At-Home Self-Administration of an Immersive Virtual Reality Therapeutic Game for Post-Stroke Upper Limb Rehabilitation

Abstract

After a stroke, it is common to experience weakness or paralysis on one side of the body, including difficulty incorporating an affected upper extremity in activities of daily living. Virtual reality and video games that encourage task-oriented movement have been recognized as a valid clinical approach for providing stroke survivors with additional therapy. However, there have been few, if any, reports that examine the use of immersive virtual reality in the home for this purpose. Here, we describe a case study of a stroke survivor utilizing a therapeutic gaming system in the home over the course of several months. The digital therapeutic, CogniviveVR, utilizes head-mounted display-based virtual reality to provide patients with an immersive world where therapeutic tasks can be generated and dynamically self-adapted within a patient's peripersonal space. The therapy was found to be feasible, well-tolerated, and engaging, with the study participant selfadministering therapy approximately half an hour per day, 5-6 times a week over the course of eight weeks. Analysis of 3D motion data collected during sessions showed significant improvements in movement smoothness during performance of game tasks. After this pilot study, the system was successfully adapted to run on a stand-alone virtual reality headset. This has substantially reduced system setup requirements and will enable additional home-based studies to be conducted without the need for a study staff member to visit patients' homes to verify installation.

Cognitive Training With Head-Mounted Display Virtual Reality in Neurorehabilitation: Pilot Randomized Controlled Trial

“…This is in line with what the COVID-19 pandemic has uncovered: the need for digitized rehabilitation tools, bringing the general problem of accessibility of rehabilitation services to center, for example, for people living in rural areas or simply an insufficient number of neuropsychologists or occupational therapists in Germany, which prevents the actual implementation of necessary aftercare in neurological rehabilitation with a regular high number of treatment sessions for manifesting rehabilitation progress. Further development of video game–based rehabilitation approaches with digitized platforms to bring care home should be the focus of other groups active in this field, which is also emphasized by Ong et al [ 56 ] and Salisbury et al [ 57 ], who stated that VR is a promising technology to foster home care and shorten hospitalization. As prices for HMD-VR devices continuously decrease and the acceptance of digitized treatments in Germany increases, it augments the chance that access to VR-assisted rehabilitation will become more accessible and a standard in a wide range of treatment settings.…”

A Free Weekly Self-Administered at-Home Virtual Reality based Protocol for Overcoming the Psychological Burden of Coronavirus: A Pragmatic Waitlist-Controlled Trial Conducted During COVID-19 lockdown in Italy with 2-week follow-up

“…At the same time, VR-based protocols allow precise control over the sessions' delivery, according to both to therapeutic strategies and patients' progress; this aspect is particularly relevant for self-help protocol administered in absence of the therapists' guidance. These advantages offered by VR has been already exploited in VR-based self-help treatments for treating phobias and anxiety disorders 85,8643 Here, we have further exploited the potentiality of VR as a "simulative instrument" to provide participants with the opportunity to be immersed in a naturalistic and safe digital place 55 , far from the stressful situations experienced in routine daily contexts, where they can learn how to relax and reflect upon their experience following a guided protocol. This effect has been enhanced by creating a bridge with the real-life context with different daily social tasks aiming at facilitating a process of critical examination and eventually revision of core assumptions and beliefs 52 .…”

A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up

“…At the same time, VR-based protocols allow precise control over the sessions' delivery, according to both therapeutic strategies and patients' progress; this aspect is particularly relevant for self-help protocols administered in the absence of a therapist's guidance. These advantages offered by VR have already been exploited in VR-based self-help treatments for treating phobias and anxiety disorders [42,52,53].…”