Virtual Reality Upper Limb Therapy (VRULT)
Research type
Research Study
Full title
The Feasibility of Virtual Reality-Based Activities for Upper Limb Rehabilitation of People with Acute/Sub-Acute Tetraplegia.
IRAS ID
336594
Contact name
Lorna Paul
Contact email
Sponsor organisation
Glasgow Caledonian University
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 0 months, 0 days
Research summary
Research summary
Improving arm and hand function is a high priority for people with spinal cord injury (SCI) and even small improvements in arm and hand function can reduce reliance on others for self-care, promoting independence and positively affecting quality of life.Virtual reality (VR) training has been used as a form of arm and hand rehabilitation in different clinical conditions. In VR, a person with SCI is able to complete exercise in an interactive virtual environment. This can foster more enjoyable and motivating experiences compared to traditional exercise therapy, potentially increasing the amount of therapy undertaken, leading to improvements in arm and hand function.
The study has two objectives. The first is to find out if VR technology is usable by people with spinal cord injuries and their therapists while in hospital. The second objective is to get an indication if this therapy could be effective.
Participants who have had a spinal cord injury and have tetraplegia will be recruited from the Queen Elizabeth National Spinal Injuries Unit, Glasgow. After they have provided informed consent, they will receive 12 weeks of either standard upper limb therapy (‘control group’), or both the VR activities and standard treatment (‘VR Group’). Participants who receive VR activities will engage in immersive VR games.
The participants who are in the control group will receive their usual rehabilitation and will be given the opportunity to try the VR games after the completion of their involvement in the trial.
All participants will be asked to attend three assessment sessions during the study. These will last up to two hours each and monitor how their arm and hand function changes. Participants will also be interviewed and complete a questionnaire to see what they thought about using the VR games.
Summary of results
tudy titleVirtual Reality Upper Limb Therapy for People with Tetraplegia (the VRULT study). Virtual reality, often shortened to VR, means a computer-made world that a person sees through a headset.
Why was the research needed?
People with a new spinal cord injury sometimes have to spend a long time in hospital and will need to practise repetitive arm and hand movements. Repeating movements is a key part of recovery. In practice, people often manage only a small number of repetitions during a therapy session.
Video games played in virtual reality might help. They can make repeated movement more interesting. However, nobody knew whether this would work on a busy spinal injuries ward.What was the purpose of the study?
This was a feasibility study. That means it tested whether the treatment (the VR exercise games) could be delivered at all, not whether it works.
We looked for answers to the following questions:
1. Could people with very different arm problems use the games?
2. Could therapists fit the sessions into the ward routine?
3. Was the treatment safe?
4. Did patients and therapists find the games useful?How patients and the public helped
The VR games were designed together with people who have lived experience of spinal cord injury. Fifteen people with tetraplegia and eleven therapists took part in this design work.
Tetraplegia means weakness or paralysis affecting both arms and both legs. It is caused by injury to the spinal cord in the neck. The therapists were occupational therapists and physiotherapists.
They told us what the games should do and how they should work. Their ideas shaped every part of the final design.
Where and when the study took place
The study ran at the Queen Elizabeth National Spinal Injuries Unit in Glasgow. It took place between March 2024 and August 2025. All participants were staying on the ward at the time.Who took part?
We approached 45 patients. Eighteen were suitable for the study. Twelve agreed to take part.
One person left before being placed in a group. Eleven people were then placed into a group at random. Eight received the VR treatment and three continued with their usual therapy only.
Their average age was 57 years. Four were women and eight were men.
What treatment did participants receive?
The VR group used a Meta Quest 3 headset. This is a headset that works on its own, without a computer attached. It can track a person's hands using cameras, so controllers are not always needed.
They played three games: archery, boxing and 3D puzzles. A therapist chose which arm or hand movement each person should practise. The games were then set up so that this movement controlled the game.
Sessions lasted up to 30 minutes, three times a week, for six weeks. This was in addition to their usual therapy, not instead of it. The comparison group carried on with usual therapy and could try the games afterwards.What happened during the study?
Nine of the eleven participants stayed in the study to the end. That is 82 out of every 100.
The VR group attended 61 out of every 100 possible sessions. Most missed sessions happened for medical reasons, such as illness, tiredness or hospital appointments. When these unavoidable reasons were set aside, attendance rose to 83 out of every 100.
Fewer people joined the study than we hoped for. We had aimed for 24. Many patients were either too unwell to use the games or recovered and went home too quickly.
What medical problems did participants have?
Three medical events happened during the study. None of them was caused by the VR treatment. Two were COVID-19 infections and one was a fall, after which that person stopped the treatment.
No one felt sick or dizzy from using the headset. This had been a worry beforehand, so it is a reassuring result.
The equipment developed 17 faults, mostly software problems. These caused only one session to be cancelled, which was rearranged. All faults were fixed, often by updating the software during the study.What were the results of the study?
People rated the games highly. On a scale of 1 to 7, average satisfaction was 6.4 and usefulness was 6.0. Everyone learned to use the headset in their first session.
The games allowed a lot of movement in a short time. A typical session lasted about 19 minutes and involved around 190 arm or hand movements. Published research suggests around 42 arm movements a day is usual in standard ward therapy.
Everyone could set the games up to suit their own arms, whatever their level of injury. Most people preferred using their bare hands to using handheld controllers.
In interviews, participants described the games as enjoyable and motivating. It also distracted them from pain and boredom.
People also told us what did not work. The jigsaw puzzles were too long and could not be saved partway through. The scoring system in boxing was confusing. The headset was uncomfortable for one person until a different strap was found. The headset's own start-up menus were hard to use for people with limited hand or neck movement.
Therapists said the treatment fitted into their sessions. Their main concern was staff time. Setting the equipment up takes a member of staff away from a group.What about arm strength and independence?
We measured arm strength, feeling, hand function, independence and pain. Both groups improved a little over the six weeks.
We cannot say that VR caused these improvements. The study was far too small to answer that question. People also recover naturally in the early months after injury, and everyone received their usual therapy as well.
Importantly, we found no sign that the VR treatment did any harm.
How has this study helped patients and researchers?
The study shows that this treatment can be delivered safely in a busy spinal injuries unit. It shows the games can be adapted to a wide range of arm problems. It also shows people enjoy them and can learn them quickly.
This is the first randomised study of a co-designed VR arm treatment for people with a new spinal cord injury. It gives other researchers practical information about running trials of this kind.Who carried out the research?
The study was sponsored by Glasgow Caledonian University. It was funded by Stoke Mandeville Spinal Research. The research team declares no competing interests.
Thank you!
We are very grateful to everyone who took part in this study. We also thank the therapists and staff at the Queen Elizabeth National Spinal Injuries Unit who supported it.
Further research planned
The games will be improved first. Planned changes include more types of games, shorter puzzles, clearer scoring, and a way to play alongside other patients.
A larger study is needed to find out whether the treatment actually helps recovery. One hospital could not recruit this many alone, so most of the eleven UK spinal injury centres would need to take part. Using the games at home after discharge is another possibility worth testing.REC name
West of Scotland REC 4
REC reference
24/WS/0002
Date of REC Opinion
23 Feb 2024
REC opinion
Further Information Favourable Opinion