Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study

Mattias Erhardsson, Margit Alt Murphy, Katharina S Sunnerhagen, Mattias Erhardsson, Margit Alt Murphy, Katharina S Sunnerhagen

Abstract

Background: Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research.

Methods: A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results.

Results: Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50-0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935 min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900 min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home.

Conclusions: This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies. Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331 ) prior to participant enrolment.

Keywords: Activity; Head-mounted display; Kinematics; Movement; Rehabilitation; Stroke; Upper extremity; Video games; Virtual reality.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Participant recruitment flowchart
Fig. 2
Fig. 2
Screenshot of Mixed Reality footage of a participant playing Beat Saber. Mixed Reality was provided by the 3rd party software LIV, and was captured with OBS Studio
Fig. 3
Fig. 3
Activity domain outcome measures: Action Research Arm Test (a), Box and Blocks Test (b) and the ABILHAND (c) questionnaire. Outcomes were assessed on a weekly basis during baseline (Phase A) and intervention (Phase B), and at 6-month follow-up
Fig. 4
Fig. 4
Kinematic body function outcome measures: Total Movement Time (a), Number of Movement Units (b) and Trunk Displacement (c). Outcomes were assessed on a weekly basis during baseline (Phase A) and intervention (Phase B), and at 6-month follow-up

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