Comparison of brain activation and functional outcomes between physical and virtual reality box and block test: a case study

Abstract

Purpose

Immersive Virtual Reality (VR) systems allow for highly repetitive tasks to be performed within a virtual environment that increases practice in home environments. VR can increase access to rehabilitation by reducing access barriers. However, rehabilitation outcomes between immersive VR systems and conventional physical rehabilitation are not well understood. The purpose of this case study was to assess the use of a custom clinically based VR simulation for testing gross hand dexterity with an individual with chronic stroke.

Materials and methods

The participant performed the box and blocks test (BBT) in an immersive VR environment and a physical environment. Three trials of the BBT were performed with their less-affected and affected hands each in both environments while measuring cortical activity using fNIRS. Rests were given between trials and environment conditions.

Results

Our results show that there was no statistical difference in the number of blocks moved between the physical and VR BBT for both the affected and less-affected hands. Furthermore, our results also indicate no statistically significant difference between the physical BBT and VR BBT conditions on contralateral motor cortex activation, suggesting that cortical involvement is comparable between physical and VR conditions.

Conclusions

These results suggest that an immersive VR system may be able to elicit functional and motor cortex activations that are comparable to the conventional physical BBT. Importantly, these findings highlights the potential benefits of VR therapy as a remote therapy intervention and/or to increase the effectiveness and practicality of current in-person rehabilitation programs.

Implications for rehabilitation

• These findings highlight the potential benefits of immersive virtual reality as a remote therapy intervention.

• Immersive virtual reality use has potential benefits to increase the effectiveness and practicality of current in-person rehabilitation programs.

Keywords:

• Virtual reality
• box and block test
• chronic stroke
• functional near-infra-red spectroscopy
• fNIRS
• rehabilitation

Acknowledgements

The authors would like to acknowledge Kyle Coulter and Emma Buckley for the development of the VR BBT simulation.

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

The data is available upon reasonable request from the corresponding author.

Additional information

Funding

The study is supported by the National Institute of Health (NIH) grants R15 HD094194, P20 GM 109090, and R01 NS114282.