Please select the eligibility criteria that correspond to the clinical trial below.
Title: Trial of Virtual Reality Biofeedback in Patients With Motor Neglect From Chronic Pain or Cerebrovascular Disease
Brief Summary: Motor neglect describes a loss of function without a loss of strength, reflexes or sensation. Motor neglect has been described in patients with traumatic brain injury, stroke and chronic pain conditions, e.g. complex regional pain syndrome. These conditions affect hundreds of thousands of patients in the UK each year and motor neglect is a significant obstacle in their rehabilitation towards a good outcome. By focussing on improving motor neglect, outcomes including function and quality of life for these groups of patients may significantly improve.

Motor neglect is potentially reversible. Rehabilitation using repetition, feedback and motivation are beneficial for optimal outcome. Current protocols use face-to-face physical therapies which can not optimise intensity due to a lack of resources. Furthermore, engagement with exercise is recognised to be poor, in part, due to a lack of attention. Innovative technologies may well improve engagement. Furthermore, telemedicine, or remote delivery of healthcare, offer opportunities in resource management, which can be delivered through the use of such innovative technologies.

Virtual reality systems have been designed and utilised in rehabilitation in various conditions, e.g post-stroke, cerebral palsy and Parkinson's disease. Studies demonstrate improved function in both upper and lower limbs. Potentially more effective treatments for motor neglect utilising such technology are therefore available but need more formal evaluation.

This protocol describes a Phase II randomised controlled trial for both in-patients and out-patients requiring rehabilitation with motor neglect from neurological causes (stroke, traumatic brain injury) and chronic pain conditions (Complex Regional Pain Syndromes, chronic low back pain and referred leg pain (sciatica)). The intervention will be a novel interactive virtual reality system using established technology and tailored software used in conjunction with a treadmill. The control group will be the same screen showing random static images whilst on the treadmill. Rehabilitation for each group will be offered in 3-4 sessions per week for 2 weeks. Each session will last about 30 minutes supervised by a physiotherapist. Follow-up will be by questionnaire at weeks 2, 6 and 12 and by face-to-face consultation at weeks 2 and 12.


Options:
A: Inclusion Criteria:

* Patients with a diagnosis of stroke (of any cause), traumatic brain injury or chronic pain condition of more than 3 months duration (e.g. back and referred leg pain; complex regional pain syndrome; fibromyalgia) who are undergoing an inpatient or out-patient rehabilitation programme
* Motor neglect as assessed by standard clinical examination by a physiotherapist trained to detect such motor neglect (EV). This is defined as weakness and functional impairment without a loss of strength, reflexes or sensation.

Exclusion Criteria:

* Patients with active serious medical problems that might affect their ability to participate in the exercise protocol (e.g. ongoing sepsis; recent myocardial infarction)
* Patients who are unable to use treadmill safely as judged by the screening physiotherapist (EV).
* Patients who are unable to give informed consent, either through issues relating to competency or to language.
* Patients with significant previous experience of virtual reality rehabilitation.
B: Inclusion Criteria:

* Right-handed
* All subjects must be between the ages of 18-80
* Patient with unilateral negligence consecutive to a right hemispheric stroke
* Hospitalized in the Department of Physical Medicine and Rehabilitation (day or week) or external monitoring
* Ischemic or hemorrhagic stroke with right hemispheric topography - evidenced by a radiological report
* Diagnosis of negligence evidenced by Behavioural Inattention Test (BIT) : score ≤ 129
* Stroke \>1 month prior to study enrollment

Exclusion Criteria:

* Degenerative neurological complaint
* Uncontrolled epilepsy
* Temporo-spatial disorientation
* Language disorders or psychiatric disorders preventing understanding instructions
* History of prior stroke, multiple stroke
* Medical condition not stabilized
* Pregnancy
* Implanted material (pacemaker, defibrillator, cochlear implant, surgical clips, metal object)
* Intra-cranial material
* Unweaned alcoholism
C: Inclusion Criteria:

1. Clinical diagnosis of unilateral cerebral infarction or hemorrhage
2. Be able to perform a pinch task with the thumb and index finger
3. With premorbid right-handedness

Exclusion Criteria:

1. Subject has a uncontrolled hypertension
2. Subject has major cognitive-perceptual deficits
3. Subject has other brain disease
D: Inclusion Criteria:

* a first-time stroke in the right hemisphere (confirmed by cranial CT or MRI) within the last six months,
* a left-sided hemispatial neglect (as detected in at least one subtest of the neuropsychological test battery at screening),
* the ability to read and understand German language and
* the ability to give informed consent.

Exclusion Criteria:

* dementia
* other structural brain lesions besides the unilateral stroke (e.g. multiple or bilateral stroke lesions, hydrocephalus, inflammatory lesions, etc.)
* low vision (corrected \<0.7) due to ophthalmological diseases

Answer: A