Issue 24-4, 2025
Original article
Rehabilitation of Patients with Ischemic Stroke Using Virtual Reality: a Prospective Randomized Study
Elena F. Turovinina1,*,
Dmitrij N. Plotnikov2
1 Tyumen State Medical University, Tyumen, Russia
2 Regional Hospital No. 23 (Yalutorovsk), Yalutorovsk, Russia
ABSTRACT
INTRODUCTION. The current problem lies in developing and evaluating the effectiveness of new rehabilitation methods for patients with ischaemic stroke during the acute phase.
AIM. To evaluate the result of a prospective (6 month) follow-up of patients with ischemic stroke after rehabilitation using virtual reality on the dynamics of mobility and motor functions of the lower extremities.
MATERIALS AND METHODS. On the basis of Regional Hospital No. 23 (Yalutorovsk), in the primary vascular department (neurological profile), a single-center prospective randomized trial was conducted to evaluate the effectiveness of integrated rehabilitation methods using virtual reality in patients with ischemic stroke. By the method of blind randomization, after receiving written consent to participate in the study, the patients were divided into 3 groups. All three groups underwent an identical rehabilitation course according to clinical recommendations after the end of the acute period of stroke. The main group (n = 30) patients received immersive virtual (VR) and augmented reality (AR) in addition to the basic rehabilitation course. The comparison group (n = 30) — patients received basic rehabilitation, etc. The control group (n = 30) — patients received a basic course of rehabilitation without AR and VR. The effectiveness was assessed using identical clinical and functional scales after the rehabilitation course and after 6 months.
RESULTS AND DISCUSSION. Examination of patients after 10 days showed an increase in strength in the lower extremities and improved coordination in support. In the main group, after 10 days, the load distribution index on the affected side increased from 39 [13; 94] % to 46 [15; 63] % on stabilometry, compared with 31.5 [6; 88] % to 41 [9; 71] % in the control group (p < 0.05). There was a decrease in the severity of disorders in the functioning of patients in all three groups. After 6 months, it was revealed that in the main group, 50 % of the patients had moderate neurological disorders that had developed into milder grades. The results indicated a better recovery in the main group with VR and AR.
CONCLUSION. mmersive and augmented virtual reality. The technique can be used for rehabilitation in the acute period of ischemic stroke in the preparation of rehabilitation programs and is subject to further study.
KEYWORDS: stroke, rehabilitation, virtual reality, recovery
FOR CITATION:
Turovinina E.F., Plotnikov D.N. Rehabilitation of Patients with Ischemic Stroke Using Virtual Reality: a Prospective Randomized Study. Bulletin of Rehabilitation Medicine. 2025; 24(4):54–66. https://doi.org/10.38025/2078-1962-2025-24-4-54-66 (In Russ.).
FOR CORRESPONDENCE:
Elena F. Turovinina, Е-mail: e_turov@mail.ru, turovinina@tyumsmu.ru
References:
- Avan A., Digaleh H., Di Napoli M., et al. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017. BMC Med. 2019; 17(1): 191. https://doi.org/10.1186/s12916-019-1397-3
- van der Krogt H.J., Meskers C.G., de Groot J.H., et al. The gap between clinical gaze and systematic assessment of movement disorders after stroke. J NeuroEngineering Rehabil. 2012; 9: 61. https://doi.org/10.1186/1743-0003-9-61
- Румянцева С.А., Силина Е.В., Свищева С.П., Комаров А.Н. Медицинские и организационные проблемы до- и постинсультной инвалидизации. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2013; 113(9-2): 43-49. [Rumiantseva S.A., Silina E.V., Svishcheva S.P., Komarov A.N. Medical and organizational issues of pre- and post-stroke disablement. S.S. Korsakov Journal of Neurology and Psychiatry. 2013; 113(9-2): 43–49 (In Russ.).]
- Белкин А.А. Синдром последствий интенсивной терапии (ПИТ-синдром). Вестник интенсивной терапии имени А.И. Салтанова. 2018; 2: 12–23. https://doi.org/10.21320/1818-474X-2018-2-12-23 [Belkin A.A. Syndrome Effects of Intensive Therapy — Post Intensive Care Syndrome (PICS). Alexander Saltanov Intensive Care Herald. 2018; 2: 12–23. https://doi.org/10.21320/1818-474X-2018-2-12-23 (In Russ.).]
- Xu B., Lin X. The influence of early comprehensive rehabilitation on the quality of life of stroke patients with hemiplegia. Modern Medicine and Health Research. 2023; 7(4): 60–2. https://doi.org/10.3969/j.issn.2096-3718.2023.04.020
- Belda-Lois J.M., Mena-del Horno S., Bermejo-Bosch I., et al. Rehabilitation of gait after stroke: a review towards a top-down approach. J NeuroEngineering Rehabil. 2011; 8: 66. https://doi.org/10.1186/1743-0003-8-66
- Wei X., Sun S., Zhang M., et al. A systematic review and meta-analysis of clinical efficacy of early and late rehabilitation interventions for ischemic stroke. BMC Neurol. 2024; 24: 91. https://doi.org/10.1186/s12883-024-03565-8
- Talbot L.R., Viscogliosi C., Desrosiers J., et al. Identification of rehabilitation needs after a stroke: an exploratory study. Health Qual Life Outcomes. 2004; 2: 53. https://doi.org/10.1186/1477-7525-2-53
- Tadi P, Lui F. Acute Stroke. [Updated Aug. 17, 2023]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK535369/ (Accessed 01.01.2025).
- Epple C., Maurer-Burkhard B., Lichti MC., et al. Vojta therapy improves postural control in very early stroke rehabilitation: a randomised controlled pilot trial. Neurol. Res. Pract. 2020; 2: 23. https://doi.org/10.1186/s42466-020-00070-4
- Макаров А.О., Иванова Н.Е., Ефимова М.Ю. и др. Стратификация факторов риска развития повторного инсульта и оптимизация реабилитационных мероприятий у лиц пожилого возраста, страдающих гипертонической болезнью. Вестник восстановительной медицины. 2015; 4(68): 27–32. [Makarov A.O., Ivanova N.E., Efimova M.J., et al. Stratification of the repeat stroke risk factors optimization of rehabilitation measures in relation to elderly patients suffering from hypertension. Bulletin of Rehabilitation Medicine. 2015; 4(68): 27–32 (In Russ.).]
- Ferrarello F., Deluca G., Pizzi A., et al. Passive standing as an adjunct rehabilitation intervention after stroke: a randomized controlled trial. Arch Physiother. 2015; 5: 2. https://doi.org/10.1186/s40945-015-0002-0
- Li J., Zhong D., Ye J. et al. Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis. BMJ Open. 2019; 9(7): e026844. https://doi.org/10.1136/bmjopen-2018-026844
- Воловец С.А., Сергеенко Е.Ю., Даринская Л.Ю. и др. Современный подход к восстановлению постурального баланса у пациентов с последствиями острого нарушения мозгового кровообращения. Вопросы курортологии, физиотерапии и лечебной физической культуры. 2018; 95(2): 4–9. https://doi.org/10.17116/kurort20189524–9 [Volovets S.A., Sergeenko E.Yu., Darinskaya L.Y., et al. The modern approaches to the restoration of postural balance in the patients suffering from the consequences of an acute cerebrovascular accident (CVA). Problems of balneology, physiotherapy, and exercise therapy. 2018; 95(2): 4–9. https://doi.org/10.17116/kurort20189524-9 (In Russ.).]
- Tsang S., Royse C.F., Terkawi A.S. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth. 2017; 11(Suppl 1): S80–S89. https://doi.org/10.4103/sja.SJA_203_17
- Faber M.J., Bosscher R.J., van Wieringen P.C. Clinimetric properties of the performance-oriented mobility assessment. Phys Ther. 2006; 86(7): 944–954.
- Воловик М.Г. Технологии виртуальной реальности в комплексной медицинской реабилитации пациентов с ограниченными возможностями. Москва. 2018; 10(4): 173–182. https://doi.org/10.17691/stm2018.10.4.21 [Volovik M.G. Virtual reality technology in complex medical rehabilitation of patients with disabilities (review). Sovremennye tehnologii v medicine 2018; 10(4): 173–182. https://doi.org/10.17691/stm2018.10.4.21 (In Russ.).]
- Краснова-Гольева В.В., Гольев М.А. Виртуальная реальность в реабилитации после инсульта. Современная зарубежная психология. 2015; 4(4): 39–44. https://doi.org/10.17759/jmfp.2015040406 [Krasnova-Goleva V.V., Golev M.A. Virtual reality in rehabilitation after stroke. Journal of Modern Foreign Psychology. 2015; 4(4): 39–44. https://doi.org/10.17759/jmfp.2015040406 (In Russ., Abstr. In Engl.).]
- Левин О.С., Боголепова А.Н. Постинсультные двигательные и когнитивные нарушения: клинические особенности и современные подходы к реабилитации. Журнал неврологии и психиатрии им. С.С. Корсакова. 2020; 120(11): 99–107. https://doi.org/10.17116/jnevro202012011199 [Levin O.S., Bogolepova A.N. Poststroke motor and cognitive impairments: clinical features and current approaches to rehabilitation. S.S. Korsakov Journal of Neurology and Psychiatry. 2020; 120(11): 99–107. https://doi.org/10.17116/jnevro202012011199 (In Russ.).]
- Cai H., Lin T., Chen L., et al. Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial. Trials 22. 2021; 91. https://doi.org/10.1186/s13063-021-05031-z
- Bergmann J., Krewer C., Bauer P., et al. Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. 407. Eur J Phys Rehabil Med. 2018; 54(3): 397–407.
- Cortés-Pérez I., Nieto-Escamez F.A., Obrero-Gaitán E. Immersive virtual reality in stroke patients as a new approach for reducing postural disabilities and falls risk: a case series. Brain Sci. 2020; 10(5): 296. https://doi.org/10.3390/brainsci10050296
- Колышенков В.А., Просвирин А.Н. Оценка эффективности применения комплексной программы реабилитации с использованием технологий виртуальной реальности: проспективное когортное исследование 59 пациентов с повреждением ротаторной манжеты плеча. Вестник восстановительной медицины. 2022; 21(4), 159–172. https://doi.org/10.38025/2078-1962-2022-21-4-159-72 [Kolyshenkov V.A., Prosvirnin A.N. Evaluation of the effectiveness of the virtual reality technologies comprehensive rehabilitation program application: a prospective cohort study of 59 patients with rotator cuff injury. Bulletin of Rehabilitation Medicine. 2022; 21 (4): 159–172. https://doi.org/10.38025/2078-1962-2022-21-4-159-172 (In Russ.).]
- Захаров А.В., Хивинцева Е.В., Чаплыгин С.С. и др. Двигательная реабилитация пациентов в остром периоде инсульта с использованием технологии виртуальной реальности. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2021; 121(8–2): 71–75. https://doi.org/10.17116/jnevro202112108271 [Zakharov A.V., Khivintseva E.V., Chaplygin S.S., et al. Motor rehabilitation of patients in the acute period of stroke using virtual reality technology. S.S. Korsakov Journal of Neurology and Psychiatry. 2021; 121(8–2): 71–75. https://doi.org/10.17116/jnevro202112108271 (In Russ.).]

The content is available under the Creative Commons Attribution 4.0 License.
©
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.