Consumer virtual reality headsets were first released by video game companies in the early-mid 1990s. Beginning in the 2010s, next-generation commercial tethered headsets were released by Oculus (Rift), HTC (Vive) and Sony (PlayStation VR), setting off a new wave of application development (Source). It is no surprise that the medical community jumped on board to utilize this technology for their patients. Virtual rehabilitation has been supported by the International Society on Virtual Rehabilitation since the mid 2010s. Virtual Rehabilitation is where a patient's treatment is based on, or supplemented with, virtual reality simulation, exercises, and tasks.

Dr. Seema Aggarwal, Assistant Professor in the Cizik School of Nursing, Center for Nursing Research, asked the question, "Could this VR technology become a form of therapy for stroke patients with limited mobility?" VR has not been used in stroke patients for rehab and the team believes that it will be useful for the delivery of remote upper extremity and cognitive rehabilitation. This prompted her and her team to submit a grant application to support their "The Feasibility, Usability, and Acceptability of Using the Oculus™ Virtual Reality Gaming Technology in Stroke Survivors for Upper Extremity and Cognitive Rehabilitation" study. In August, 2022, they were awarded with a UTHealth grant to continue their research.

This Aging-In-Place grant will support the testing of the feasibility, usability and acceptability of using the Oculus VR for chronic stroke survivors who have mild-moderate cognitive and unilateral arm impairment to administer upper extremity and cognitive rehabilitation. Other specific aims will be to calculate the change in upper extremity and cognition scores and explore the impact of engaging caregivers in supporting the stroke survivor’s rehabilitation. 

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 use of cognitive stimulation in conjunction with physical exercise in older adults has been shown to improve episodic memory, visual attention, and functional mobility. The Oculus VR is a novel way to promote dual-tasking for stroke rehabilitation. 

This study would go beyond telehealth rehab in that the user/patient, using the Virtual Reality (VR) headsets and technology, would be immersed in a real-world environment simulation, the Aging-In-Place Apartment, which will allow them to practice household chores, job-related tasks, and every day skills. The added benefit are games the patient can play which are useful for cognitive rehabilitation. Telehealth/rehabilitation is on the rise and has shown to be beneficial for patients who are unable to travel for appointments. The long-term goal is to increase access to stroke rehabilitation activities that can be performed at home with or without a rehabilitation therapist. The long-term goal is to increase access to stroke rehabilitation activities that can be performed at home with or without a rehabilitation therapist.

When it comes to stroke survivors the growing population is geriatric and they require rehab for months to years following a stroke. Dr. Aggarwal's grant application stresses, "There are significant health disparities related to access to rehabilitation because over half of all stroke survivors experience reduced mobility, and insurance may not cover the high cost of outpatient stroke rehabilitation at $17,000 during the first year after discharge. One study determined that 57% of stroke patients did not receive recommended therapies 6 months following discharge from inpatient facilities. Thus, there is a critical need for less costly stroke rehabilitation that can be more easily accessible at home. "

Primary Investigator (PI): Seema Aggarwal, PhD

Co-PI: Mary Russell, DO

Co-PI: Xiaoqian Jiang, PhD

Co-PI: Emily Stevens, OT

Co-PI: Heather Smith, SLP

Co-PI: Carina Katigbak, PhD

Co-I: Sean Savitz MD