Globally, there are 15m strokes every year. Most people survive a first stroke but often have significant morbidity. In the UK there are 152,000 strokes annually (King’s Fund) and 1.2m survivors, mostly older people. A third have a significant cognitive impairment affecting their functional ability, in addition to motor disability, and require substantial socio-economic support, sometimes for the rest of their lives. Apart from the personal devastation, strokes cost the UK £9 billion a year, 50% being direct formal care including lengthy hospital stays and nursing, clinician and therapy provision for those with cognitive impairment.
Rehabilitation helps brain recovery by stimulating new areas to compensate for damaged ones (neurogenesis / neuroplasticity). This involves repetitive tasks to relearn function, hard, tedious work giving the patient little evidence of improvement. NICE recommends 40 minute sessions, daily, 5 days a week yet many patients find this insufficient and frustrating, and many hospitals fail to provide even this. The average amount of one-to-one therapy provided is small, 6% of the working day. A review of inpatient and outpatient studies found that doubling therapy intensity significantly improved functional recovery.
Providing sufficient therapy is a challenge for hospitals due to cost constraints and a chronic shortage of trained physiotherapists, occupational health therapists and stroke consultants. A 2016 Stroke Association survey found that over 45% of stroke survivors felt abandoned after leaving hospital, 50% rating the support received for fatigue, memory and emotional problems as poor.
A 2015 Cochrane review found evidence that Virtual Reality can be used to improve visual attention, short-term visuospatial memory and cognitive functioning, attention and executive functions when compared to conventional therapy, while reducing costs. However, the state-of-the-art is non-immersive and focuses on physical not cognitive rehabilitation.
Virtue is a VR system for cognitive rehabilitation that adapts for each user. it is designed to provide personalised rehabilitation programmes for delivery with minimal supervision and greater frequency. In addition, Virtue will improve the mental well-being of stroke patients, motivated through visible progress feedback and empowered as agents in their recovery.
A prototype system has been developed and clinical trials are due to start in August 2019