Assessing the impact of music & mirror therapy in virtual reality on arm function after stroke.

INTERVENTION NAME: REFLECT REFLECT is an acronym for: Rehabilitation with Engaging Feedback and Learning Enrichment through Combined Therapies. INTERVENTION DESCRIPTION: Music-supported mirror therapy delivered via a novel virtual reality (VR) application, co-designed with stroke survivors (n=13) and professionals (n=12). The content of REFLECT includes 10x guided mirror therapy + song pairs ranging from gross motor to fine motor exercises, plus the option to create music with 10x different songs; the upper limb rehab exercises built into REFLECT include: Shoulder Flexion Up/Down; Reach Forwards/Return; Clapping In/Out; Wrist Pronation/Supination; Elbow Flexion/Extension; Wrist Flexion/Extension; Fist Clench/Unclench; Cylindrical Grip; Finger Counting; Thumb Opposition MATERIALS: 1x VR headset (with REFLECT pre-loaded) + 1x Axivity AX6 activity monitor. Participants will also be provided with an information sheet, user guide, and weekly journal. The information sheet, user guide, and weekly journal have been designed specifically for this study and are intended to be used as a resource and for for participant documentation throughout the pilot trial. Participants will be asked to continuously wear an activity monitor on the wrist of their affected side for 12 weeks (during the 8 week intervention + 2 weeks before/after). The wrist-worn activity monitor should be worn at all times (including sleeping and bathing), however, the participant may temporarily remove it at their discretion if continual use become uncomfortable/unbearable. This will provide an indicator of general upper limb use over time. REFLECT involves the translation of upper limb rehabilitation exercises, and functional activities of daily living into music-based mirror therapy movements that will be performed in VR. SCHEDULE: Prior to commencing use with REFLECT, participants will complete a 2-hour onboarding & training session in their home, led by the Principal Investigator. The onboarding session will include a full demonstration of REFLECT, connection to the home Wi-Fi, and a Q&A with the participant, and any family members/ carers/ support workers present. In line with literature guidelines, the participants will be asked to use REFLECT for 1 hour/day 2x 30 min, 3x 20 min, or 4x 15 min sessions totalling 1 hour/day, 5 days/week, for 8 weeks (40 hours total). However, this may not be possible for all participants. There will not be any consequence the participants need to take days off or shorten the use due to family/ work/ volunteering/ person commitments/ additional therapy/ fatigue. Participants will not be asked to increase or decrease their usage of REFLECT during the pilot trial, however, if no usage is recorded for over 1 week, the research term may enquire whether the user is encountering any technical difficulties. Adherence will be monitored via continual uploads of (non-identifying) usage & app interaction data to a secure server, accessible only to the Principal Investigator. A mid-point check-in visit is built into the pilot trial to download the data from the activity monitor and recharge it's batteries, which will also provide an opportunity of in-person technical support. LOCATION: Participant's home. TAILORING: All participants will receive the same version REFLECT, however, they will have the choice of how they use it (e.g. which songs are selected and movements are performed). Additionally, users will be encouraged to calibrate the system to their range of motion.