Number: NCT03095560).

          Results:

          The S-IVT S group showed a greater improvement in visuo-constructive skills and sustained attention, as compared with the S-IVT group. The other measures showed nonsignificant within-group and between-group differences.

          Conclusion:

          Our results showed that body shadow may represent a high-priority class of stimuli that act by “pushing” attention toward the body itself. Further studies are needed to clarify the role of body shadow in promoting the internal representation construction and thus self-recognition.

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          Outcome and time course of recovery in stroke. Part II: Time course of recovery. The Copenhagen Stroke Study.

          Henrik Jørgensen, Hirofumi Nakayama, Hans Raaschou … (1995)
          To determine the time course of both neurological and functional recovery from stroke. Prospective, consecutive, and community based. The stroke unit of a hospital in Copenhagen, Denmark. This setting receives all acute stroke patients admitted from a well-defined catchment area of 239,886 inhabitants within the city of Copenhagen. Acute treatment as well as all stages of rehabilitation are cared for within the stroke unit regardless of age, stroke severity, and premorbid condition. 1,197 patients with acute stroke. Weekly examinations of neurological deficits (using the Scandinavian Neurological Stroke Scale) and functional disabilities (Activity of Daily Living (ADL) measured by the Barthel Index) were performed from the time of acute admission to the end of rehabilitation. These evaluations were repeated 6 months poststroke. Time course of recovery was stratified according to initial stroke severity and disability. Functional recovery was completed within 12.5 weeks (95% confidence interval (CI) 11.6 to 13.4) from stroke onset in 95% of the patients. However, 80% of the patients had reached their best ADL function within 6 weeks (CI 5.3 to 6.7) from onset. The time course of functional recovery was strongly related to initial stroke severity. Best ADL function was reached within 8.5 weeks (CI 8 to 9) in patients with initially mild strokes, within 13 weeks (CI 12 to 14) in patients with moderate strokes, within 17 weeks (CI 15 to 19) in patients with severe strokes, and within 20 weeks (CI 16 to 24) in patients with very severe strokes. After these time-points, no significant changes occurred. However, a valid prognosis of functional outcome can be made much earlier. Best ADL function was reached by 80% of the patients with initially mild strokes within 3 weeks (CI 2.6 to 3.4), within 7 weeks (CI 6 to 8) of the patients with moderate strokes, and within 11.5 weeks (CI 10 to 13) of the patients with severe and very severe strokes. The time course of neurological recovery followed a pattern similar to that of functional recovery, but preceeded functional recovery by 2 weeks on average. A reliable prognosis can in all stroke patients be made within 12 weeks from stroke onset. Even in patients with severe and very severe strokes, neurological and functional recovery should not be expected after the first 5 months.
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            Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies.

            Philip Burton, Darren C Greenwood, Jenni Murray … (2013)
            Negative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool. Databases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I(2) statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8-29%, I(2)  = 97%) and was 25% (95% confidence interval 21-28%, I(2)  = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale 'probable' and 'possible' cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13-27%, I(2)  = 96%) within one-month of stroke; 23% (95% confidence interval 19-27%, I(2)  = 84%) one to five-months after stroke; and 24% (95% confidence interval 19-29%, I(2)  = 89%) six-months or more after stroke. Anxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.
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              Motor rehabilitation using virtual reality

              Heidi Sveistrup (2004)
              Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Medicine (Baltimore)
                Journal ID (iso-abbrev): Medicine (Baltimore)
                Journal ID (publisher-id): MEDI
                Title: Medicine
                Publisher: Wolters Kluwer Health
                ISSN (Print): 0025-7974
                ISSN (Electronic): 1536-5964
                Publication date Collection: September 2017
                Publication date (Electronic): 22 September 2017
                Volume: 96
                Issue: 38
                Electronic Location Identifier: e8096
                Affiliations
                [a ]IRCCS Centro Neurolesi Bonino Pulejo
                [b ]Stroke Unit, Policlinico Universitario, Messina, Italy.
                Author notes
                [∗ ]Correspondence: Rocco Salvatore Calabrò, IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113, Contrada Casazza, Messina 98124, Italy (e-mail: salbro77@ 123456tiscali.it ).
                Article
                Publisher ID: MD-D-17-02893 Accession ID: 08096
                DOI: 10.1097/MD.0000000000008096
                PMC ID: 5617719
                PubMed ID: 28930852
                SO-VID: 6c595d6c-18cd-4d80-bf4c-7ca8f52ea4a8
                Copyright © Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.
                License:

                This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. http://creativecommons.org/licenses/by-sa/4.0

                History
                Date received : 9 May 2017
                Date revision received : 21 August 2017
                Date accepted : 29 August 2017
                Categories
                Subject: 5300
                Subject: Research Article
                Subject: Clinical Trial/Experimental Study
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: body shadow,cognitive,rehabilitation,stroke,virtual reality
                Data availability:
                Keywords: body shadow, cognitive, rehabilitation, stroke, virtual reality

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