Virtual reality-guided therapy on a stroke unit: a feasibility study

Background: VR (Virtual Reality) has emerged as a recent treatment approach in neurorehabilitation. The feasibility of VR-guided therapy in the acute phase after stroke has not been assessed.

Methods: This was a cohort study of consecutive patients with suspected stroke who were admitted to the Essen University Hospital Stroke Unit between March 2022 and May 2022. All patients who had an indication for physical or occupational therapy due to upper extremity sensorimotor, cognitive or perceptual deficits were included and considered for VR-guided treatment. We excluded patients with predominant deficits in lower extremity function, since these could not be targeted with our VR system. A multidimensional approach was used to assess the feasibility of VR-guided therapy, which included characterization of eligible patients, resource utilization as well as treatment acceptance. For this purpose, we analyzed baseline and clinical characteristics, causes for withholding the treatment as well as qualitative and quantitative treatment metrics in patients who received VR-guided therapy.

Results: Out of 326 patients admitted with suspected stroke, n = 172 were included in our final analysis. Of these, n = 37 (21.5%) received VR-guided therapy. The most common cause for withholding treatment were neuropsychological limitations (22.9%), followed by physical impairment, comorbidity and level of consciousness alterations (all 17.8%). Patients who received VR-guided therapy tended to have better functional status and less severe neurological deficits. VR-guided sessions had a median duration of 20 min (IQR 17-29) with additional 13 min (IQR 9-17) of preparation time. In the majority of patients who received VR-guided therapy, motivation was rated equal or higher as compared with conventional treatment (76%) and therapists considered VR-guided therapy well feasible (65%).

Conclusions: Despite important treatment barriers, VR may provide additional opportunities to enhance functional recovery in the acute phase after stroke for selected patients. Our findings could aid in planning further randomized controlled trials which are required to refine approaches and assess the effectiveness of VR-guided therapy in the acute setting.