Article

Despite interest in virtual environments (VEs) for poststroke arm
motor rehabilitation, advantages over physical environment (PE) training have not
been established. OBJECTIVE: The authors compared kinematic and clinical outcomes
of dose-matched upper-limb training between a 3D VE and a PE in chronic stroke.
METHODS: Participants (n = 32) were randomized to a 3D VE or PE for training.
They pointed to 6 workspace targets (72 trials, 12 trials/target, randomized) for
12 sessions over 4 weeks with similar feedback on precision, movement speed, and
trunk displacement. Primary (kinematics, clinical arm motor impairment) and
secondary (activity level, arm use) outcomes were compared by time (PRE, POST,
and follow-up, RET), training environment, and impairment severity (mild,
moderate-to-severe) using mixed-model analyses of variance (ANOVAs). RESULTS:
Endpoint speed, overall performance on a reach-to-grasp task, and activity levels
increased in both groups. Only participants in the VE group improved shoulder
horizontal adduction at POST (9.5 degrees ) and flexion at both POST (6.3 degrees
) and RET (13 degrees ). Impairment level affected outcomes. After VE training,
the mild group increased elbow extension (RET, 25.5 degrees ). The
moderate-to-severe group in VE increased arm use at POST (0.5 points) and
reaching ability at RET (2.2 points). The moderate-to-severe group training in PE
increased reaching ability earlier (POST, 1.7 points) and both elbow extension
(10.7 degrees ) and arm use (0.4 points) at RET, but these changes were
accompanied by increased compensatory trunk displacement (RET, 30.2 mm).
CONCLUSION: VE training led to more changes in the mild group and a motor
recovery pattern in the moderate-to-severe group indicative of less compensation,
possibly because of a better use of feedback.

Langue : ANGLAIS