A task-specific interactive game-based virtual reality rehabilitation system for patients with stroke: a usability test and two clinical experiments

Background: Virtual reality (VR) is not commonly used in clinical rehabilitation, and commercial VR gaming systemsmay have mixed effects in patients with stroke. Therefore, we developed RehabMaster™, a task-specific interactivegame-based VR system for post-stroke rehabilitation of the upper extremities, and assessed its usability and clinicalefficacy.Methods: A participatory design and usability tests were carried out for development of RehabMaster withrepresentative user groups. Two clinical trials were then performed. The first was an observational study in whichseven patients with chronic stroke received 30 minutes of RehabMaster intervention per day for two weeks. Thesecond was a randomised controlled trial of 16 patients with acute or subacute stroke who received 10 sessions ofconventional occupational therapy only (OT-only group) or conventional occupational therapy plus 20 minutes ofRehabMaster intervention (RehabMaster + OT group). The Fugl-Meyer Assessment score (FMA), modified BarthelIndex (MBI), adverse effects, and drop-out rate were recorded.Results: The requirements of a VR system for stroke rehabilitation were established and incorporated intoRehabMaster. The reported advantages from the usability tests were improved attention, the immersive flowexperience, and individualised intervention. The first clinical trial showed that the RehabMaster interventionimproved the FMA (P = .03) and MBI (P = .04) across evaluation times. The second trial revealed that the addition ofRehabMaster intervention tended to enhance the improvement in the FMA (P = .07) but did not affect theimprovement in the MBI. One patient with chronic stroke left the trial, and no adverse effects were reported.Conclusions: The RehabMaster is a feasible and safe VR system for enhancing upper extremity function in patientswith stroke.This study was supported by grants from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A112074), the Ministry of Culture, Sports, and Tourism (MCST), and the Korea Creative Content Agency (KOCCA) through the Culture Technology (CT) Research & Development Program 2012