Comparison of the Effects of Task-oriented training and Virtual reality training on upper extremity function, balance ability, and depression in stroke patients

과제지향적 상지 운동과 가상현실 훈련이 뇌졸중 환자의 상지 기능과 균형, 우울감에 미치는 영향 비교

Song, Gui-bin;Park, Eun-cho

  • Received : 2015.12.07
  • Accepted : 2016.02.11
  • Published : 2016.02.29


PURPOSE: The purpose of this study was to compare the effects of task-oriented training and virtual reality training on upper extremity function, balance ability, depression in stroke patients. METHODS: Forty stroke patients were randomly allocated into a task oriented training group (TTG, n = 20), a virtual reality training group (VRG, n = 20). Both groups received the usual physical therapy. In addition, TTG patients underwent task training such as sweeping the table, cup stacking, carrying wood block. VRG patients underwent virtual reality training using X-box kinect. Both groups received 30 minutes of training per day, five times per week, for twelve weeks. RESULTS: After intervention, both groups showed significant improvement on upper extremity function, balance ability, and depression. VRG showed more improvement on upper extremity function, balance ability, and depression than TTG. CONCLUSION: According to the results of this study, task-oriented training and virtual reality training are feasible and suitable for stroke patients. And virtual reality training is more effective method than task oriented training.


Task-oriented training;Upper extremity function;Virtual reality training


  1. Amazeen EL, Amazeen PG, Post AA, et al. Timing the Selection of Information During Rhythmic Catching. J Mot Behav. 1999; 31(3): 279-89.
  2. Barker RN, Brauer SG, Carson RG. Training of reaching in stroke survivors with severe and chronic upper limb paresis using a novel nonrobotic device: A randomized clinical trial. Stroke. 2008; 39(6): 1800-7.
  3. Betker AL, Desai A, Nett C, et al. Game-based Exercises for Dynamic Short-Sitting Balance Rehabilitation of People With Chronic Spinal Cord and Traumatic Brain Injuries. Phys Ther. 2007; 87(10): 1389-98.
  4. Blennerhassett J, Dite W. Additional task-related practice improves mobility and upper limb function early after stroke: A randomised controlled trial. Aust J Physiother. 2004; 50(4): 219-24.
  5. Cherniack EP. Not just fun and games: applications of virtual reality in the identification and rehabilitation of cognitive disorders of the elderly. Disability and rehabilitation. Assistive technology. 2010.
  6. Cho K, Yu J, Jung J. Effects of Virtual Reality-Based Rehabilitation on Upper Extremity Function and Visual Perception in Stroke Patients: a Randomized Control Trial. J Phys Ther Sci. 2012; 24(11): 1205-8.
  7. Cho GH, Shin HS. The Effect of Virtual Reality Training on Lower Extremity Muscle Activation in Elderly. J Korean Soc Phys Med, 2014; 9(1): 55-62.
  8. Choi SR. (The) effects of group counseling for using recollection on self-integration and object relations : old people using mainly welfare centers. Department of counseling Psychology Seoul Graduate School of Buddhism, 2007.
  9. Choi SJ, Shin WS. The Effect of Patient-Selected, Task-Oriented Training on Activities of Daily Living, Quality of Life, and Depression in Stroke Patients. J Korean Soc Phys Med, 2014; 9(2): 213-22.
  10. Cromwell F. Occupation therapist's manual for basic skill assessment: Primary prevocational evaluation. Altadena, CA: Fair Oaks Printing, 1976.
  11. Eren-Wolters CV, van Dijk H, de Kort AC, et al. Virtual reality for mobility devices: training applications and clinical results: a review. Int J Rehabil Res. 2007;30(2): 91-6.
  12. Flynn S, Palma P, Bender A. Feasibility of using the Sony PlayStation 2 gaming platform for an individual poststroke: a case report. J Neurol Phys Ther. 2007;31(4): 180-9.
  13. Gergory TT, Dean CM, Gentile AM. Rehabilitation of reaching after stroke: task-related training versus progressive resistive exercise. Arch Phys Med Rehabil. 2004;85(10): 1613-8.
  14. Horak FB. Assumptions underlying motor control for neurologic rehabilitation. In M. J. Lister, Contemporary Management of Motor Control Problems: Proceedings of II STEP conference(pp.11-27). Alexandria:Foundation of Physical Therapy. 1991.
  15. Horstmann S, Koziol JA, Martinez-Torres F, et al. Sonographic monitoring of mass effect in stroke patients treated with hypothermia. Correlation with intracranial pressure and matrix metalloproteinase 2 and 9 expression. J Neurol Sci. 2009; 276(1-2): 75-7.
  16. Jebsen RH, Taylor N, Trieschmann RB. An objective and standardized test of hand function. Arch Phys Med Rehabil, 1969; 50:311-9.
  17. Jeong W, Yun T, Choi Y, et al. The Effect of Action Observation on Motor Function of Paretic Upper Extremity in Stroke Patients: Single Subject Study. J Korean Soc Phys Med, 2013; 8(2): 271-80.
  18. Jung JH, Cho YN, Chae SY. The Effect of Task-Oriented Movement Therapy on Upper Extremity, Upper Extremity Function and Activities of Daily Living for Stroke Patients. Journal of Rehabilitation Research. 2011; 15(3): 231-53.
  19. Jung J, Yu J, Kang H. Effects of Virtual Reality Treadmill Training on Balance and Balance Self-efficacy in Stroke Patients with a History of Falling. J Phys Ther Sci. 2012; 24 (11): 1133-6.
  20. Khandelwal S, Chowdhury A, Regmi S, et al. Conquering depression: World Health Organization Office for South-East Asia. 2001.
  21. Kim SJ, Ryu JK, Kim MJ, et al. The Effects of Bilateral Movement Training on Upper Limb Function in Chronic Stroke Patients. Korean Journal of Sport Psychology. 2010; 21(4): 13-24 .
  22. Kim WO, Kang HS, Wang MJ, et al. Relationships among Activity of Daily Living, Depression, and Quality of Life(QOL) in Patients with Stroke. Journal of East-West Nursing Reseach. 2007; 13(2): 138-46.
  23. Lange B, Flynn S, Proffitt R, et al. Development of an interactive game-based rehabilitation tool for dynamic balance training. Top Stroke Rehabil. 2010; 17(5): 345-52.
  24. Lee SY, Lee SK, Kim YH, et al. The Effects of 4 Weeks Training using Virtual Reality Game on Balance and Gait Ability, Depression of Elderly People. Journal of the Korean Proprioceptive Neuromuscular Facilitation Association. 2012; 10(2): 41-6.
  25. Lee GC. Effects of Training Using Video Games on the Muscle Strength, Muscle Tone, and Activities of Daily Living of Chronic Stroke Patients. J Phys Ther Sci. 2013;25(5): 595-7.
  26. Lee D. The Effects of Virtual Reality Training using Xbox Kinect on Balance, Gait and Function Recovery in Stroke patients. Master's Degree. Sahmyook University. 2014.
  27. Lee DH, Choi SJ, Choi HS, et al. Comparison of Visual and Auditory Biofeedback during Sit-to-stand Training for Performance and Balance in Chronic Stroke Patients. J Korean Soc Phys Med, 2015; 10(4): 59-68.
  28. Leroux A, Pinet H, Nadeau S. Task-oriented intervention in chronic stroke: Changes in clinical and laboratory measures of balance and mobility. Am J Phys Med Rehabil. 2006; 85: 820-30.
  29. Lin KC, Wu CY, Liu JS, et al. Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions and quality of life in stroke. Neuro rehabil Neural Repair. 2009; 23(2): 160-5.
  30. Ma SR, Jung SM. The effect of the task-oriented upper extremity motor task on upper extremity function and activities of daily living performance in the stroke patients. JKEIA, 2015; 9(1): 227-34
  31. Michaelsen SM, Dannenbaum R, Levin MF. Task-Specific Training With Trunk Restraint on Arm Recovery in Stroke. Stroke. 2006; 37: 186-92.
  32. Richard LH, Elliot JR, David Y. Rehabilitation in stroke syndromes. In: Braddom RL Eds Physical medicine and rehabilitation(3TH ed). Philadelphia. Sauders. 2007.
  33. Rose FD, Attree EA, Brooks BM, et al. Training in virtual environments: transfer to real world tasks and equivalence to real task training. Ergonomics. 2000;43(5): 494-511.
  34. Rossini PM, Pauri F. Neuromagnetic integrated methods tracking human brain mechanism of sensorimotor areas plastic reorganization. Brain Res Re. 2000;33(2-3), 131-54.
  35. Saposnik G, Teasell R, Mamdani M et al. Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation. Stroke. 2010; 41: 1477-84.
  36. Shumway-Cook A, Woollacott M. Motor control(3th ed). Philadelphia: Lippincott Williams & Wilkins. 2007.
  37. Summers JJ, Kagerer FA, Garry MI, et al. Bilateral and unilateral movement training on upper limb function in chronic stroke patients: ATMS study. J Neurol Sci. 2007;252: 76-82.
  38. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics-2006 update: are port from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006;113(6): e85-151.
  39. Turolla A, Mauro Dam M, Ventura L, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil. 2013; 10:85.
  40. Van Peppen RP, Kwakkel G, Wood-Dauphinee S, et al. The impact of physical therapy on functional outcomes after stroke: what's the evidence. Clin Rehabil. 2004:18(8): 833-62.
  41. Whitall J, Waller SM, Silver KHC, et al. Repetitive bilateral arm training with rhythmic auditory cueing improves motor function in chronic hemiparetic stroke. Stroke. 2000: 31(10): 2390-5.
  42. Wu CY, Chen CL, Tsai WC, et al. A randomized controlled trial of modified constraint-induced movement therapy for elderly stroke survivors: changes in motor impairment, daily functioning, and quality of life. Arch Phys Med Rehabil. 2007; 88(3): 273-8.
  43. Yoo H, Chung E, Lee B. The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women. J Phys Ther Sci. 2013; 25(7):797-801.