A virtual reality tool for measuring and shaping trunk compensation for persons with stroke: Design and initial feasibility testing

Background: Compensatory movement, such as flexing the trunk during reaching, may negatively affect motor improvement during task-based practice for persons with stroke. Shaping, or incrementally decreasing, the amount of compensation used during rehabilitation may be a viable strategy with methods using virtual reality. Methods: A virtual reality tool was designed to (1) monitor upper extremity movement kinematics with an off-the-shelf motion sensor (Microsoft Kinect V2), (2) convert movements into control of widely available computer games, and (3) provide real-time feedback to shape trunk compensation. This system was tested for feasibility by a small cohort of participants with chronic stroke (n = 5) during a 1-h session involving 40 min of virtual reality interaction. Outcomes related to repetitions, compensation, movement kinematics, usability, motivation, and sense of presence were collected. Results: Participants achieved a very high dose of reaching repetitions (461 ± 184), with an average of 81% being successful and 19% involving compensatory trunk flexion. Participants rated the system as highly usable, motivating, engaging, and safe. Conclusions: VRShape is feasible to use as a tool for increasing repetition rates, measuring and shaping compensation, and enhancing motivation for upper extremity therapy. Future research should focus on software improvements and investigation of efficacy during a virtual reality-based motor intervention.