The Use of Virtual Reality in Stable Sitting Trunk Rehabilitation for Stroke Patients: A Pilot Study

INTRODUCTION: Virtual reality (VR) holds promise for stroke rehabilitation. However, many existing VR systems requires users to stand while playing, posing a potential falling risk for stroke patients. This study investigated the effects of a custom-developed VR system that focus on trunk rehabilitation in stable sitting position on muscle activities, postural control, and physiological cost compared to conventional  trunk exercises in stroke patients. MATERIALS AND METHODS: A cross-sectional observational pilot study was conducted involving 12 paretic stroke subjects performing four exercises: two Conventional Trunk Exercises (CTE) and two VR-based Trunk Exercises (VRTE) using customized Tilt-The-Maze (self-paced) or Catch-The-Mole (game-paced) games. Muscle activity was measured using electromyography (EMG). Postural control data in the Anterior-Posterior (AP) and Medio-Lateral (ML) axes was recorded using a force plate, while the physiological cost was measured via a heart rate sensor during the exercises. RESULTS: The results indicated low muscle activity and light-intensity cardiovascular responses in all CTE and VRTE exercises. Game-paced VRTE recorded slightly higher Center of Pressure (CoP) velocity in the AP and ML axes versus CTE (AP:4.40±1.80 vs. 4.02±1.20 cm/s; ML:6.40±2.54 vs. 5.42±2.21 cm/s). In contrast, the self-paced VRTE showed an insignificant impact on postural control than both CTE and game-paced VRTE. CONCLUSION: The game-paced VRTE induced comparable effects on muscular activation, postural control, and physiological cost to that of CTE in stroke patients. The findings suggest the stable-sitting VR system as a supplementary approach to the existing trunk rehabilitation protocols for stroke patients.