Development and Testing of a Virtual Reality Mirror Therapy System for the Sensorimotor Performance of Upper Extremity: A Pilot Randomized Controlled Trial

Abstract

Mirror therapy (MT) has been proposed as an essential component of upper limb neuro-rehabilitation, using mirror illusion of the unaffected hand movement and superimposing it on the affected hand to improve neuroplasticity for improving motor recovery in stroke patients. In this paper, we developed a virtual reality mirror therapy (VRMT) system, and examined the performance of the proposed VRMT system. The VRMT system consists of a motion-tracking device, a VR goggle, and a VRMT software. Young, healthy participants, and stroke patients with mild-to-severe hemiparesis were recruited in this study, to validate the effectiveness of the proposed VRMT system. Experimental results based on the pinch-holding-up activity (PHUA) test revealed a significant effect on the precision pinch performance of young-healthy participants receiving VRMT, whereas traditional MT could not improve the precision pinch performance in young-healthy participants (Wilcoxon signed-rank test, Z = -2.693, = 0.007). For patients having suffered a stroke and being treated with VRMT, significant beneficial effects examined by mixed effect model were found on the total score of FMA ( = 0.033) and hand part of FMA ( = 0.008). The findings in this study indicate that the VRMT system has a potentially positive effects on the sensorimotor performance of hands in healthy participants. In addition, add-on effect of VR to MT provides beneficial effects on motor function of the upper extremity in chronic stroke patients.

Development and Testing of a Portable Virtual Reality-Based Mirror Visual Feedback System with Behavioral Measures Monitoring

“…Although technically it would be possible to add additional trackers to detect the motion of other parts of the body (such as the elbow and shoulder) to give more precision to the system and contribute to generate greater embodiment, that will also add complexity and reduce portability, making it less suitable for home-based rehabilitation or training. Consequently, the system just focuses on the tracking of hand movements and gestures, which is also the case in VR-based MVF systems that can be found in the literature [ 24 , 25 , 28 , 29 ].…”

“…Most of the previous VR-based MVF systems were based on head-mounted displays that needed to be connected to a computer [ 24 , 25 , 27 , 28 , 29 , 33 , 39 ] and required their use in special facilities (hospital, rehabilitation centers, universities). The current system does not need a computer, making it more appropriate for home-based training.…”

“…Usually, VR-based MVF systems are based in self-developed software with simple training exercises such as wrist or fingers flexions and extensions, pinches or turns, finger movements or virtual blocks movements [ 24 , 25 , 28 , 34 ]. A similar approach has been followed in the present work, programming a simple motor task (moving an object from an initial to a final position) that must be performed repetitively, which is considered a critical component for neurological recovery [ 29 , 44 ].…”

“…As happened with the traditional MVF, VR-based MVF therapy has been applied for stroke patients [ 24 ], phantom limb pain [ 19 , 25 ] and complex regional pain syndrome [ 26 ]. The technique has also been applied in combination with other VR techniques such as exposure therapy for patients with functional neurological disorders [ 27 ].…”

Effects of a Virtual Reality–Based Mirror Therapy Program on Improving Sensorimotor Function of Hands in Chronic Stroke Patients: A Randomized Controlled Trial

“…VR-MT system 26 : A personal computer–based desktop VR-MT system (Figure 2) was developed for providing immersive mirror visual feedback. The system contained a personal computer (operating system: Windows ® 10; central processing unit: Intel i5-4590 equivalent or greater; Compatible HDMI 1.3 video output), a Leap Motion Controller (LMC) with 3 infrared light-emitting diode lights, 2 monochromatic infrared camera sensors as real-time motion capture devices for the hands, and an Oculus Rift as the VR headset.…”