Home-based virtual reality therapy for hand recovery after stroke

Background Many stroke survivors experience arm and hand weakness, but there are only limited efficacious options for arm therapy available. Objective To assess the feasibility of unsupervised home-based use of a virtual reality device (Smart Glove) for hand rehabilitation post stroke. Design Prospective single-arm study consisting of a 2-week run-in phase with no device use followed by an 8-week intervention period. Setting Participants were recruited at the Stanford Neuroscience Outpatient Clinic. Participants Twenty chronic stroke patients with upper extremity impairment. Interventions Participants were instructed to use the Smart Glove 50 minutes per day, 5 days per week for 8 weeks. Main Outcome Measures The following outcomes were measured: (1) compliance, (2) patients' impression of the intervention, and (3) efficacy using the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT), and the Stroke Impact Scale (SIS). Results Of 20 participants, seven (35%) met target compliance of 40 days use, and six (30%) used the device for 20-39 days. Eighty-five percent of participants were satisfied with the therapy, with 80% reporting improvement in hand function. During the run-in phase there were no improvements in hand function. During the intervention, patients improved by a mean of 26.6 +/- 48.8 seconds on the JTHFT (P = .03), by 16.1 +/- 15.3 points on the hand-domain of the SIS (P < .01) and there was a trend toward improvement on the UE-FM (2.2 +/- 5.5 points, P = .10). Conclusions Unsupervised use of the Smart Glove in the home environment may improve hand/arm function in subacute/chronic stroke patients. A randomized controlled trial is needed to confirm these results.