Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II

Singapore Med J. 2017 Oct;58(10):610-617. doi: 10.11622/smedj.2016111. Epub 2016 Jun 17.


Introduction: This study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke.

Methods: This was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement.

Results: Of 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group.

Conclusion: Our results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.

Keywords: dopamine; kinematics; rehabilitation; stroke; virtual-reality.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Aged
  • Biomechanical Phenomena
  • Computer Simulation
  • Dopamine / therapeutic use
  • Dopamine Agents / therapeutic use
  • Extremities / physiology
  • Female
  • Humans
  • Levodopa / therapeutic use*
  • Male
  • Middle Aged
  • Movement
  • Paresis
  • Pilot Projects
  • Single-Blind Method
  • Stroke / drug therapy*
  • Stroke / therapy*
  • Stroke Rehabilitation / methods*
  • Treatment Outcome
  • Virtual Reality Exposure Therapy*


  • Dopamine Agents
  • Levodopa
  • Dopamine