JMIR Publications

ABSTRACT

Background:

Hand motor dysfunctions significantly reduce the performance of stroke survivors. This affects their motor task abilities to perform effectively. Patients receive slow intervention due to interventional limitations in stroke rehabilitation, which pose challenges for sustaining enduring improvements. The immersive virtual reality (VR) games in this study utilized an innovative approach to cognitive engagement within visual training feedback to attain long-lasting improvements.

Objective:

This study aimed to evaluate the effectiveness of fully immersive virtual reality (VR) hand games compared to conventional physical therapy and to assess the correlation between electromyographic data and clinical outcome instruments in subacute stroke patients for improving hand motor functions.

Methods:

A randomized controlled study was conducted for 52 subacute stroke patients who met the inclusion criteria. These patients were equally allocated to the experimental group (n=26) and control group (n=26). The experimental group underwent both fully immersive VR hand games intervention and conventional physical therapy, whereas the control group only received conventional physical therapy. Due to the nature of the intervention, the study was unblinded, and both therapists and patients were aware of the interventions. Both groups underwent 24 intervention sessions, four days a week, for six weeks. Both groups also underwent two weeks of follow-up. Clinical outcome measures Fugl–Meyer assessment-upper extremity (FMA-UE), Action research arm test (ARAT), and Box and block test (BBT), were assessed for motor recovery and functional performance. Minimal clinically meaningful differences (MCID) were utilized to compare with clinical outcome measures to examine intervention changes perceived clinically meaningful improvements. Furthermore, the correlation between electromyography and clinical outcome measures and the weekly progression of movement performance were also evaluated for improvements in hand motor functions.

Results:

FMA-UE, ARAT, and BBT revealed significant differences (all, P<.05) between the experimental and control groups after the VR games intervention. MCID illustrated that the experimental group perceived clinically meaningful improvements compared to the control group. The results showed a significant correlation (P<.05) between EMG signal features and clinical outcome measures in both groups after rehabilitation. However, the experimental group exhibits a strong positive correlation compared to the control group, which has a moderate positive correlation. Moreover, the higher mean accuracies of classifiers in the experimental group at the follow-up assessment were 83.59 ± 1.1. This implied significant improvements in hand motor functions due to better progression in movement performance than the control group, with classifiers mean accuracies of 79.20 ± 0.8.

Conclusions:

The findings revealed that hand motor functions were substantially improved due to enhanced visual training feedback in VR-based hand games. Clinical Trial: ClinicalTrials.gov NCT06582303; https://clinicaltrials.gov/study/NCT06582303