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PLoS One. 2018 Oct 24;13(10):e0204455. doi: 10.1371/journal.pone.0204455. eCollection 2018.

Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial.

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Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.
Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland.
Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland.
Physiotherapy Department, Buergerspital Solothurn, Solothurn, Switzerland.
Physiotherapy Department, Zurcher RehaZentrum Lengg, Zurich, Switzerland.
Institute of Human Movement Sciences, ETH Zurich, Zurich, Switzerland.



Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery.


The aim of this study was to directly compare virtual reality-based training with conventional therapy.


In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16x45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects. Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale).


54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20-81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences.


Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients.


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Conflict of interest statement

All co-authors report grants from Swiss Commission for Technology and Innovation and non-financial support from YouRehab AG (now renamed REHA STIM MEDTEC AG) during the conduct of the study. KE and DK declare personal fees from YouRehab AG (now renamed REHA STIM MEDTEC AG) outside the submitted work. In addition, KE and DK have a patent US13060344 (Adjustable virtual reality system) with royalties paid to YouRehab AG (now renamed REHA STIM MEDTEC AG) and were co-founder and KE former CTO (part-time) of YouRehab AG (now renamed REHA STIM MEDTEC AG) during part of the study period. The study funding organization, the Swiss Commission for Technology and Innovation, had no authority over and was not involved in the study design; the collection, management, analysis or interpretation of data; the writing of the report; and the decision to submit the report for publication. The study sponsor (YouRehab AG (now renamed REHA STIM MEDTEC AG)) was involved in the study design. They did not write the study report and did not have authority over the decision to submit the study report for publication.

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