In a new article from the series "CUREosity explains" we go into detail about what stroke means. What are the causes? How do the treatment options look like? We show that VR therapy is increasingly recommended in the field of stroke therapy and that our system CUREO, among other indications, was designed precisely for such therapy.
Definition Stroke
A stroke, or apoplexy, is a sudden neurological deficit due to a focal (originating from a disease focus) brain dysfunction. Among the causes of this brain dysfunction, a distinction is made between ischemic stroke and hemorrhagic stroke.
Ischemic stroke is much more common, occurring in about 80-85% of cases, and is caused by vascular occlusion. This occlusion causes a deficiency of blood supply to the brain up to the interruption of the cerebral blood supply, which leads to the undersupply of the brain with oxygen and nutrients.
Cause of stroke (apoplexy)
Approximately 10-15% of all apoplectic strokes are due to a hemorrhagic stroke, which is caused by a cerebral hemorrhage. This can occur either directly in the brain (intracerebral hemorrhage) or in the subarachnoid space between two meninges, where cerebrospinal fluid circulates (subarachnoid hemorrhage, SAB). In the case of hemorrhagic stroke, the neurological deficits are caused by an increase in intracranial pressure (intracranial pressure), by a lack of oxygen and nutrient supply, or by a neurotoxic effect.
Stroke is the second leading cause of death worldwide and one of the most common causes of adult disability. 40% of survivors suffer long-term limitations in activities of daily living.
Signs of stroke
The following symptoms occur with a stroke:
Dysarthria (speech disorder), aphasia (language disorder), dysgraphia (writing disorder).
Contralateral hemiparesis (hemiplegia)
Altered gait pattern
Dizziness, nausea, acute headache
Memory impairment
Loss of consciousness until coma
If a stroke is suspected, fast action is essential. The "FAST test" can be used at home. The "F" stands for Face. The affected person is unable to smile normally. The "A" stands for Arms, which a person restricted by the stroke cannot lift at the same time. The third letter "S" stands for Speech. A stroke patient cannot repeat a simple sentence. The "T" represents Time. If the affected person has problems with the above-mentioned tasks, the emergency physician must be called immediately with the indication "Suspicion of stroke". Early therapy is particularly important: the number of neurons (brain cells) damaged by stroke is 1.9 million per minute, so only a few seconds can mean long-term damage.
Stroke diagnosis and treatment
In the hospital, a cerebral hemorrhage is identified mainly by computed tomography (CT). There are two options for removing the vascular blockage (thrombus). One is intravenous thrombolysis, in which a drug is given directly into the vein. This drug dissolves the structure of the thrombus, thus opening the blockage.
Secondly, the thrombus can be removed mechanically, endovascularly. This involves inserting a catheter, which the physician can use to drain the thrombus. Both forms can also be used adjuvantly (complementing/supporting each other).
Therapy and rehabilitation after stroke
After the treatment of the acute cause, the determination of deficits (e.g. swallowing disorders), as well as rehabilitation should be started as early as possible. In this way, deterioration can be counteracted and the best possible restoration of the patient's abilities can be achieved. Physical and occupational therapy as well as speech therapy, among others, are used to achieve this goal. However, in addition to conventional therapy methods, VR therapy is increasingly being referred to.
VR therapy for stroke patients
According to the S3 guideline of the DGNR (German Society for Neurorehabilitation), the following is listed:
"Thus, the efficacy of VR-based therapies varied across the studies assessed; superiority was most evident when VR-based therapy was offered in addition and at sufficient therapy intensity; content and therapy dose of each system should be considered in relation to individual therapy goals; specialized systems developed for rehabilitation may be more therapeutically effective compared with commercial game consoles; use of a haptic interface may be favorable.
Recommendation
For subacute and chronic stroke patients with mild to moderate arm paresis or, in the case of devices with arm weight support, also with severe incomplete paresis, VR-assisted hand training or arm training can be additionally considered in a facility or as home-based self-training if the treatment goal is the improvement of selective movement ability or active range of motion (evidence 1a, estimate of effects: low quality; grade of recommendation 0; strong consensus)." (S3 Guideline DGNR, pp. 127-128).
Use of CUREO as VR therapy for stroke
CUREO is developed for motor and cognitive rehabilitation for the indication, among others, stroke of ischemic- or hemorrhagic genesis with residual hemiplegia/paresis and is based on virtual reality. Thus, further possibilities can be offered that are not feasible in the context of conventional therapy and are listed by the DGNR as supporting methods in the context of rehabilitation.
CUREO offers:
Possibility of flexible, stepless change of therapy methods and parameters adapted to the therapy situation.
Individual adaptation to patient and acute therapy situation by the therapist without disturbing the patient in his immersive therapy setting
Multimodal and multisensory guidance and immediate feedback to the patient
Possibility of unilateral, bilateral or mixed arm training and/or preference for one side of the body
Possibility of integrating mirror therapy, if necessary, into the course of therapy
The application of CUREO additionally motivates patients and offers, for example, relaxation exercises in the "relax" module in addition to physical and occupational therapy exercises. In "daily", patients can prepare themselves for everyday activities in the home and are supported in expanding their visual field and training their cognitive performance.
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