Immersive virtual reality gaming versus dose-matched conventional task-oriented training for hand function in chronic incomplete tetraplegia: a pilot randomised controlled trial
Main Article Content
Abstract
Background. Recovery of hand function is the highest-ranked rehabilitation priority among people with tetraplegia, yet meaningful gains remain difficult to achieve in the chronic phase. Immersive virtual reality (VR) gaming may increase repetition and engagement relative to conventional therapy, but randomised evidence in cervical spinal cord injury (SCI) is limited and dominated by non-immersive systems.
Objective. To compare an 8-week immersive VR gaming programme with dose-matched conventional task-oriented training on hand function in adults with chronic incomplete tetraplegia.
Methods. Two-arm, parallel-group, assessor-blinded pilot randomised controlled trial. Twenty adults (18–60 years) with chronic (≥ 1 year) incomplete cervical SCI (C6–C8; AIS grade C or D) were randomised 1:1 to immersive VR gaming delivered through a head-mounted display or to conventional task-oriented training. Both arms received 60-minute supervised sessions three times weekly for 8 weeks (24 sessions). The primary outcome was the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) total score. Secondary outcomes were GRASSP subcomponents, the Box and Block Test (BBT), Jamar grip strength and the Spinal Cord Independence Measure (SCIM). Between-group differences in change from baseline were tested with the Mann–Whitney U test.
Results. All 20 participants completed the intervention and were analysed; no adverse events occurred. Groups were comparable at baseline. GRASSP total improved by 24.30 ± 3.37 points with VR and by 10.30 ± 3.50 points with conventional training (median between-group difference 14.0 points; U = 100, p < 0.001; r = 0.85). Larger gains also favoured VR for the BBT (median difference 7.0 blocks, p < 0.001), grip strength (3.0 kg, p < 0.001) and SCIM (10.0 points, p < 0.001). The between-group difference in GRASSP prehension performance was smaller and did not survive correction for multiple comparisons (p = 0.027).
Conclusions. In this pilot trial, immersive VR gaming produced greater improvement than dose-matched conventional training across all measured domains of hand function and functional independence. The trial was not powered for definitive superiority; the effect estimates are imprecise and require confirmation in an adequately powered multicentre trial with longer follow-up.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
References
Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21(10):1371–83.
Kirshblum SC, Burns SP, Biering-Sørensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535–46.
Coulter EH, McLean AN, Hasler JP, Allan DB, McFadyen A, Paul L. The effectiveness and satisfaction of web-based physiotherapy in people with spinal cord injury: a pilot randomised controlled trial. Spinal Cord. 2017;55(4):383–9.
Rutkowski S, Kiper P, Cacciante L, Cieślik B, Mazurek J, Turolla A, et al. Use of virtual reality-based training in different fields of rehabilitation: a systematic review and meta-analysis. J Rehabil Med. 2020;52(11):jrm00121.
Lee HY, Kim YL, Lee SM. Effects of virtual reality-based training and task-oriented training on balance performance in stroke patients. J Phys Ther Sci. 2015;27(6):1883–8.
Souchet AD, Lourdeaux D, Burkhardt JM, Hancock PA. Design guidelines for limiting and eliminating virtual reality-induced symptoms and effects at work: a comprehensive, factor-oriented review. Front Psychol. 2023;14:1161932.
Amin F, Waris A, Syed S, Amjad I, Umar M, Iqbal J, et al. Effectiveness of immersive virtual reality-based hand rehabilitation games for improving hand motor functions in subacute stroke patients. IEEE Trans Neural Syst Rehabil Eng. 2024;32:2060–9.
Abd El-Kafy EM, Alshehri MA, El-Fiky AAR, Guermazi MA. The effect of virtual reality-based therapy on improving upper limb functions in individuals with stroke: a randomized control trial. Front Aging Neurosci. 2021;13:731343.
Rodríguez-Hernández M, Polonio-López B, Corregidor-Sánchez AI, Martín-Conty JL, Mohedano-Moriano A, Criado-Álvarez JJ. Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial. J Neuroeng Rehabil. 2023;20(1):38.
Jaramillo JP, Johanson ME, Kiratli BJ. Upper limb muscle activation during sports video gaming of persons with spinal cord injury. J Spinal Cord Med. 2019;42(1):77–85.
Prasad S, Aikat R, Labani S, Khanna N. Efficacy of virtual reality in upper limb rehabilitation in patients with spinal cord injury: a pilot randomized controlled trial. Asian Spine J. 2018;12(5):927–34.
Lim DY, Hwang DM, Cho KH, Moon CW, Ahn SY. A fully immersive virtual reality method for upper limb rehabilitation in spinal cord injury. Ann Rehabil Med. 2020;44(4):311–9.
Dimbwadyo-Terrer I, Trincado-Alonso F, de los Reyes-Guzmán A, Aznar MA, Alcubilla C, Pérez-Nombela S, et al. Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment. Disabil Rehabil Assist Technol. 2016;11(6):462–7.
Al Nattah MMA, Tiberti S, Segaletti L. Semi-immersive virtual reality exercise therapy for upper limb rehabilitation in patients with spinal cord injury using the Leap Motion controller. Cureus. 2024;16(1):e52222.
Gutiérrez Á, Farella N, Gil-Agudo Á, de los Reyes Guzmán A. Virtual reality environment with haptic feedback thimble for post spinal cord injury upper-limb rehabilitation. Appl Sci. 2021;11(6):2476.
De Araújo AVL, Neiva JFO, Monteiro CBM, Magalhães FH. Efficacy of virtual reality rehabilitation after spinal cord injury: a systematic review. Biomed Res Int. 2019;2019:7106951.
de Miguel-Rubio A, Rubio MD, Salazar A, Camacho R, Lucena-Anton D. Effectiveness of virtual reality on functional performance after spinal cord injury: a systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2020;9(7):2065.
de Miguel-Rubio A, Rubio MD, Alba-Rueda A, Salazar A, Moral-Munoz JA, Lucena-Anton D. Virtual reality systems for upper limb motor function recovery in patients with spinal cord injury: systematic review and meta-analysis. JMIR Mhealth Uhealth. 2020;8(12):e22537.
Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.
Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016;355:i5239.
Kalsi-Ryan S, Curt A, Verrier MC, Fehlings MG. Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia. J Neurosurg Spine. 2012;17(1 Suppl):65–76.
Kalsi-Ryan S, Beaton D, Curt A, Duff S, Popovic MR, Rudhe C, et al. The Graded Redefined Assessment of Strength Sensibility and Prehension: reliability and validity. J Neurotrauma. 2012;29(5):905–14.
Mathiowetz V, Volland G, Kashman N, Weber K. Adult norms for the Box and Block Test of manual dexterity. Am J Occup Ther. 1985;39(6):386–91.
Catz A, Itzkovich M, Agranov E, Ring H, Tamir A. SCIM — spinal cord independence measure: a new disability scale for patients with spinal cord lesions. Spinal Cord. 1997;35(12):850–6.
Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45(4):275–91