According to the World Health Organization, stroke is the second world’s debilitating disease. Around 2/3 of individuals with stroke suffer from upper limb motor dysfunctions, which affect their quality of life. To predict long-term rehabilitation, experts recommend frequent assessments of body functions and activity limitations. In clinical routine, the Action Research Arm Test (ARAT) is the gold-standard assessment of post-stroke upper limb capacity. This test, comprising 19 different items, consists of realizing functional tasks (involving objects of different sizes and shapes) according to standardized instructions.
An immersive virtual reality version of the ARAT (ARAT-VR) has been developed, allowing for self-assessment and collection of objective kinematic data to help predicting long-term rehabilitation.
The program uses a hand tracki
ng technology, which allows the user to use only his hands to interact with the virtual environment (see figure). It includes videos on how to pass each item, and the user has the possibility to skip a task if it is too difficult.
A study assessed the difficulty, validity, usability and reproducibility (test-retest reliability) of the ARAT-VR as compared to the ARAT among individuals with stroke, rehabilitation professionals and healthy subjects with promising results suggesting that the ARAT-VR is a valid, usable and reliable tool that enables to assess post-stroke activity of the upper limb.
The ARAT and ARAT-VR were administered to 30 individuals with stroke, 25 healthy subjects, and 11 healthcare professionals. Healthcare professionals were asked to rate the difficulty of the movement in VR compared to the traditional version of the ARAT for each item. At the end of the experiment, all healthy subjects and individuals with stroke provided a feedback on the usability assessment of systems. Finally, a subgroup of healthy subjects and individuals with stroke performed the ARAT-VR a second time in a convenient delay (test-retest reliability). According to healthcare professionals, the global difficulty was similar between the ARAT and the ARAT-VR. Strong correlations were observed between the scores of the ARAT-VR and the ARAT. The usability of the system was ranked as excellent by individuals with stroke. Lastly, no significant difference was observed between the first and second score of the ARAT-VR, suggesting a good test-retest reliability. These findings give new perspectives for the use of immersive VR to provide autonomous, objective and quantitative measures of performance in neurorehabilitation.
Burton Q, Lejeune T, Dehem S, Lebrun N, Ajana , Edwards MG, Everard G. Performing a shortened version of the Action Research Arm Test in immersive virtual reality to assess post-stroke upper limb activity. J Neuroeng Rehabil 2022; 19(1):133. doi: 10.1186/s12984-022-01114-3. Link to the paper here