Adapting Off-the-Shelf Games to Serve as Useful Games in the Process of Post Stroke Upper Limb Rehabilitation

This trial focuses on how 'off-the-shelf' virtual reality games for the Meta Quest 2 VR headset can be adapted to improve upper limb outcomes post stroke. The goal is to use these adapted games and the virtual reality system to supplement regular therapy hours to hopefully improve upper limb outcomes post stroke. Furthermore, a protocol will likely be developed that can make these findings easily reproducible in other settings that are focussed on upper limb stroke rehabilitation. Participants will be required to take part in a 6 week program, in which the first 2 weeks will be baseline, second two weeks will include the intervention, and the last 2 weeks will be baseline again. During the intervention phase, participants will be required to play adapted games on the VR headset for an hour each weekday along with their regular physiotherapy sessions. This will equate to 10 hours over the two week intervention phase. During baseline, participants will continue their regular physiotherapy with no VR intervention. Mode of delivery will be face to face an individually with one participant at a time. The intervention will be delivered by a 4th year Occupational Therapy student as part of their research honours. They will be supervised by a neurological physiotherapist with many years of clinical and research training in stroke recovery at all times. Intervention will be delivered at a Medical Clinic in the Rehabilitation Gym. The purpose of this study is to see how these games can be adaptable and suitable for different levels of stroke impairment. Therefore, the games will be personalised for each participant depending on where they are in their rehabilitation journey. One example of an adapted game is Beat Saber, which involves slicing blocks in a timely manner as they fly towards you. Another example is Cubism, which involves using fine motor skills to manipulate puzzle pieces and solve puzzles. Some examples of adaptations in these games include the types of games played, speed of games, complexity, number of task demands, overall difficulty, fine motor/gross motor requirements, and periods for which games will be played without rest. For example, Beat Saber may be adapted to run at a slower pace, with a reduce number of blocks, or with less complexity by reducing the number of different directions in which the block needs to be hit,. Adaptations will be made when the task is deemed too difficult or easy by the primary researcher and the participant. It will also be adapted by either the primary researcher or the participant. Adherence will also be measured by a participation checklist, to be measured by the chief investigator (Occupational Therapy student). There will not be common goals put in place. Rather, the study will just learn if there is any preliminary benefits of using the adapted games and may suggest in the future that common goals be set.