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Abstract

Objective:

To compare the effectiveness of upper extremity virtual reality rehabilitation training (VR) to time-matched conventional training (CT) in the subacute phase after stroke.

Methods:

In this randomized, controlled, single-blind phase III multicenter trial, 120 participants with upper extremity motor impairment within 12 weeks after stroke were consecutively included at 5 rehabilitation institutions. Participants were randomized to either VR or CT as an adjunct to standard rehabilitation and stratified according to mild to moderate or severe hand paresis, defined as ≥20 degrees wrist and 10 degrees finger extension or less, respectively. The training comprised a minimum of sixteen 60-minute sessions over 4 weeks. The primary outcome measure was the Action Research Arm Test (ARAT); secondary outcome measures were the Box and Blocks Test and Functional Independence Measure. Patients were assessed at baseline, after intervention, and at the 3-month follow-up.

Results:

Mean time from stroke onset for the VR group was 35 (SD 21) days and for the CT group was 34 (SD 19) days. There were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with ARAT was similar at the postintervention (p = 0.714) and follow-up (p = 0.777) assessments. Patients in VR improved 12 (SD 11) points from baseline to the postintervention assessment and 17 (SD 13) points from baseline to follow-up, while patients in CT improved 13 (SD 10) and 17 (SD 13) points, respectively. Improvement was also similar for our subgroup analysis with mild to moderate and severe upper extremity paresis.

Conclusions:

Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation.

ClinicalTrials.gov identifier:

NCT02079103.

Classification of evidence:

This study provides Class I evidence that for patients with upper extremity motor impairment after stroke, compared to conventional training, VR training did not lead to significant differences in upper extremity function improvement.

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Information & Authors

Information

Published In

Neurology®
Volume 89Number 24December 12, 2017
Pages: 2413-2421
PubMed: 29142090

Publication History

Received: June 1, 2017
Accepted: September 18, 2017
Published online: November 15, 2017
Published in print: December 12, 2017

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Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

Funding was provided by the Norwegian Research Council, Regional Hospital Central Jutland Research Fund, Western Norway Regional Health Authority, Norwegian Fund for Post-Graduate Training in Physiotherapy, and Danish Physiotherapists' Research Fund.

Authors

Affiliations & Disclosures

Iris Brunner, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jan Sture Skouen, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Håkon Hofstad, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Jörg Aßmus, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Frank Becker, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
(1) Topics in Stroke Rehabilitation, Editorial Board member, 2010-2017
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017 (2) South-Eastern Norway Regional Health Authority, Grant number 2015037, PI PhD project, 2
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Anne-Marthe Sanders, MSc
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017 (2) Norwegian Research Council, Grant number 248238. Founding an innovation-prosject and study, “PersonAAL”, on healthy older adults and development of new applications/ programs. Not related to the VIRTUES-study. March 2016 to october 2018.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Hanne Pallesen, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Lola Qvist Kristensen, MSc
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Norwegian Research Council, Grant number 228792 Funded major part of the study from April 2014 until March 2017
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Marc Michielsen, MSc
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Liselot Thijs, MSc
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Geert Verheyden, PhD
From the University of Bergen (I.B., J.S.S.), Norway; Department of Clinical Medicine (I.B.), University of Aarhus, Denmark; Haukeland University Hospital (J.S.S., H.H.); Competence Center for Clinical Research (J.A.), Haukeland University Hospital, Bergen; Sunnaas Rehabilitation Hospital (F.B., A.-M.S.), Nesoddtangen; Department of Clinical Medicine (F.B.), University of Oslo, Norway; Hammel Neurorehabilitation Center and University Research Clinic (H.P.); Neurorehabilitation Skive (L.Q.K.), Hammel Neurorehabilitation Center and University Research Clinic, Skive, Denmark; Jessa Hospitals (M.M., L.T.), Herk-de-Stad; and KU Leuven (G.V.), Belgium.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Physiotherapy Research International, Editor-in-Chief, since 2015
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
(1) Research Fund Flanders, 1518814N, PI, 2014-2016 (2) Norwegian Research Council, Grant number 228792, funded major part of the VIRTUES study from April 2014 until March 2017
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Promobilia Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Brunner: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Iris Brunner and Jan Sture Skouen: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, study supervision, obtaining funding. Håkon Hofstad: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval. Jörg Aßmus: drafting/revising the manuscript, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, statistical analysis. Frank Becker: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, acquisition of data, study supervision. Anne-Marthe Sanders: drafting/revising the manuscript, study concept or design, accepts responsibility for conduct of research and will give final approval. acquisition of data, study supervision. Hanne Pallesen: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, contribution of vital reagents/tools/patients, study supervision. Lola Qvist Kristensen: drafting/revising the manuscript, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, data collection. Marc Michielsen: drafting/revising the manuscript, accepts responsibility for conduct of research and will give final approval, study supervision. Liselot Thijs: study concept or design, accepts responsibility for conduct of research and will give final approval, acquisition of data, statistical analysis. Geert Verheyden: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, accepts responsibility for conduct of research and will give final approval, study supervision, obtaining funding.

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Cited By
  1. Technology-Related Interventions to Improve Performance in Activities of Daily Living for Adults With Stroke (2012–2019), The American Journal of Occupational Therapy, 77, Supplement 1, (2023).https://doi.org/10.5014/ajot.2022.77S10002
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  2. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals, Brain Sciences, 13, 5, (717), (2023).https://doi.org/10.3390/brainsci13050717
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  3. Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke—A network meta-analysis of randomized controlled trials, Frontiers in Neurology, 14, (2023).https://doi.org/10.3389/fneur.2023.1125172
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  8. The Critical Period After Stroke Study (CPASS) Upper Extremity Treatment Protocol, Archives of Rehabilitation Research and Clinical Translation, 5, 3, (100282), (2023).https://doi.org/10.1016/j.arrct.2023.100282
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  9. A new adaptive VR-based exergame for hand rehabilitation after stroke, Multimedia Systems, 29, 6, (3385-3402), (2023).https://doi.org/10.1007/s00530-023-01180-0
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  10. Motorische Neurorehabilitation, Bewegung, Training, Leistung und Gesundheit, (439-462), (2023).https://doi.org/10.1007/978-3-662-53410-6_67
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