Mirror VR: The design of a fully immersive virtual reality game for upper limb rehabilitation post-stroke using mirror therapy

Motor rehabilitation post-stroke requires practice that is high-intensity, repetitive, task-specific, challenging, and goal-oriented to promote neuroplasticity to maximise functional recovery outcomes. There is concern that people with stroke (PwS) are not engaging in sufficient therapy dose to induce significant neuroplastic changes. PwS can utilise motor priming techniques, such as mirror therapy (MT), that are low-cost adjuncts to conventional physical rehabilitation proposed to induce neuroplasticity. However, the repetitive and perceived boring elements of conventional physical therapy exercises are potential reasons for low adherence in home-based independent rehabilitation. Interactive rehabilitation-focused video games have shown initial promise for facilitating engagement in rehabilitation. Virtual reality (VR) games focus on movement and promote increased immersion in virtual environments compared to 2D interfaces. The recent emergence of low-cost and standalone consumer-based VR headsets opens the accessibility of VR to new audiences. VR, in combination with interactive gaming, affords opportunities to extend the visual and proprioceptive feedback employed in MT and use gamification to facilitate engagement in rehabilitation. This thesis involved the design of a fully immersive VR game based on MT. The research comprised three stages: empathic design through a design thinking workshop, iterative prototyping, and expert review of game design with clinicians. A design thinking workshop involving PwS and stroke rehabilitation experts informed the construction of design criteria for the game. Research through design, using the design criteria, was conducted iteratively. An expert review by clinicians evaluated the potential usability of the game as well as validated the game against our design criteria. VR enhanced the visual illusion employed in mirror therapy and could provide an immersive and novel self-management tool for PwS to positively engage with their rehabilitation. Future directions will include testing how VR could facilitate engagement in rehabilitation through qualitative and quantitative analysis of the user testing with PwS.