Virtual Reality Mirror Therapy (VRMT) to Improve Finger Dexterity in Post-stroke Survivors: A Preliminary Feasibility Study of a Home-based Intervention

There are 1.2 million stroke survivors living in the UK, of which approximately 77% have lost some upper limb function. Traditional mirror therapy (MT) uses repetition, motor priming, and action observation to promote motor recovery in stroke patients. Although a range of intense repetitive exposure to therapeutic interventions, such as exercises and mirror therapy, appear key in motor recovery, it can be difficult to keep patients motivated as change can be slow and therapy appears monotonous. Virtual reality (VR) systems offer the ability of tracking hand function, which could benefit MT as it may provide realistic feedback, in a game like environment to increase motivation. In addition, VR may increase the variety of therapeutic exercises needed for patients as it is not restricted by the physical barrier of the mirror box. This study aimed to develop and evaluate the feasibility and effectiveness of a Virtual Reality Mirror Therapy (VRMT) system, intended to improve finger dexterity in post-stroke patients. Ten post stroke participants with upper limb hemiparesis were recruited for this study, which was run virtually at the participants’ home. Participants were randomly allocated into three groups: Group 1 used the VRMT intervention; Group 2 used the Nine-hole peg (9HPT) test and Group 3 received no intervention (Control group). The results show that Groups 1 and 2 increased their 9HPT scores more than Group 3. Feedback from participants highlighted functional issues with the VR controller, which may have impacted on usability and motivation. The results of this study indicate that VRMT has the potential to improve finger function, can be used by post-stroke individuals and could increase engagement with therapeutic exercises post-conventional treatment.

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Bethany Strong

Dr Biao Zeng

Dr Peter McCarthy

Dr Ali Roula

Dr Liucheng Guo

Conference

Publication date: July 2022

Publication date (Print): July 2022

Pages: 1-7

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[0001]University of South Wales Treforest, Pontypridd, Wales CF37 1DL

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DOI: 10.14236/ewic/HCI2022.27

SO-VID: 5529c367-42a0-4efc-b5ac-0476d005718b

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This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

Conference name: 35th International BCS Human-Computer Interaction Conference

Conference acronym: HCI2022

Conference number: 35

Conference location: Keele, Staffordshire

Conference date: July 11th to 13th, 2022

Conference sponsor: Electronic Workshops in Computing (eWiC)

Conference theme: Towards a Human-Centred Digital Society

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1477-9358 BCS Learning & Development

Self URI (article page): https://www.scienceopen.com/hosted-document?doi=10.14236/ewic/HCI2022.27

Self URI (journal page): https://ewic.bcs.org/

REFERENCES

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[[14]] H. C. Fischer, K. Stubblefield, T. Kline, X. Luo, R. V. Kenyon, and D. G. Kamper, "Hand rehabilitation following stroke: a pilot study of assisted finger extension training in a virtual environment," Topics in stroke rehabilitation, vol. 14, no. 1, pp. 1-12, 2007.
[[15]] Z.-r. Wang, P. Wang, L. Xing, L.-p. Mei, J. Zhao, and T. Zhang, "Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients," Neural regeneration research, vol. 12, no. 11, p. 1823, 2017.
[[16]] E. Flores, G. Tobon, E. Cavallaro, F. I. Cavallaro, J. C. Perry, and T. Keller, "Improving patient motivation in game development for motor deficit rehabilitation," in Proceedings of the 2008 international conference on advances in computer entertainment technology, 2008, pp. 381-384.
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[[24]] J. R. Lewis, J. Sauro.” Item benchmarks for the system usability scale. Journal of Usability Studies” 13(3). 2018

Comments

Comment on this article

[1] [[1]] G. Saposnik et al., "Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle," Stroke, vol. 41, no. 7, pp. 1477-1484, 2010.

[2] [[2]] S. Handelzalts, G. Ballardini, C. Avraham, M. Pagano, M. Casadio, and I. Nisky, "Integrating Tactile Feedback Technologies into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic," Frontiers in Neurorobotics, vol. 15, p. 4, 2021.

[3] [[3]] M.-A. Choukou, S. Mbabaali, J. Bani Hani, and C. Cooke, "Haptic-Enabled Hand Rehabilitation in Stroke Patients: A Scoping Review," Applied Sciences, vol. 11, no. 8, p. 3712, 2021.

[4] [[4]] J. C. Bollen, S. G. Dean, R. J. Siegert, T. E. Howe, and V. A. Goodwin, "A systematic review of measures of self-reported adherence to unsupervised home-based rehabilitation exercise programmes, and their psychometric properties," BMJ open, vol. 4, no. 6, p. e005044, 2014.

[5] [[5]] W. J. Harmsen, J. B. Bussmann, R. W. Selles, H. L. Hurkmans, and G. M. Ribbers, "A mirror therapy–based action observation protocol to improve motor learning after stroke," Neurorehabilitation and neural repair, vol. 29, no. 6, pp. 509-516, 2015.

[6] [[6]] T. S. In, K. S. Jung, S. W. Lee, and C. H. Song, "Virtual reality reflection therapy improves motor recovery and motor function in the upper extremities of people with chronic stroke," Journal of Physical Therapy Science, vol. 24, no. 4, pp. 339-343, 2012.

[7] [[7]] P. Dias et al., "Using virtual reality to increase motivation in poststroke rehabilitation," IEEE computer graphics and applications, vol. 39, no. 1, pp. 64-70, 2019.

[8] [[8]] L. M. Weber, D. M. Nilsen, G. Gillen, J. Yoon, and J. Stein, "Immersive virtual reality mirror therapy for upper limb recovery following stroke: A pilot study," American journal of physical medicine & rehabilitation, vol. 98, no. 9, p. 783, 2019.

[9] [[9]] S. V. Adamovich, G. G. Fluet, A. Mathai, Q. Qiu, J. Lewis, and A. S. Merians, "Design of a complex virtual reality simulation to train finger motion for persons with hemiparesis: a proof of concept study," Journal of neuroengineering and rehabilitation, vol. 6, no. 1, pp. 1-10, 2009.

[10] [[10]] R. Gentner et al., "A novel virtual reality based finger movement training system to investigate mechanisms of training induced plasticity," Aktuelle Neurologie, vol. 36, no. S 02, p. V137, 2009.

[11] [[11]] K. O. Thielbar et al., "Training finger individuation with a mechatronic-virtual reality system leads to improved fine motor control post-stroke," Journal of neuroengineering and rehabilitation, vol. 11, no. 1, pp. 1-11, 2014.

[12] [[12]] S.-C. Yeh, S.-H. Lee, R.-C. Chan, Y. Wu, L.-R. Zheng, and S. Flynn, "The efficacy of a haptic-enhanced virtual reality system for precision grasp acquisition in stroke rehabilitation," Journal of healthcare engineering, vol. 2017, 2017.

[13] [[13]] A. S. Merians, H. Poizner, R. Boian, G. Burdea, and S. Adamovich, "Sensorimotor training in a virtual reality environment: does it improve functional recovery poststroke?," Neurorehabilitation and neural repair, vol. 20, no. 2, pp. 252-267, 2006.

[14] [[14]] H. C. Fischer, K. Stubblefield, T. Kline, X. Luo, R. V. Kenyon, and D. G. Kamper, "Hand rehabilitation following stroke: a pilot study of assisted finger extension training in a virtual environment," Topics in stroke rehabilitation, vol. 14, no. 1, pp. 1-12, 2007.

[15] [[15]] Z.-r. Wang, P. Wang, L. Xing, L.-p. Mei, J. Zhao, and T. Zhang, "Leap Motion-based virtual reality training for improving motor functional recovery of upper limbs and neural reorganization in subacute stroke patients," Neural regeneration research, vol. 12, no. 11, p. 1823, 2017.

[16] [[16]] E. Flores, G. Tobon, E. Cavallaro, F. I. Cavallaro, J. C. Perry, and T. Keller, "Improving patient motivation in game development for motor deficit rehabilitation," in Proceedings of the 2008 international conference on advances in computer entertainment technology, 2008, pp. 381-384.

[17] [[17]] K. Oyake, M. Suzuki, Y. Otaka, and S. Tanaka, "Motivational strategies for stroke rehabilitation: a descriptive cross-sectional study," Frontiers in neurology, vol. 11, p. 553, 2020.

[18] [[18]] D. Cheng, Z. Qu, J. Huang, Y. Xiao, H. Luo, and J. Wang, "Motivational interviewing for improving recovery after stroke," Cochrane Database of Systematic Reviews, no. 6, 2015.

[19] [[19]] D. Jack et al., "Virtual reality-enhanced stroke rehabilitation," IEEE transactions on neural systems and rehabilitation engineering, vol. 9, no. 3, pp. 308-318, 2001.

[20] [[20]] C. E. Lang, K. R. Lohse, and R. L. Birkenmeier, "Dose and timing in neurorehabilitation: prescribing motor therapy after stroke," Current opinion in neurology, vol. 28, no. 6, p. 549, 2015.

[21] [[21]] V. Mathiowetz, K. Weber, N. Kashman, and G. Volland, "Adult norms for the nine-hole peg test of finger dexterity," The Occupational Therapy Journal of Research, vol. 5, no. 1, pp. 24-38, 1985.

[22] [[22]] A. Heller, D. T. Wade, V. A. Wood, A. Sunderland, R. L. Hewer, and E. Ward, "Arm function after stroke: measurement and recovery over the first three months," Journal of Neurology, Neurosurgery & Psychiatry, vol. 50, no. 6, pp. 714-719, 1987.

[23] [[23]] K. E. Laver, B. Lange, S. George, J. E. Deutsch, G. Saposnik, and M. Crotty, "Virtual reality for stroke rehabilitation," Cochrane database of systematic reviews, no. 11, 2017.

[24] [[24]] J. R. Lewis, J. Sauro.” Item benchmarks for the system usability scale. Journal of Usability Studies” 13(3). 2018

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