Improving neuropsychiatric symptoms following stroke using virtual reality A case report

Abstract

Rationale: Post-stroke cognitive impairment occurs frequently in patients with stroke, with a 20% to 80% prevalence. Anxiety is common after stroke, and is associated with a poorer quality of life. The use of standard relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects, whereas virtual reality seems to have a role in the treatment of anxiety disorders, especially when associated to neurological damage. Patients concerns: A 50-year-old woman, smokers, affected by hypertension and right ischemic stroke in the chronic phase (i.e., after 12 months by cerebrovascular event), came to our observation for a severe anxiety state and a mild cognitive deficit, mainly involving attention and visuo-executive processes, besides a mild left hemiparesis. Diagnosis: Anxiety in a patient with ischemic stroke. Interventions: Standard relaxation techniques alone in a common clinical setting or the same psychological approach in an immersive virtual environment (i.e., Computer Assisted Rehabilitation Environment – CAREN). Outcomes: The patient’s cognitive and psychological profile, with regard to attention processes, mood, anxiety, and coping strategies, were evaluated before and after the 2 different trainings. A significant improvement in the functional and behavioral outcomes were observed only at the end of the combined approach. Lessons: The immersive virtual reality environment CAREN might be useful to improve cognitive and psychological status, with regard to anxiety symptoms, in post-stroke individuals. Abbreviations: CAREN = Computer Assisted Rehabilitation ENvironment, COPE-NVI = Coping Orientation to the Problems Experienced-New Italian Version, DB = diaphragmatic breathing, FIM = functional independence measure, MoCA = Montreal Cognitive Assessment, VR = virtual reality.