Feasibility of Low-Cost Virtual Reality Motor Amplification for Stroke Rehabilitation

Purpose: Virtual reality (VR) shows promise for supporting stroke rehabilitation and motor recovery. One design feature is motor amplification, a reinforcement-based approach with early evidence for reducing learned non-use among stroke survivors. However, its clinical use remains limited, with little understanding of its technical feasibility and user experience. To inform the ongoing development of VR rehabilitation systems, we assessed the technical feasibility and tolerability of automated, controller-free motor amplification in healthy young adults. Design: Here we outline the initial development of the REVIVE system, a VR stroke rehabilitation system operating on the standalone Meta Quest line of Head Mounted Displays which are wireless, low cost, and require no external hardware. Hand tracking, voice recognition and an automated motor amplification algorithm enable accessible engagement for users. An animated coach in the virtual environment guides users through gamified exercises which simulate activities of daily living and functional movements. We tested the system with 60 healthy young adults, with a primary goal of validating the feasibility of the controller-free amplification feature on a low-cost headset. Findings: Users reported minimal visually induced motion sickness even when experiencing the visuomotor perturbation generated by amplification, and more positive attitudes toward VR technology after the experience. Additionally, we provide a young healthy reference dataset for several REVIVE tasks to serve as a healthy baseline for future research with clinical populations. Value: Our findings suggest that the addition of motor amplification to a consumer-grade system is technically feasible, has good user acceptance, and demonstrates short-term tolerability.