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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EStroke is a leading cause of adult disability, and around two thirds of stroke survivors continue to experience motor deficits in their arms and hands that are associated with diminished quality of life [Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. The current paradigm in stroke rehabilitation involves repetitive, high-intensity, task-specific stimulation to improve motor recovery [Luft AR, Hanley DF. \u003Cem\u003EJAMA\u003C\/em\u003E 2006; Kalra L, Ratan R. \u003Cem\u003EStroke\u003C\/em\u003E 2007]. However, only a few of the current techniques have effectively shown a significant improvement in arm function after stroke [Langhorne P et al. \u003Cem\u003ELancet Neurol\u003C\/em\u003E 2009]. There are many benefits of using virtual reality (VR) gaming technology in stroke rehabilitation and how VR may engage the brain reward system.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESystemic Atrophies\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EFeatured Meeting - Specialty page\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECerebrovascular Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESystemic Atrophies\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EStroke is a leading cause of adult disability, and around two thirds of stroke survivors continue to experience motor deficits in their arms and hands that are associated with diminished quality of life [Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. The current paradigm in stroke rehabilitation involves repetitive, high-intensity, task-specific stimulation to improve motor recovery [Luft AR, Hanley DF. \u003Cem\u003EJAMA\u003C\/em\u003E 2006; Kalra L, Ratan R. \u003Cem\u003EStroke\u003C\/em\u003E 2007]. However, only a few of the current techniques have effectively shown a significant improvement in arm function after stroke [Langhorne P et al. \u003Cem\u003ELancet Neurol\u003C\/em\u003E 2009]. Gustavo Saposnik, MD, MSc, St. Michael\u0027s Hospital, University of Toronto, Toronto, Ontario, Canada, presented the benefits of using virtual reality (VR) gaming technology in stroke rehabilitation and how VR may engage the brain reward system.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EConventional stroke rehabilitation has several limitations [Langhorne P et al. \u003Cem\u003ELancet Neurol\u003C\/em\u003E 2009]. It is time consuming, and labor and resource intensive. It provides modest effects that are initially underappreciated by stroke survivors, and compliance problems and high dropout rates can limit recovery. In addition, in certain regions the availability and conventional rehabilitation may be costly.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EVR allows a user to interact with a multisensory computer-simulated environment and receive instant feedback on performance. Neuroplasticity and the reorganization of cerebral activity are the basis of stroke rehabilitation, and VR has the potential to affect neuroplasticity through repetition, intensity, and task-oriented training [Kalra L, Ratan R. \u003Cem\u003EStroke\u003C\/em\u003E 2007; Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. The availability of VR video game systems for home use has made this technology less expensive, and more accessible to clinicians and patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA meta-analysis of the available data on VR in stroke rehabilitation revealed that 11 of 12 studies showed a significant benefit of VR in stroke rehabilitation [Saposnik G et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011]. Five small clinical trials showed that patients randomized to VR were nearly 5 times more likely to benefit compared with controls. Among observational studies, there was a 20.1% (95% CI, 11.0 to 33.8) improvement in motor function and a 14.7% (95% CI, 8.7 to 23.6) improvement in motor impairment after several 30- to 60-minute VR sessions in a 4- to 6-week time period (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Meta-Analysis of Observational Studies Using Virtual Reality Systems in Upper Limb Stroke Rehabilitation\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1634961403\u0022 data-figure-caption=\u0022Meta-Analysis of Observational Studies Using Virtual Reality Systems in Upper Limb Stroke Rehabilitation\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/34\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/34\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/34\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12853\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMeta-Analysis of Observational Studies Using Virtual Reality Systems in Upper Limb Stroke Rehabilitation\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAdapted from Saposnik et al. \u003Cem\u003EStroke\u003C\/em\u003E 2011.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003ECurrently, the Efficacy of Virtual Reality Exercises in Stroke Rehabilitation [EVREST; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01406912\u0026amp;atom=%2Fspmdc%2F13%2F1%2F34.atom\u0022\u003ENCT01406912\u003C\/a\u003E] multicenter trial is evaluating the effectiveness of the Nintendo Wii gaming technology in promoting motor function improvement of the upper extremities in stroke survivors. Initiated in Canada, and funded by Heart and Stroke Foundation of Canada and the Ontario Ministry of Health, EVREST is being expanded to other countries, including Argentina, Brazil, Peru, Thailand, and possibly the United States. This trial is applying the basic concepts in stroke rehabilitation. It may also engage the \u201cmirror neuron\u201d system, which is a set of neurons activated when individuals observe an action performed by someone else, and the \u201cbrain reward system\u201d to promote motor recovery.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe brain reward system, which can be activated by a VR game, involves the mesolimbic structures of the brain and is dopamine-mediated. For the brain reward system to be activated, the game has to be emotionally engaging; give credit for everything the patient does; provide rapid, frequent, and clear feedback; and involve an element of uncertainty.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Saposnik said, \u201cVirtual reality is a novel, affordable, and enjoyable intervention that may help intensify treatment and promote motor recovery after stroke.\u201d He also emphasized that larger randomized studies are needed before changing practice. He noted that \u201crewarding the brain is a powerful mechanism to embrace rehabilitation after stroke.\u201d\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/1\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo3z1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo3z1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}