At the end of last year, the Congress of the German Society for Neurorehabilitation (DGNR) was held together with the European Congress of Neurorehabilitation as an online event from December 8 to 11, 2021.
True to the motto "Neurorehabilitation - where did we come, where do we go?", the milestones of neurorehabilitation were highlighted and a look into the future was ventured. In exciting event blocks with top-class lectures, current advances in research and patient treatment were presented and discussed, and the use of virtual reality (VR) of neurorehabilitation was omnipresent. In addition, there is growing evidence that VR-based therapies are helping patients in rehab at least as much as conventional therapies.
CUREO study at the St. Mauritius Therapy Clinic
A highlight of the DGNR for us was the presentation of the CUREO study at the St. Mauritius Therapy Clinic in Meerbusch (STMTK) as part of the lecture series "Berufsverband 1 DVE: Deutscher Verband der Ergotherapeuten e.V.". The study entitled "Study on the effectiveness of VR-assisted occupational therapy of the upper extremities after stroke" was initiated in October 2020 by Prof. Dr. med. Schmidt-Wilcke (former head physician of Neurology II at the St Mauritius Therapy Clinic in Meerbusch, now head physician at the Neurological Center of the Mainkofen District Hospital) at the STMTK. Dr. Bettina Studer (former head of research and development at STMTK and private lecturer at Heinrich-Heine-University (HHU) Düsseldorf, now at Hocoma) and Dr. Heidrun Pickenbrock (head of motor function at STMTK) presented the current evidence of VR therapy and the CUREO study very clearly in a 30-minute lecture and were able to present the first interim results.
Comparison of VR therapy and non-immersive therapy
The aim of the study is to compare the clinical efficacy of two device-based VR therapy methods for the treatment of hemiparesis after stroke. A CUREO prototype (immersive VR therapy) was compared with the Armeo®Spring (non-immersive VR therapy) to investigate the success in a therapy program to restore gross motor movements. In doing so, the main research question is whether the therapy with CUREO is not inferior to the already established Armeo®Spring therapy.
Positive interim results
After enrolling half of the patients, first interim results could now be presented by Dr. Bettina Studer and Dr. Heidrun Pickenbrock. In total, 27 of 60 targeted patients have been fully enrolled in the study so far. The patients have completed a total of 10 units of VR therapy (CUREO or Armeo®Spring) in combination with conventional occupational therapy over 3 weeks. The patients have severely limited arm ability after stroke and an average age of 74 years.
Across the entire group, the before-after comparison shows a clear improvement in arm ability with both therapies, as measured by the Action Reach Arm Test (ARAT, see figure below). It is becoming apparent that therapy with our VR system CUREO is not inferior to Armeo®Spring therapy. On the contrary, at present CUREO seems to induce a stronger improvement when comparing the mean values (CUREO: +16.6 points; Armeo®Spring: +5.18 points on the ARAT scale) (Figure 2).
In addition, the individual therapy results of the patients were shown. It appears that the majority of patients benefit from a clinically relevant improvement. There also appears to be a trend for more treated patients to improve in a clinically relevant manner compared to Armeo®Spring therapy (8 of 16), with CUREO therapy (8 of 11). We will await the further course of the study to draw a definitive conclusion and to respect spontaneous remissions (Figure 3).
The study is expected to be completed this year, so that final statements on the effectiveness of VR therapy in patients with severe arm paresis after stroke can be derived. It can already be stated that immersive VR therapy offers very great potential in neurorehabilitation.
By the way: For the study, the clinic was provided with a prototype of CUREO, with which the two therapy programs "Meteor" and "Caterpillar Race" can be performed. In comparison: Our current system has a total of 6 modules with over 16 therapy applications.
Further VR highlights of the DGNR
In addition to the CUREO study, many other highlights were presented. These included the promising study results of the Charité by Prof. Carsten Finke, MD. He showed the high potential of VR for the diagnosis of Alzheimer patients as well as for their therapy. For this purpose, the Charité used the tracking of motion vectors via VR to investigate the spatial memory of Alzheimer's patients. In doing so, the VR system was able to achieve more specific results of ability than the traditional pen-and-paper test.
Enriched Environments
The topic of VR as an "enriched environment" in therapy settings was also very interesting. Prof. Dr. Dr. Volker Hömberg, head physician for neurology, and senior physician Dr. Dana Boering (both from the Bad Wimpfen Health Center) vividly demonstrated that a lack of stimulating environments can have a negative impact on rehabilitation outcomes. Thus, new strategies for motivating and stimulating environments are needed to best promote rehabilitation. However, these demands usually exceed existing resources in clinical practice. It is at this point that VR is handled as a promising solution, for a varied and stimulating environment through immersion as well as for increasing patients' motivation through gamification.
Prof. Dr. Dr. Hömberg concludes by recommending that the new possibilities of VR and gamification should be used and integrated for rehabilitation. It is also important to evaluate and promote the interaction between medicine and software development.
Dr. Müller underlines this appeal in her presentation "VR Reha - More than just a gimmick", in which she comments positively on the added value of VR in rehabilitation and concludes that the patient should always be the focus of development.
We are very proud to be a part of modern VR neurorehabilitation with CUREO and hope to support many patients and therapists in therapy in the future.
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