Asymmetric Training Using Virtual Reality Reflection Equipment and the Enhancement of Upper Limb Function in Stroke Patients: A Randomized Controlled Trial

Background: Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients. Methods: Twenty-four stroke patients were randomly allocated to an experimental group (n = 12) or a control group (n = 12). Both groups participated in conventional physical therapy for 2x30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl-Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed. Results: Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (P < .05, 1-way repeated-measures analysis of variance [ANOVA]). A significant group-time interaction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (P < .05, 2-way repeated-measures ANOVA). Conclusions: This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted. (C) 2014 by National Stroke Association