Myoelectric pattern recognition with virtual reality and serious gaming improves upper limb function in chronic stroke: a single case experimental design study

Background: Myoelectric pattern recognition (MPR) combines multiple surface electromyography channels with a machine learning algorithm to decode motor intention with an aim to enhance upper limb function after stroke. This study aims to determine the feasibility and preliminary effectiveness of a novel intervention combining MPR, virtual reality (VR), and serious gaming to improve upper limb function in people with chronic stroke.

Methods: In this single case experimental A-B-A design study, six individuals with chronic stroke and moderate to severe upper limb impairment completed 18, 2 h sessions, 3 times a week. Repeated assessments were performed using the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), grip strength, and kinematics of the drinking task at baseline, during, and post intervention. The results were analyzed by using visual analysis and Tau-U statistics.

Results: All participants improved upper limb function assessed by FMA-UE (Tau-U 0.72-1.0), and five out of six improved beyond the minimal clinical important difference (MCID). Four participants improved ARAT and grip strength scores (Tau-U 0.84-1.0), with one reaching the MCID for ARAT. Three out of four participants in the kinematic analysis achieved improvements beyond the MCID in movement time and smoothness, two with a Tau-U > 0.90, and two participants improved trunk displacement beyond the MCID (Tau-U 0.68). Most participants showed some deterioration in the follow-up phase.

Conclusions: MPR combined with VR and serious gaming is a feasible and promising intervention for improving upper limb function in people with chronic stroke.

Trial registration: ClinicalTrials.gov, reference number NCT04154371.