Embodied the Healthy Arm: Virtual Reality Rehabilitation for Stroke Patients with Proprioceptive Upper-Limb Deficit

The aim of the present project is to investigate whether patients who embody a virtual arm with their injured one would induce the motor rehabilitation of the upper limb after stroke. The protocol has been approved by the Scientific Ethical Committee of ASL Bologna (ASL_BO n. 0115481). The patients to be included in the rehabilitation program must have a motor deficit of the upper limb assessed by the Motricity Index and a proprioceptive deficit of the injured upper limb assessed by the Thumb Location Form. In addition, patients must have good cognitive ability to manage the study. The rehabilitation program lasts 4 weeks, three sessions each at ISN—Hospital Bellaria of Bologna, Italy. The VR adopted is both immersive and non-immersive. The immersive technology uses a head-mounted display playing Khymeia software (khymeia.com/it), and patients are invited to perform exergames with the injured arm based on precision tasks. The non-immersive technology is the innovative Virtual Reality Rehabilitation System-Handbox for hand and wrist rehabilitation, which tracks the patient's hand and projects it onto a screen without the need to wear a sensor. Through the VR Handbox, the patient performs hand exergames based on pinching, grasping, single-finger coordination, and wrist movements customized according to the patient's motor abilities. Prior to the rehabilitation program, the illusion of the injured limb with the virtual arm is assessed to test how the patient perceives the augmented arm as her own.8 The main outcomes are motor ability assessed by Fugl-Meyer, Motricity Index, and Box and Blocks, and upper-limb proprioception assessed by the rubber hand illusion.