Kenea Chala Diriba, Abessa Teklu Gemechu, Lamba Dheeraj, Bonnechère Bruno
Department of Information Science, Faculty of Computing and Informatics, Jimma Institute of Technology, Jimma University, Jimma P.O. Box 378, Oromia, Ethiopia.
REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
Bioengineering (Basel). 2025 May 28;12(6):581. doi: 10.3390/bioengineering12060581.
Stroke remains a significant global health challenge, particularly in low- and middle-income Countries (LMICs), where two-thirds of stroke-related deaths occur, and disability-adjusted life years are seven times higher compared to high-income Countries (HICs). The majority of stroke survivors suffer from upper limb impairment, severely limiting their daily activities and significantly diminishing their overall quality of life. Rehabilitation plays a critical role in restoring function and independence, but it faces challenges such as low engagement, limited customization, difficulty tracking progress, and accessibility barriers, particularly in LMICs. Immersive virtual reality (imVR) has shown promise in addressing these challenges, but most commercial imVR systems lack therapeutic design and cultural adaptation. This study aimed to develop culturally adaptable imVR games for upper limb stroke rehabilitation (ULSR) in the context of LMICs, with a particular focus on Ethiopia. The AdaptRehab VR system was developed including six imVR games (Basket Bloom, Strike Zone, TapQuest, FruitFall Frenzy, Precision Pitch, and Bean Picker Pro) through co-creation approaches involving Ethiopian and Belgian physiotherapists, stakeholders, and patients, incorporating game development mechanics in rehabilitation, such as therapeutic aims, cultural factors, feedback, automatic progression recording, task variety, and personalized rehabilitation. It was designed with the Unity 3D engine and Oculus Quest headsets, supporting controllers and hand tracking. This culturally tailored imVR platform has demonstrated significant potential to enhance ULSR accessibility, patient motivation, and outcomes in resource-constrained settings, addressing critical gaps in stroke rehabilitation solutions. In conclusion, the AdaptRehab VR system was successfully developed as a culturally contextualized imVR platform tailored to tackle ULSR challenges in LMICs, with a specific focus on Ethiopia.
中风仍然是一项重大的全球健康挑战，在低收入和中等收入国家（LMICs）尤其如此，这些国家三分之二的中风相关死亡事件发生于此，且其伤残调整生命年是高收入国家（HICs）的七倍。大多数中风幸存者患有上肢损伤，这严重限制了他们的日常活动，并显著降低了他们的整体生活质量。康复在恢复功能和独立性方面起着关键作用，但它面临着参与度低、定制性有限、难以跟踪进展以及可及性障碍等挑战，在低收入和中等收入国家尤其如此。沉浸式虚拟现实（imVR）已显示出应对这些挑战的潜力，但大多数商业imVR系统缺乏治疗设计和文化适应性。本研究旨在为低收入和中等收入国家背景下的上肢中风康复（ULSR）开发具有文化适应性的imVR游戏，特别关注埃塞俄比亚。通过埃塞俄比亚和比利时的物理治疗师、利益相关者及患者共同参与的共创方法，开发了AdaptRehab VR系统，其中包括六个imVR游戏（《篮子绽放》《打击区》《点击任务》《水果掉落狂热》《精准投球》和《专业采豆工》），将游戏开发机制融入康复过程，如治疗目标、文化因素、反馈、自动进展记录、任务多样性和个性化康复。它采用Unity 3D引擎和Oculus Quest头戴式设备进行设计，支持控制器和手部追踪。这个经过文化定制的imVR平台已显示出在资源有限的环境中增强上肢中风康复可及性、患者积极性和康复效果的巨大潜力，填补了中风康复解决方案中的关键空白。总之，AdaptRehab VR系统已成功开发成为一个针对低收入和中等收入国家上肢中风康复挑战进行文化情境化定制的imVR平台，特别聚焦于埃塞俄比亚。
