Combining aerobic exercise with virtual reality for stroke rehabilitation

Priming the Rehabilitation Engine: Aerobic Exercise as the Fuel to Spark Behavioral Improvements in Stroke

This study is testing if combining aerobic exercise with a fun virtual reality game can help stroke survivors improve their movement and thinking skills during rehabilitation.

Quick facts

• Phase: Early Phase 1
• Study type: Interventional
• Enrollment: 40 (estimated)
• Ages: 50 Years to 90 Years
• Sex: All
• Sponsor: VA Office of Research and Development (Federal)
• Locations: 1 site (Charleston, South Carolina)
• Trial ID: NCT04877444 on ClinicalTrials.gov

What this trial studies

This project investigates the effects of aerobic exercise (AEx) as a priming tool to enhance motor rehabilitation in chronic stroke survivors. The study aims to combine AEx with a virtual reality rehabilitation game called Duck Duck Punch to improve physical and cognitive functions. Participants will undergo an 8-week program where they will engage in AEx before targeted rehabilitation sessions. The goal is to create a neuroplastic environment that enhances the brain's ability to adapt and respond to rehabilitation efforts.

Who should consider this trial

Good fit: Ideal candidates are chronic stroke survivors aged 50-90 with moderate arm movement impairment who can engage in aerobic exercise.

Not a fit: Patients with lesions in the brainstem or cerebellum, or other neurological diseases that impair motor learning, may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly improve physical and mental recovery outcomes for stroke survivors.

How similar studies have performed: Other studies have shown promising results using aerobic exercise as a priming tool for rehabilitation, suggesting potential success for this approach.

Eligibility criteria

Inclusion Criteria:

* experienced unilateral stroke at least 6 months prior;
* voluntarily shoulder flexion of the affected arm 20 degrees with simultaneous elbow extension 10 degrees;
* moderate arm movement impairment (UE Fugl-Meyer Assessment \> 21 but \< 52 points;
* passive range of motion in paretic shoulder, elbow, wrist, thumb and fingers within 20 degrees of normal;
* 50-90 years of age;
* ability to communicate as per the therapists' judgement at baseline testing;
* ability to complete and pass an exercise tolerance test; 8) Box \& Block test score of at least 3 blocks in 60 seconds with the affected arm.

Exclusion Criteria:

* lesion in brainstem/cerebellum as these may interfere with visual-perceptual/cognitive skills needed for motor re-learning;
* presence of other neurological disease that may impair motor learning skills;
* orthopedic condition or impaired corrected vision that alters reaching ability (e.g., prior rotator cuff tear without full recovery);
* paretic arm pain that interferes with reaching;
* unable to understand or follow 3-step directions;
* severe cognitive impairment (MoCA score 17);
* severe aphasia;
* inability to read English,
* history of congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during ADL's;
* Severe hypertension with systolic \>200 mmHg and diastolic \>110 mmHg at rest;
* History of COPD or oxygen dependence;
* History of DVT or pulmonary embolism within 6 months;
* Uncontrolled diabetes with recent weight loss, diabetic coma, or frequent insulin reactions;
* UBACC score \< 15; and for brain stimulation procedures only:
* electronic or metallic implants;
* history of seizures;
* women of child bearing potential.

Where this trial is running

Charleston, South Carolina

• Ralph H. Johnson VA Medical Center, Charleston, SC — Charleston, South Carolina, United States (Recruiting)

Study contacts

• Principal investigator: Ryan E Ross, PhD — Ralph H. Johnson VA Medical Center, Charleston, SC
• Study coordinator: Ryan E Ross, PhD

Conditions Stroke; rehabilitation; exercise; brain-derived neurotrophic factor; upper extremity