Medicine in Novel Technology and Devices 11 (2021) 100069

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Medicine in Novel Technology and Devices

journal homepage: www.journals.elsevier.com/medicine-in-novel-technology-and-devices/

Research Paper

A novel glasses-free virtual reality rehabilitation system on improving upper

limb motor function among patients with stroke: A feasibility pilot study
Haoyu Xie a, Hantao Zhang b, Haowen Liang b, Hang Fan c, Jianying Zhou b, c,
Wai Leung Ambrose Lo a, **, Le Li a, d, *
a
Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China
b
School of Physics, Sun Yat-sen University, Guangzhou, 510275, China
c
Guangzhou Midstereo Co. Ltd., Guangzhou, 510275, China
d
Institute of Medical Research, Northwestern Polytechnical University, Xi’an, 710072, China

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Virtual reality (VR) technology is increasingly used in stroke rehabilitation. This study aimed to
Virtual reality investigate the effectiveness of using the glasses-free VR training to improve motor function of upper limb in
Transcranial magnetic stimulation patients with stroke.
Stroke
Methods: Twelve patients with stroke were recruited to participate in the intervention of 3 weeks. At the baseline
Upper limb motor function
Fugl-meyer upper-extremity scale
and post intervention, two times of evaluation including Fugl-Meyer upper-extremity scale (FMS-UE), transcranial
Corticospinal excitability magnetic stimulation (TMS) measurement and motion evaluation were performed.
Results: No significant difference was observed between two groups at baseline evaluation. After the intervention,
the FMS-UE scores presented a greater improvement in the VR group compared with the control group. TMS
measurement showed that there was significant difference in cortex latency and central motor conduction time
between two groups after the intervention, but no significant difference in the amplitude of motor event potential
was observed. In addition, there was a significant correlation between game scores and FMS-UE scores.
Conclusions: The novel glasses-free VR training was at least as effective as conventional occupational therapy in
upper limb motor function, improving nerve conduction time and corticospinal excitability in patient with stroke.

1. Introduction
Stroke is among the leading cause of long-term disability with up to
85% of patients with stroke experience upper limb motor deficits [1].
Motor function of upper limb, in particular the hand function, occupies
more than 60% of the physical function for an individual [2]. However,
the recovery of upper limb motor function post stroke is clinical chal-
lenging, and the outcomes of upper limb rehabilitation remains unsat-
isfactory [1]. The loss of control input from the brain is believed to be a
contributor to muscle spasm and flaccid paresis, leading to the difficulty
in performing daily activities and reduced quality of life among patients
with stroke [3]. Additionally, early literature also suggested that there
was a significant descending information flow which potentially re-
flected the recruitment of motor neurons from the supplementary motor
area [4]. Thus, the recovery of the corticospinal pathway is likely to be a
precondition of motor function improvement for patients with stroke [4,
5].
Virtual reality (VR) technology has emerged as a promising inter-
vention to facilitate functional recovery among patients with stroke [6].
VR intervention provides interactive tasks within a computer-generated
virtual environment which incorporates auditory and visual feedback
[7]. It has the advantage to increase users’ motivation by providing the
high intensity repetitive tasks [8]. A previous review demonstrated the
potential benefits of VR to improve upper limb function and activities of
daily living (ADL) function in patients with stroke [9]. However, the
clinical effectiveness of VR systems in the recovery of hand function re-
mains unsatisfied [9]. The high complexity of the hand represents a
challenge to accurately capture and simulate the movements of the hands
and fingers [6,10,11].Thus, stroke patients could not obtain precise and
timely feedback from the VR system, which contribute to poor clinical
outcome [9,12]. Although gloves or other wearable devices with built-in
motion sensors are often adopted in some VR systems to capture hand

* Corresponding author. Department of Rehabilitation Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China.
** Corresponding author.
E-mail addresses: ambroselo0726@outlook.com (W.L. Ambrose Lo), lile5@nwpu.edu.cn (L. Li).

https://doi.org/10.1016/j.medntd.2021.100069
Received 11 August 2020; Received in revised form 8 February 2021; Accepted 2 March 2021
2590-0935/© 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
H. Xie et al.
movements, these wearable items place extraneous load on the users
which reduce motion velocity and increases the difficulty of training for
patients with stroke [13,14]. Leap Motion© Controller (LMC) is a device
designed to capture the fine motions of hands and fingers [6]. Compared
with other devices, LMC has the benefits of low-cost and easiness to use
[15]. To date, three studies were found that had trialed the LMC as part of
a VR training system to capture hand movements in patients with stroke,
and reported improvements in Wolf motor function test (WMFT) scores
and performance time [6], higher hand abilities and grasp force [16], and
increased Fugl-Meyer scale (FMS) scores and Box-and-Blocks Test scores
[17]. These studies demonstrated the feasibility and potential benefits of
LMC-based VR training in improving upper limb motor function among
stroke patients. It should be noted that only a two-dimension (2D) display
was used in those studies, which would not provide a stereoscopic virtual
environment for patients with stroke.
The neurological mechanism of VR training to improve upper limb
motor function in patients with stroke mainly involved two aspects,
cortical reorganization [6] and the recovery of corticospinal tract [18].
Wang et al. [6] observed an increase in activation intensity from func-
tional magnetic resonance imaging (fMRI) of the lesioned hemisphere in
sub-acute stroke patients after four weeks of Leap Motion-based VR
training. This finding provided support that Leap Motion-based VR
intervention promote neuroplasticity which contribute to functional
improvement [6,19].
The integrity of the corticospinal tract was demonstrated to be asso-
ciated with motor function recovery in chronic stroke patients [20,21]. A
previous study suggested the positive relationship between the integrity
of corticospinal tract and upper limb motor recovery in patients with
cerebrovascular accidents [18]. Another research reported an improve-
ment in the functional integrity of ipsilateral corticospinal tract and
upper limb motor function after two weeks of VR training in patients with
subacute stroke [22]. The author stated that stroke patients with higher
motor evoked potentials (MEPs) had a significantly greater FMS and
WMFT scores than those with MEP absence. It suggested that functional
recovery of upper limb post stroke may be related to the ipsilesional
corticospinal tract [22,23]. However, there is still a lack of evidence
whether neural conduction time would change after the VR training
among stroke patients, and more research is needed.
Our institute has recently developed a novel glasses-free VR reha-
bilitation system that addressed the issues of external sensors to capture
hands and finger motion of the existence VR system discussed above. This
study was aimed to investigate whether the novel VR rehabilitation
system was able to facilitate the recovery of upper limb motor function,
as well as the corticospinal tract in patients with stroke. We hypothesized
that after the glasses-free VR training, there would be an improvement in
upper limb motor function and the function of corticospinal tract among
patients with stroke.
2. Method
2.1. Participants
Patients with stroke were recruited between July 2018 and February
2019 from the Department of Rehabilitation Medicine, the First Affiliated
Hospital of Sun Yat-sen University, Guangzhou, China. In the beginning
of the study, these participants were subjected to a clinical evaluation
including physical and neurological examination, computed tomography
(CT) or MRI scans, and their medical history was reviewed in detail.
The inclusion criteria were as follows: 1) First ever occurrence of
stroke (including infraction and hemorrhage); 2) Between one to twelve
months of stroke onset; 3) Hand function beyond Brunnstrom III classi-
fication; 4) Age between 35 and 70 years of age; 5) Able to sit inde-
pendently without assistance. The exclusion criteria were as follows: 1)
Unstable vital signs; 2) History of congestive heart failure within 3
months; 3) History of psychiatric disorders, cognitive impairment or
aphasia; 4) History of fracture, surgery, arthritis or pain in the affected
2
Medicine in Novel Technology and Devices 11 (2021) 100069
upper limb; 5) Upper limb muscle spasm (modified Ashworth scale >
grade II).
The study protocol was approved by the ethical committee of the First
Affiliated Hospital, Sun Yat-sen University (Ethics no.: [2013]C-068). All
participants were informed of the study protocol, and all questions were
explained in detail. Informed written consent was obtained prior to data
collection. Participants were free to withdraw from the study at any time
without providing a reason. The Declaration of Helsinki was strictly fol-
lowed throughout the course of the study.
2.2. Procedure
Fig. 1 presents the overall procedure of the study. Random number
was generated in a statistical software (IBM SPSS 20.0) to randomly
assign participants to either the VR group or control group. Participants
received assessments at baseline and post intervention by a single
assessor who was not involved in this study. Intervention period lasted
for 3 weeks with 5 treatment sessions per week. Participants in the VR
group received VR training for 30 min (10 min on each of the training
items) and conventional occupational therapy for 30 min (including
passive hand mobilization, hands functional training and activity of daily
living training) per day. Participants in the control group received con-
ventional occupational therapy for 60 min per day. Participants could
take breaks at any time if they wish to do so.
2.3. Apparatus
2.3.1. Intelligent glasses-free virtual reality rehabilitation system
The novel intelligent glasses-free VR rehabilitation system was
designed by the School of Physics, Sun Yat-sen University, which consists
of three units, including a central processing unit (CPU), a three-
dimension (3D) display, and the LMC. Fig. 2 illustrates the schematic
of the glasses-free VR rehabilitation system. The featured specifications
of the glasses-free VR rehabilitation system are listed in Table 1. The low
crosstalk of 3% [24] of this VR system is capable to provide intuitive 3D
perception images for users so that they can continuously reach the 3D
virtual object with fewer side effects, while previous study reported that
the crosstalk over 5% would lead to nausea or dizziness [25]. The hybrid
spatial-temporal directional backlight (HSTDB) technology within the
system creates and displays 3D effects [26] (Fig. 2B). The 3D stereoscopic
vision unit works in conjunction with HSTDB to project 3D images
directly into the eyes which creates the intense level of immersion.
Therefore, the system does not require users to wear external equipment,
such as 3D goggles or helmets, to interact with the virtual environment.
In addition, the non-immersive feature makes this VR system not be
completely isolated from outside environment, which further minimize
the potential side-effects such as dizziness for users.
Hand movements are tracked by LMC that consists of two stereo
cameras and three infrared LEDs (Fig. 2D). These LEDs emit infrared light
with a wavelength of 850 nm that is outside the visible light spectrum
[27,28]. The 3D coordinate system created by LMC captures the infor-
mation about the spatial location of palms and fingers. Then, after the
information were converted into digital format by CPU, a virtual hand is
displayed on the screen of the 3D display [29]. The high accuracy of LMC
to track hand position is able to mimic a vivid virtual hand of users, as
well as capturing accurate motion data for analysis. Users need to move
their hands to manipulate the virtual hands on the screen. The visual and
auditory feedback from the VR system provide information for users to
adjust their movements to complete training through the hand-eye co-
ordination in the real world. The use of LMC provides a user-friendly
interactive environment, as patients do not have to wear a
head-mounted device or any other assisted equipment. A height adjust-
able arm support could be provided to those who have difficulty main-
taining the arm in the required position.
The content of the glasses-free VR rehabilitation system was created
on the Unity 3D© platform. The training items consists of 1) Picking
H. Xie et al. Medicine in Novel Technology and Devices 11 (2021) 100069

Fig. 1. The overall procedure of the study.

Fig. 2. The glasses-free VR rehabilitation system. (A) A participant with stroke was using the glasses-free VR rehabilitation system to do VR training; (B) HSTDB
projected 3D effect to a viewer; (C) Schematic diagram of the glasses-free VR rehabilitation system; (D) Leap Motion Controller.

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H. Xie et al.
Table 1
Specifications of the glasses-free VR rehabilitation system.
Parameters Value
Resolution in 3D mode 1920
1080 per eye
Global crosstalk across entire screen 3% in average
Color gamut 72% NTSC
Luminance ~300 cd/m2
Viewing angle 25
Viewing distance From 22.4 to 39.4 inches
2D/3D switching ✓
Accuracy of positioning 0.7 mm
Flowers; 2) Grabbing Cups; and 3) Tracing Balls. These training tasks
were designed to focus on the rehabilitation of fine motions, which in-
cludes pinching and cyathiform grasping, and extensive upper limb
movements. Picking Flowers (Fig. 3A) was designed for the rehabilitation
of the pinching motion, along with wrists, elbows, and shoulders. Users
were required to pick the petals and stems of the flowers in a virtual
environment. Each successfully completed task counted for a point.
Grabbing Cups (Fig. 3B) focused on the dexterity and coordination of
fingers through performing cyathiform grasping movement and posi-
tioning the arms at different directions in the coronal plane and sagittal
plane. Users were asked to manipulate the virtual hand to grasp the cup
and move to a designated area on the virtual wooden desk. Each
completed task counted for a point. Tracing Balls (Fig. 3C) was designed
to improve the range of motion of elbows and shoulders and motion
control. Users needed to manipulate the virtual hand to hold and follow
the ball. The ball moved along an expected “8”-shape trajectory in a 3D
reference system. The closer the virtual hand got to the ball, the lighter
the color of the virtual hand would be. There were no points counted in
this item. The difficulty of Tracing Balls could be adjusted according to
the functional level of users. The ratio of movement between users’ hand
and virtual hands could be adjusted from 1:1 to 1:5. It means when a user
Fig. 3. The training items within system. (A) Picking Flowers; (B) Grabbing Cups; (C) Tracing Balls.
Fig. 4. Transcranial Magnetic Stimulation. (A) A participant with stroke was performing TMS measurements; (B) The TMS example of a participant, where M1 and C7
represent that coil was placed on motor cortex and C7, respectively. Number 1 to 5 represents the first to fifth time of MEP measurement.
4
Medicine in Novel Technology and Devices 11 (2021) 100069
moved hands for 1 cm in the physical space, the virtual hands on the
screen would move for 1–5 cm based on the set ratio.
2.3.2. Transcranial magnetic stimulator
TMS measurements were recorded by a figure-of-eight 7-cm diameter
coil (model CCY-I, Yiruide Wuhan, China) that was capable of generating
a 3-T maximum field intensity (Fig. 4A). Motor evoked potential (MEP)
was recorded by placing conventional surface electrodes on the surface of
abductor pollicis brevis (APB) of the affected side, using classic bipolar
tendon-muscle mounting method [30]. The myoelectric signals were
acquired by electromyography. The measurements of latencies were
performed according to the published protocol [30], with 20%
above-threshold and maximal stimulation output. The coil was placed on
motor cortex (M1 region) of the lesioned hemisphere. The response time
for signals to conduct from the cortex to the muscle was cortex latency
(CL). Peripheral conduction time (C7 latency) was recorded by posi-
tioning the coil on the affected side of cervical 7 (C7) nerve root. Central
motor conduction time (CMCT), the conduction time in the central ner-
vous system, was calculated by subtracting C7 latency from CL [31].
2.4. Outcome measures
The outcome included three parts. Firstly, FMS-UE was adopted to
assess the upper limb function in patients with stroke by the same
assessor at the baseline and post-intervention [32,33]. FMS-UE consists
of 33 items, rated on a three-point ordinal scale (0–2) with the maximum
score of 66 points. A higher score indicates better upper limb function.
FMS-UE evaluation was performed for three times and the mean was
included in the analysis. Secondly, the parameters of CL, CMCT, and the
amplitude of MEP were recorded by transcranial magnetic stimulator at
baseline and post-intervention to evaluate the recovery of corticospinal
tract function. All three parameters were measured ten times and the
H. Xie et al. Medicine in Novel Technology and Devices 11 (2021) 100069

mean was included in the analysis. Thirdly, in each session of VR Table 3

training, game scores of the Picking Flowers and Grabbing Cups of each Results of TMS measurement and FMS-UE assessment.
participant in the VR group were recorded as game scores. VR group (n ¼ Control group (n ¼
6) 6)
3. Data analysis Parameters Mean (SD) Mean (SD) p value
a

Data analysis was conducted in the statistical software (IBM SPSS Male/Female 5/1 5/1
20.0). Descriptive statistics were employed to describe the sample Age (years) 48.8 (9.6) 53.3 (6.4) 0.363
characteristics. A paired t-test was used to compare the FMS-UE and TMS Months since stroke 5.0 (3.4) 5.6 (4.4) 0.774
(months)
data between the baseline and post intervention in both groups. An in-
FMS-UE
dependent t-test was used to compare the FMS-UE and TMS data between Baseline 32.2 (19.5) 33.5 (14.4) 0.896
the VR group and control group before and after intervention. This study Post 40.8 (18.9)* 39.0 (13.3)* 0.042
adopted the parametric analysis of t-test to the ordinal scale due to the TMS measurements
small sample size. Early literature indicated that t-test is sufficiently CL (ms)
Baseline 29.1 (1.9) 31.4 (2.1) 0.641
robust on ordinal scales and minimize the probability of rejecting a
Post 25.4 (1.1)* 29.2 (1.3)* ＜0.001
correct null hypothesis when sample population is small [34]. A Spear- CMCT (ms)
man’s correlation analysis was used to investigate the association be- Baseline 18.6 (1.7) 19.6 (2.3) 0.412
tween game scores and FMS-UE scores in the VR group. In consideration Post 16.1 (2.1)* 18.3 (2.4)* 0.034
Amplitude of MEP (μV)
of the FMS-UE as an ordinal scale, this study adopted the Spearman’s
Baseline 216.3 (128.4) 193.2 (89.9) 0.228
correlation to quantify the relationships between the ordinal data and the Post 279.0 (155.3)* 266.3 (86.6)* 0.188
continuous data [35]. Statistics significant level was set at 0.05.
* Significant difference between baseline and post assessment within group (p <
0.05).
4. Results a
The p value of the independent t-test between the VR group and control
group.
A total of eighteen patients with stroke were screened. Four patients
were excluded due to the exclusion criteria and two patients refused to
Table 4
participate, leaving the final sample size of twelve participants (10 males Spearman’s correlation analysis between game scores and FMS-UE scores.
and 2 females; mean age ¼ 51.08 (8.14) years; mean onset time of
FMS-UE p value
stroke ¼ 5.5 (3.6) months). Table 2 shows demographic and clinical
information of the sample population. Six participants were randomly Picking Flowers 0.941* 0.005
Grabbing Cups 0.889* 0.020
assigned to the VR group (n ¼ 6, one female, mean age ¼ 48.3 (9.6)
years, mean onset time of stroke ¼ 5.2 (3.2) months) and control group *Spearman’s correlation coefficient.
(n ¼ 6, one female, mean age ¼ 53.3 (6.4) years, mean onset time of
stroke ¼ 5.6 (4.4) months). There was no significant difference in de- The Spearman’s correlation coefficients between game scores of Picking
mographics and all outcome measures between the VR and control group Flowers and FMS-UE scores were 0.941 (p ¼ 0.005), and 0.889 (p ¼
at baseline. After 3 weeks of intervention, the FMS-UE scores in both 0.020) for the correlation between Grabbing Cups and FMS-UE.
groups significantly increased (p＜0.05). The increase in FMS-UE
observed in VR group was significantly greater than those observed in 5. Discussion
the control group (p＜0.05).
The parameters of CL and CMCT significantly decreased, whereas the The present study evaluated the feasibility of the novel glasses-free
amplitude of MEP significantly increased after intervention in both VR training combined with physical therapy on patients with stroke,
groups (p＜0.05). The improvement of CL and CMCT was greater in the and confirmed our hypothesis that the glasses-free VR training could
VR group than the control group (p < 0.05) No significant difference in facilitate the recovery of upper limb motor function, as well as the
the amplitude of MEP between two groups was observed after the function of corticospinal tract, post stroke.
intervention (p＞0.05). Table 3 presents the data of all outcome measures Participants in both groups exhibited a significant increase in the
before and after intervention. Table 4 presents the correlation analysis FMS-UE scores after the intervention of three weeks, which indicated
results between game scores and FMS-UE scores. that both the glasses-free VR training and conventional occupational
Fig. 5 presents the game scores of Picking Flowers and Grabbing Cups therapy could facilitate the recovery of upper limb motor function in
for each participant in the VR group during the intervention of 3 weeks. patients with stroke. The variation of FMS-UE scores varied among
studies, and the present study showed a greater improvement of 8.67
Table 2 (2.66) points in stroke patients who received the novel glasses-free VR
Demographic and clinical characteristics of the sample population. training, when compared with previous studies with similar intervention
Participant Gender Age Months since Etiology Site of durations but different VR devices [14,19]. However, the average
No. (years) stroke lesion pre-post intervention difference between VR and control group was 3
1 male 56 11 Infraction Lt. points on the FMS-UE. Previous studies reported similar amount of 4.07,
2 male 52 4 Infraction Rt. 3.3, and 1.0 points difference between VR intervention and control
3 male 63 5 Infraction Rt. therapy [36–38]. Thus, the observed small differences may not constitute
4 male 41 3 Hemorrhage Lt.
to the evidence to suggest that VR training is clinically more effective
5 female 40 2 Infraction Rt.
6 male 41 6 Hemorrhage Lt.
than conventional therapy, despite the reaching statistical significance
7 female 45 7 Infraction Lt. [39]. The increase of the FMS-UE score in the VR group might be due to
8 male 60 2 Infraction Rt. not only the combined occupational therapy, but also the usage of the
9 male 49 3 Infraction Rt. novel glasses-free VR rehabilitation system. The features of the
10 male 50 12 Hemorrhage Lt.
glasses-free VR rehabilitation system mainly include the following two
11 male 61 9 Infraction Lt.
12 male 55 2 Infraction Rt. aspects. Firstly, the usage of LMC provides greater freedom of mobility
for stroke patients to interact with virtual environment [6]. Besides, the
Key: Lt - left side; Rt - right side.

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H. Xie et al.
Fig. 5. Game scores of each participant in the VR group. (A) Game scores of Picking Flowers; (B) Game scores of Grabbing Cups. P1–P6 represents the six participants
in the VR group.
absence of extra wearable devices, such as motion gloves or wires,
minimizes the stroke patients’ load during the VR training, so that the
time for which stroke patients are involved in rehabilitation program
enhanced [16]. Secondly, the adding of the 3D display with lower
crosstalk reduced the load of wearing 3D glasses or helmets and the
probability of dizziness during the VR training for stroke patients.
Compared with previous 2D VR systems with LMC, our system could
provide spatial information involving depth for stroke patients, which
may help them re-build stereognosis further [6,16]. Therefore, the
combination of LMC and 3D display in this system provides more positive
stimulation for stroke patients while allowing them to be completely free
of device load than other 2D VR systems. Our glasses-free VR rehabili-
tation system integrates the virtual environment, 3D sense of space and
rehabilitation training to simulate the real scene furthest.
Improvements in nerve conduction time, as indicated by the signifi-
cant reduction in CL and CMCT, were observed in both groups post
intervention. A larger reduction in the CL and CMCT in the VR group than
the conventional group were observed which suggested a combination of
VR intervention with occupational therapy may be superior to occupa-
tional therapy alone in promoting corticospinal tract function. MEP
amplitude improved significantly post intervention in both groups but
the difference between the VR group and the control group was not
significantly different. A study by Kang et al. [40] reported that the MEP
amplitude and MEP latency in people with stroke who received VR
mirror training were significantly higher than those who received actual
mirror training task. One of the confounding factor within the present
study was the inclusion of both subacute and chronic stroke patients.
Previous study reported that patients with stroke at the subacute and
chronic stage had different mechanisms of neuroplasticity [41]. Thus, the
effect of the glasses-free VR training on improving corticospinal excit-
ability observed in the present study may be underestimated.
The game scores recorded by the VR system during the training ses-
sions were included as part of the evaluation the motor function of the
participants who underwent VR intervention. A significant correlation
between the game scores and FMS-UE scores was found which implied
the feasibility of the game scores to evaluate functional recovery of the
affected upper limb among patients with stroke (Table 4). A previous
study that also reported correlation between game score and FMS-UE
provided further support of the feasibility to assess motor function by
built-in games score [17]. However, further research about the validity of
game score to assess the upper limb motor function recovery in stroke
patients is recommended.
6. Limitation
The findings of the present study must be interpreted with cautious
due to its limitations. The sample size of the study was small and
6
Medicine in Novel Technology and Devices 11 (2021) 100069
therefore was likely to contact type II error. The present study included
subacute and chronic stroke participants which may lead to underesti-
mation of VR training effects. Future studies should include patients with
single type of stroke to enhance internal validity. This study could not
rule out spontaneous recovery which may contribute to the improvement
of outcomes [42].
7. Conclusions
This study demonstrated that the novel glasses-free VR training was at
least as effective as conventional occupational therapy in improving
upper limb motor function, improving nerve conduction time and cor-
ticospinal excitability in patients with stroke. The VR training had better
effect on improving upper limb motor function in patients with stroke.
The novel glasses-free VR training system is potentially feasible to be
adopted as part of the upper limb rehabilitation program for patients
with stroke. Further research on its clinical effectiveness is warranted.
Funding
This study was supported by National Natural Science Foundation of
China (Nos. 31771016, 32071316, and 81971224), and partly supported
by Guangdong Basic and Applied Basic Research Foundation (No.
2020A1515011356), Guangzhou Research Collaborative Innovation
Projects (No. 201907010034) and the Non-profit Central Research
Institute Fund of Chinese Academy of Medical Sciences (No.2020-JKCS-
005).
Authors contributions
LL, WL conceived and designed the study. HX, HZ, and HL performed
the experiments. HX and WL wrote the paper. WL, HL, FH, JZ, LL made
contributions to the experiments. WL, HL, JZ, and LL reviewed and edited
the manuscript. All authors had read and approved the manuscript.
Declaration of competing interest
The authors declare that there are no conflicts of interest.
Acknowledgements
We would like to thank all the clinical staff and participants for their
contribution to the study.
H. Xie et al. Medicine in Novel Technology and Devices 11 (2021) 100069

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