VR-based Rehabilitation in the Treatment and Prevention of Sarcopenia of Older Residents
Condition: Sarcopenia
MeSH terms: Sarcopenia
Study type: Interventional

Summary: 
      Background:

      Sarcopenia is the progressive loss of skeletal muscle mass and decline of muscle function
      associated with aging. The prevalence of sarcopenia among people older than 65 years old in
      Taiwan is over 20%. Sarcopenia is one of the most important causes of functional decline and
      loss of independence, even mortality in older adults. Literatures have found that resistant
      or aerobic exercise could improve muscle strength and function in older adults. However, due
      to shortage in healthcare provider, long-term rehabilitation program is difficult to provide
      in senior caring facilities of countryside in Taiwan.

      Method:

      The investigators conducted a study to screen sarcopenia among residents in senior caring
      facilities in Ci-Shan and Mei-Nong district, Kaohsiung, Taiwan. Older adults diagnosed as
      sarcopenia after screening received a virtual reality (VR)-based rehabilitation program that
      lasts for 12 weeks, twice per week, 30 minutes per time. The program was combined with
      progressive resistant training and functional movement of dominant upper (UE) limb. Criteria
      of sarcopenia including (1) handgrip strength of dominant hand (HGS), (2) walking speed, and
      (3) skeletal muscle mass of 4 extremities (SKM), were measured as primary outcomes. (1) Range
      of motions in dominant UE (ROM), (2) maximal voluntary isometric contraction of
      biceps/triceps brachial muscles of dominant side (MVC of biceps/triceps), and (3) box and
      block test (BBT), were measured as secondary outcomes before and after the programs.

      Anticipated benefits:

      VR-based rehabilitation program could enhance the motivation toward rehabilitation of older
      adults and reduce the health provider demand of senior caring facilities in countryside. It
      could also increase muscle mass, strength, and functional ability of dominant UE and reach
      the clinical effectiveness in treatment of sarcopenia.
    

Detailed description: 
      Sarcopenia is an involuntary loss of skeletal muscle mass and strength related with age. It
      is one of the most important causes of functional decline and loss of independence in older
      adults. In Taiwan, more than 20% of elders over the age of 65 are diagnosed with sarcopenia,
      and most of them are institutionalized. However, due to the lack of medical resources and
      medical professions, only a few elders with sarcopenia have received adequate rehabilitation.
      Recently, there are prevalence of research about integrating Virtual-Reality (VR) into
      various rehabilitations. Most of them have found that these VR-based rehabilitation can boost
      the motivation for participation, decrease the use of medical resources, and effectively
      contribute to the recovery of the patients. Inspired from these results, I think it might be
      interesting to integrate VR into the sarcopenia rehabilitation of elders.

      This research has combined existed VR games with progressive resistance exercise of the upper
      limbs and exercises for the function movement system (F.M.S) of the upper limbs, establishing
      a VR-based rehabilitation program designed for sarcopenia elders. The rehabilitation programs
      spans for 8 weeks, and is conducted at least twice a week for each subject. The research
      question of this research is: "What is the impact of Virtual Reality-based rehabilitation on
      upper limb sarcopenia patient?".

      The primary outcome of this research examines the change in muscle mass (measured by skeletal
      mass index, fat mass index and fat-free mass index), hand grip strength of the dominant hand
      and gait speed. The secondary outcome of this research examines the the change in range of
      motion of the upper limbs (shoulder flexion, shoulder external rotation, shoulder abduction,
      elbow flexion, elbow extension, elbow supination, elbow pronation, wrist flexion, wrist
      extension) and the functional ability of the upper limbs (measured by box and block test).

      Hypothesis:

        1. After two months of participating in the rehabilitation program, the primary outcomes
           (muscle mass, hand grip strength, and gait speed), show statistically significant
           increase.

        2. After two months of participating in the rehabilitation program, the secondary outcomes
           (change of range of motion of the upper limbs and functional ability of upper limbs)
           show statistically significant increase.

      Flow of the research:

        1. Sarcopenia patients are first selected from the daycare and nursing home of Chi-Shan
           Hospital.

        2. The first period of rehabilitation begins right after the selection and lasts for one
           month.

        3. The first evaluation begins after the first period of rehabilitation

        4. The second period of rehabilitation begins and lasts for one month.

        5. The second evaluation begins after the second period of rehabilitation.

      Apparatus in this study:

        1. Leap Motion Controller

        2. Oculus Rift headset (CV1)

        3. Oculus Sensors (a pair)

        4. (oculus) Touch Controllers

        5. Omron KARADA Scan Body Composition & Scale (HBF-701)

        6. JAMAR Hand Dynamometer

        7. MicroFET3 Dynamometer and ROM Evaluator

        8. Goniometer

        9. Box and Block Test Apparatus
    

Intervention name(s): Virtual reality-based rehabilitation programs
Intervention type(s): Other
Intervention description(s): A virtual reality (VR)-based rehabilitation program that lasts for 12 weeks, twice per week, 30 minutes per time. The program was combined with progressive resistant training and functional movement of dominant upper (UE) limb. The device of the VR including one computer, one oculus headset, and one hand-hold sensor. The rehabilitation secession contains 4 different VR games in total, including (1) Leap Motion Blocks (2) Slum Ball VR Tournament (3) VR Super Sports 10th Edition- Basketball (4) VR Super Sports 10th Edition- Soccer.
Intervention model: Single Group Assignment
Intervention model description: elder residents in caring facilities, including nursing home and daycare center 15 participants in nursing home and 15 participants in daycare center
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: virtual reality; sarcopenia; elderly