A Music-based VR Intervention for Upper Limb Motor Rehabilitation in Hemiparetic Patients

Study Overview
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Brief Summary
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Hemiparesis affects the majority of stroke patients in the acute phase. In post-stroke motor rehabilitation patients can re-learn motor sequences through repetitive training. Research showed that virtual reality (VR) can be effectively used in upper limb motor rehabilitation by training motor coordination and gestures in an immersive virtual environment. Another promising line of intervention in post-stroke rehabilitation is the use of music, with evidence supporting the notion that a rhythmic accompaniment promotes the recovery of motor coordination in patients with hemiparetic stroke. Furthermore, studies showed a beneficial effect of the observation of movements performed by a third person in patients with post-stroke hemiparesis. Based this evidence, the present study aims at testing the feasibility and efficacy of a novel music-based VR intervention designed for upper limb motor rehabilitation in post-stroke hemiparetic patients. The treatment consists in upper limb repetitive training activities through the imitation of movements synchronized with a musical accompaniment and is delivered in 10 sessions over 2 weeks, supervised by a physical therapist. Participants wear a VR headset through which they observe egocentric 180° 3D videoclips. The experimental condition (group A) will be compared with a no-music condition (group B), to test the specific effect of music, and with traditional physiotherapy rehabilitation (group C), to test the efficacy of the approach. The investigators expect that the patients undergoing the experimental intervention (group A and group B) will show a greater upper limb motor function improvement, as compared to the active control group. As a secondary endpoint the investigators expect the music component to induce a greater motor improvement as compared to the experimental condition without music.

Official Title
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Music in Action: A Music-based Virtual Reality Intervention for Upper Limb Motor Rehabilitation in Post-stroke Hemiparetic Patients

Conditions
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Hemiparesis

Intervention / Treatment
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* Behavioral: VR+MUSIC
* Behavioral: VR
* Behavioral: TAU


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Post-stroke patients in acute/subacute phase Upper limb hemiparesis (Ashworth scale: 0-2; MRC scale: 3-5) Age between 18 and 80 years Currently enrolled in inpatient rehabilitation Exclusion Criteria: Psychiatric disorders, Neglect Epilepsy MMSE rating < 24 Difficulty with visual-spatial exploration Visual deficits.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: VR+MUSIC<br>Upper limb repetitive training activities through the imitation of movements (i.e., unscrew the cap of a bottle, pour water into a glass, drink water from a glass, sugaring coffee, placing an object in a box) synchronized with a musical accompaniment (i.e., a selection of classical music pieces). Participants will wear a VR headset (Gear VR, Samsung) through which they will observe egocentric 180° 3D videoclips shot from a first-person perspective, as if the patient himself was performing the movement, while listening to music. | Behavioral: VR+MUSIC<br>* A novel VR intervention designed for upper limb motor rehabilitation in post-stroke hemiparetic patients consisting in 10 daily sessions of 30 minutes, over 2 weeks, supervised by a physical therapist.<br>|
| Experimental: VR<br>Upper limb repetitive training activities through imitation of movements, without any musical accompaniment. Participants will wear a VR headset through which they will observe egocentric 180° 3D silent videoclips. | Behavioral: VR<br>* A novel VR intervention designed for upper limb motor rehabilitation in post-stroke hemiparetic patients consisting in 10 daily sessions of 30 minutes, over 2 weeks, supervised by a physical therapist.<br>|
| Active Comparator: TAU<br>Treatment as usual (TAU). Patients will be engaged in upper limb repetitive training activities through traditional physiotherapy rehabilitation. | Behavioral: TAU<br>* Traditional post-stroke upper limb motor rehabilitation under the supervision of a physical therapist, for 0 daily sessions of 30 minutes, over 2 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Motricity Index (Collin, 1990) | Motricity scale | 2 weeks post-test | 
| Medical Research Council (MRC) Muscle strength scale (Paternostro-Slug et al., 2008) | Muscle strenght scale | 2 weeks post-test | 
| The Chedoke arm and Hand Activity Inventory (CAHAI) - short form (Barreca, 2013) | Hand activity scale | 2 weeks post-test | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Virtual reality, Music, Motor coordination, Embodied cognition, Rehabilitation, Action observation