VR gaming has proven to be uniquely valuable for stroke rehabilitation.

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ContextOver 1.2 million people in the UK are living with the effects of a stroke, most commonly an impaired arm. Stroke research indicates that better recovery is possible with therapies that promote use of the affected limb. Based upon this principle, our proposed research will establish the foundational science necessary to develop new Virtual Reality (VR) based therapies for stroke survivors. By targeting processes that govern hand choice, these new therapies will increase the likelihood that patients will choose to use their affected hand.RationaleVR gaming has proven to be uniquely valuable for stroke rehabilitation. The storytelling nature and richly immersive environment is highly engaging, and can easily be practiced from the patient's home. The proposed research will take VR gaming for upper-limb rehabilitation in a new direction. Instead of focusing only on the movements themselves, we will target and exploit 'upstream' processes underpinning the choice of which hand to use to perform actions. Aims We will develop VR games that track hand movements and use this information to dynamically alter the user's hand choice. We will then trial these methods with stroke patients, co-designing their refinement according to individual needs.Research questions(1) What game features influence hand choice? (2) What game features should be customisable given a patient's rehabilitation needs?(3) What makes games engaging? Methods Our first games will closely model the experimental paradigms we have used to study hand choice in the lab (e.g., Valyear et al. 2018). From this basepoint, the student will have ample opportunity to steer the research in their preferred directions. There are many exciting, unexplored possibilities-for example, can we change a user's hand choice by systematically rewarding more game points to actions made with one hand? And, would reward schemes with social elements, like shared leaderboards, be useful?Games will be designed in cooperation with patients and according to known rehabilitation principles. We may, for example, augment performance of the patient's affected side, and gradually phase this out, consistent with the principles of 'shaping'. Rescape has immense expertise in storytelling and personalising games to enhance user engagement. We will draw from this knowledge, and explore new ways to further our understanding of what makes games engaging and fun. Outcomes(1) A greater understanding of the principles that govern hand choice.(2) The development of new VR-based therapies for upper-limb rehabilitation.(3) Initial tests of clinical feasibility and proof-of-concept.