Use of Virtual Reality Game in Rehabilitation of Stroke Patients in Tan Tock Seng Hospital

Either 1 of 3 physiotherapists will recruit the patient from NICU if the GCS is 14 - 15. Silverfit 3D will then be used for 20 minutes each day to train the knee and arm strength until the patient's discharge from ICU. Baseline muscle strength will be measured and graded by the physiotherapist using Medical Research Council grading then followed up by the same physiotherapist on discharge from ICU and on discharge from hospital.

Inclusion criteria

• Patients 21 - 90 years old
• Diagnosis of stroke of pure motor/sensory type affecting the limbs, all levels of severity and at all stages post stroke, defined by the WHO as "a syndrome of rapidly developing symptoms and signs of focal, and at times global, loss of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin" (WHO 1989), diagnosed by imaging or neurological examination
• GCS 14 - 15
• RASS -1 to +1
• Blood pressure within 20% of patient's baseline
• Muscle power at least 2 out of 5 on the affected side, as assessed by the physiotherapist or clinician

Exclusion criteria

• Age less than 21 or more than 90 years old
• Neurological instability
• Poor prognosis/expected withdrawal of treatment/palliative care patient
• Visual loss/hearing loss
• Active delirium with inability to cooperate as determined by CAM-ICU positivity
• Severe cognitive impairment/dementia
• Haemodynamic instability