Abstract Background and aims Extended reality (XR) offers a promising platform for upper-limb assessment and rehabilitation after stroke. XR can deliver engaging tasks that quantify arm use and allow controlled manipulation of reward feedback. In this study, we develop an XR reaching game to test whether stroke patients rely more on their ipsilesional arm, whether reward can modify this preference, Methods Patients (current n = 6, 18-176 days post-stroke; target n = 15) play an XR reaching game with virtual targets overlaid on the real environment. Reaches are made with either arm and points are awarded for each target hit. Arm use is quantified as the proportion of reaches made with each arm. Unbeknownst to participants, the point schedule is manipulated so that points periodically favour the contralesional arm. Results Preliminary results are descriptive; planned statistical analyses will be completed prior to presentation. Patients rely more on their ipsilesional arm. This preference appears modifiable: when the point schedule favours the contralesional arm, some patients increase use of that arm. Tolerability was high: all participants to date have completed the XR game and rated the experience as enjoyable; no adverse effects have been reported. Conclusions Early data support the tolerability and clinical feasibility of an XR reaching game for quantifying arm use after stroke. This platform may enable longitudinal recovery monitoring and provide an engaging therapeutic exercise, but conclusions about reward-related changes in arm use and potential rehabilitation benefits await the full sample and completed patient–control comparisons. Conflict of interest
Jackson et al. (Fri,) studied this question.