Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR and telemedicine: the upper limb tele-rehabilitation <s> Four short, simple measures of arm function, suitable for use with patients recovering from acute stroke, are described. These tests are: the Frenchay Arm Test, the Nine Hole Peg Test, finger tapping rate and grip strength. Good interobserver and test-retest reliability was demonstrated for all tests, and the Frenchay Arm Test was shown to be valid. Normal values for all tests were established on 63 controls. It was found that the limited sensitivity of the Frenchay Arm Test could be improved using the Nine Hole Peg Test and grip strength. Recovery of arm function has been studied in a sample of 56 patients seen regularly over the first 3 months after their stroke, using these standard measures. The results demonstrated a wide variation in recovery curves between patients. The use of the Nine Hole Peg Test enabled further recovery to be detected after patients achieved a top score on the Frenchay Arm Test. Failure to recover measureable grip strength before 24 days was associated with absence of useful arm function at three months. Measurement of finger tapping rate was not useful. <s> BIB001 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR and telemedicine: the upper limb tele-rehabilitation <s> We undertook this investigation to determine the interrater reliability of manual tests of elbow flexor muscle spasticity graded on a modified Ashworth scale. We each independently graded the elbow flexor muscle spasticity of 30 patients with intracranial lesions. We agreed on 86.7% of our ratings. The Kendall's tau correlation between our grades was .847 (p less than .001). Thus, the relationship between the raters' judgments was significant and the reliability was good. Although the results were limited to the elbow flexor muscle group, we believe them to be positive enough to encourage further trials of the modified Ashworth scale for grading spasticity. <s> BIB002 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR and telemedicine: the upper limb tele-rehabilitation <s> This retrospective pilot study was conducted to examine the validity of upper extremity Motricity Index scores. The strength of the paretic upper extremity of 10 patients with stroke was measured using the Motricity Index and dynamometry. Specifically measured were hand-grasp, elbow flexion, and shoulder abduction. The criterion validity of the Motricity Index scores was supported by their significant and high correlations with dynamometer measures (r >.74). The construct validity of the Motricity Index scores was demonstrated by their high Cronbachis alpha (.968). The Motricity Index is a valid instrument for characterizing the strength of the paretic upper extremity following stroke. <s> BIB003 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR and telemedicine: the upper limb tele-rehabilitation <s> BACKGROUND AND PURPOSE ::: Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities. ::: ::: ::: METHODS ::: One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software. ::: ::: ::: RESULTS ::: The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures. ::: ::: ::: CONCLUSIONS ::: The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale. <s> BIB004 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR and telemedicine: the upper limb tele-rehabilitation <s> Objective: Clinical scales evaluating arm function after stroke are weak at detecting quality of movement. Therefore a new scale, the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), was developed, comprising 22 items pertaining to arm and hand performance. The scale was investigated for validity and unidimensionality using the Rasch measurement model, and for inter-rater reliability.Setting: Twelve hospitals and rehabilitation centres in Belgium, Germany and Switzerland.Patients: There were 396 patients (average age 63.38±12.89 years) in the Rasch study and 56 patients (average age 65.68±12.75 years) in the reliability study.Main measures: The scale was examined on its fit to the Rasch model, thereby evaluating the scale’s unidimensionality and validity. Differential item functioning was performed to test the stability of item hierarchy on several variables. Inter-rater reliability was examined with kappa values, weighted percentage agreement and intraclass correlation coefficient... <s> BIB005
VR settings are usable in the transfer of available occupational treatments to a platform for rehabilitation at home, with remote control by therapist. Broeren and coworkers have emphasized the reduced labor, logistics and costs of the state-of art web-based video/audio systems for telemedicine and tested their protocol in a case study, with VR associated to the haptic force feedback necessary for VR object manipulation. The hand fine dexterity and grip improved after treatment  . More recently, Trotti and colleagues proposed VR-supported training as an integration of the conventional rehabilitation protocols  ). They used kinematics indexes (such as movement execution time and precision) and validated clinical scales, such as Nine-Hole Peg Test (NHPT)  , Frenchay Arm Test (FAT) BIB001 , Medical Research Council (MRC)  , Motricity Index (MI) BIB003 , and the Motor Evaluation Scale for Upper extremity in Stroke Patients (MESUPES) BIB005 to measure the upper limb impairment in a patient with stroke before and after therapy with VR-supported upper limb rehabilitation. Kinematic analysis and most clinical scales (MRC of fingers, MESUPES and NHPT time, but not MI and FAT) showed a decrease in movement execution time and increase in precision, with improved muscle strenght and movement control  ). VR-mediated telerehabilitation was further investigated  ) by comparing two groups (18 subjects each) of patients with stroke treated for four weeks by a VR-assisted rehabilitation program operated through Internet or by conventional therapy. Motor impairment was assessed one month before, at the beginning and end of therapy, and one month later by means of the Fugl-Meyer Upper Extremity (FM EU), Abilhand BIB004 and Ashworth BIB002 scales. The setting included a virtual teacher showing the correct trajectories as set by the therapist in association with the patient's actual movement. The knowledge-of-performance was provided via videoconference. No differences were observed when comparing the assessments one month before and at beginning of therapy, but both groups improved after therapy and the improvement was evident also one month after the end of therapy. The FM UE showed better recovery for patients treated through VR-based telerehabilitation.