Authors: (including presenting author): :
Chau HI(1), Chan CS(1), Chan F(1), Ching WK(1)
Affiliation: :
(1)Occupational Therapy Department, North District Hospital
Keyword 1: :
Stroke Rehabilitation
Keyword 3: :
Virtual Reality
Keyword 4: :
Reflex Inhibition
Keyword 5: :
Technology-Enhanced Therapy
Introduction: :
Reflex inhibition, a core component of neurodevelopmental treatment, effectively suppresses hyperexcitable stretch reflexes and manages post-stroke upper limb spasticity. Sustained reflex-inhibiting positioning, however, often causes discomfort and pain—particularly in patients with low pain threshold—reducing engagement, inducing tonic contractions, and potentially worsening spasticity. In patients requiring frequent reassurance, maintaining compliance demands significant therapist effort via continuous prompting, motivation and adjustments. Relaxation techniques potentiate reflex inhibition by activating parasympathetic responses and lowering muscle tone. Conventional relaxation methods require high cognitive effort, limiting the use in cognitively impaired individuals. Immersive virtual reality (VR) emerges as a promising adjunct, offering a multisensory, low-cognitive-load experience that reduces distractions, deepens relaxation, and enhances parasympathetic engagement—providing a novel, accessible approach that may lower therapist workload through improved patient self-regulation and tolerance.
Objectives: :
This study explored feasibility and preliminary effects of combining immersive VR relaxation with reflex inhibition to improve outcomes in stroke patients with upper limb spasticity, focusing on pain reduction, relaxation, patient experience and therapist efficiency.
Methodology: :
A prospective case series enrolled stroke patients with upper limb spasticity (Modified Ashworth Scale ≥1) in occupational therapy. Intervention: 15-minute reflex-inhibiting positioning with and without 15-minute immersive VR relaxation. Outcome measures: pre- and post-intervention spasticity (Modified Ashworth Scale), pain (Visual Analog Scale), self-reported relaxation levels and satisfaction. Therapist effort for session management was descriptively evaluated.
Result & Outcome: :
Six stroke patients completed the program. Two showed mild spasticity reduction after reflex-inhibiting positioning alone; one participant showed further improvement in spasticity with VR added. The combined intervention significantly reduced perceived pain (Visual Analog Scale; p = 0.002) and increased relaxation (p < 0.001). All reported markedly more positive therapy experiences, with greater enjoyment, improved relaxation ability and heightened engagement. Therapists reported reduced need for continuous prompting or redirection in most cases. No adverse effects, including cybersickness, occurred.
This case series presents a novel, patient-centered innovation integrating immersive VR relaxation with reflex inhibition techniques. The approach reduces pain, deepens relaxation, enhances satisfaction and engagement in upper limb spasticity management for stroke rehabilitation. VR’s distraction and self-guided relaxation particularly benefit patients with low pain threshold by reducing positioning discomfort and those needing frequent reassurance by sustaining motivation with minimal therapist prompting. This reduces therapist workload and improves clinical efficiency. These promising findings highlight accessible VR’s feasibility in overcoming traditional limitations.
