Combined tendon vibration and virtual reality for post-stroke hand rehabilitation

Sensory function is essential for functional post-stroke recovery and control of basic hand movements like grasping. Despite this fact, therapy focuses strongly on motor aspects of rehabilitation, requiring active participation and thus excluding stroke patients with severe paresis. The aim of our novel therapeutic approach combining virtual reality, based on clinically proven mirror therapy, and tendon vibration of hand and wrist muscles is to induce neuroplastic changes leading to improved hand function. This paper presents the further development and evaluation of a robotic device, which can apply vibrations at precise locations on the finger flexor tendons to create illusions of extension movements and visualize the movements with a virtual hand. A preliminary study including 16 healthy subjects investigated the influence of the virtual reality on the perception of proprioceptive illusory movements. The experimental results provided evidence that the addition of the virtual reality enhanced the perception of the illusory movement generated by tendon vibration, by inducing movements with significantly higher extension (+4.5%, p <; 0.05). Furthermore, the virtual reality allowed a better controlled temporal elicitation of the illusion. These findings indicate the potential of this novel strategy for a more effective therapy, especially for severely impaired patients.