Virtual Reality-Based Upper Extremity Rehabilitation in Subacute Stroke: A Pilot Study
Abstract
Background. Virtual reality (VR) technology has emerged as a promising modality for stroke rehabilitation, yet the relationship between baseline motor function and user experience remains poorly understood. Understanding how motor impairment severity influences VR engagement, satisfaction, and tolerability is crucial for optimising clinical implementation.
Aim. This pilot study investigated the relationship between baseline upper extremity motor function and key user experience metrics during VR-based rehabilitation in subacute stroke patients.
Methods. Twelve participants with subacute stroke (140 ± 23 days post-onset) completed a single 60-minute VR-based upper extremity training session. Baseline motor function was assessed using the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Primary outcomes included user satisfaction (User Satisfaction Evaluation Questionnaire), training engagement (movement repetitions per minute), session duration, and adverse events.
Results. Participants (8 males, 4 females; age 41.58 ± 14.51 years) demonstrated substantial heterogeneity in baseline motor function (FMA-UE: 18–56 points, mean 39.08 ± 11.36). User satisfaction was consistently high across motor severity levels (22.92 ± 4.29 points). Counterintuitively, a moderate negative correlation emerged between baseline motor function and training engagement (r = –0.445, p = 0.148), with more severely impaired participants achieving higher movement repetition rates. Eight participants (66.7%) completed the full protocol, while four required early termination. Mild to moderate discomfort affected 50% of participants, with higher rates among those with severe to moderate impairments.
Conclusions. VR-based upper extremity training demonstrates feasibility and acceptability across motor impairment severities in subacute stroke. The unexpected finding that participants with greater motor deficits exhibited higher engagement challenges conventional assumptions about technology-assisted rehabilitation. These results suggest VR interventions should not be restricted to individuals with preserved motor function, though individualised safety protocols may be necessary for more severely impaired patients.
Keywords: stroke rehabilitation; virtual reality; motor function; user experience
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