We thank the patients and healthcare staff of the First Affiliated Hospital of Zhejiang University School of Medicine for their support and cooperation throughout this study.

This study protocol received approval from the ethics committee of the First Affiliated Hospital of Zhejiang University (approval number IIT20210035C-R2), and informed consent was obtained from all participants. An experimental study employing quasi-randomization, single-blinding, and a control group was conducted to assess the feasibility and effectiveness of the program. 24 patients hospitalized in the rehabilitation medicine ward of the First Affiliated Hospital of Zhejiang University were invited to participate in th...

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

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Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+therapy+for+upper-limb+rehabilitation+in+subacute+stroke+patients:+A+systematic+review+and+meta-analysis.">Robot-assisted therapy for upper-limb rehabilitation in subacute stroke patients: A systematic review and meta-analysis.</a> Brain Behav. 10 (8), e01742 (2020).</li><li>Zhang, L., Jia, G., Ma, J., Wang, S., Cheng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Short+and+long-term+effects+of+robot-assisted+therapy+on+upper+limb+motor+function+and+activity+of+daily+living+in+patients+post-stroke:+A+meta-analysis+of+randomized+controlled+trials.">Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: A meta-analysis of randomized controlled trials.</a> J Neuroeng Rehabil. 19 (1), 76 (2022).</li><li>Lu, C., Hua, <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effects+of+digital+cognitive+training+in+occupational+therapy+on+cognition,+upper+limb+movement,+and+activities+of+daily+living+in+stroke+patients.">The effects of digital cognitive training in occupational therapy on cognition, upper limb movement, and activities of daily living in stroke patients.</a> Modern Medicine. 47, 373-376 (2019).</li><li>Yun, S. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cognitive+training+using+fully+immersive,+enriched+environment+virtual+reality+for+patients+with+mild+cognitive+impairment+and+mild+dementia:+Feasibility+and+usability+study.">Cognitive training using fully immersive, enriched environment virtual reality for patients with mild cognitive impairment and mild dementia: Feasibility and usability study.</a> JMIR Serious Games. 8 (4), 18127 (2020).</li><li>Kim, W. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+application+of+virtual+reality+for+upper+limb+motor+rehabilitation+in+stroke:+Review+of+technologies+and+clinical+evidence.">Clinical application of virtual reality for upper limb motor rehabilitation in stroke: Review of technologies and clinical evidence.</a> J Clin Med. 9 (10), 3369 (2020).</li><li>H&#248;eg, E. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=System+immersion+in+virtual+reality-based+rehabilitation+of+motor+function+in+older+adults:+A+systematic+review+and+meta-analysis.">System immersion in virtual reality-based rehabilitation of motor function in older adults: A systematic review and meta-analysis.</a> Frontiers in Virtual Reality. 2, 39-56 (2021).</li><li>Bevilacqua, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-immersive+virtual+reality+for+rehabilitation+of+the+older+people:+A+systematic+review+into+efficacy+and+effectiveness.">Non-immersive virtual reality for rehabilitation of the older people: A systematic review into efficacy and effectiveness.</a> Journal of Clinical Medicine. 8 (11), 1882 (2019).</li></ol>

The authors have stated that there are no conflicts of interest or financial disclosures associated with this study.

A virtual reality rehabilitation system was implemented to support the recovery of stroke patients, utilizing the latest multi-touch screen technology to enhance training engagement, immersion, interactivity, and conceptualization. This system provides interactive upper limb motor control training that integrates vision, hearing, and touch. It also includes rehabilitation training modules targeting memory, attention, spatial perception, computing, hand-eye coordination, and virtual tasks, offering personalized cognitive ...

There is a high incidence, mortality, disability rate, and recurrence associated with stroke, or cerebrovascular accident1. Globally, stroke has surpassed tumors and heart disease to become the second leading cause of death, and it is the primary cause in China2. The incidence and social burden of stroke are expected to increase significantly in the coming years as the population ages. Survivors of stroke may continue to experience sensory, motor, cognitive, and psychological impairments3. The effects of a stroke can include paralysis of one side of the body, including the face, arms, and legs, a condition known as hemiplegia. This is the most common sequel to stroke and significantly impacts people's quality of life4.
Stroke poses a significant threat to people's health. Due to brain tissue damage, stroke and hemiplegia can result in hand dysfunction, hindering patients' activities of daily living (ADLs) and diminishing their quality of life5. Decreased upper limb function, especially of the hands as the distal body part, presents the most significant challenge in upper limb recovery6. Therefore, functional rehabilitation is crucial. Additionally, 20%-80% of stroke patients experience cognitive impairment, leading to deficits in attention, memory, language, and executive abilities7.
Currently, the clinical rehabilitation of upper limb hemiplegia primarily relies on comprehensive upper limb training and various occupational therapies (e.g., mirror box treatment8, suspension9, functional electrical stimulation10, among others). Recently, virtual reality and interactive video games have emerged as alternative rehabilitation methods. These interventions can facilitate high-capacity practice and reduce demands on therapists' time11. Virtual reality systems have rapidly evolved into new commercial devices that can be utilized to enhance cognitive and upper limb motor function in stroke survivors12. Despite these advancements, there are still unexplored avenues in this field.
Therefore, this study aims to investigate the effects of upper limb rehabilitation training combined with conventional upper limb rehabilitation on cognitive and upper limb motor function in stroke patients during the recovery period of hemiparesis, typically spanning the initial 6-24 weeks after the incident stroke. Additionally, we will examine its impact on daily life abilities. This research seeks to provide valuable evidence for the clinical application of robotic interventions.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>FlexTable digital occupational training system</td>
			<td>Guangzhou Zhanghe Intelligent Technology Co., Ltd.</td>
			<td>Observation on the rehabilitation effect of digital OT cognitive function training on stroke patients with decreased attention function</td>
			<td>FlexTable digital operation training system uses the latest multi-touch screen technology, virtual reality and human-computer interaction technology, integrates a variety of training methods, and provides digital advanced brain function and hand-eye coordination training</td>
		</tr>
		<tr>
			<td>SPSS 25.0</td>
			<td>IBM</td>
			<td></td>
			<td>https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-25</td>
		</tr>
	</tbody>
</table>

cognitive function and upper limb rehabilitation training post-stroke using a digital occupational training system

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the potential to meet these demands by providing engaging and motivating therapy options. The digital occupational training system is a VR application that utilizes cutting-edge technologies, including multi-touch screens, virtual reality, and human-computer interaction, to offer diverse training techniques for advanced cognitive capacity and hand-eye coordination abilities. The objective of this study was to assess the effectiveness of this program in enhancing cognitive function and upper extremity rehabilitation in stroke patients. The training and assessment consist of five cognitive modules covering perception, attention, memory, logical reasoning, and calculation, along with hand-eye coordination training. This research indicates that after eight weeks of training, the digital occupational training system can significantly improve cognitive function, daily living skills, attention, and self-care abilities in stroke patients. This software can be employed as a time-saving and clinically effective rehabilitation aid to complement traditional one-on-one occupational therapy sessions. In summary, the digital occupational training system shows promise and offers potential financial benefits as a tool to support the functional recovery of stroke patients.

Author Spotlight: Rehabilitation of Stroke Patients With a Digital Occupational Training System

Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System

Our research focus on enhancing cognitive function and up-limb rehabilitation in stroke patients using our digital occupational training system. We aim to evaluate its effectiveness in improving cognitive ability, up-limb function, and daily living skills. Current challenges include helping new patients adjust to the system, as it represents a new approach that requires some time to learn.Therefore, it is important that therapists receive comprehensive training in the use of this system and provide proper guidance to patients. Our protocol is more efficient and effective than traditional methods. It uses find games for personalized therapy and better patient focus.It also requires important data like test performance, completion time, and motion tests. Useful for later rehab evaluations.

In this study, 24 patients were enrolled presenting with upper limb dysfunction combined with various types of cognitive impairment following a stroke. The observed types of cognitive impairment included Amnesia, Agnosia, Executive Dysfunction, Attentional Impairments, among others. No statistically significant differences were found between the two groups in terms of sex, age, duration of disease, and type of stroke (P &#62; 0.05), as detailed in Table 1. The experimental group, which underwent...

Watch this Scientific Journal Video about Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System at JoVE.com

The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Stroke rehabilitation often requires frequent and intensive therapy to improve functional recovery. Virtual reality (VR) technology has shown the ...

cognitive-function-upper-limb-rehabilitation-training-post-stroke

Research

JoVE Journal

Medicine

Rehabilitation of Patient Cognitive Dysfunction Using a Digital Training System

To begin, position the patient in front of the digital occupational training system, adjust the instrument's display to the appropriate height and tilt angle, allowing the patient to touch the screen. Select the appropriate training program based on the patient's cognitive impairment and muscle strength. Then set the parameters, such as training duration, difficulty level, and side for each program.For rapid matching training, click on Pictures on the screen and ask the patient to remember the pictures shown. Click the icon button to confirm if the shown picture matches the previous one. For memory matrix training, click to make three bright squares flash at different locations on the screen matrix.Then click to darken all squares and ask the patient to click on the bright squares. To train the patient's reaction ability, instruct the patient to click on the catch icon when the cake falls above the cartoon avatar to prevent the cake from hitting the head. To train the color match ability, guide the patient to click on the corresponding color of a ball when it is close to the center of the circle.This will make the ball bounce either two or four times. Next, train the patient's reactive ability by asking the patient to click and hit the bad guy or gopher when it sticks its head out. For memory training, display information of cards on the screen.Now, flip the card and change its position. Ask the patient to find and click on the target card. To train the patient's judgment, display a left and right hand gesture on the screen.Ask the patient to determine which hand wins or if it is a tie. Perform arithmetic reasoning training by instructing the patient to calculate the arithmetic problem on the screen and compare it to the number. Ask the patient to select the appropriate button corresponding to greater than, less than, or equal to.Train the patient in sorting and picking by instructing the patient to pick and click on the appropriate type and item quantity from the list provided. Additionally, train the patient's judgment by asking the patient to click and capture a specific type and number of fish. For unilateral neglect training, ask the patient to click according to the video prompts to control the swimming red fish and consume as many fish as possible.Next, train the patients with a jigsaw puzzle by clicking on the broken puzzle pieces to reposition them correctly. Finally, perform picture combination training by choosing the appropriate pictures from various shapes and colors on the left side of the screen and placing them in the correct order on the right side of the screen to form a specific pattern. For patients with executive dysfunction, train them with the following programs.For food preparation, instruct the patient to virtually turn on the faucet, clean the tomatoes, and cut them into pieces. Next, place the cutup tomatoes onto a plate. Place the eggs into the bowl and stir them together.Instruct the patient to fire up the stove, pour the cooking oil, beaten eggs, and then the tomatoes. Once cooking is complete, guide the patient to turn off the heat and transfer the cooked dish onto a plate. Train the patients with thinking and reasoning dysfunction with naming, card memory, and object differentiation programs.For naming training, guide the patients to find and click on the correct picture or item name based on the information and sound prompts. For the card memory training, ask the patient to find and click the card that is the same as the one in the hand of the cartoon avatar in the upper right corner. To train the patient in object differentiation, identify and click on the object that is unique and different from the remaining objects.To perform upper limb functional training, ask the patient to draw specific pattern lines according to the path prompts on the screen. Train the patient in musical recognition by erasing the gray squares in sync with the music rhythm, transforming them into colorful squares. For walking the maze, ask the patient to hold onto the small ball in the maze and navigate the maze to reach the diamond at the maze's end.Finally, train the patients for two-handed coordination using the given programs. For the balance ball training, have the patient place their left and right fists on both ends of the balance beam with a ball on it. Instruct the patient to maintain the ball's balance on the beam.To play the fish feeding game, instruct the patient to hold down the feed with one hand and click the small fish on the screen with the other hand. Next, guide the patient for archery practice by making the patient place one hand on the bow and the other on the arrow. Click control the arrow to release it and hit the target.Finally, train the reaction coordination of the patient by instructing the patient to hold the hammer down using both hands, then click to hit the yellow ball alternately. Patients that underwent rehabilitation with a digital occupational system displayed greater improvements relative to the conventional system.

725 Views.  Wenzhou Medical University.  The current protocol outlines how the VR-based digital occupational training system enhances the rehabilitation of patients with cognitive impairment and upper limb dysfunction following a stroke.

Enhancing Stroke Rehabilitation with Virtual Reality-Based Occupational Training

Summary