Effectiveness of virtual reality technology in the rehabilitation of patients with visuospatial neglect due to cerebral stroke

Анотація

Effectiveness of existing methods of therapy for functional impairment due to upper limb dysfunction in patients with visuospatial neglect (VSN) due to acute cerebral stroke remains uncertain. This requires the search for new methods of occupational therapy interventions, in particular, taking into account the capabilities of virtual reality technologies. The aim of this study was to evaluate the therapeutic effect of virtual reality technology on the state of visuospatial perception, fine and gross motor function of the upper extremities, cognitive functions and limitations activities of daily living in patients with neglect due to cerebral stroke. In the study 47 patients, 10 women and 30 men, aged from 23 to 86 years old (mean age was 63.3 (13.2) years) were included. All patients were assessed for the state of visuospatial perception, cognitive function, motor and sensory functions, and activity limitations at the beginning and at the end of rehabilitation. There were 7 people dropped out of the study based on the results of the application of exclusion criteria. At the first stage during 2023-2024, 18 patients were included in the study and assigned a standardized rehabilitation program. In the second phase, during 2024-2025, 22 patients participated in the study and were assigned  an author's occupational therapy program using the Arm-Therapy-System Diego, the effect of which is based on the use of virtual reality technology. All patients were assigned 3 hours of rehabilitation interventions per day for 14 days. The application of the program using virtual reality technology showed 31.3% greater efficiency in restoring the level of cognitive functions according to the Montreal Cognitive Assessment, 68.4% better efficiency in restoring large motor functions according to the "Box and Blocks" test, 40.2% better dynamics according to the sensorimotor state of the upper limb according to the Fugl-Meyer assessment of motor recovery after stroke (p<0.05), 25.0% less manifestations of visuospatial neglect according to the tests of dividing lines in half and drawing stars, which together contributed to a better restoration of the level of independent activity when performing everyday tasks according to the Barthel Index (p<0.05) as compared to standard therapy. The predominant effectiveness of the developed author's program using virtual reality technology in improving fine motor skills of the upper limb according to the Nine-Hole Peg Test (p>0.05) compared to the standard therapy program was not established. Thus, the use of virtual reality technology is promising for restoring the functioning of the upper limb in patients with the consequences of cerebral stroke and impaired visual-spatial perception.