Use of Virtual Reality Game in Rehabilitation of Stroke Patients in Tan Tock Seng Hospital

Study Overview
=================
Brief Summary
-----------------
Use of SIlverfit 3d to aid in rehab of stroke patients focusing on their shoulder and knee strength

Detailed Description
-----------------
Either 1 of 3 physiotherapists will recruit the patient from NICU if the GCS is 14 - 15. Silverfit 3D will then be used for 20 minutes each day to train the knee and arm strength until the patient's discharge from ICU. Baseline muscle strength will be measured and graded by the physiotherapist using Medical Research Council grading then followed up by the same physiotherapist on discharge from ICU and on discharge from hospital.

Official Title
-----------------
A Proof Of Concept Single Arm Study To Use Virtual Reality in Rehabilitation of Stroke Patients in Neuro Intensive Care Unit in Tan Tock Seng Hospital

Conditions
-----------------
Stroke, Acute

Intervention / Treatment
-----------------
* Device: Silverfit 3D


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients 21 - 90 years old Diagnosis of stroke of pure motor/sensory type affecting the limbs, all levels of severity and at all stages post stroke, defined by the WHO as a syndrome of rapidly developing symptoms and signs of focal, and at times global, loss of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin (WHO 1989), diagnosed by imaging or neurological examination GCS 14 - 15 RASS -1 to +1 Blood pressure within 20% of patient's baseline Muscle power at least 2 out of 5 on the affected side, as assessed by the physiotherapist or clinician Exclusion Criteria: Age less than 21 or more than 90 years old Neurological instability Poor prognosis/expected withdrawal of treatment/palliative care patient Visual loss/hearing loss Active delirium with inability to cooperate as determined by CAM-ICU positivity Severe cognitive impairment/dementia Haemodynamic instability

Ages Eligible for Study
-----------------
Minimum Age: 21 Years
Maximum Age: 90 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: Single Arm study
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Silverfit 3D<br>The subject will use SIlverfit 3D for rehabilitation of his/her shoulder/knee strength post stroke. | Device: Silverfit 3D<br>* Virtual reality game used for rehabilitation of stroke patients<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To estimate an improvement in muscle strength using the Medical Research Council (MRC) grading following the intervention. | Use of MRC grade to estimate improvement in muscle strength by a group of trained physiotherapists before, during and after the use of virtual reality equipment. | 3 months | 
| estimate how much a patient can do compared to his/her baseline in terms of ability to stand/ambulation/reaching out for objects based on the physiotherapist who first saw the patient. | Patients will be interviewed on admission by the physiotherapist to find out his/her baseline activities of daily living/strength and limb power. Physiotherapists will assess the patient again on day of discharge to find out how much the patient is able to return to his/her baseline post stroke. This is a descriptive outcome measure as it is only measured by 1 physiotherapist who has seen the patient on admission and then on discharge from hospital. | 3 months | 
| increase frequency and intensity of rehab activities in stroke patients | To increase frequency of rehab activities in patients in terms of percentage of patients who can do, time of each exercise | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| reduce length of stay in ICU | Reduce length of stay in ICU | 3 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
virtual reality, Silverfit 3D, rehabilitation