VR Therapy Notes

Jeff Soa - Stroke Patient & Virtual Reality Therapy

Introduction

• Jeff Soa, a stroke patient, is exploring virtual reality (VR) therapy options after seeing other stroke patients benefit.
• He experiences speech difficulties and visual field effects.

Digital Therapeutics for Visual Field Effects in Stroke Patients

• An article from 2020, published in 2021, discusses VR-based digital therapeutics.
• The study suggests this therapy is safe and effective for visual field effects in stroke patients.
• It indicates potential for long-term improvement in visual field perception after 12 weeks of visual training.
• Previous studies had smaller sample sizes or lacked randomization, posing risks.
• Hypothesis: Visual perceptual learning via visual training in blind visual fields can restore visual field sensitivity in cortical blindness.

Confrontation Visual Field Test

• The test involves flashing lights at different degrees of the visual field (e.g., 24 degrees, 54 degrees).
• Significant improvement is defined as six decibels (dB) of gain.

Study Participants & Methodology

• 88 people were screened, but only 79 completed the experiment.
• 41 in the experimental group, 38 in the control group.
• Participants had to be more than six months post-stroke to ensure recovery had plateaued.
• The experimental group received organized, massed perimetric stimulus with 4.3 times more frequent stimulation in the impaired field of vision than in the central field.
• Demographics like age, sex, and area of impairment were considered.
• The trial consisted of 384 trials per day, five days a week, for twelve weeks.
• The flashes task required participants to identify if and where they saw the light.

Results of VR Therapy Study

• The experimental group showed improvement.
• The control group showed only slight to no improvement.
• Post-12 weeks, both groups showed clinically significant improvement, but there was no significant difference between the groups.
• Secondary outcomes, analyzed using the Wilcoxon signed-rank test, also showed no significant difference between the groups.
• Both groups improved by over six decibels.
• Potential biases existed due to a lack of access to prior medical records and medications.

Critique of the Study

• Creating a true double-blind study is challenging because all groups would need VR, which could skew the results.
• The study suggests that the central field training given to the control group might have impacted the results.
• A better approach might involve on-screen training.

Recovery Model Study

• 33 participants, average age 28.
• Some were excluded due to psychological issues, etc.
• Data analysis focused on early experimental and control groups.
• The experimental group had a 60% increase in lower muscle click and something else. It's not clear.
• The neural group didn't change.
• At baseline, changes in terms of depression were noted.
• A life equation was used that takes into account other factors to analyze the data.
• The average value of the equation was 0.5, with p < 0.01. These p-values means the correlation is statistically significant.
• Future studies should be longer, harder, and include more functional tasks, objective photo assessments, and longer follow-up durations (beyond two to seven weeks).

Personal Thoughts on VR Therapy Studies

• There are problems with study designs, such as a lack of information on direction or standardized VR training.
• Some patients received VR five times, while others received it 50,000 times, indicating a lack of standardization.

Non-Immersive Peripheral Reology

• This approach does not use a headset; it involves looking at a screen.
• It was a randomized, multi-centered, single-blind study funded by the Neuro Foundation and conducted at stroke rehab centers across four countries.
• The study investigates the effectiveness of non-immersive peripheral reology on upper extremity movement post-stroke.
• Hypothesis: Non-immersive peripheral reology therapy will lead to greater movement improvement post-stroke compared to recreational therapy.

Methodology

• 893 patients were screened, and 141 were assigned.
• The groups are divided almost evenly: 71 in the experimental group and 70 in the recreational group.
• However, only 47 experimental and 54 recreational participants were related to the assessments.
• The study was randomized and single-blinded (investigators were blinded).
• There were 10 sixty-minute sessions over two weeks.
• Assessments were conducted at baseline, immediately after treatment, and four weeks after treatment.
• The Wolf Motor Function Test was used.

Therapy Types

• The experimental group played games like League Party (esports) and Game Party.
• The recreation group got bingo, farming.

Primary Outcome Variable

• Aggregate seconds, measured via the ''that'll be I mean, discuss the primary domain variable that they were looking at.'' which are measuring how long it takes individuals to do six different tasks.
• Tasks included lifting a pen, lifting a hand, standing on a table and standing on a box and folding a towel.
• Compared to baseline, it took less time to complete the tasks post-intervention.
• However, there was no statistically significant difference between the experimental and recreation groups after the two-week intervention and four-week assessment.
• Graphs show the median amount of seconds and percentage of change time from baseline.
• Measurements with units were mainly strength-related.