Efficacy of virtual reality technology on cognitive dysfunction in patients with cerebral vascular accident: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

MA Xichao ^1,2 , ZHU Shijie ³ , LIN Yang ^1,2 , XIE Guosheng ^1,2 ,  YANG Yonghong ^1,2

1. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Chengdu West Area Angel Women’s & Children’s Hospital, Chengdu 610041, P.R.China;

Corresponding author：

YANG Yonghong, Email: nicole@scu.edu.cn

Keywords：

Virtual reality; Cerebral vascular accident; Cognitive dysfunction; Meta-analysis; Systematic review; Randomized controlled trail

DOI：

10.7507/1672-2531.202102109

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the efficacy of virtual reality technology on cognitive dysfunction in patients with cerebral vascular accident (CVA).Methods EMbase, Web of Science, PubMed, The Cochrane Library, WanFang Data, VIP and CNKI databases were electronically searched to collect the randomized controlled trials (RCTs) on virtual reality technology on cognitive dysfunction in patients with CVA from inception to December 31^st, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 25 RCTs involving 1 113 patients were included. The results of the meta-analysis showed that the scores of MBI (MD=9.24, 95%CI 1.91 to 16.56, P=0.01), MMSE (MD=3.02, 95%CI 1.11 to 4.93, P=0.002) and RBMT-2 (MD=2.74, 95%CI 1.97 to 3.51, P<0.000 01) in VR group were superior to the control group. However, there were no significant differences between the two groups in scores of BI, MOCA, and VCPT.Conclusions Current evidence shows that virtual reality technology may have positively influence on cognitive function and participation in the daily life activities of patients with CVA. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.

Citation： MA Xichao, ZHU Shijie, LIN Yang, XIE Guosheng, YANG Yonghong. Efficacy of virtual reality technology on cognitive dysfunction in patients with cerebral vascular accident: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(8): 907-914. doi: 10.7507/1672-2531.202102109 Copy

1.	Donovan NJ, Kendall DL, Heaton SC, et al. Conceptualizing functional cognition in stroke. Neurorehabil Neural Repair, 2008, 22(2): 122-135.
2.	Nys GM, van Zandvoort MJ, de Kort PL, et al. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis, 2007, 23(5-6): 408-416.
3.	中国医师协会神经内科分会认知障碍专业委员会, 《中国血管性认知障碍诊治指南》编写组. 2019年中国血管性认知障碍诊治指南. 中华医学杂志, 2019, 99(35): 2737-2744.
4.	Crescentini C, Seyed-Allaei S, Vallesi A, et al. Two networks involved in producing and realizing plans. Neuropsychologia, 2012, 50(7): 1521-1535.
5.	Miller HL, Bugnariu NL. Level of immersion in virtual environments impacts the ability to assess and teach social skills in autism spectrum disorder. Cyberpsychol Behav Soc Netw, 2016, 19(4): 246-256.
6.	Pareto L, Sharkey P, Merrick J. Using virtual reality technologies to support everyday rehabilitation. J Pain Manage, 2016, 9: 197-198.
7.	Wiley E, Khattab S, Tang A. Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol, 2020, 5: 1-11.
8.	Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (version 5.0. 1), 2008. Available at: www.cochrane-handbook.org.
9.	Kim BR, Chun MH, Kim LS, et al. Effect of virtual reality on cognition in stroke patients. Ann Rehabil Med, 2011, 35(4): 450-459.
10.	Choi JH, Han EY, Kim BR, et al. Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients. Ann Rehabil Med, 2014, 38(4): 485-493.
11.	陈姣姣, 胡江波, 翟宏伟, 等. 虚拟现实技术在脑卒中患者记忆障碍治疗中的临床研究. 徐州医学院学报, 2016, 36(5): 307-310.
12.	Faria AL, Andrade A, Soares L, et al. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil, 2016, 13(1): 96.
13.	Rozental-Iluz C, Zeilig G, Weingarden H, et al. Improving executive function deficits by playing interactive video-games: secondary analysis of a randomized controlled trial for individuals with chronic stroke. Eur J Phys Rehabil Med, 2016, 52(4): 508-515.
14.	王辉, 吴吉生. 虚拟现实训练对认知障碍的脑卒中偏瘫患者的影响. 中国康复, 2017, 32(4): 299-301.
15.	温鸿源, 李力强, 龙洁珍, 等. 3D虚拟现实技术对脑卒中记忆功能障碍患者疗效及1H-MRS的影响. 中国老年学杂志, 2017, 37(1): 100-102.
16.	Gamito P, Oliveira J, Coelho C, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil, 2017, 39(4): 385-388.
17.	Maier M, Banuelos NL, Ballester BR, et al. Conjunctive rehabilitation of multiple cognitive domains for chronic stroke patients in virtual reality. IEEE Int Conf Rehabil Robot, 2017, 2017: 947-952.
18.	胡艳群, 李斌, 王蛟颜, 等. 短期虚拟现实康复训练联合认知干预对老年脑卒中偏瘫患者运动功能, Lovett肌力分级及生存质量的影响分析. 中国医学前沿杂志(电子版), 2018, 10(8): 97-101.
19.	De Luca R, Russo M, Naro A, et al. Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations. Int J Neurosci, 2018, 128(9): 791-796.
20.	Faria AL, Cameirão MS, Couras JF, et al. Combined cognitive-motor rehabilitation in virtual reality improves motor outcomes in chronic stroke - a pilot study. Front Psychol, 2018, 9: 854.
21.	付亏杰, 刘旭东, 范飞, 等. 虚拟现实技术对脑卒中恢复期患者认知功能的影响. 承德医学院学报, 2019, 36(4): 303-305.
22.	肖湘, 梁斌. 虚拟现实训练对脑卒中恢复期患者认知功能和P300的影响. 中国康复医学杂志, 2019, 34(3): 339-341.
23.	张红利, 车文生, 楚娜娜. 头针联合虚拟情景互动训练对脑卒中患者功能康复的影响. 中国老年学杂志, 2019, 39(20): 4902-4906.
24.	Baltaduonienė D, Kubilius R, Berškienė K, et al. Change of cognitive functions after stroke with rehabilitation systems. Transl Neurosci, 2019, 10: 118-124.
25.	Cho DR, Lee SH. Effects of virtual reality immersive training with computerized cognitive training on cognitive function and activities of daily living performance in patients with acute stage stroke: A preliminary randomized controlled trial. Medicine (Baltimore), 2019, 98(11): e14752.
26.	Rogers JM, Duckworth J, Middleton S, et al. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil, 2019, 16(1): 56.
27.	Torrisi M, Maresca G, De Cola MC, et al. Using telerehabilitation to improve cognitive function in post-stroke survivors: is this the time for the continuity of care? Int J Rehabil Res, 2019, 42(4): 344-351.
28.	Oh YB, Kim GW, Han KS, et al. Efficacy of virtual reality combined with real instrument training for patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil, 2019, 100(8): 1400-1408.
29.	杨恒. 灯盏花素注射液联合虚拟现实康复训练对脑卒中患者认知功能及平衡能力的影响. 中国疗养医学, 2020, 29(7): 755-756.
30.	薛慧. 神经电生理监测虚拟现实训练对脑卒中恢复期患者认知功能和肢体运动功能的影响. 现代实用医学, 2020, 32(6): 613-615.
31.	钱平安, 冯红静, 沈凯杰, 等. 体感互动虚拟现实技术辅助用于脑卒中患者的康复效果. 中国乡村医药, 2020, 27(7): 3-4.
32.	Maier M, Ballester BR, Leiva Bañuelos N, et al. Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial. J Neuroeng Rehabil, 2020, 17(1): 42.
33.	Ersoy C, Iyigun G. Boxing training in patients with stroke causes improvement of upper extremity, balance, and cognitive functions but should it be applied as virtual or real? Top Stroke Rehabil, 2021, 28(2): 112-126.
34.	Quinn TJ, Elliott E, Langhorne P. Cognitive and mood assessment tools for use in stroke. Stroke, 2018, 49(2): 483-490.
35.	Burton L, Tyson SF. Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility. J Rehabil Med, 2015, 47(3): 193-203.
36.	Geffen GM, Butterworth P, Geffen LB. Test-retest reliability of a new form of the auditory verbal learning test (AVLT). Arch Clin Neuropsychol, 1994, 9(4): 303-316.
37.	Koh CL, Lu WS, Chen HC, et al. Test-retest reliability and practice effect of the oral-format Symbol Digit Modalities Test in patients with stroke. Arch Clin Neuropsychol, 2011, 26(4): 356-363.
38.	Arbuthnott K, Frank J. Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J Clin Exp Neuropsychol, 2000, 22(4): 518-528.
39.	Putrino D. Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation. Curr Opin Neurol, 2014, 27(6): 631-636.
40.	Garcia N, Sabater-Navarro JM, Gugliemeli E, et al. Trends in rehabilitation robotics. Med Biol Eng Comput, 2011, 49(10): 1089-1091.
41.	Bao X, Mao Y, Lin Q, et al. Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke. Neural Regen Res, 2013, 8(31): 2904-2913.
42.	Orihuela-Espina F, Fernández del Castillo I, Palafox L, et al. Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy. Top Stroke Rehabil, 2013, 20(3): 197-209.
43.	姜财, 黄佳, 陶静, 等. 计算机辅助认知训练对脑卒中患者认知功能恢复的影响及其机制的fMRI研究. 中国康复医学杂志, 2015, 30(9): 911-914.
44.	王晓娜, 顾莹, 刘敏. 电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察. 中国康复, 2013, 28(5): 330-332.
45.	Shin JH, Ryu H, Jang SH. A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments. J Neuroeng Rehabil, 2014, 11: 32.
46.	Barrett AM, Buxbaum LJ, Coslett HB, et al. Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. J Cogn Neurosci, 2006, 18(7): 1223-1236.

1. Donovan NJ, Kendall DL, Heaton SC, et al. Conceptualizing functional cognition in stroke. Neurorehabil Neural Repair, 2008, 22(2): 122-135.
2. Nys GM, van Zandvoort MJ, de Kort PL, et al. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis, 2007, 23(5-6): 408-416.
3. 中国医师协会神经内科分会认知障碍专业委员会, 《中国血管性认知障碍诊治指南》编写组. 2019年中国血管性认知障碍诊治指南. 中华医学杂志, 2019, 99(35): 2737-2744.
4. Crescentini C, Seyed-Allaei S, Vallesi A, et al. Two networks involved in producing and realizing plans. Neuropsychologia, 2012, 50(7): 1521-1535.
5. Miller HL, Bugnariu NL. Level of immersion in virtual environments impacts the ability to assess and teach social skills in autism spectrum disorder. Cyberpsychol Behav Soc Netw, 2016, 19(4): 246-256.
6. Pareto L, Sharkey P, Merrick J. Using virtual reality technologies to support everyday rehabilitation. J Pain Manage, 2016, 9: 197-198.
7. Wiley E, Khattab S, Tang A. Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol, 2020, 5: 1-11.
8. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions (version 5.0. 1), 2008. Available at: www.cochrane-handbook.org.
9. Kim BR, Chun MH, Kim LS, et al. Effect of virtual reality on cognition in stroke patients. Ann Rehabil Med, 2011, 35(4): 450-459.
10. Choi JH, Han EY, Kim BR, et al. Effectiveness of commercial gaming-based virtual reality movement therapy on functional recovery of upper extremity in subacute stroke patients. Ann Rehabil Med, 2014, 38(4): 485-493.
11. 陈姣姣, 胡江波, 翟宏伟, 等. 虚拟现实技术在脑卒中患者记忆障碍治疗中的临床研究. 徐州医学院学报, 2016, 36(5): 307-310.
12. Faria AL, Andrade A, Soares L, et al. Benefits of virtual reality based cognitive rehabilitation through simulated activities of daily living: a randomized controlled trial with stroke patients. J Neuroeng Rehabil, 2016, 13(1): 96.
13. Rozental-Iluz C, Zeilig G, Weingarden H, et al. Improving executive function deficits by playing interactive video-games: secondary analysis of a randomized controlled trial for individuals with chronic stroke. Eur J Phys Rehabil Med, 2016, 52(4): 508-515.
14. 王辉, 吴吉生. 虚拟现实训练对认知障碍的脑卒中偏瘫患者的影响. 中国康复, 2017, 32(4): 299-301.
15. 温鸿源, 李力强, 龙洁珍, 等. 3D虚拟现实技术对脑卒中记忆功能障碍患者疗效及1H-MRS的影响. 中国老年学杂志, 2017, 37(1): 100-102.
16. Gamito P, Oliveira J, Coelho C, et al. Cognitive training on stroke patients via virtual reality-based serious games. Disabil Rehabil, 2017, 39(4): 385-388.
17. Maier M, Banuelos NL, Ballester BR, et al. Conjunctive rehabilitation of multiple cognitive domains for chronic stroke patients in virtual reality. IEEE Int Conf Rehabil Robot, 2017, 2017: 947-952.
18. 胡艳群, 李斌, 王蛟颜, 等. 短期虚拟现实康复训练联合认知干预对老年脑卒中偏瘫患者运动功能, Lovett肌力分级及生存质量的影响分析. 中国医学前沿杂志(电子版), 2018, 10(8): 97-101.
19. De Luca R, Russo M, Naro A, et al. Effects of virtual reality-based training with BTs-Nirvana on functional recovery in stroke patients: preliminary considerations. Int J Neurosci, 2018, 128(9): 791-796.
20. Faria AL, Cameirão MS, Couras JF, et al. Combined cognitive-motor rehabilitation in virtual reality improves motor outcomes in chronic stroke - a pilot study. Front Psychol, 2018, 9: 854.
21. 付亏杰, 刘旭东, 范飞, 等. 虚拟现实技术对脑卒中恢复期患者认知功能的影响. 承德医学院学报, 2019, 36(4): 303-305.
22. 肖湘, 梁斌. 虚拟现实训练对脑卒中恢复期患者认知功能和P300的影响. 中国康复医学杂志, 2019, 34(3): 339-341.
23. 张红利, 车文生, 楚娜娜. 头针联合虚拟情景互动训练对脑卒中患者功能康复的影响. 中国老年学杂志, 2019, 39(20): 4902-4906.
24. Baltaduonienė D, Kubilius R, Berškienė K, et al. Change of cognitive functions after stroke with rehabilitation systems. Transl Neurosci, 2019, 10: 118-124.
25. Cho DR, Lee SH. Effects of virtual reality immersive training with computerized cognitive training on cognitive function and activities of daily living performance in patients with acute stage stroke: A preliminary randomized controlled trial. Medicine (Baltimore), 2019, 98(11): e14752.
26. Rogers JM, Duckworth J, Middleton S, et al. Elements virtual rehabilitation improves motor, cognitive, and functional outcomes in adult stroke: evidence from a randomized controlled pilot study. J Neuroeng Rehabil, 2019, 16(1): 56.
27. Torrisi M, Maresca G, De Cola MC, et al. Using telerehabilitation to improve cognitive function in post-stroke survivors: is this the time for the continuity of care? Int J Rehabil Res, 2019, 42(4): 344-351.
28. Oh YB, Kim GW, Han KS, et al. Efficacy of virtual reality combined with real instrument training for patients with stroke: a randomized controlled trial. Arch Phys Med Rehabil, 2019, 100(8): 1400-1408.
29. 杨恒. 灯盏花素注射液联合虚拟现实康复训练对脑卒中患者认知功能及平衡能力的影响. 中国疗养医学, 2020, 29(7): 755-756.
30. 薛慧. 神经电生理监测虚拟现实训练对脑卒中恢复期患者认知功能和肢体运动功能的影响. 现代实用医学, 2020, 32(6): 613-615.
31. 钱平安, 冯红静, 沈凯杰, 等. 体感互动虚拟现实技术辅助用于脑卒中患者的康复效果. 中国乡村医药, 2020, 27(7): 3-4.
32. Maier M, Ballester BR, Leiva Bañuelos N, et al. Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial. J Neuroeng Rehabil, 2020, 17(1): 42.
33. Ersoy C, Iyigun G. Boxing training in patients with stroke causes improvement of upper extremity, balance, and cognitive functions but should it be applied as virtual or real? Top Stroke Rehabil, 2021, 28(2): 112-126.
34. Quinn TJ, Elliott E, Langhorne P. Cognitive and mood assessment tools for use in stroke. Stroke, 2018, 49(2): 483-490.
35. Burton L, Tyson SF. Screening for cognitive impairment after stroke: A systematic review of psychometric properties and clinical utility. J Rehabil Med, 2015, 47(3): 193-203.
36. Geffen GM, Butterworth P, Geffen LB. Test-retest reliability of a new form of the auditory verbal learning test (AVLT). Arch Clin Neuropsychol, 1994, 9(4): 303-316.
37. Koh CL, Lu WS, Chen HC, et al. Test-retest reliability and practice effect of the oral-format Symbol Digit Modalities Test in patients with stroke. Arch Clin Neuropsychol, 2011, 26(4): 356-363.
38. Arbuthnott K, Frank J. Trail making test, part B as a measure of executive control: validation using a set-switching paradigm. J Clin Exp Neuropsychol, 2000, 22(4): 518-528.
39. Putrino D. Telerehabilitation and emerging virtual reality approaches to stroke rehabilitation. Curr Opin Neurol, 2014, 27(6): 631-636.
40. Garcia N, Sabater-Navarro JM, Gugliemeli E, et al. Trends in rehabilitation robotics. Med Biol Eng Comput, 2011, 49(10): 1089-1091.
41. Bao X, Mao Y, Lin Q, et al. Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke. Neural Regen Res, 2013, 8(31): 2904-2913.
42. Orihuela-Espina F, Fernández del Castillo I, Palafox L, et al. Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy. Top Stroke Rehabil, 2013, 20(3): 197-209.
43. 姜财, 黄佳, 陶静, 等. 计算机辅助认知训练对脑卒中患者认知功能恢复的影响及其机制的fMRI研究. 中国康复医学杂志, 2015, 30(9): 911-914.
44. 王晓娜, 顾莹, 刘敏. 电脑辅助认知康复系统治疗脑卒中后认知障碍的疗效观察. 中国康复, 2013, 28(5): 330-332.
45. Shin JH, Ryu H, Jang SH. A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments. J Neuroeng Rehabil, 2014, 11: 32.
46. Barrett AM, Buxbaum LJ, Coslett HB, et al. Cognitive rehabilitation interventions for neglect and related disorders: moving from bench to bedside in stroke patients. J Cogn Neurosci, 2006, 18(7): 1223-1236.

Chinese Journal of Evidence-Based Medicine

Efficacy of virtual reality technology on cognitive dysfunction in patients with cerebral vascular accident: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content