Evaluating the Effectiveness of Immersive Virtual Reality Rehabilitation Games With Enhanced Visual Training for Hand Motor Function Improvement Using Electromyography: Randomized Controlled Trial.

Background: Hand motor dysfunction greatly reduces the performance of stroke survivors. This affects their ability to perform hand motor tasks effectively. Patients receive slow interventions due to interventional limitations in stroke rehabilitation, which can pose challenges for sustaining enduring improvements. We developed immersive virtual reality (VR) games that used an innovative approach to cognitive engagement within visual training feedback for achieving long-lasting improvements. Objective: This study aimed to evaluate the effectiveness of fully immersive VR-based hand games compared with conventional physical therapy and to assess the correlations between electromyographic data and clinical outcome measures for improving hand motor function in patients with subacute stroke. Methods: A randomized controlled study was conducted among 52 patients with subacute stroke who met the inclusion criteria. These patients were equally allocated to an experimental group (n=26) and a control group (n=26). The experimental group received both fully immersive VR-based hand game therapy and conventional physical therapy, whereas the control group received only conventional physical therapy. Owing to the nature of the intervention, the study was unblinded, and both therapists and patients were aware of the intervention. Both groups participated in intervention sessions 4 days a week for 6 weeks (24 sessions in total). Moreover, both groups underwent 2 weeks of follow-up. Clinical outcome measures, including the Fugl-Meyer Assessment-upper extremity (FMA-UE), Action Research Arm Test (ARAT), and Box and Block Test (BBT), were used to assess motor recovery and functional performance. The minimal clinically meaningful difference (MCID) was used for comparing clinical outcome measures to examine clinically meaningful improvements. Furthermore, the correlation between electromyography data and clinical outcome measures, and the weekly progression in movement performance were evaluated to identify improvements in hand motor function. Results: After the intervention, there were significant differences in FMA-UE, ARAT, and BBT scores (all P<.001) between the experimental and control groups. The MCID findings illustrated that the experimental group had clinically meaningful improvements compared to the control group. There were significant correlations between electromyography signal features and clinical outcome measures (all P<.05) in both groups after rehabilitation. However, the experimental group exhibited strong positive correlations, while the control group exhibited moderate positive correlations. At follow-up, the mean movement accuracy was notably higher in the experimental group than in the control group (mean 83.59%, SD 1.1% vs mean 79.20%, SD 0.8%), indicating that hand motor function was effectively sustained through the use of the VR-based intervention in the experimental group. Conclusions: The findings of this study revealed that VR-based hand games with enhanced visual training feedback substantially improved hand motor function in patients with subacute stroke.