Virtual reality-based training to augment recovery of hand dexterity after surgery for degenerative cervical myelopathy

Abstract

Degenerative cervical myelopathy (DCM), the leading cause of non-traumatic spinal cord injury, frequently results in impaired hand dexterity. While surgical decompression is the primary treatment, over 40% of patients report residual hand disability after surgery. There are no therapies to restore hand function after surgery for DCM. In this single-arm clinical trial, post-surgical DCM participants (within 12 months after surgery) underwent a 4-week VR training protocol using the Virtual Keyboard system, which promotes practice of finger individuation. Assessments of hand dexterity were performed at baseline (at week 1), post-training (at week 6) and follow-up (at week 10). The primary outcome measure for hand dexterity assessment was the Jebsen-Taylor Hand Function Test (JTHFT). Twenty-two post-surgical DCM participants were included in the final analysis. Statistically significant improvement in the JTHFT was observed at both post-training (p < 0.001, Δ= -15.21s) and follow-up (p < 0.001, Δ= -17.84s), with changes exceeding the Minimal Clinically Important Difference (MCID) at both time points. VR hand training also produced significant, sustained and clinically meaningful improvements in quantitative hand dexterity tests and health-related quality of life. The results of this uncontrolled, single-arm study demonstrate the feasibility and efficacy of targeted neurorehabilitation to augment post-surgical neurological recovery in people with DCM.