Highlights
- •We tested the effects of an immersive VR approach on UL rehabilitation in PwMS.
- •An immersive VR approach improved gross dexterity in less affected limb in PwMS.
- •An immersive VR approach is feasible for arm rehabilitation in PwMS.
Abstract
Background
Upper limb dysfunctions are common in people with multiple sclerosis (PwMS) and lead
to limitations in activities of daily living. In this study, we investigated the feasibility
and effects of an immersive commercial virtual reality system for upper limb bilateral
rehabilitation.
Methods
A total of 20 participants were included in a cross over study with two arm sequences:
Treatment-Waiting List (T-WL; N = 9) and Waiting List-Treatment (WT-T; N = 11). T-WL sequence performed 12 sessions of bilateral UL rehabilitation over a
4-week period, based on the use of a commercially VR immersive platform (Oculus Rift),
followed by a 4-week wash-out period and a 4-week waiting list period. WL-T sequence
followed the protocol in the reverse order.
Participants were tested at baseline (T0), after the end of the first 4-week period
(T1), at the end of the wash-out period and finally at the end of the third 4-week
period (T2). The primary outcome was the Box and Blocks test (BBT). Secondary outcome
measures were: Nine Hole Peg Test (NHPT), Maximal isometric handgrip strength, Manual
Ability Measure-36 (MAM-36), Modified Fatigue Impact Scale (MFIS), and the System
Usability Scale (SUS).
In absence of carryover effects, we analyzed primary and secondary outcome measures
with mixed linear effect models. Treatment efficacy was assessed on the within-subject
differences. Specifically, we used the intra-individual differences at the end of
treatment and waiting-list periods (T1 and T2) as dependent variables and sequences
(T-WL or WL-T) as independent variable. In presence of carryover effects (p-value <0.05), we assessed between sequence differences by an unpaired t-test considering T0 and T1 as time points, and sequence as group factor.
Results
We observed clinical and statistical improvements for BBT, with an overall between-sequence
difference of 8.6 ± 2.6 blocks (p < 0.01) favoring treatment period in the less affected side, and a not significant
change of 3.0 ± 2.6 blocks (p = 0.28) in the most affected side. Small and not significant between-sequence differences
were found for 9HPT, and handgrip strength in both sides. Similarly, no differences
were found for patient reported outcomes, MFIS and MAM-36. Finally, mean SUS score
was 45.9 ± 11.1 points, representing a moderate usability of the system.
Conclusion
An immersive VR-based approach resulted useful to improve gross manual dexterity in
the less affected limb in PwMS. However, such improvement did not translate into modifications
in terms of self-reported ability to carry out activities of daily living nor went
along with improvement in fine hand dexterity, strength or fatigue. Finally, usability
of this technology was overall judged moderate, with lower scores assigned to items
representing user-friendliness.
Keywords
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Article info
Publication history
Published online: June 29, 2022
Accepted:
June 26,
2022
Received in revised form:
June 22,
2022
Received:
April 6,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
