At-home self-administration of an immersive virtual reality therapeutic game for post-stroke upper limb rehabilitation

After a stroke, it is common to experience weakness or paralysis on one side of the body, including difficulty incorporating an affected upper extremity in activities of daily living. Virtual reality and video games that encourage task-oriented movement have been recognized as a valid clinical approach for providing stroke survivors with additional therapy. However, there have been few, if any, reports that examine the use of immersive virtual reality in the home for this purpose. Here, we describe a case study of a stroke survivor utilizing a therapeutic gaming system in the home over the course of several months. The digital therapeutic, CogniviveVR, utilizes head-mounted display-based virtual reality to provide patients with an immersive world where therapeutic tasks can be generated and dynamically self-adapted within a patient's peripersonal space. The therapy was found to be feasible, well-tolerated, and engaging, with the study participant self-administering therapy approximately half an hour per day, 5-6 times a week over the course of eight weeks. Analysis of 3D motion data collected during sessions showed significant improvements in movement smoothness during performance of game tasks. After this pilot study, the system was successfully adapted to run on a stand-alone virtual reality headset. This has substantially reduced system setup requirements and will enable additional home-based studies to be conducted without the need for a study staff member to visit patients? homes to verify installation.