Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial

Abstract

Objective: To compare participation and subjective experience of participants in both home-based multiuser virtual reality (VR) therapy and home-based single-user (SU) VR therapy.

Design: Crossover, randomized trial.

Setting: Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants' homes.

Participants: Survivors of stroke with chronic upper extremity impairment (N=20).

Interventions: Four weeks of in-home treatment using a custom, multiuser virtual reality system (VERGE): 2 weeks of both multiuser (MU) and SU versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into 2 groups, First MU and First SU.

Main outcome measures: We measured arm displacement during each session (m) as the primary outcome measure. Secondary outcome measures include time participants spent using each MU and SU VERGE and Intrinsic Motivation Inventory scores. Fugl-Meyer Assessment of Motor Recovery After Stroke Upper Extremity (FMA-UE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session.

Results: Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, P=.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (P=.04). FMA-UE score improved significantly across all participants (Δ3.2, P=.001).

Conclusions: Multiuser VR exercises may provide an effective means of extending clinical therapy into the home.

Trial registration: ClinicalTrials.gov NCT03062345.

Keywords: Rehabilitation; Stroke; Telerehabilitation; Upper extremity; Virtual reality.