1000 Section - Unlocking Recovery: A Randomized Controlled Trial of Virtual Reality-Assisted Rehabilitation After Botulinum Toxin-A in Post-Stroke Spasticity

Objectives : To assess the effectiveness of early semi-immersive VR rehabilitation following BoNT-A injection in improving upper limb motor recovery and functional independence in stroke survivors.

Design: In this randomized controlled trial, 34 post-stroke patients (21–70 years) with upper limb spasticity were recruited at AIIMS Jodhpur and randomized into two groups:

< ![if !supportLists] >·         < ![endif] >Group A: BoNT-A + Conventional Rehabilitation (CR) + VR

< ![if !supportLists] >·         < ![endif] >Group B: BoNT-A + CR only
All participants received ultrasound-guided BoNT-A injections. Group A completed a six-week combined CR and VR program using the NIRVANA system, featuring interactive, goal-oriented tasks with real-time feedback to improve motor control and motivation. Group B received BoNT-A and CR alone. Both groups attended 60-minute sessions, six days a week. Outcomes assessments were conducted at baseline, 1 month, and 3 months using the Fugl-Meyer Assessment (FMA-UE), Motor Activity Log (MAL), and Modified Ashworth Scale (MAS).

Results: Both groups improved significantly, but the VR group showed greater gains in motor recovery (FMA-UE: +10.27 vs +6.84), MAL scores, and spasticity reduction. Early VR initiation (< 1 year post-stroke) was associated with better fine motor recovery, ADL performance, and adherence. No adverse events were reported.

Conclusion: Early integration of VR with BoNT-A and CR significantly enhances upper limb recovery, reduces spasticity, and improves ADL independence, offering a safe and effective post-stroke rehabilitation strategy