Immersive Virtual Reality Enhanced Reinforcement Induced Physical Therapy (EVEREST) A pilot case–control study of virtual reality-enhanced upper limb rehabilitation for stroke survivors

Abstract

Abstract Motor impairment of the upper limb after a stroke is common, which negatively impacts patients’ quality of life. New technologies have been applied to stroke rehabilitation alongside conventional techniques in recent years. For example, immersive virtual reality (IVR) has emerged as a new treatment approach for stroke rehabilitation, simulating real-life activities to work on self-care skills. In this pilot study, we evaluated the efficacy of the IVR. Eighteen participants were randomized to an IVR group to receive VR intervention plus physical therapy (PT) sessions or a control group to receive PT sessions alone. Participants were instructed to reach with either their affected or unaffected hand to a randomly appearing target in the VR. The movement of the virtual image of the affected upper limb was reinforced by visual feedback to the participants. Treatment effects on motor recovery were investigated using the Fugl-Meyer upper extremity (FM) scale, kinematic dataset, and a questionnaire to obtain information regarding the sense of agency and comments about the training sessions in the IVR environment. The IVR group exhibited significant improvements in FM scores (p < 0.05) compared with the control group, reflecting the recovery of UE motor function. The time to target in the last session reduced compared with that in the first session, indicating motor learning and recovery of the affected limb (p < 0.05). The patients were highly engaged and motivated during the sessions because they felt like they were in charge of the virtual image of their upper body. The results suggest that positive reinforcement within the IVR could encourage the motor recovery of the affected hand and may facilitate the application of motor learning and neuroplasticity principles during neurological rehabilitation.