Trunk exercise programme post-stroke using a virtual reality video game-based system: a mixed methods feasibility study

Background: Trunk control post-stroke can be affected by muscle weakness, reduced position sense and poor coordination leading to decreases in balance and functional ability. Virtual reality (VR) technology in stroke rehabilitation has been demonstrated to improve function and activity. However, the feasibility of using VR to deliver post-stroke trunk exercises is unknown. Objective: To investigate the feasibility of conducting trunk exercise using VR video game-based system (Valedo®) by measuring adherence, safety, acceptability and participation. In addition, changes in pre-post measures of trunk impairment, balance and upper and lower limb motor function were assessed. Methods: The intervention consisted of 18 sessions of VR video games trunk training program (3 days/week, 45 min./day) over 6 weeks. The exercises consisted of specific upper and lower trunk exercises including lateral flexion, rotation, flexion and extension. The feasibility of using the Valedo® system was measured by means of adherence, safety, acceptability (post intervention semi structure interview) and participation in each session (Pittsburgh Rehabilitation Participation Scale (PRPS)). Pre- and post-intervention testing included the Trunk Impairment Scale (TIS), Streamlined Wolf Motor Function Test (SWMFT), Fugl-Meyer Assessment Motor Function (FMA), Berg Balance Scale (BBS). Results: Five chronic stroke survivors participated in the intervention. Post intervention results showed adherence was excellent, no adverse events occurred, acceptability was high and the PRPS revealed very good to excellent participation. The clinical outcome measures demonstrated the following improvements (shown as an average change in percentage): TIS (24%), SWMFT (5.5%), BBS (14%), FMA upper limb (1.6%) and FMA lower limb (3%). Conclusion: Results suggest that it is feasible to utilise VR video game-based system for trunk rehabilitation post-stroke. A wider scale study is warranted, to determine feasibility and large sample size of randomised controlled trial investigating the effectiveness of trunk exercises using VR video games for improving trunk and balance ability post- stroke.