Occupational therapists (OTs) at MossRehab Jenkintown have a new virtual reality (VR) rehabilitation tool that helps patients recover from stroke. Focusing on upper body and cognitive functions, the REAL System features activities that help patients improve core strength, mobility, range of motion, eye-hand coordination, decision-making, memory processing, balance, and functional movements associated with activities of daily living.

“A stroke generally causes damage in a certain area of the brain, resulting in physical, communication, and cognitive deficits,” explains Kristin Beltz, OTR/L, who has worked 10 of her more than 14 years at MossRehab in the Stroke Comprehensive Outpatient Rehabilitation (SCOR) Program at the Jenkintown location. “As occupational therapists, we look at deficits that impact a patient’s ability to participate in meaningful activities or perform basic self-care tasks. So, if patients want to cook, we evaluate if they can follow a recipe, use their hands to stir, or keep their balance at the stove. After identifying patient impairments and strengths, we generate treatment activities and interventions that specifically target these areas.”

Composed of a VR headset and wireless sensor bands that patients wear on their body, the REAL System transports users into a virtual world featuring realistic visual representations of their arms and hands while participating in different activities.

“I’m using the REAL system for a patient with visual deficits caused by a stroke. One eye is slightly weaker from a motor perspective, so it drags a bit when the eyes move together,” explains Melissa Meyers, OTD, OTR/L, who has worked for over a decade with patients recovering from a stroke at MossRehab Jenkintown. “The patient plays VR games where he scans objects using both eyes and turns his head to find different targets. He likes working in the VR environment because it doesn’t have distractions and allows him to focus better.”  

Life-changing experience

While some individuals are more receptive than others to using the device during rehab, results were life-changing for one patient who was having a hard time demonstrating improvements with conventional therapeutic practices.

“The first time this patient used the REAL VR system, she started moving her arm in a way I hadn’t previously seen,” notes Beltz. “Seeing a visual representation of her arm moving at a slightly better pace than her actual movement engaged her brain differently. She and her family cried during the first session and became more invested and hopeful for her recovery.”

Beltz explains that when patients participate in activities using the VR tool, movements appear more fluid so individuals are not as self-conscious about moving their hands and arms more. OTs can scale efforts to give patients an extra push to try harder and duplicate the image seen in virtual reality.

In addition, the therapists can grade a game for someone who is very self-conscious or doesn’t have a lot of movement to ensure success. So, a patient at a very impaired level can participate and be successful, which makes them engage and persist longer in the action.

“An activity called Creative Canvas enables a person to paint using a non-dominant hand,” notes Meyers. “I have a patient in his 70s with left-sided weakness. He likes the painting activity because he can use his hands more freely than painting in real life. The game gives him the opportunity to move his left hand and practice motion that he could not do in a real environment.”

Greater engagement, better outcomes

Engagement is important in rehabilitation. Full participation in therapeutic activities at high repetitions are proven ingredients to better patient outcomes. For both young and old at any age, the REAL VR system makes a difference in rehab engagement.

"I have a patient in his 20s with weakness on one side of his body, that had a hard time persisting with routine therapy activities at a level needed to see motor improvement,” says Meyers. “The VR technology provided a way to do those same movements in a virtual context that was more engaging and exciting.”

For some patients, the games featured in the REAL system tune out distractions and the environment so they can focus on activities longer. “Sometimes, I have patients with difficulties in physical and cognitive endurance who benefit from working on sustaining attention and improving focus for long periods during therapy,” says Beltz, “The device helps in this regard.”

Gamers and non-gamers benefit

Patients don’t need to be gamers to appreciate and respond well to the REAL system. “I've had individuals use it who were in their 80s,” says Beltz. “They responded very well to it even though they are not a gamer or even familiar with this kind of technology.”

On the other hand, a patient in a more chronic stage that was plateauing with conventional therapy showed significant improvements with the REAL system as she was a gamer. The activities tapped into prior skills and interests, leading to increased persistence and greater enjoyment and participation in therapy. 

VR therapy has the best efficacy when used in combination with conventional therapy. It also requires a therapist to understand how to utilize this technology to translate skills and improvements made in VR therapy into participation in real world activities. “I’ll use it for 15 to 30 minutes of a 60-minute therapy session, depending on the patient and what they like,” says Meyers. “The remainder of the session is used to make a connection between activities used in VR therapy and improving skills in the patient’s real life. Overall, I find it to be engaging and motivating for most patients.”

MossRehab maintains one of the largest portfolios of robotics that help therapists treat patients in their recovery and it continually adds cutting-edge technology to maintain its competitive edge in care.  (Read how MossRehab researches new therapy tools that integrate gaming and virtual reality elements.)

“MossRehab picks technology that offers meaningful activities to achieve meaningful outcomes while having the evidence to support it,” explains Meyers. “The REAL System is an important addition as it is small, compact, and mobile and offers multiple and engaging uses in one piece of equipment.”

Get more details on MossRehab's SCOR program , which provides outpatient services for patients who had a stroke or traumatic brain injury.