Wrist Rehabilitation System Using Augmented Reality for Hemiplegic Stroke Patient Rehabilitation: A Feasibility Study

Objective: Our objective was to investigate the effect of the rehabilitation system using augmented reality (AR) on upper extremity motor performance of patients with stroke. Methods: The system using AR applying mirror therapy mechanism provides the intervention protocol for the patient with hemiplegia after stroke. The system consists of a patient positioning tool (a chair), a white surface table, an image acquisition unit, an image processing unit, an image displaying unit, an arm holder, a Velcro-strap, and two blue circle stickers. To assess the feasibility of our system in motor function recovery, a stroke patient was recruited to receive the AR intervention. The treatment was performed two times a day for ten minutes over two weeks (ten days of treating weeks), except for the time of installation, calibration, and three minute breaks. Jebsen Taylor hand function test and Arm Motor Fugl-Meyer assessment were used as primary and secondary outcome measures, respectively, to evaluate the effect of motor function recovery. Additionally, stroke impact scale, Korean version-Modified Barthel Index (K-MBI), active range of motion of wrist joint (ROM), and the grasp force in Newtons were measured. Participants’ feedback and adverse effects were recorded as well. Results: Motor function improvements were exhibited in wrist and hand subtest of Arm Motor Fugl-Meyer (baseline: 19; post-intervention: 23), proximal arm subtest of Fugl-Meyer (baseline: 31; post-intervention: 34), ROM (extending ROM: 10° and 3° for flexion and extension, repeatedly), stroke impact scale (baseline: 46; post-intervention: 54), K-MBI (baseline: 92; post-intervention: 95), nine-hole pegboard (baseline: 30 s; post-intervention: 25 s), and grasp force in Newtons (baseline: 12.7; post-intervention: 17.7). However, the adverse effects were reported after the intervention. Conclusion: The system using AR applying mirror therapy mechanism demonstrated the feasibility in motor function recovery for the stroke patient.

[1]  M. Maier,et al.  Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review , 2016, PloS one.

[2]  K. Koo,et al.  Enhanced Reality Showing Long-Lasting Analgesia after Total Knee Arthroplasty: Prospective, Randomized Clinical Trial , 2018, Scientific Reports.

[3]  P. Tonin,et al.  Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial , 2013, Journal of NeuroEngineering and Rehabilitation.

[4]  K. Fong,et al.  Systematic Review on the Effectiveness of Mirror Therapy in Training Upper Limb Hemiparesis after Stroke , 2012 .

[5]  T. Mulder,et al.  Patients' and relatives' reports of disturbances 9 months after stroke: subjective changes in physical functioning, cognition, emotion, and behavior. , 2005, Archives of physical medicine and rehabilitation.

[6]  S. Adamovich,et al.  Virtual reality-augmented rehabilitation for patients following stroke. , 2002, Physical therapy.

[7]  E. Kaplan,et al.  Neuropsychological and neuroanatomical dimensions of ideomotor apraxia. , 1992, Brain : a journal of neurology.

[8]  S. Page,et al.  Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer Assessment in minimally impaired upper extremity hemiparesis in stroke. , 2012, Archives of physical medicine and rehabilitation.

[9]  Dae-Hyouk Bang,et al.  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial , 2019, Medical science monitor : international medical journal of experimental and clinical research.

[10]  S. Embretson,et al.  The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. , 1999, Stroke.

[11]  M. Levin,et al.  New Approaches to Enhance Motor Function of the Upper Limb in Patients with Hemiparesis , 2005 .

[12]  V. Santilli,et al.  Cross-Cultural Adaptation and Validation of the Jebsen-Taylor Hand Function Test in an Italian Population , 2016, Rehabilitation research and practice.

[13]  Ronald Azuma,et al.  Recent Advances in Augmented Reality , 2001, IEEE Computer Graphics and Applications.

[14]  Andrea Turolla,et al.  Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial. , 2018, Archives of physical medicine and rehabilitation.

[15]  J. Marler,et al.  Measurements of acute cerebral infarction: a clinical examination scale. , 1989, Stroke.

[16]  Sergi Bermúdez i Badia,et al.  Combined Cognitive-Motor Rehabilitation in Virtual Reality Improves Motor Outcomes in Chronic Stroke – A Pilot Study , 2018, Front. Psychol..

[17]  P. Sizer,et al.  3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study , 2017, The Journal of manual & manipulative therapy.

[18]  A. Beck,et al.  Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. , 1996, Journal of personality assessment.

[19]  Nadina B. Lincoln,et al.  Reliability and Revision of the Nottingham Sensory Assessment for Stroke Patients , 1998 .

[20]  Suhyun Lee,et al.  Effect of Virtual Reality-based Bilateral Upper Extremity Training on Upper Extremity Function after Stroke: A Randomized Controlled Clinical Trial. , 2016, Occupational therapy international.

[21]  Hee-Soon Woo,et al.  Application of the Korean Version of the Modified Barthel Index: Development of a keyform for use in Clinical Practice , 2017, Hong Kong journal of occupational therapy : HKJOT.

[22]  Chang Ho Hwang,et al.  Individual finger synchronized robot-assisted hand rehabilitation in subacute to chronic stroke: a prospective randomized clinical trial of efficacy , 2012, Clinical rehabilitation.

[23]  R. Casale,et al.  Mirror Therapy in the Rehabilitation of Lower-Limb Amputation: Are There Any Contraindications? , 2009, American journal of physical medicine & rehabilitation.

[24]  N. Smania,et al.  Effects of High-intensity Robot-assisted Hand Training on Upper Limb Recovery and Muscle Activity in Individuals With Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial , 2018, Front. Neurol..

[25]  Bogdan Gabrys,et al.  An overview of self-adaptive technologies within virtual reality training , 2016, Comput. Sci. Rev..

[26]  J. A. Stevens,et al.  Using motor imagery in the rehabilitation of hemiparesis. , 2003, Archives of physical medicine and rehabilitation.

[27]  H. Stam,et al.  Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. , 2008, Archives of physical medicine and rehabilitation.

[28]  Robert Teasell,et al.  Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial , 2016, The Lancet Neurology.

[29]  A. Maravita,et al.  Perceptual effects of the mirror box training in normal subjects. , 2013, Restorative neurology and neuroscience.

[30]  B. Darnall,et al.  Home-based self-delivered mirror therapy for phantom pain: a pilot study. , 2012, Journal of rehabilitation medicine.

[31]  Burcu Ersoz Huseyinsinoglu,et al.  The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients , 2015, Journal of physical therapy science.

[32]  R. H. Jebsen,et al.  An objective and standardized test of hand function. , 1969, Archives of physical medicine and rehabilitation.

[33]  Hunter G Hoffman,et al.  Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. , 2007, Archives of physical medicine and rehabilitation.

[34]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[35]  N. Silberberg,et al.  Hand strength and dexterity. , 1971, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[36]  V. Mathiowetz,et al.  Adult Norms for the Nine Hole Peg Test of Finger Dexterity , 1985 .

[37]  Robert Teasell,et al.  Stroke Rehabilitation: An International Perspective , 2009, Topics in stroke rehabilitation.

[38]  Rosanna Maria Viglialoro,et al.  Review of the Augmented Reality Systems for Shoulder Rehabilitation , 2019, Inf..

[39]  H. Hoffman,et al.  Effectiveness of Virtual Reality–Based Pain Control With Multiple Treatments , 2001, The Clinical journal of pain.

[40]  Malek Amini,et al.  The Effects of Virtual Reality on Upper Limb Function in Chronic Stroke Patients: A Clinical Trial , 2019, Iranian Rehabilitation Journal.

[41]  Bernadette A. Thomas,et al.  Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.