Nov 14, 2024
Strokes can decimate motor skills, and research shows that stroke patients need hours of practice to make significant improvements.
But due to challenges in healthcare funding, access to services and lack of motivation, many patients aren’t logging the amount of rehabilitation necessary to improve their outcomes.
Department of Occupational and Recreational Therapies Chair Lorie Richards, PhD, is helping lead a study to find out if using virtual reality devices for extra motor practice in patients' rooms—beyond the regular therapy they receive—can make a big enough change to justify using these devices at home and in clinics.
“The key is to look at how much change a patient experiences when using the device, and if that change is meaningful enough to make it worthwhile enough for people to pay for it,” she said.
The five-year grant is funded by the NIH StrokeNet, which facilitates the development of large multi-site clinical trials and research studies to advance prevention, acute treatment, recovery for stroke. The University of Utah has been a regional coordinating center for over a decade and Richards has served on the leadership team for the center the entire time.
For this particular grant, she’s a co-investigator working with leading researchers at UCLA. First the UCLA team completed a randomized trial that found patients’ upper extremity function significantly improved when they completed an intensive home-based practice with VR devices. Now they want to explore the economic impacts of using VR for telerehabilitation in addition to the usual care that stroke patients receive.
Telehealth increases access to rehabilitation therapy and can be a gamechanger in improving motor function post-stroke. A recent study of more than 23,000 U.S. patients who had a stroke in the last 30 days revealed that 59% had not seen an occupational or physical therapist at all—and Medicare is limited for these services.
Stroke care is expensive, and telerehabilitation may give patients better results and be cheaper than the usual therapy they’d receive in a clinical setting. In addition, it would increase access for those living far from rehabilitation clinic or have transportation challenges.
Along with the VR game component, therapists can interact with patients through videoconferencing, and provide treatment plans and remote assessments online. Another plus is that the game aspect of telerehabilitation with VR is often more motivating and fun than traditional therapy.
“We have so much tech in our homes already and there’s nothing super fancy about these devices,” Richards said. “It will connect to their TV with Wii-type controllers. It will cost something like a PlayStation and it’s likely that if we can show it’s effective, insurance may cover it in the future.”
For this study, the team will recruit 202 patients with substantial arm motor deficits after stroke and randomize them. Some will receive a six-week course of intensive daily telerehabilitation therapy, coupled with usual care, while the others will receive only usual care. Patients will be assessed until eight months after randomization, with the goal of determining if telerehabilitation creates better functional outcomes.
In a rehab setting, task practice is essential to force neuroplasticity of the brain. Virtual reality is appealing because it gamifies this practice, making it easier for patients to pay attention. That might motivate them to spend more hours practicing either in the hospital or at home, which can accelerate their motor skills recovery.
“I don’t think it’s a magic panacea, but it has the features that make it more fun,” Richards said. “It also has the capability for people to practice by themselves. It’s a matter of what we can get patients to do in a way that doesn’t require a lot of extra time with therapists.”
To determine whether the devices help make enough change, Richards and her team will look both at objective and holistic measures. Reducing caregiver burden can be quantified, as well as reducing healthcare utilization. But other changes will require a more subjective lens.
“Change can be vastly different depending on how much fine motor skills people use in day-to-day life,” Richards said. “Say I have a person who enters the study needing a lot of help dressing, but at the end they only need help with some fasteners. They need significantly less help, and their feelings of independence significantly increase. But you have to make sure that the scale you are using to assess outcomes can pick up such important change. Some scales that have been used in stroke research cannot measure these changes, so we are using a variety of scales to be able to detect them.”
In the end, there’s no guarantee that telerehabilitation can help stroke patients become completely independent again. But Richards and her team are optimistic that VR devices can help make a huge difference in their quality of life and positively impact the nation’s healthcare costs.
“The more dependent stroke patients are, the more healthcare they need,” she said. “If we can reduce caregiver burden, we might decrease healthcare utilization as well.”