Impact of Virtual Reality Home Therapy on Post-Stroke Upper-Limb Recovery

Thesis Abstract

This study investigates the effectiveness of Virtual Reality (VR) home therapy as an adjunct to conventional rehabilitation for improving upper-limb function after stroke, addressing the gap in scalable, patient-centered home-based interventions with rigorous evidence of clinical impact. The aim is to determine whether a structured VR home-therapy program improves motor impairment, functional use, and daily activity performance of the affected upper limb, compared with standard care alone. Specific objectives are to (1) quantify changes in motor impairment using the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE) and the Box and Block Test (BBT) over 12 weeks and at a 3-month follow-up; (2) evaluate functional performance in activities of daily living with the Motor Activity Log (MAL) and the Wolf Motor Function Test (WMFT); (3) examine adherence, user satisfaction, and perceived ease of use of the VR system; (4) identify predictors of treatment response, including baseline impairment, age, time since stroke, and cognitive status; and (5) compare cost-effectiveness between VR-enhanced home therapy and conventional rehabilitation alone. The methodology employs a parallel-group randomized controlled trial (RCT) with 200 stroke survivors (?6 months post-stroke) assigned to VR home therapy plus standard care (n=100) or standard care only (n=100). Data collection uses validated instruments FMA-UE, BBT, WMFT, MAL, Stroke Impact Scale, and the System Usability Scale (SUS) for user experience. Adherence is tracked via embedded VR telemetry and weekly caregiver check-ins. A mixed-methods analytical approach integrates quantitative and qualitative data primary outcomes analyzed with repeated-measures ANOVA and linear mixed-effects modeling to account for intra-individual correlations across time points; regression analyses to identify predictors of response; and cost-utility analysis employing quality-adjusted life years (QALYs). Secondary qualitative data are gathered through semi-structured interviews with participants, caregivers, and therapists, analyzed thematically using Braun and Clarke’s framework to elucidate contextual factors influencing engagement and transfer to daily living. The theoretical framework draws on the Neuroplasticity model of motor recovery and the Technology Acceptance Model (TAM) to interpret mechanisms of functional improvement and user adoption in home-based VR therapy. Expected findings include statistically significant greater gains in FMA-UE and WMFT scores for the VR group at 12 weeks and sustained at 3 months, higher MAL scores indicating improved functional use, and favorable SUS ratings reflecting acceptability and usability. It is anticipated that higher baseline impairment, shorter time since stroke, and greater cognitive capacity will predict better responsiveness to VR therapy. The study also projects improved health-related quality of life and a favorable cost-effectiveness profile due to reduced face-to-face therapy time and potential reductions in caregiver burden. The anticipated contribution to knowledge includes robust evidence on the clinical efficacy, usability, and economic implications of home-based VR for upper-limb rehabilitation post-stroke, integration of telemetry-based adherence data with clinical outcomes, and practical guidelines for implementing scalable VR interventions within existing rehabilitation pathways. The main conclusion is that VR home therapy, when combined with standard rehabilitation, can produce meaningful, clinically relevant improvements in upper-limb function and daily activity performance, with sustained benefits and acceptable cost-effectiveness for moderate to high-adherence patients. Recommendations emphasize (a) tailoring VR protocols to individual impairment levels and cognitive profiles, (b) incorporating caregiver training and remote monitoring to sustain engagement, (c) developing standardized protocols for data sharing with clinicians, and (d) conducting longer-term follow-up studies to assess durability of gains and impact on participation and return-to-work outcomes.