Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis

Abstract

Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.

Keywords: head-mounted display; immersive virtual reality; motor recovery; rehabilitation; stroke.

Figure 1

Consort diagram of study selection.

Figure 2

Pooled standardized mean differences and overall effect size (95% CI) on the TUG test immediately after the intervention.

Figure 3

Funnel plot for the TUG measure.

Figure 4

Pooled standardized mean differences and overall effect size (95% CI) on the FRT test immediately after the intervention. (a) Treadmill with optic flow versus control group. (b) Treadmill group versus control group.

Figure 5

Pooled standardized mean differences and overall effect size (95% CI) on 6MWT test immediately after the intervention in Kang et al.’s study. (a) VR treadmill group versus control group. (b) VR treadmill group versus treadmill group.

Figure 6

Pooled standardized mean differences and overall effect size (95% CI) on 10MWT immediately after the intervention in Kang et al.’s study. (a) VR treadmill with optic flow versus control group. (b) VR treadmill with optic flow group versus treadmill group.

Figure 7

Pooled standardized mean differences and overall effect size (95% CI) on the ARAT immediately after the intervention.

Figure 8

Pooled standardized mean differences and overall effect size (95% CI) on the FMUE test immediately after the intervention.

Figure 9

Pooled standardized mean differences and overall effect size (95% CI) on the stride length (paretic side) immediately after the intervention.