Enhancing Mirror Therapy via Scaling and Shared Control: A Novel Open-Source Virtual Reality Platform for Stroke Rehabilitation.

Mirror therapy is increasingly used in stroke rehabilitation to improve functional movements of the affected limb. However, the extent of mirroring in conventional mirror therapy is typically fixed (1:1) and cannot be tailored based on the patient's impairment level. Further, the movements of the affected limb are not actively incorporated in the therapeutic process. To address these issues, we developed an immersive VR system using HTC Vive and Leap Motion, which communicates with our free and open-source software environment programmed using SteamVR and the Unity 3D gaming engine. The mirror therapy VR environment was incorporated with two novel features: (1) scalable mirroring and (2) shared control. In the scalable mirroring, mirror movements were programmed to be scalable between 0 and 1, where 0 represents no movements, 0.5 represents 50% mirroring, and 1 represents 100% mirroring. In shared control, the contribution of the mirroring limb to the movements was programmed to be scalable between 0 to 1, where 0 represents 100% contribution from the mirroring limb (i.e., no mirroring), 0.5 represents 50% of movements from the mirrored limb and 50% of movements from the mirroring limb, and 1 represents full mirroring (i.e., no shared movements). Validation experiments showed that these features worked appropriately. The proposed VR-based mirror therapy is the first fully developed system that is freely available to the rehabilitation science community. The scalable and shared control features can diversify mirror therapy and potentially augment the outcomes of rehabilitation, although this needs to be verified through future experiments.