Development of a Compensation-aware Virtual Rehabilitation System for Upper Extremity Rehabilitation in Community-Dwelling Older Adults with Stroke

Abstract

Background: Compensatory movements are commonly observed in older adults with stroke when they take motor practice for rehabilitation, which could limit their motor recovery.Aim: This study aims to develop one virtual rehabilitation system (VRS) that can detect and reduce compensatory movements to improve the quality of upper extremity (UE) movements and hence the outcome of rehabilitation in community-dwelling older adults with stroke. Method: To design and validate the algorithm of compensation detection equipped in VRS, a study was first conducted to recruit 17 healthy and 6 stroke participants to identify and quantify compensatory movements when they played rehabilitation games provided by the VRS. Then a pilot study was conducted to test the feasibility and efficacy of the VRS deployed in community, where 18 stroke participants were assigned to either virtual reality (VR) group or conventional treatment (CT) group, and each participant underwent 10 sessions of an additional 6 minutes of VR games or CT respectively, on top of their usual rehabilitation programme. Participants were assessed before and after interventions using Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Test(WMFT), Stroke Rehabilitation Motivation Scale (SRMS), Range of Motion (ROM) measurements and the number of compensatory movements.Results: VR group demonstrated a trend in reduction of trunk and upper-extremity compensations, increased intrinsic motivation scores, and statistically significant improvements in FMA-UE (p=0.045) and WMFT (p=0.009, p=0.0355) scores. There was, however, no significant difference in all outcome measures between two groups. Conclusion: The compensation-aware VRS demonstrates a trend towards reduced compensation and higher motivation level, which could be an effective adjunct to the conventional therapy with less supervision from a therapist as well as be potentially deployed in a community center or at an elder adult’s home.