Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 May 15;16(1):56.
doi: 10.1186/s12984-019-0531-y.

Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study

Jeffrey M Rogers  1 , Jonathan Duckworth  2 , Sandy Middleton  3 , Bert Steenbergen  4 , Peter H Wilson  5
Affiliations
Randomized Controlled Trial

Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study

Jeffrey M Rogers et al. J Neuroeng Rehabil. .

Abstract

Background: Virtual reality technologies show potential as effective rehabilitation tools following neuro-trauma. In particular, the Elements system, involving customized surface computing and tangible interfaces, produces strong treatment effects for upper-limb and cognitive function following traumatic brain injury. The present study evaluated the efficacy of Elements as a virtual rehabilitation approach for stroke survivors.

Methods: Twenty-one adults (42-94 years old) with sub-acute stroke were randomized to four weeks of Elements virtual rehabilitation (three weekly 30-40 min sessions) combined with treatment as usual (conventional occupational and physiotherapy) or to treatment as usual alone. Upper-limb skill (Box and Blocks Test), cognition (Montreal Cognitive Assessment and selected CogState subtests), and everyday participation (Neurobehavioral Functioning Inventory) were examined before and after inpatient training, and one-month later.

Results: Effect sizes for the experimental group (d = 1.05-2.51) were larger compared with controls (d = 0.11-0.86), with Elements training showing statistically greater improvements in motor function of the most affected hand (p = 0.008), and general intellectual status and executive function (p ≤ 0.001). Proportional recovery was two- to three-fold greater than control participants, with superior transfer to everyday motor, cognitive, and communication behaviors. All gains were maintained at follow-up.

Conclusion: A course of Elements virtual rehabilitation using goal-directed and exploratory upper-limb movement tasks facilitates both motor and cognitive recovery after stroke. The magnitude of training effects, maintenance of gains at follow-up, and generalization to daily activities provide compelling preliminary evidence of the power of virtual rehabilitation when applied in a targeted and principled manner.

Trial registration: this pilot study was not registered.

Keywords: Cognition; Motor activity; Rehabilitation; Stroke; Upper extremity; Virtual reality.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Human Research Ethics Committees of South Eastern Sydney Local Health District (Ref: 14/316) and the Australian Catholic University (Ref: 2016-2R), and performed in accordance with their guidelines. All participants (or their carers) provided written informed consent prior to participation.

Consent for publication

All participants (or their carers) provided written informed consent for aggregate, de-identified study results to be published in peer-reviewed journals, presentation at conferences or other professional forums.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Examples of the Elements (a) goal-directed Bases task with visual augmented feedback, and (b) exploratory Squiggles task
See this image and copyright information in PMC

References

    1. Deloitte access economics . Stroke in Australia: No postcode untouched. Melbourne: National Stroke Foundation; 2017.
    1. Meyer S, Verheyden G, Brinkmann N, Dejaeger E, De Weerdt W, Feys H, Gantenbein AR, Jenni W, Laenen A, Lincoln N, et al. Functional and motor outcome 5 years after stroke is equivalent to outcome at 2 months: follow-up of the collaborative evaluation of rehabilitation in stroke across Europe. Stroke. 2015;46:1613–1619. doi: 10.1161/STROKEAHA.115.009421. - DOI - PubMed
    1. Kalaria RN, Akinyemi R, Ihara M. Stroke injury, cognitive impairment and vascular dementia. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2016;1862:915–925. doi: 10.1016/j.bbadis.2016.01.015. - DOI - PMC - PubMed
    1. Barker-Collo S, Starkey N, Lawes CM, Feigin V, Senior H, Parag V. Neuropsychological profiles of 5-year ischemic stroke survivors by Oxfordshire stroke classification and hemisphere of lesion. Stroke. 2012;43:50–55. doi: 10.1161/STROKEAHA.111.627182. - DOI - PubMed
    1. Vargus-Adams JN, Majnemer A. International classification of functioning, disability and health (ICF) as a framework for change: revolutionizing rehabilitation. J Child Neurol. 2014;29:1030–1035. doi: 10.1177/0883073814533595. - DOI - PubMed

Publication types