The Feasibility, Usability, and Acceptability of Using the Oculus™ Virtual Reality Gaming Technology in Stroke Survivors for Upper Extremity and Cognitive Rehabilitation

Funded in 2022

The University of Texas Health Science Center at Houston Cizik School of Nursing, Maria C. and Christopher J. Pappas Family Distinguished Chair in Nursing Endowment, and the UTHealth Consortium on Aging awarded two grants for FY 2022-2023.

PI: Seema Aggarwal, PhD, APRN, AGNP-C, UTHealth, Cizik School of Nursing 

Co-PI: Mary Russell, DO, UTHealth, McGovern Medical School, Medical Director of Inpatient Rehabilitation at TIRR Memorial Hermann-The Woodlands 

Co-PI: Xiaoqian Jiang, PhD, UTHealth, School of Biomedical Informatics 

Co-PI: Carina Katigbak, PhD, MS, ANP-BC, UTHealth, Cizik School of Nursing 

Co-PI: Emily Stevens, UTHealth, Institute for Stroke and Cerebrovascular Disease 

Co-PI: Heather Smith,, UTHealth, Institute for Stroke and Cerebrovascular Disease 

Co-I: Sean Savitz, MD, UTHealth, McGovern Medical School, Director of the UTHealth, Institute for Stroke and Cerebrovascular Disease 

Over half of stroke patients develop arm weakness post-injury, 30-50% of stroke patients develop cognitive impairment (CI) within the first 6 months of injury, and 1 in 5 stroke patients develop dementia. Stroke rehabilitation is the most important means for gaining independence and functional recovery in stroke survivors. Chronic stroke survivors (≥ 6 months post-stroke) need upper extremity and cognitive therapies to prevent contractures and cognitive decline. Many stroke survivors have reduced access to stroke rehabilitation due to reduced mobility, lack of insurance coverage for outpatient rehabilitation, and living in rural areas. The Oculus Virtual Reality (VR)  headset may be a cost-effective way to deliver stroke rehabilitation in the home setting. The Oculus VR allows the stroke patient to be fully immersed in a 3-D gaming environment that simulates activities of daily living. Combining motor and cognitive rehabilitation, known as dual-tasking, encourages neuro-stimulation and interaction between multiple brain regions. This is thought to promote neuroplasticity, the brain’s ability to develop new neuronal connections and may lead to improved functional recovery. The Oculus VR is a novel way to promote dual-tasking for stroke rehabilitation.  The rationale for this project is that the Oculus VR has not been used in stroke patients for rehabilitation and we believe that it will be useful for the delivery of remote upper extremity and cognitive rehabilitation. Our primary aim is to test the (a) feasibility, (b) usability, and (c) acceptability of using the Oculus VR for chronic stroke survivors (6 months-2 years post-stroke) who have mild-moderate cognitive and unilateral arm impairment to administer upper extremity and cognitive rehabilitation. Our secondary aim is to qualitatively explore the impact of engaging caregivers in supporting the stroke survivor’s rehabilitation and the impact of this engagement on the stroke survivor and caregiver dyad using semi-structured interviews. Upon completion of this study, the expected outcomes are to develop randomized control trials to determine the effectiveness of the Oculus VR for stroke rehabilitation and influence of the caregiver on remote stroke rehabilitation outcomes.