User-centered development of a personalized adaptive mirror therapy for upper-limb post-stroke rehabilitation using virtual reality and myoelectric control

Introduction: Cerebral stroke often results in significant motor deficits, including contralateral hemiparesis of the upper limb. Rehabilitation protocols with high-intensity and task-specific exercises can improve these deficits. Recent technological advancements in virtual reality (VR), myoelectric control, and exergames may be exploited to enhance rehabilitation effectiveness. However, novel rehabilitation approaches combining these novel methodologies have rarely been developed with the active involvement of both therapists and patients. Methods: An interdisciplinary team developed a novel system, Validation of the Virtual Therapy Arm (VVITA), for post-stroke upper-limb rehabilitation combining VR, myoelectric control, and exergames using a user-centered design (UCD) approach. The VVITA hardware includes a head-mounted VR display, motion tracking devices integrated in the VR system, and wireless armbands to record electromyographic (EMG) signals, providing an interactive virtual environment for immersive rehabilitation exercises implementing a virtual mirror therapy. Assistance and task difficulty are adjusted dynamically based on patient performance, promoting active participation and motor learning. Results: The development process involved iterative phases, involving focus groups with stroke patients, therapists, and researchers. A pilot study with four stroke survivors assessed the system’s feasibility, demonstrating its potential for personalized and adaptive rehabilitation. Conclusion: The VVITA system enhances mirror therapy by integrating VR and myoelectric control, providing a tailored approach to upper-limb post-stroke rehabilitation. The UCD approach ensured the system met patient and therapist needs, showing promise for improving motor recovery and rehabilitation outcomes.