Performing a shortened version of the Action Research Arm Test in immersive virtual reality to assess post-stroke upper limb activity

Abstract

Background To plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation advances, new technology based methods, such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement neurorehabilitation. Objective This study aimed to assess the validity, usability and test–retest reliability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS). Methods Among the 19 items of the ARAT, 13 items were selected and developed in immersive VR. 11 healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking healthcare professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT-19). Concurrent validity was first measured using correlation (Spearman tests) between the ARAT-VR and ARAT-19 scores for the individuals with stroke, and second through correlation and comparison between the scores of the ARAT-VR and the reduced version of the ARAT (ARAT-13) for both individuals with stroke and HCS (Wilcoxon signed rank tests and Bland–Altman plots). Usability was measured using the System Usability Scale. A part of individuals with stroke and HCS were re-tested following a convenient delay to measure test–retest reliability (Intra-class correlation and Wilcoxon tests). Results Regarding the content validity, median difficulty of the 13 ARAT-VR items (0[0 to − 1] to 0[0–1]) evaluated by healthcare professionals was rated as equivalent to the classical ARAT for all tasks except those involving the marbles. For these, the difficulty was rated as superior to the real tasks (1[0–1] when pinching with the thumb-index and thumb-middle fingers, and 1[0–2] when pinching with thumb-ring finger). Regarding the concurrent validity, for paretic hand scores, there were strong correlations between the ARAT-VR and ARAT-13 (r = 0.84), and between the ARAT-VR and ARAT-19 (r = 0.83). Usability (SUS = 82.5[75–90]) and test–retest reliability (ICC = 0.99; p < 0.001) were excellent. Conclusion The ARAT-VR is a valid, usable and reliable tool that can be used to assess upper limb activity among individuals with stroke, providing potential to increase assessment frequency, remote evaluation, and improve neurorehabilitation. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04694833; Unique identifier: NCT04694833, Date of registration: 11/24/2020.

Technological Features of Immersive Virtual Reality Systems for Upper Limb Stroke Rehabilitation: A Systematic Review

“…Fine Motor Skills Grasp, Grip, Pinch, and Gross Movement [35] Involves tasks such as lifting, pouring, and pinching various objects. Aimed at improving fine motor skills crucial for daily tasks.…”

Accuracy and Reliability of Remote Categorization of Upper Limb Outcome After Stroke

“… 10 Several shortened versions of the ARAT have been introduced recently, and all provide an exact score. 11 - 13 We previously introduced the Fast Outcome Categorization of the Upper Limb after Stroke-4 (FOCUS-4) assessment for classifying upper limb outcome into Excellent, Good, Limited, and Poor categories ( Figure 1 ). 14 The FOCUS-4 assessment is unique among shortened versions of the ARAT as it classifies participants into outcome categories corresponding to a range of ARAT scores rather than providing an exact score, and it was developed with the intention to be administered and scored remotely during a videocall.…”

Visual feedback and age affect upper limb reaching accuracy and kinematics in immersive virtual reality among healthy adults

“…Immersive VR provides potential for the remote assessment of functional and cognitive health-related problems, using objective and advocated measures such as detection timing and tridimensional upper limb (UL) kinematics. Several studies have been conducted to develop and validate immersive VR applications measuring motor and cognitive dysfunctions such as memory deficits, spatial neglect, manual dexterity and UL capacity impairments [4][5][6][7]. Another interest in immersive VR lies in the manipulation of sensorial feedback.…”