Virtual Reality Mirror Therapy for Stroke
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 11/16/2018 |
| Start Date: | October 16, 2017 |
| End Date: | July 27, 2018 |
Virtual Reality Mirror Therapy for Upper Limb Rehabilitation Following Stroke
Mirror box therapy is a treatment option that has shown promise for people with difficulty
moving their arm after a brain injury, such as stroke. During mirror box therapy, people
place their affected arm inside a box, where they are unable to see it. They then focus their
attention on the outside of the box, which has been fitted with a mirror. The mirror reflects
the movements of their intact hand and makes it appear that both hands are moving normally.
Research has shown that this type of therapy can help people recover some use of the arm.
This study is designed to examine a new type of treatment, which uses a virtual reality
headset (Oculus Rift) to recreate this effect in a virtual environment. Up to twenty people
who have had a stroke and now have difficulty using an arm (Fugl-Meyer UE range 10-50) will
be asked to come in for four weeks of treatment, during which they will perform a set of
movements and games using the virtual reality platform, while focusing on the image of their
affected arm. Treatment will include two fifteen minute sessions, three times/week for a
period of four weeks. Participants will complete pre-testing, which will provide a baseline
measure of performance, and post-testing, to see if the treatment has been well-tolerated and
has had any impact on their motor performance.
This research is important because it may demonstrate the usefulness of a new treatment
method for people who have suffered a stroke, or generally demonstrate that virtual reality
platforms may be useful treatment tools for stroke survivors. It may also provide a
relatively low-cost and motivating rehabilitation tool for use in the hospital or home
environment outside of therapy hours.
moving their arm after a brain injury, such as stroke. During mirror box therapy, people
place their affected arm inside a box, where they are unable to see it. They then focus their
attention on the outside of the box, which has been fitted with a mirror. The mirror reflects
the movements of their intact hand and makes it appear that both hands are moving normally.
Research has shown that this type of therapy can help people recover some use of the arm.
This study is designed to examine a new type of treatment, which uses a virtual reality
headset (Oculus Rift) to recreate this effect in a virtual environment. Up to twenty people
who have had a stroke and now have difficulty using an arm (Fugl-Meyer UE range 10-50) will
be asked to come in for four weeks of treatment, during which they will perform a set of
movements and games using the virtual reality platform, while focusing on the image of their
affected arm. Treatment will include two fifteen minute sessions, three times/week for a
period of four weeks. Participants will complete pre-testing, which will provide a baseline
measure of performance, and post-testing, to see if the treatment has been well-tolerated and
has had any impact on their motor performance.
This research is important because it may demonstrate the usefulness of a new treatment
method for people who have suffered a stroke, or generally demonstrate that virtual reality
platforms may be useful treatment tools for stroke survivors. It may also provide a
relatively low-cost and motivating rehabilitation tool for use in the hospital or home
environment outside of therapy hours.
Up to twenty stroke survivors with upper extremity impairment will be enrolled in this study.
After subjects have been consented, they will undergo screening to ensure they meet
inclusion/exclusion criteria. This will include the Motion Sickness Susceptibility
Questionnaire (Short Form). Demographics will be recorded including: relevant medical history
(including any contraindications to engage in virtual reality therapy), age, gender, hand
dominance, and location and date of stroke. The Montreal Cognitive Assessment will be
performed to assess feasibility of the intervention for subjects of varying cognitive levels.
Subjects who meet study requirements and score between 10-50 points on the Fugl-Meyer
Assessment of Motor Recovery after Stroke (Arm/hand section) will complete pre-testing using
the Action Research Arm Test (ARAT).
Virtual reality mirror therapy will be delivered via the commercially available Oculus Rift
gaming system, using novel software (WiseMind), developed by Realiteer. Subjects will
complete treatment in a designated space clear of distractions and physical objects. They
will remain seated in a chair throughout treatment.
A member of the research team will configure the system, entering in the subject's skin tone,
height, and weight to enable the system to best approximate their physical form. The subject
will then don the Oculus Rift headset, which will block external visual stimuli and provide
an immersive visual environment for training. Researchers will position game controller using
a wrist strap to ensure patient safety. Researchers will orient subjects to the training
environment and ensure patient comfort with the system before initiating treatment. Patients
will complete a System Usability Scale and the Simulator Sickness Questionnaire on the first
and final treatment day to assess system tolerance. Adherence and adverse events will also be
recorded throughout the trial.
The WiseMind software will allow subjects to view an approximation of their upper limbs. As
the subject moves their arms, the system will detect these movements and mimic them through
the headset, so the patient envisions a virtual limb moving as their own. Training will
incorporate range of motion exercises, virtual reality games that require reaching, and
interacting with functional objects in the virtual environment.
An occupational therapist, physical therapist or exercise physiologist from the research team
will run all treatment sessions. Training will be immediately terminated if the subject feels
excessively queasy or requests termination for any reason. Training will consist of two,
fifteen minute sessions, 3x/week for four weeks.
At the completion of treatment, subjects will repeat the Fugl-Meyer and ARAT assessments to
determine if improvements have been made in motor performance.
After subjects have been consented, they will undergo screening to ensure they meet
inclusion/exclusion criteria. This will include the Motion Sickness Susceptibility
Questionnaire (Short Form). Demographics will be recorded including: relevant medical history
(including any contraindications to engage in virtual reality therapy), age, gender, hand
dominance, and location and date of stroke. The Montreal Cognitive Assessment will be
performed to assess feasibility of the intervention for subjects of varying cognitive levels.
Subjects who meet study requirements and score between 10-50 points on the Fugl-Meyer
Assessment of Motor Recovery after Stroke (Arm/hand section) will complete pre-testing using
the Action Research Arm Test (ARAT).
Virtual reality mirror therapy will be delivered via the commercially available Oculus Rift
gaming system, using novel software (WiseMind), developed by Realiteer. Subjects will
complete treatment in a designated space clear of distractions and physical objects. They
will remain seated in a chair throughout treatment.
A member of the research team will configure the system, entering in the subject's skin tone,
height, and weight to enable the system to best approximate their physical form. The subject
will then don the Oculus Rift headset, which will block external visual stimuli and provide
an immersive visual environment for training. Researchers will position game controller using
a wrist strap to ensure patient safety. Researchers will orient subjects to the training
environment and ensure patient comfort with the system before initiating treatment. Patients
will complete a System Usability Scale and the Simulator Sickness Questionnaire on the first
and final treatment day to assess system tolerance. Adherence and adverse events will also be
recorded throughout the trial.
The WiseMind software will allow subjects to view an approximation of their upper limbs. As
the subject moves their arms, the system will detect these movements and mimic them through
the headset, so the patient envisions a virtual limb moving as their own. Training will
incorporate range of motion exercises, virtual reality games that require reaching, and
interacting with functional objects in the virtual environment.
An occupational therapist, physical therapist or exercise physiologist from the research team
will run all treatment sessions. Training will be immediately terminated if the subject feels
excessively queasy or requests termination for any reason. Training will consist of two,
fifteen minute sessions, 3x/week for four weeks.
At the completion of treatment, subjects will repeat the Fugl-Meyer and ARAT assessments to
determine if improvements have been made in motor performance.
Inclusion Criteria:
- History of one or more ischemic or hemorrhagic stroke
- Reduced use/weakness of the arm
- Ability to follow two-step commands
- Ability to provide informed consent
- Fugl-Meyer Arm/Hand score between 10-50
Exclusion Criteria:
- Serious visual or visual-perceptual deficits, neuropsychological impairments, or
orthopedic conditions that would prevent participation in the protocol as determined
by the treatment team
- Concurrent participation in another study protocol related to motor function after
stroke
- High susceptibility to motion sickness, as evidence by a score of 26 or greater on the
Motion Sickness Susceptibility Questionnaire Short-Form (90th percentile)
- Receiving ongoing occupational or physical therapy for upper limb motor retraining
We found this trial at
1
site
630 W 168th St
New York, New York
New York, New York
212-305-2862
Principal Investigator: Joel Stein, MD
Phone: 212-305-6722
Columbia University Medical Center Situated on a 20-acre campus in Northern Manhattan and accounting for...
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