Title : Unlocking recovery: A randomized controlled trial of virtual reality-assisted rehabilitation after botulinum toxin-A in post-stroke spasticity
Abstract:
Background: Stroke is a major cause of long-term disability, with upper limb dysfunction and spasticity significantly affecting independence in Activities of Daily Living (ADLs). Botulinum toxin type-A (BoNT-A) is the standard treatment for focal spasticity, but tone reduction alone does not guarantee functional recovery. Virtual Reality (VR), by providing repetitive, task-specific, and engaging training, is a promising adjunct to enhance neuroplasticity and motor outcomes.
Objective: To assess the effectiveness of early semi-immersive VR rehabilitation following BoNT-A injection in improving upper limb motor recovery and functional independence in stroke survivors.
Design : In this randomized controlled trial, 34 post-stroke patients (21–70 years) with upperlimb spasticity were recruited at AIIMS Jodhpur and randomized into two groups:
Group A: BoNT-A + Conventional Rehabilitation (CR) + VR
Group B: BoNT-A + CR only
All participants received ultrasound-guided BoNT-A injections. Group A completed a six-week combined CR and VR program using the NIRVANA system, featuring interactive, goal-oriented tasks with real-time feedback to improve motor control and motivation. Group B received BoNT-A and CR alone. Both groups attended 60-minute sessions, six days a week. Outcomes assessments were conducted at baseline, 1 month, and 3 months using the Fugl-Meyer Assessment Upper Extremity (FMA-UE), Motor Activity Log (MAL), and Modified Ashworth Scale (MAS).
Results: Both groups improved significantly, but the VR group showed greater gains in motor recovery (FMA-UE: +10.27 vs +6.84), MAL scores, and spasticity reduction. Early VR initiation (<1 year post-stroke) was associated with better fine motor recovery, ADL performance, and adherence. No adverse events were reported.
Conclusion: Early integration of VR with BoNT-A and CR significantly enhances upper limb recovery, reduces spasticity, and improves ADL independence, offering a safe and effective post-stroke rehabilitation strategy.
