Extending the Proportional Recovery Rule to Virtual Reality Based Neurorehabilitation

Conference Paper (PDF Available) · April 2018with 73 Reads
Conference: European Stroke Conference, At Athens, Greece
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Abstract
Studies suggest that post-stroke improvement of sensorimotor function follows a proportional recovery rule according to which, at three months after the lesion, patients achieve approximately 70% of their maximum potential recovery, independently of the type of therapy (i.e. conventional therapy) [1]. We conduct a retrospective analysis on longitudinal clinical data to (1) examine whether the same principle applies to patients who undergo virtual reality (VR)-based treatment using the Rehabilitation Gaming System [2]; and (2) to determine whether the dose of the proposed intervention influences the recovery. First, we evaluate the prognostic power of baseline Fugl-Meyer (FM) scores from 153 hemiparetic patients, at the acute (n=44, age=62.4±12.6 years, 23.9±18.2 days post-stroke) and chronic (n=109, age=62.8±12.4 years, 1134±952.4 days post-stroke) stages post-stroke. Second, we compute the differences in motor recovery across three groups of patients who received 3, 4 and 12 weeks of treatment, respectively. Our results suggest that motor recovery of patients who undergo virtual reality-based treatment follow the proportional recovery rule in acute (R2=0.43, p<.001) but not in chronic stages (R2=0.01, p>.1). Increasing dosage did not influence recovery in acute patients (p>.1, Kruskal-Wallis Test) but it did show a significant effect at the chronic stage (p<.001, Kruskal-Wallis Test). Altogether, these results support the existence of biological processes of recovery that are unique to the injured brain at the acute phase. These mechanisms may be masking the specific benefits of sustained practice at early stages post-stroke. In contrast, at the chronic stage, improvements captured by the FM scale may be mostly driven by general principles of motor learning, which are modulated by therapy dose. [1] Winters, C., et al. Neurorehabilitation and neural repair 29(7),2015,614. [2] Cameirao, M., et al. Journal of Neuroengineering and Rehabilitation 7(1),2010,48
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