It is well known that strokes often have serious, lasting effects on patients as discussed in a previous post. While the cognitive complications from stroke may be more commonly heard of, psychological effects of stroke are possible and common for post-stroke patients. Such effects like anxiety and depression are thought to be attributed to the physical injury and disruption of the brain, decreased quality of life from the stroke, and/or a combination of preexisting personality traits. Anxiety after a stroke is common among post-stroke patients and persistent, as it can be further complicated by changes in cognitive function. Past study has shown that implementation of standard relaxation techniques such as diaphragmatic ‘deep’ breathing, progressive relaxation of muscles and autogenic training can help such patients suffering from anxiety when used during rehabilitation. Additionally, technologies for stroke rehabilitation have been researched and implemented in past study such as virtual reality (VR) with interactive games. Studies have shown positive results for post stroke patients as well as patients undergoing treatment for mood and anxiety disorders. These studies most likely helped to motivate the research team from IRCCS Centro Neurolesi to further explore the combination of these two rehabilitation methods, VR and standard relaxation methods.
Researchers conducted a study on a woman who had suffered a hemorrhagic stroke 5 months prior. Over the course of 2 months, she received rehabilitation therapy for emotional and cognitive conditions. She experienced two types of rehabilitation: standard relaxation with diaphragmatic breathing, and a combined therapy of diaphragmatic breathing and VR. To assess the therapies, the cognition and psychological conditions of the patient were evaluated by a neuropsychologist. During the standard rehabilitation sessions, the patient was instructed to breathe in a specific way, focusing on the diaphragm. For the combination rehabilitation sessions, the NIRVANA system from BTS Bioengineering was utilized. NIRVANA is multisensory stimulation VR system developed for motor and cognitive rehabilitation. The system consists of a marker less infrared sensor and large screen in addition to the computer and workstation to operate the system. NIRVANA includes many different movement games and tests which are adaptable for difficulty. For this study, calming landscapes were used with audio-video sensory feedback and sensory motor interaction.
It was found that for the combined therapy of breathing training in the VR environment, researchers observed significant improvements in both cognitive and behavioral function. While the standard therapy without VR led to significant improvements in attention functions, the combination therapy including VR demonstrated more improvement. Specifically, the patient demonstrated significantly improved attention processes and verbal memory as well as a reduced anxiety symptoms after the end of the three-month therapy program. The patient demonstrated more positive attitudes towards solutions to problems and decreased prevalence of avoidance strategies. Coping strategies were improved as well vital parameters: the patient’s heart rate and blood pressure gradually decreased. Researchers also stated how the reduction of anxiety may have also factored in to the improved motor function, as the reduction of anxiety could have helped the patient relax and perform functional movements.
The results of this study may help the approach of more holistic rehabilitation. Attention to motor rehabilitation and cognitive function is vastly important for post-stroke patients and addressing the full-body response to stroke can help to improve the wellbeing of a patient to improve quality of life. It is important that we do not discount the emotional and psychological factors of the body when addressing movement and function, as it is clear there are vital connections with mental health and function of the body. This study is just one example of how powerful the combination of technology and interdisciplinary, conscientious healthcare practices can improve the life of those who suffer.
To read about other work from the IRCCS Centro Neurolesi, check out a previous post, Stroke Series: Virtual reality rehabilitation
This article was based on the following article, cited:
De Luca, R., Torrisi, M., Piccolo, A., Bonfiglio, G., Tomasello, P., Naro, A., & Calabrò, R. S. (2018). Improving post-stroke cognitive and behavioral abnormalities by using virtual reality: A case report on a novel use of nirvana. Applied Neuropsychology: Adult, 25(6), 581-585.