Vivid illusions and realtime feedback in VR-improved motor imagery and motivation of stroke patients with impaired motor imagery

Virtual reality (VR) enhances subjective imagery experience. However, no previous studies have investigated whether VR can improve subjective imagery experience in stroke patients who specifically present with motor imagery (MI) impairment. The present work aimed to examine the effect of interactive virtual reality on subjective imagery experience in such a patient population. Twenty-eight stroke patients with hemiplegia who were specifically recruited based on objectively assessed motor imagery impairment (as measured by the KVIQ-10) participated in the study. Following interactive VR training, all subjects completed questionnaires assessing subjective imagery experience, sense of embodiment, motivation, and adverse reactions. A 1-week follow-up was conducted. The results showed that these patients with pre-existing MI impairment did not differ from the healthy control group in terms of sense of embodiment or subjective imagery experience under VR conditions. Furthermore, the patient group demonstrated significantly higher system acceptance in motivation assessments compared to the healthy controls. Most patients voluntarily recalled the VR scenes during the follow-up week, whereas participants in the control group did not. These findings indicate that stroke patients with overt motor imagery deficits can benefit from the proposed VR rehabilitation system, supporting its potential for further development in VR-based neurorehabilitation programs.