Virtual Reality Mirror Therapy for Stroke

Stroke Clinical Trial

Official title:

Virtual Reality Mirror Therapy for Upper Limb Rehabilitation Following Stroke

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03582397
• Other study ID #: AAAR5098
• Status: Completed
• Phase: N/A
• Start date: October 16, 2017
• Est. completion date: July 27, 2018

Study information

• Verified date: October 2019
• Source: Columbia University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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 Upper Extremity 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.

Description:

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 11
• Est. completion date: July 27, 2018
• Est. primary completion date: July 27, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 85 Years

Eligibility

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

Related Conditions & MeSH terms

• Stroke

Intervention

Device:
• Virtual Reality Mirror Therapy
Virtual reality mirror therapy (WiseMind) developed by Realiteer and delivered via Oculus Rift virtual reality platform.

Locations

Country	Name	City	State
United States	Columbia University Medical Center	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
Columbia University	Realiteer Corp.

Country where clinical trial is conducted

United States, 

References & Publications (31)

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* Note: There are 31 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Adherence	Percentage of intervention visits completed (full 30 minute period) with a higher percentage indicating stronger adherence.	Up to 20 weeks.
Primary	Initial Tolerance of System	Simulator sickness questionnaire. Self-report checklist to screen for adverse symptoms following simulations. Scores range from 0-26, with higher scores indicating increased physical symptoms and poorer tolerance for the intervention.	Treatment Day 1
Primary	Initial Perception of System Usability	System Usability Scale: Subject questionnaire to assess ease of use of the system. Scores range from 0-100, with higher scores indicating greater usability.	Treatment Day 1
Primary	Adverse Event Tracking	Researchers to track observed or reported adverse events related to the intervention. Higher number of adverse events indicates poorer tolerance of intervention.	20 weeks
Primary	Montreal Cognitive Assessment	Cognitive screening tool. Scores range from 0-30, with a score of 26 or above indicating "normal" cognition. This will be used to ascertain feasibility of the intervention for patients of various cognitive levels.	Baseline visit
Primary	Change in tolerance of system	Simulator Sickness Questionnaire Scores following 1st treatment session, compared to 12th treatment session. Self-report checklist to screen for adverse symptoms following simulations. Scores range from 0-26, with higher scores indicating increased physical symptoms and poorer tolerance for the intervention.	20 Weeks
Primary	Change in Perception of System Usability	System Usability Scale: Subject questionnaire to assess ease of use of the system. Scores range from 0-100, with higher scores indicating greater usability. Score on final treatment day (session 12) to be compared with score from treatment session 1.	20 Weeks
Secondary	Fugl-Meyer Assessment of Motor Recovery after Stroke (arm/hand section)	Standardized test of upper extremity motor function following stroke. Scores range from 0-66 for this section of the Fugl-Meyer, with higher scores indicating better motor function.	Baseline study visit and following treatment completion, up to 20 weeks.
Secondary	Action Research Arm Test	Standardized test of hand and arm function. Scores range from 0-57, with higher scores indicating enhanced motor performance.	Baseline study visit and following treatment completion, up to 20 weeks.