Personalized Adaptive Mirror Therapy in Upper Limb Post Stroke Rehabilitation: Usability, Acceptability, and Feasibility Study Using Virtual Reality and Myoelectric Control (Preprint)

BACKGROUND Stroke remains a primary cause of long-term disability worldwide, with upper limb deficits affecting up to 80% of survivors acutely and 40% chronically. Many stroke survivors face upper limb deficits, leading to considerable effects on their independence and overall quality of life. Conventional rehabilitation therapies are most effective when initiated shortly after a stroke, yet many patients face barriers to ongoing therapy post-discharge. Recent advancements in low-cost rehabilitation systems, particularly those utilizing Virtual Reality (VR) technologies, offer promising alternatives for enhancing upper limb recovery. OBJECTIVE Given the burden on healthcare systems and the limitations in access to high-intensity post-discharge rehabilitation, this study aimed to evaluate the feasibility, acceptability, and usability of an upper-limb adaptive mirror therapy using Virtual Reality (VR) and myoelectric control for rehabilitation of chronic stroke patients and developed through a User-Centered Design approach. METHODS In this study a total of 12 community-dwelling chronic stroke survivors (mean age 52.9 ± 16.0 years, 4 females) with moderate to severe upper limb impairments were enrolled. Participants were stratified by age (young: 18–55 years; older: 56–80 years) and impairment level (FMA-UE score: 18–36 = severe; 37–54 = moderate). Acceptability was assessed for each session by patient self-evaluation of satisfaction and motivation through a Visual Analogue Scale, while the therapist assessed the patient’s participation to therapy using the Pittsburgh Participation Rehabilitation Scale. Usability was measured with the USEQ scale and feasibility through NASA TLX cognitive workload indices. RESULTS Patients reported a significant increase in satisfaction from the intermediate to the final assessment (72% vs. 85%, T1 vs. T2, p = 0.014) and stable high motivation levels. Differences in participation and motivation were observed based on impairment level with no effect of age. Usability ratings remained high (> 80%) throughout the intervention, with no significant differences between baseline and endline. Cognitive workload assessments showed a significant reduction over time, with impairment level being a critical factor influencing perceived cognitive and physical effort (p CONCLUSIONS The VR therapy was found to be feasible, usable, and acceptable among chronic stroke patients, especially those with moderate impairment, supporting its potential for home-based rehabilitation strategies. CLINICALTRIAL The study was registerd at ClinialTrial.gov with the indentifier number: NCT07103122