Extended reality to assess post-stroke manual dexterity: contrasts between the classic box and block test, immersive virtual reality with controllers, with hand-tracking, and mixed-reality tests

Abstract

Background Recent technological advancements present promising opportunities to enhance the frequency and objectivity of functional assessments, aligning with recent stroke rehabilitation guidelines. Within this framework, we designed and adapted different manual dexterity tests in extended reality (XR), using immersive virtual reality (VR) with controllers (BBT-VR-C), immersive VR with hand-tracking (BBT-VR-HT), and mixed-reality (MD-MR). Objective This study primarily aimed to assess and compare the validity of the BBT-VR-C, BBT-VR-HT and MD-MR to assess post-stroke manual dexterity. Secondary objectives were to evaluate reliability, usability and to define arm kinematics measures. Methods A sample of 21 healthy control participants (HCP) and 21 stroke individuals with hemiparesis (IHP) completed three trials of the traditional BBT, the BBT-VR-C, BBT-VR-HT and MD-MR. Content validity of the different tests were evaluated by asking five healthcare professionals to rate the difficulty of performing each test in comparison to the traditional BBT. Convergent validity was evaluated through correlations between the scores of the traditional BBT and the XR tests. Test-retest reliability was assessed through correlations between the second and third trial and usability was assessed using the System Usability Scale (SUS). Lastly, upper limb movement smoothness (SPARC) was compared between IHP and HCP for both BBT-VR test versions. Results For content validity, healthcare professionals rated the BBT-VR-HT (0[0–1]) and BBT-MR (0[0–1]) as equally difficult to the traditional BBT, whereas they rated BBT-VR-C as more difficult than the traditional BBT (1[0–2]). For IHP convergent validity, the Pearson tests demonstrated larger correlations between the scores of BBT and BBT-VR-HT (r = 0.94;p < 0.001), and BBT and MD-MR (r = 0.95;p < 0.001) than BBT and BBT-VR-C (r = 0.65;p = 0.001). BBT-VR-HT and MD-MR usability were both rated as excellent, with median SUS scores of 83[57.5–91.3] and 83[53.8–92.5] respectively. Excellent reliability was found for the BBT-VR-C (ICC = 0.96;p < 0.001), BBT-VR-HT (ICC = 0.96;p < 0.001) and BBT-MR (ICC = 0.99;p < 0.001). The usability of the BBT-VR-C was rated as good with a median SUS of 70[43.8–83.8]. Upper limb movements of HCP were significantly smoother than for IHP when completing either the BBT-VR-C (t = 2.05;p = 0.043) and the BBT-VR-HT (t = 5.21;p < 0.001). Conclusion The different XR manual tests are valid, short-term reliable and usable tools to assess post-stroke manual dexterity. Trial registration https://clinicaltrials.gov/ct2/show/NCT04694833; Unique identifier: NCT04694833, Date of registration: 11/24/2020.

Clinical Utility and Usability of the Digital Box and Block Test: Mixed Methods Study

“…Everard et al [ 3 14 ] reported comparable usability results, with SUS scores of 78 and 83 among healthy participants using a virtual BBT. At the time of this study, no additional results on the usability of digitized BBTs were available.…”

“…To our knowledge, no studies have explored the clinical advantages of newly developed digital versions of the BBT using the dimensions proposed by Fawcett et al [23]. Everard et al reported comparable usability results with SUS scores of 78 [3] and 83 [14] among healthy subjects using a virtual BBT. At the time of this study, no additional results on the usability of digitized BBTs were available.…”

“…Technologies such as depth cameras [ 8 ], sensor wristbands [ 9 ], and infrared sensors [ 10 ] have been used to monitor hand and block movements, providing detailed data on hand dexterity, including kinematic movement profiles [ 11 ]. Virtual adaptations of the BBT use leap motion sensors [ 12 ], Microsoft Kinect sensors [ 11 12 ], or virtual reality headset [ 3 13-16 undefined undefined undefined ], eliminating the need for physical BBT materials and offering cost-effective alternatives that are suitable for home use. Additionally, interactive haptic devices provide tactile and force feedback in a virtual environment, aiding in motor function recovery [ 7 ].…”