Institute of Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 14, 3rd Floor, 41345, Gothenburg, Sweden.
Institute of Biomedicine, Medical Biochemistry and Cell Biology, Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 9 A, 413 90, Gothenburg, Sweden.
J Neuroeng Rehabil. 2020 Nov 23;17(1):154. doi: 10.1186/s12984-020-00788-x.
Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research.
A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results.
Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50-0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935 min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900 min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home.
This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies. Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331 ) prior to participant enrolment.
康复对于最大限度地恢复中风后患者的功能至关重要。本身具有趣味性和激励性的康复活动比不具备这些特点的活动更有效。虚拟现实（VR）游戏化利用了这一原理。本单病例设计研究旨在探索使用商业现成的、房间规模的头戴式 VR 进行慢性中风患者上肢康复的潜力，研究结果可为进一步研究提供信息。
通过广告招募了 7 名患有中风的异质志愿者参与者。采用单病例设计，5 周基线期（A），随后 10 周干预期（B）和 6 个月随访期。使用经过验证的摄动分析评估上肢运动功能饮料任务。通过动作研究臂测试、方块和块测试以及 ABILHAND 问卷评估活动能力。每周和随访时进行评估。使用带有头戴式显示器（HTC Vive）的 VR 系统玩游戏作为康复干预。共筛选了约 300 款游戏，其中 6 款进行了测试。视觉分析和 Tau-U 统计用于解释结果。
趋势、水平转移和重叠的视觉分析以及 Tau-U 统计表明，6 名参与者的动作研究臂测试有所改善。其中 4 名参与者的 Tau-U 评分至少为中度（0.50-0.92），在至少一半的评估结果中。这 4 名参与者总共接受了 361 到 935 分钟的训练。在能够完成饮料任务的 4 名参与者中，有 2 名接受了最高的训练剂量（>900 分钟），且运动学也有所改善。最常玩的游戏是《Beat Saber》。没有观察到与研究相关的严重不良事件，一名参与者因在家中摔倒而中断了干预阶段。
这项将商业游戏、商业头戴式 VR 和商业触觉手控器相结合的首次研究结果显示，该方法对慢性中风患者上肢康复具有良好的效果。由于其价格合理、制作精良，且易于获取现成产品，这种 VR 技术变体可能会促进广泛应用。本研究获得的见解可以为未来的研究提供便利。试验注册：该研究在参与者入组前已在 researchweb.org（项目编号 262331，注册于 2019 年 1 月 30 日，https://www.researchweb.org/is/vgr/project/262331）上进行了注册。
