With post-stroke care and treatment under threat, a new virtual rehab platform for stroke survivors could be a lifeline for many patients
As with most people with serious health issues, the Stroke Association reports that the pandemic has affected every aspect of stroke treatment and care for stroke survivors in the UK.
The following quote from a patient sums up the situation:
Sadly, in the outside world, it’s nothing but Covid-19, all else has been ignored.
According to the Stroke Association, almost two-thirds of stroke survivors leave hospital with a disability, and many will experience depression and anxiety as they adjust to life after stroke. Naturally, to be a stroke survivor during a pandemic, whether the stroke happened years ago or more recently, intensifies existing challenges, and creates significant new ones. These challenges, such as missing essential physiotherapy sessions or being isolated with no-one to provide emotional support, no-one to share their fears and concerns, can considerably reduce their best possible recovery.
The NHS already has a huge backlog of non-essential appointments and, with the ever-increasing likelihood of another COVID-19 spike, it seems unlikely that stroke aftercare will resume to satisfactory levels for a considerable time.
It is therefore timely that researchers at the University of East Anglia (UEA) have created a new gaming virtual rehab platform which uses low-cost videogame technology to improve the lives of stroke patients suffering from complex neurological syndromes caused by their stroke.
It is hoped that this type of technology, which can be used in patients’ own homes, could prove particularly beneficial for rehabilitation during periods of lockdown, social distancing and shielding caused by the Covid-19 pandemic.
Around 20-40 per cent of stroke survivors suffer a debilitating disorder called ‘hemispatial neglect’. The condition leaves people unaware of things located on one side of their body and greatly reduces their ability to live independently.
A new study published today is the first to explore the usability of virtual reality games for helping stroke patients recover from this condition.
Lead researcher Dr Stephanie Rossit, from UEA’s School of Psychology, said:
“A stroke can damage the brain, so that it no longer receives information about the space around one side of the world. If this happens, people may not be aware of anything on one side, usually the same side they also lost their movement. This is called hemispatial neglect.
These people tend to have very poor recovery and are left with long-term disability. Patients with this condition tell us that it is terrifying. They bump into things, they’re scared to use a wheelchair, so it really is very severe and life-changing.
Current rehabilitation treatments involve different types of visual and physical coordination tasks and cognitive exercises – many of which are paper and pen based.
We have pioneered new non-immersive VR technology which updates these paper and pen tasks for the digital age – using videogame technology instead.
But we know that adherence is key to recovery – so we wanted to know more about how people who have had strokes get on with using the new technology.”
The team tested out three new games on stroke survivors, their carers and stroke clinicians (including an occupational therapist, healthcare assistant, physiotherapist, and clinical psychologist) to better understand how user-friendly the technology is.
The specially designed games included a boxing game where the player spars with a virtual partner, ‘Bullseyes and Barriers’ where the player hits or avoids targets and ‘In the Kitchen’ which sees the player search for objects in a realistic kitchen layout.
They also tested a game which involves lifting rods on a table while a portable low-cost motion sensor tracks the patient’s movements. These balancing exercises are targeted to improve spatial neglect.
The UEA researchers worked with industry collaborator Evolv to create the games, which aim to improve rehabilitation by including elements such as scoring and rewards to engage the patient and improve adherence to their treatment.
Helen Morse, also from UEA’s School of Psychology, said:
“Overall we found that the end-users were really positive and interested in using virtual reality games to help their special neglect. The participants particularly liked the competition elements and performance feedback like cheers and clapping in the games, and we hope that this will help increase engagement with rehabilitation.
But some of the older participants found that their lack of experience with technology could be a potential barrier to using the new gaming platform,”
It is believed that this new approach has the potential to improve both independence and quality of life of stroke survivors. Additionally, it is felt the project will prove to be a cost-effective stroke rehabilitation option for the NHS as it is an enjoyable therapy that can be enjoyed by patients in their own home without the need for a therapist to be present on every occasion.
This research was funded by the NIHR Brain Injury MedTech Co-operative (MIC) and a further trial is being funded by the Stroke Association.
‘Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke’ is published in the journal Neuropsychological Rehabilitation.
More more information about the symptoms, impact and after of care of stroke, more information is provided by this infographic