Accepted for/Published in: JMIR XR and Spatial Computing (JMXR)
Date Submitted: Nov 9, 2024
Date Accepted: Mar 15, 2025
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Co-production of a Platform Neurotechnology for XR Biofeedback Training for Functional Upper Limb Weakness
ABSTRACT
Background:
Humans continuously adapt through a perception-action cycle, where sensory inputs shape actions, and subsequent outcomes, influenced by rewards and penalties, modify future behaviors. Functional Neurological Disorder (FND) may arise from maladaptive learning in this cycle, creating dysfunctional behavior patterns that reduce agency and disrupt functional responses. FND encompasses functional seizures, movement disorders, dizziness, and cognitive impairments, significantly impacting quality of life. Recent advances in neurotechnologies, particularly extended reality (XR), present opportunities for novel therapeutic approaches targeting FND.
Objective:
This study aimed to assess the usability of an XR neurotechnology platform designed for biofeedback training in functional limb weakness, integrating haptic and visual feedback to support motor control and rehabilitation for FND patients.
Methods:
A mixed-methods approach was employed, a hands-on co-design workshop with three FND patient representatives with lived experience and three healthcare professionals from the UK’s Royal Preston Hospital. Participants engaged in usability testing across three XR training tasks: VR relaxation, XR position feedback control, and XR force feedback control. System Usability Scale (SUS) scores were collected, and qualitative written feedback data was analyzed using NVivo to identify user needs and areas for platform improvement.
Results:
High usability scores were observed for the XR position feedback control and VR relaxation training tasks, with most participants rating them above 85, reflecting excellent usability and satisfaction. However, the XR force feedback task revealed variability in scores, particularly in participant with conditions such as functional dystonia, indicating the need for task personalization. Qualitative analysis highlighted themes of customization, comfort, accessibility, and XR technological quality as critical factors for enhancing user experience.
Conclusions:
This study demonstrated the potential of XR neurotechnology for FND rehabilitation, with high usability for XR position feedback control and VR relaxation training tasks. However, the XR force feedback task showed mixed usability, suggesting that a “one-size-fits-all” approach may not be suitable for all FND conditions. Enhancements in comfort, personalization, and accessibility are essential for optimizing user satisfaction. Future research should explore task-specific customizations to better accommodate individual needs in FND rehabilitation. Clinical Trial: N/A
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