Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial

Chien-Yu Huang; Wei-Chi Chiang; Ya-Chin Yeh; Shih-Chen Fan; Wan-Hsien Yang; Ho-Chang Kuo; Ping-Chia Li

doi:10.1186/s12883-021-02547-4

Effects of virtual reality-based motor control training on inflammation, oxidative stress, neuroplasticity and upper limb motor function in patients with chronic stroke: a randomized controlled trial

BMC Neurol. 2022 Jan 11;22(1):21. doi: 10.1186/s12883-021-02547-4.

Authors

Chien-Yu Huang^{1

2}, Wei-Chi Chiang¹, Ya-Chin Yeh^{3

4}, Shih-Chen Fan¹, Wan-Hsien Yang⁵, Ho-Chang Kuo⁶, Ping-Chia Li⁷

Affiliations

¹ Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C.
² School of Occupational Therapy, National Taiwan University, Zhongzheng Dist., Taipei, 100, Taiwan, R.O.C.
³ Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, 741, Taiwan, R.O.C.
⁴ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan, R.O.C.
⁵ Tan-Chi International Technology Co., Ltd, 824, Kaohsiung, Taiwan, R.O.C.
⁶ Kawasaki Disease Center and Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 824, Taiwan R.O.C.
⁷ Department of Occupational Therapy, I-Shou University, Yanchao Dist., Kaohsiung, 824, Taiwan, R.O.C.. pingchiali@gmail.com.

Abstract

Background: Immersive virtual reality (VR)-based motor control training (VRT) is an innovative approach to improve motor function in patients with stroke. Currently, outcome measures for immersive VRT mainly focus on motor function. However, serum biomarkers help detect precise and subtle physiological changes. Therefore, this study aimed to identify the effects of immersive VRT on inflammation, oxidative stress, neuroplasticity and upper limb motor function in stroke patients.

Methods: Thirty patients with chronic stroke were randomized to the VRT or conventional occupational therapy (COT) groups. Serum biomarkers including interleukin 6 (IL-6), intracellular adhesion molecule 1 (ICAM-1), heme oxygenase 1 (HO-1), 8-hydroxy-2-deoxyguanosine (8-OHdG), and brain-derived neurotrophic factor (BDNF) were assessed to reflect inflammation, oxidative stress and neuroplasticity. Clinical assessments including active range of motion of the upper limb and the Fugl-Meyer Assessment for upper extremity (FMA-UE) were also used. Two-way mixed analyses of variance (ANOVAs) were used to examine the effects of the intervention (VRT and COT) and time on serum biomarkers and upper limb motor function.

Results: We found significant time effects in serum IL-6 (p = 0.010), HO-1 (p = 0.002), 8-OHdG (p = 0.045), and all items/subscales of the clinical assessments (ps < 0.05), except FMA-UE-Coordination/Speed (p = 0.055). However, significant group effects existed only in items of the AROM-Elbow Extension (p = 0.007) and AROM-Forearm Pronation (p = 0.048). Moreover, significant interactions between time and group existed in item/subscales of FMA-UE-Shoulder/Elbow/Forearm (p = 0.004), FMA-UE-Total score (p = 0.008), and AROM-Shoulder Flexion (p = 0.001).

Conclusion: This was the first study to combine the effectiveness of immersive VRT using serum biomarkers as outcome measures. Our study demonstrated promising results that support the further application of commercial and immersive VR technologies in patients with chronic stroke.

Keywords: 8-hydroxydeoxyguanosine (8-OHdG); Brain-derived neurotrophic factor (BDNF); Heme oxygenase-1 (HO-1); Inflammation; Neuroplasticity; Oxidative stress; Stroke rehabilitation; Virtual reality (VR).

Publication types

Randomized Controlled Trial

MeSH terms

Humans
Inflammation
Neuronal Plasticity
Oxidative Stress
Recovery of Function
Stroke Rehabilitation*
Stroke* / therapy
Treatment Outcome
Upper Extremity
Virtual Reality*