Virtual reality (VR)-based rehabilitation is being increasingly used for post-stroke rehabilitation . A recent systematic review mentioned that VR is an emerging treatment option for upper limb rehabilitation among stroke patients . The benefits of VR include real-time feedback, easy adaptability, and the provision of safe environments that mimic the real world [3, 4]. The gaming property of VR allows patients to experience fun, active participation, positive emotions, and engagement [5, 6]. Therefore, rehabilitation with VR enables more intense and repetitive training, which is important for rehabilitation and the promotion of neural plasticity .
VR systems commonly used in the entertainment industry, such as Wii and Kinect, could be used for rehabilitation. However, these game-like systems are only applicable to patients with muscle strength above a certain value, thus limiting their use by more affected patients. Therefore, adjunct therapies, such as functional electrical stimulation and robotics, have been combined with these systems [8, 9, 10, 11]. However, those adjunct therapies are costly and require continuous monitoring by healthcare professionals because of safety concerns [12, 13]. Therefore, their use is restricted to clinical settings, and they are not actively used for telerehabilitation or home-based rehabilitation. A non-motorized or non-assisted device is required for more active use of VR for rehabilitation.
We developed the Rapael Smart Board™ (SB; Neofect Inc., Yong-in, Korea), which is a VR-based rehabilitation device incorporating planar motion exercise that does not require additional gravity compensation. This two-dimensional planar movement with full gravitational support, which lessens the need for antigravity muscle facilitation, allows for much easier participation than three-dimensional movement under gravity. Additionally, it is known to be safe and easy to learn, and it has been shown to improve motor ability with less aggravation of shoulder pain and spasticity; therefore, it is useful to patients with reduced motor ability . Planar motion exercises provoke less maladaptive compensatory movements. Additionally, the nearly zero friction of the linear guides enable a wide range of repetitive active range of motion (AROM) exercises. Furthermore, the SB adopted Rapael Clinic software that was originally developed for patients with disabilities and has proven efficacy for stroke rehabilitation [9, 15]. Therefore, the SB, which has multiple advantages because of its hardware and software, might be beneficial for the functional improvement of the upper extremities. Moreover, the SB could have a role as an assessment tool because VR has been reported to be useful for objective kinematic measurements of the upper extremities .
The present pilot study aimed to assess the availability of this newly developed VR-based rehabilitation device incorporating planar exercises for the upper extremities as an intervention and assessment tool among stroke patients in the chronic phase of recovery. To assess the availability in terms of clinical effectiveness, we compared the effects of an intervention involving the SB and that involving dose-matched occupational therapy (OT) on upper extremity function and health-related quality of life (HRQoL). We also investigated the correlations between kinematic data from the SB and data from clinical scales regarding upper extremity function.