Authors (including presenting author) :
Koo LY (1), Cheung WL (1), Lam CM (1), Lam HW (1), Chan SP (1), Cheung NH (1), Chan CK (1), Chung CY (1)
Affiliation :
(1) Occupational Therapy Department, Tuen Mun Hospital
Keyword 1: :
Stroke rehabilitation
Keyword 2: :
Virtual reality
Keyword 3: :
Mirror therapy
Introduction :
Immersive Virtual Reality (VR) has gained wide popularity in the rehabilitation field in recent years. Developed according to the principles of traditional mirror therapy, virtual reality mirror therapy (VRMT) creates a vivid visual illusion of movement from the unaffected upper limb, thereby inducing cortical reorganization and promoting neuroplasticity. The immersive, interactive, and realistic qualities of VRMT may further amplify these therapeutic effects by enhancing engagement and sensory feedback.
Objectives :
To investigate the effectiveness of combining VRMT and occupational therapy in improving activities of daily living (ADL) and upper limb functions in subacute stroke patients.
Methodology :
This was a one-group pretest-posttest design study. The VR-enhanced upper limb rehabilitation program consisted of VRMT mediated by a head-mounted display and conventional occupational therapy training, with each part lasting for 30 minutes. Patients with first-ever stroke and severe upper limb impairment were recruited in the rehabilitation stroke unit of Tuen Mun Hospital. All participants received a total of 10 60-minute training sessions. Outcome measures included Modified Barthel Index (MBI), Hong Kong Version of Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper Extremity (FMA-UE).
Result & Outcome :
A total of 14 subjects completed the study, including eight males and six females, with ages ranging from 36 to 71 years. There was statistically significant improvement in MBI (p< 0.001), reflecting enhanced independence in ADL. Significant improvements were also found in FTHUE-HK (p=0.002), ARAT (p=0.011) and FMA-UE (p< 0.001), suggesting the recovery in upper limb function. Further analysis of FMA-UE subscores revealed significant improvements in the shoulder/elbow/forearm and hand subscales (both p< 0.05), suggesting recovery across both proximal and distal upper limb functions. VRMT offered a more convincing brain illusion, allowed patients to observe the mirror image in a more neutral posture, and eliminated environmental distractions, potentially enhancing the cortical excitability achieved by conventional mirror therapy (Okamura et al., 2024). These findings support the therapeutic potential of VRMT as an adjunct to conventional occupational therapy for the patients with severe upper limb impairment following subacute stroke, promoting early and active participation and motor relearning.
