Improved Intrinsic Motivation and Muscle Activation Patterns in Reaching Task Using Virtual Reality Training for Stroke Rehabilitation: A Pilot Randomized Control Trial

Abstract

In long-term rehabilitation, stoke survivors might experience low motivation and poor adhesion to treatments. In such cases, off-the-shelf virtual reality (OTSVR) gaming systems can be a viable solution. The purpose of this exploratory study was to evaluate the effects of an affordable OTSVR treatment on patients\' motivation and motor capacities. The ultimate goal is to apply the advantages of the OTSVR system to the design of future systems. Twenty participants completed the follow-up assessment. Four parallel groups received treatments for three weeks: 1) virtual reality (VR) via Wii gaming; 2) conventional therapy; 3) a placebo board game; 4) no treatment. The training effects were evaluated immediately after and four weeks after treatment. Surface electromyographic activity for a reaching task was obtained from five muscles, and the time-to-peak (TTP) contractions, time that a muscle takes to reach maximum contractions, was used as a kinesiological parameter. Any functional gains were evaluated using the Jebsen-Taylor Hand Function Test and the Stroke Impact Scale. The VR group immediately demonstrated significantly shorter TTP contractions in their biceps and flexor carpi radialis compared to the those of the board game and no treatment groups (p < 0.05). The TTP contraction change between the VR group and the conventional therapy group did not have significant differences. The VR group having a marginally retentional improvement in the deltoids (p = 0.059). No long-term benefits persisted in any other muscle. However, the VR group showed higher intrinsic motivation than those of the other groups. In this pilot study, OTSVR gaming had immediate effects on motor recovery and provided motivation for treatment compliance in stroke patients.