The effect of virtual reality based rehabilitation on cognitive functions in stroke patients: A review

Abstract

Stroke stands as one of the primary causes of disability and fatalities on a global scale. Post-stroke cognitive impairment (PSCI) emerges as a prevalent aftermath affecting over a third of patients, with its incidence steadily rising annually. Notable clinical manifestations encompass memory decline, concentration challenges, dependency in decision-making, and struggle in problem-solving, significantly impacting participation and life contentment across various facets of daily existence. There is also a close relationship between PSCI and dementia and disability rates. Therefore, cognitive rehabilitation strategies to improve cognitive function after stroke are an important component of stroke rehabilitation interventions. In the literature, traditional cognition education, physical therapy, physical activity, psychotherapy, and complementary medicine practices are frequently used in the rehabilitation of PSCI. Alongside these advancements, the evolution of information technology has introduced alternative treatment approaches, notably the increasing utilization of Virtual Reality (VR) technologies in Cognitive Rehabilitation (CR) applications. This review aims to assess the contribution of VR applications within CR specifically tailored for stroke patients.

Keywords

• Cognitive functions
• cognitive training
• neurology
• stroke
• virtual reality

References

1. Organization WH. The Top 10 Causes of Death. 24 Maggio. 2018.
2. Zhang J, Lee DTF. Meaning in stroke family caregiving in China: A phenomenological study. J Fam Nurs. 2019;25(2):260-86.
3. Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-48.
4. Feigin VL, Stark BA, Johnson CO, Roth GA, Bisignano C, Abady GG, et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021;20(10):795-820.
5. Mijajlović MD, Pavlović A, Brainin M, Heiss W-D, Quinn TJ, Ihle-Hansen HB, et al. Post-stroke dementia–a comprehensive review. BMC medicine. 2017;15(1):1-12.
6. Rost NS, Brodtmann A, Pase MP, van Veluw SJ, Biffi A, Duering M, et al. Post-stroke cognitive impairment and dementia. Circ Res. 2022;130(8):1252-71.
7. Towfighi A, Saver JL. Stroke declines from third to fourth leading cause of death in the United States: historical perspective and challenges ahead. Stroke. 2011;42(8):2351-5.
8. Lo JW, Crawford JD, Desmond DW, Godefroy O, Jokinen H, Mahinrad S, et al. Profile of and risk factors for poststroke cognitive impairment in diverse ethnoregional groups. Neurology. 2019;93(24):e2257-e71.

9. Barbay M, Taillia H, Nédélec-Ciceri C, Bompaire F, Bonnin C, Varvat J, et al. Prevalence of poststroke neurocognitive disorders using National Institute of Neurological Disorders and Stroke-Canadian Stroke Network, VASCOG criteria (Vascular Behavioral and Cognitive Disorders), and optimized criteria of cognitive deficit. Stroke. 2018;49(5):1141-7.
10. Sexton E, McLoughlin A, Williams DJ, Merriman NA, Donnelly N, Rohde D, et al. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur Stroke J. 2019;4(2):160-71.
11. Rohde D, Gaynor E, Large M, Mellon L, Bennett K, Williams DJ, et al. Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort. PloS one. 2019;14(10):e0223997.
12. Delavaran H, Jönsson AC, Lövkvist H, Iwarsson S, Elmståhl S, Norrving B, et al. Cognitive function in stroke survivors: A 10-year follow-up study. Acta Neurol Scand. 2017;136(3):187-94..
13. Draaisma LR, Wessel MJ, Hummel FC. Non-invasive brain stimulation to enhance cognitive rehabilitation after stroke. Neurosci lett. 2020;719:133678.
14. Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10(11):634-42.
15. Vahia VN. Diagnostic and statistical manual of mental disorders 5: A quick glance. Indian J Psychiatry. 2013;55(3):220-3.
16. Langdon KD, Granter-Button S, Harley CW, Moody-Corbett F, Peeling J, Corbett D. Cognitive rehabilitation reduces cognitive impairment and normalizes hippocampal CA1 architecture in a rat model of vascular dementia. J Cereb Blood Flow Metab. 2013;33(6):872-9.
17. Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke. 2013 Jan;8(1):38-45.
18. Park J, Lee G, Lee S-U, Jung SH. The impact of acute phase domain-specific cognitive function on post-stroke functional recovery. Ann Rehabil Med. 2016;40(2):214-22.
19. Sun J-H, Tan L, Yu J-T. Post-stroke cognitive impairment: epidemiology, mechanisms and management. Ann Transl Med. 2014;2(8).
20. Levine DA, Galecki AT, Langa KM, Unverzagt FW, Kabeto MU, Giordani B, et al. Trajectory of Cognitive Decline After Incident Stroke. Jama. 2015;314(1):41-51.
21. Fride Y, Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke? Top Stroke Rehabil. 2015;22(5):317-25.
22. Cumming TB, Marshall RS, Lazar RM. Stroke, cognitive deficits, and rehabilitation: still an incomplete picture. Int J Stroke. 2013;8(1):38-45.
23. Gao Y, Ma L, Lin C, Zhu S, Yao L, Fan H, et al. Effects of Virtual Reality-Based Intervention on Cognition, Motor Function, Mood, and Activities of Daily Living in Patients With Chronic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Aging Neurosci. 2021;13:766525.
24. Stolwyk RJ, Mihaljcic T, Wong DK, Chapman JE, Rogers JM. Poststroke cognitive impairment negatively impacts activity and participation outcomes: a systematic review and meta-analysis. Stroke. 2021;52(2):748-60.
25. Farokhi-Sisakht F, Farhoudi M, Sadigh-Eteghad S, Mahmoudi J, Mohaddes G. Cognitive rehabilitation improves ischemic stroke-induced cognitive impairment: role of growth factors. J Strok Cerebrovasc Dis. 2019;28(10):104299.
26. Rohde D, Gaynor E, Large M, Conway O, Bennett K, Williams DJ, et al. Stroke survivor cognitive decline and psychological wellbeing of family caregivers five years post-stroke: a cross-sectional analysis. Top Stroke Rehabil. 2019;26(3):180-6.
27. Hochstenbach JB, den Otter R, Mulder TW. Cognitive recovery after stroke: a 2-year follow-up. Arch Phys Med Rehabil. 2003;84(10):1499-504.
28. Hindle JV, Petrelli A, Clare L, Kalbe E. Nonpharmacological enhancement of cognitive function in Parkinson's disease: a systematic review. Mov Disord. 2013;28(8):1034-49.
29. Chen X, Liu F, Lin S, Yu L, Lin R. Effects of virtual reality rehabilitation training on cognitive function and activities of daily living of patients with poststroke cognitive impairment: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2022;103(7):1422-35.
30. De Luca R, Russo M, Naro A, Tomasello P, Leonardi S, Santamaria F, 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):791-6.
31. Lumma AL, Valk SL, Böckler A, Vrtička P, Singer T. Change in emotional self‐concept following socio‐cognitive training relates to structural plasticity of the prefrontal cortex. Brain Behav. 2018;8(4):e00940.
32. Castrén E, Antila H. Neuronal plasticity and neurotrophic factors in drug responses. Mol Psychiatry. 2017;22(8):1085-95.
33. Kou Z, Iraji A. Imaging brain plasticity after trauma. Neural Regen Res. 2014;9(7):693-700.
34. De Luca R, Lo Buono V, Leo A, Russo M, Aragona B, Leonardi S, et al. Use of virtual reality in improving poststroke neglect: Promising neuropsychological and neurophysiological findings from a case study. App Neuropsychol Adult. 2019;26(1):96-100.
35. Schuster-Amft C, Henneke A, Hartog-Keisker B, Holper L, Siekierka E, Chevrier E, et al. Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI. Disabil Rehabil Assist Technol. 2015;10(5):385-92.
36. De Luca R, Leonardi S, Spadaro L, Russo M, Aragona B, Torrisi M, et al. Improving Cognitive Function in Patients with Stroke: Can Computerized Training Be the Future? J Stroke Cerebrovasc Diseases. 2018;27(4):1055-60.
37. Maggio MG, De Luca R, Maresca G, Di Lorenzo G, Latella D, Calabro RS, et al. Personal computer-based cognitive training in Parkinson's disease: a case study. Psychogeriatrics. 2018;18(5):427-9.
38. Carrieri M, Petracca A, Lancia S, Basso Moro S, Brigadoi S, Spezialetti M, et al. Prefrontal Cortex Activation Upon a Demanding Virtual Hand-Controlled Task: A New Frontier for Neuroergonomics. Front Hum Neurosci. 2016;10:53.
39. Schindler A, Bartels A. Parietal cortex codes for egocentric space beyond the field of view. Curr Biol. 2013;23(2):177-82..
40. Ammatuna G, Changcoco R. Which trends will most affect talent developers in the healthcare industry. Who is
41. Alqahtani AS, Daghestani LF, Ibrahim LF. Environments and system types of virtual reality technology in STEM: A survey. Int J Adv Compu Sci Appl. 2017;8(6).
42. Mihelj M, Novak D, Beguš S. Virtual reality technology and applications. Springer, Dordrecht, 2014
43. Mandal S. Brief introduction of virtual reality & its challenges. Int J Sci Eng Res. 2013;4(4):304-9.
44. Manuli A, Maggio MG, Latella D, Cannavò A, Balletta T, De Luca R, et al. Can robotic gait rehabilitation plus Virtual Reality affect cognitive and behavioural outcomes in patients with chronic stroke? A randomized controlled trial involving three different protocols. J Stroke Cerebrovasc Dis. 2020;29(8):104994.
45. Bauer ACM, Andringa G. The Potential of Immersive Virtual Reality for Cognitive Training in Elderly. Gerontology. 2020;66(6):614-23.
46. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225-39.
47. Zhang B, Wong K-P, Qin J. Effects of Virtual Reality on the Limb Motor Function, Balance, Gait, and Daily Function of Patients with Stroke: Systematic Review. Medicina. 2023;59(4):813.
48. Brunner I, Skouen JS, Hofstad H, Aßmuss J, Becker F, Pallesen H, et al. Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke? An analysis of treatment intensity and content. BMC Neurol. 2016;16(1):1-7.
49. Zhang B, Li D, Liu Y, Wang J, Xiao Q. Virtual reality for limb motor function, balance, gait, cognition and daily function of stroke patients: A systematic review and meta‐analysis. J Adva Nurs. 2021;77(8):3255-73.
50. 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. 2022;17(1):50-60.
51. Aminov A, Rogers JM, Middleton S, Caeyenberghs K, Wilson PH. What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes. J Neuroeng Rehabil. 2018;15(1):29.
52. Xiao Z, Wang Z, Ge S, Zhong Y, Zhang W. Rehabilitation efficacy comparison of virtual reality technology and computer-assisted cognitive rehabilitation in patients with post-stroke cognitive impairment: A network meta-analysis. J Clin Neurosci. 2022;103:85-91.
53. Zhu S, Sui Y, Shen Y, Zhu Y, Ali N, Guo C, et al. Effects of Virtual Reality Intervention on Cognition and Motor Function in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis. Front Aging Neurosci. 2021;13:586999.
54. Faria AL, Andrade A, Soares L. 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):1-12.
55. Faria AL, Pinho MS, Bermúdez i Badia S. A comparison of two personalization and adaptive cognitive rehabilitation approaches: a randomized controlled trial with chronic stroke patients. J Neuroeng Rehabil. 2020;17:1-15.
56. Kim BR, Chun MH, Kim LS, Park JY. Effect of virtual reality on cognition in stroke patients. Ann Rehabil Med. 2011;35(4):450-9.
57. Liu Z, He Z, Yuan J, Lin H, Fu C, Zhang Y, et al. Application of immersive virtual-reality-based puzzle games in elderly patients with post-stroke cognitive impairment: a pilot study. Brain Sci. 2022;13(1):79.
58. Park M, Ha Y, editors. Effects of Virtual Reality-Based Cognitive Rehabilitation in Stroke Patients: A Randomized Controlled Trial. Healthcare; 2023: MDPI.
59. Rose Sin Yi L, Jing Jing S, Hammoda AO, Jonathan B, Ladislav B, Jing Q. Effects of virtual reality‐based cognitive interventions on cognitive function and activity of daily living among stroke patients: Systematic review and meta‐analysis. J Clin Nurs. 2024.
60. Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation–a systematic review and meta-analysis. Top Stroke Rehabil. 2023;30(1):53-72.
61. Sofroniew NJ, Vlasov YA, Hires SA, Freeman J, Svoboda K. Neural coding in barrel cortex during whisker-guided locomotion. eLife. 2015;4.
62. Bagce HF, Saleh S, Adamovich SV, Tunik E. Visuomotor gain distortion alters online motor performance and enhances primary motor cortex excitability in patients with stroke. Neuromodulation. 2012;15(4):361-6.
63. Pedreira da Fonseca E, da Silva Ribeiro NM, Pinto EB. Therapeutic Effect of Virtual Reality on Post-Stroke Patients: Randomized Clinical Trial. J Stroke Cerebrovasc Dis. 2017;26(1):94-100.
64. Saleh S, Adamovich SV, Tunik E. Mirrored feedback in chronic stroke: recruitment and effective connectivity of ipsilesional sensorimotor networks. Neurorehabil Neural Repair. 2014;28(4):344-54.
65. Muratori LM, Lamberg EM, Quinn L, Duff SV. Applying principles of motor learning and control to upper extremity rehabilitation. J Hand Ther. 2013;26(2):94-102; quiz 3.
66. Gamito P, Oliveira J, Santos N, Pacheco J, Morais D, Saraiva T, et al. Virtual exercises to promote cognitive recovery in stroke patients: the comparison between head mounted displays versus screen exposure methods. Int J Disabil Hum Dev. 2014;13(3):337-42.
67. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane database of Sys Rev. 2017(11).
68. Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, et al. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. Jama. 2016;315(6):571-81.
69. Qu Y, Zhuo L, Li N, Hu Y, Chen W, Zhou Y, et al. Prevalence of post-stroke cognitive impairment in china: a community-based, cross-sectional study. PLoS One. 2015;10(4):e0122864.