Virtual Reality Training for Upper Extremity After Stroke
Virtual Reality Training for Upper Extremity After Stroke
Background: High intensity training of challenging tasks with many repetitions is a key
 factor for regaining motor function after stroke. Novel virtual reality (VR) rehabilitation
 systems provide the potential to increase intensity and offer challenging and motivating
 tasks. The efficacy of VR systems has not been demonstrated yet in sufficiently powered
 studies.

 Methods: In 5 participating rehabilitation centers patients in the subacute phase after
 stroke will be randomized to either a group receiving 4 weeks of VR training in addition to
 conventional arm training or a group receiving dose-matched and therapist attention-matched
 conventional arm-training.

 Hypothesis: VR training is more effective in improving arm motor function than conventional
 arm training in the subacute phase after stroke.
Background: Approximately two thirds of patients with stroke experience impaired arm motor
 function, which compromises independence in activities of daily living, occupational areas
 and quality of life. High intensity training of challenging tasks with many repetitions are
 key factors for regaining motor function after stroke. Novel virtual reality (VR)
 rehabilitation systems provide the potential to increase intensity and offer challenging and
 motivating tasks. The efficacy of VR systems has not been demonstrated yet in sufficiently
 powered studies.

 Methods: In this study 120 patients in 5 participating Norwegian, Danish and Belgian
 rehabilitation institutions will be randomized to either a group receiving VR training in
 addition to conventional arm training or a group receiving dose-matched and therapist
 attention-matched conventional arm-training. During a period of 4 weeks the patients will be
 offered additional 4-5 training sessions weekly of 45-60 minutes duration by a
 physiotherapist or an occupational therapist. Arm motor function, dexterity and independence
 in daily life activities will be evaluated at baseline, post and 3 months follow-up
 assessments with the Action Research Arm Test, Box and Blocks Test and the Functional
 Independence Measure. Patient satisfaction and therapist satisfaction with the implementation
 of a new technology based rehabilitation system will also be assessed with questionnaires and
 interviews.

 Objective: The objective of the VIRTUES trial is to study the effectiveness and acceptance of
 a novel VR training approach. The study will provide evidence-based knowledge of new virtual
 reality based treatment strategies to clinicians, patients and health economists.
Inclusion Criteria:

 -  First ever ischemic or hemorrhagic stroke or former stroke without any residual motor
 impairment

 -  1 - 12 weeks post stroke

 -  Impaired arm motor function but some residual arm motor activity as defined by a score
 of less than 52 on Action Research Arm Test (ARAT), and the ability to execute at
 least 20 degrees of active shoulder extension and abduction against gravity.

 Exclusion Criteria:

 -  Severe cognitive impairment defined as < 20 on Mini Mental Status Examination

 -  Orthopedic impairment, limiting mobility substantially or causing pain

 -  Visual disorders limiting the ability to comply with treatment regimen - < 18 years

 -  Unable to give informed consent