Post Stroke Cognitive Impairment

Stroke is a leading cause of death and disability with 15m occurring each year worldwide, including 100,000 in the UK which account for 5.5% of the total healthcare cost. Over two-thirds of acute patients suffer from post-stroke cognitive impairments with varying degrees of severity, leading to:

  • reduced ability to undertake activities of daily living (ADL)
  • inability to work or participate in social activities
  • increased levels of caregiver strain, institutionalisation and mortality.  

In the UK this costs £2.4b/year in informal care costs, £1.3b/year in lost income due to care, disability and death, and over £800m/year in benefit payments.


Music: Moments by Shane Ivers –

The UK’s National Institute for Health and Care Excellence (NICE) recommends a combination of restoration or compensatory strategies utilising task practice and repetition, guided by trained therapists. Mixed outcomes suggest a need for further research into more effective interventions with dose and duration vital elements. Recovery often depends on neuroplastic cortical reorganisation which highly depends on intensive, targeted therapy delivered by a multidisciplinary team. However, stroke sufferers spend over 80% of their day in non-therapeutic activities and 28% simply sitting. 40% of patients find it difficult to adjust to ‘life after stroke’ following hospital discharge with no effective intervention available.

Cognitive rehabilitation helps brain recovery by stimulating new areas to compensate for damaged ones (neurogenesis / neuroplasticity). Conventional care involves repetitive tasks to relearn function which is hard, tedious work that gives the patient little feedback about progress. Recovery is often dose-dependent and can be defined as: NICE recommends 45 minutes of inpatient therapy, five days per week but this is seldom fulfilled due to cost pressure, lack of availability or awareness. 45% of stroke survivors feel abandoned after discharge and it is vital that close monitoring and rehabilitation continues at home. While most stroke centres provide this to some degree through Early Supported Discharge (ESD) community teams, most are unable to maintain intensity. 

VR for Cognitive Rehabilitation

Virtue is one of the first systems designed to address this problem by delivering a Virtual Reality-based cognitive rehabilitation programme. It mirrors the approach that an Occupational Therapist would take, with patients re-learning a variety of everyday tasks step-by-step. A monitor allows a supervisor to oversee progress, tailoring task complexity to the user’s requirements and providing assistance if needed. It can be used in the hospital, immediately after the stroke event, as well as at home, providing continuity of treatment. 

Virtue is designed to enhance normal care, enabling the patient to receive more therapy than would otherwise be possible.  Engagement in additional therapy and opportunity to practice meaningful activities could also empower patients and improve mood. Functional improvement can lead to earlier discharge and positive recovery outcomes.

The software instructs the patient to complete various everyday tasks such as making toast, brushing their teeth, cooking dinner, buying lunch and going shopping. Objects are manipulated using hand controllers and a supervisory console allows Occupational Therapist interaction within the virtual environment. Metrics are collected as tasks are completed and the difficulty can be adjusted by adding more steps or distractions.

Virtue was been developed over a 30-month period in collaboration with The University of Chester and The Countess of Chester NHS Foundation Trust, supported with funding provided by Innovate UK.

Clinically Effective

A phase 2a clinical trial focused on patients with severe strokes, with poor prognosis, demonstrated significant improvements in the cognitive domain which led to earlier discharge and better recovery outcomes. Of the 420 patients screened on the stroke ward over a 12 months period, 23% met the trial inclusion criteria and 40 patients participated in the trial. For those in the intervention arm the length of stay in hospital was reduced by an average of  5 days. 

Patient benefits include:

  • Accelerated patient recovery through intensive, personalised therapy
  • Minimal supervision
  • Early identification of life-after-stroke issues
  • Fewer post-discharge complications
Virtue’s Kitchen Environment
Virtue Cafe Scene
Virtue Occupational Therapist Console

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