Virtual Reality-based Therapy Research Articles

Virtual Reality-Based Therapy Improves Fatigue, Impact, and Quality of Life in Patients with Multiple Sclerosis. A Systematic Review with a Meta-Analysis.

Patients with multiple sclerosis (PwMS) have a high level of fatigue and a reduced quality of life (QoL) due to the impact of multiple sclerosis (MS). Virtual reality-based therapy (VRBT) is being used to reduce disability in PwMS. The aim of this study was to assess the effect of VRBT on fatigue, the impact of MS, and QoL in PwMS. Methods: A systematic review with meta-analysis was conducted through a bibliographic search on PubMed, Scopus, Web of Science, and PEDro up to April 2021. We included randomized controlled trials (RCTs) with PwMS that received VRBT in comparison to conventional therapy (CT) including physiotherapy, balance and strength exercises, and stretching or physical activity, among others; or in comparison to simple observation; in order to assess fatigue, MS-impact, and QoL. The effect size was calculated using Cohen’s standardized mean difference with a 95% confidence interval (95% CI). Results: Twelve RCTs that provided data from 606 PwMS (42.83 ± 6.86 years old and 70% women) were included. The methodological quality mean, according to the PEDro Scale, was 5.83 ± 0.83 points. Our global findings showed that VRBT is effective at reducing fatigue (SMD −0.33; 95% CI −0.61, −0.06), lowering the impact of MS (SMD −0.3; 95% CI −0.55, −0.04), and increasing overall QoL (0.5; 95% CI 0.23, 0.76). Subgroup analysis showed the following: (1) VRBT is better than CT at reducing fatigue (SMD −0.4; 95% CI −0.7, −0.11), as well as in improving the mental dimension of QoL (SMD 0.51; 95% CI 0.02, 1); (2) VRBT is better than simple observation at reducing the impact of MS (SMD −0.61; 95% CI −0.97, −0.23) and increasing overall QoL (SMD 0.79; 95% CI 0.3, 1.28); and (3) when combined with CT, VRBT is more effective than CT in improving the global (SMD 0.6, 95% CI 0.13, 1.07), physical (SMD 0.87; 95% CI 0.3, 1.43), and mental dimensions (SMD 0.6; 95% CI 0.08, 1.11) of QoL. Conclusion: VRBT is effective at reducing fatigue and MS impact and improving QoL in PwMS.

The Effect of Virtual Reality-Based Therapy on Improving Upper Limb Functions in Individuals With Stroke: A Randomized Control Trial.

Background: Stroke is a common cause of motor disability. The recovery of upper limb after stroke is poor, with few stroke survivors regaining some functional use of the affected upper limb. This is further complicated by the fact that the prolonged rehabilitation is accompanied by multiple challenges in using and identifying meaningful and motivated treatment tasks that may be adapted and graded to facilitate the rehabilitation program. Virtual reality-based therapy is one of the most innovative approaches in rehabilitation technology and virtual reality systems can provide enhanced feedback to promote motor learning in individuals with neurological or musculoskeletal diseases.Purpose: This study investigated the effect of virtual reality-based therapy on improving upper limb functions in individuals with chronic stroke.Methods: Forty Saudi individuals with chronic stroke (6–24 months following stroke incidence) and degree of spasticity ranged between 1, 1 + and 2 according to Modified Ashworth Scale were included in this study. Participants were randomly assigned into two groups, experimental and control, with the experimental group undertaking a conventional 1-h functional training program, followed by another hour of virtual reality-based therapy using Armeo Spring equipment and the control group received 2 h of a conventional functional training program. The treatment program was conducted three times per week for three successive months. The change in the scores of Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), WMFT-Time (time required to complete the test) and Hand Grip Strength (HGS) were recorded at baseline and after completion of the treatment. Parametric (paired and unpaired t-tests) non-parametric (Wilcoxon and Mann–Whitney tests) statistical tests were used to identify the differences within and between groups (experimental group and control group) and evaluation times (pre- and immediately post-treatment).Results: Both groups showed significant differences (all, P < 0.05) in all measured variables after 3 months of the treatment. Individuals with stoke in the experimental group had a better improvement in ARAT (P < 0.01), WMFT (P < 0.01) and WMFT-Time (P < 0.01) scores after completion of the treatment compared to the control group. No significant difference in HGS scores was detected between groups after completion of the treatment (P = 0.252).Conclusion: The use of combined treatment of virtual reality-based therapy and conventional functional training program is more effective for improving upper limb functions in individuals with chronic stroke than the use of the conventional program alone.

Virtual Reality-Based Psychological Therapy for the Treatment of Driving Anxiety

Virtual Reality-Based Psychological Therapy for the Treatment of Driving Anxiety

Effects of Specific Virtual Reality-Based Therapy for the Rehabilitation of the Upper Limb Motor Function Post-Ictus: Randomized Controlled Trial.

This research analyzed the combined effect of conventional treatment and virtual reality exposure therapy on the motor function of the upper extremities in people with stroke. We designed a randomized controlled trial set in the rehabilitation and neurology departments of a hospital (Talavera de la Reina, Spain). The subjects included 43 participants, all randomized into experimental (conventional treatment + virtual reality exposure therapy) and control group (conventional treatment).; The main measures were Fugl-Meyer Assessment for upper extremity, Modified Ashworth Scale, and Stroke Impact Scale 3.0. The results included 23 patients in the experimental (62.6 ± 13.5 years) and 20 in the control group (63.6 ± 12.2 years) who completed the study. After the intervention, muscle tone diminished in both groups, more so in the experimental group (mean baseline/post-intervention: from 1.30 to 0.60; η2 = 0.237; p = 0.001). Difficulties in performing functional activities that implicate the upper limb also diminished. Regarding the global recovery from stroke, both groups improved scores, but the experimental group scored significantly higher than the controls (mean baseline/post-intervention: from 28.7 to 86.5; η2 = 0.633; p = 0.000). In conclusion, conventional rehabilitation combined with specific virtual reality seems to be more efficacious than conventional physiotherapy and occupational therapy alone in improving motor function of the upper extremities and the autonomy of survivors of stroke in activities of daily living.

Effects of Virtual Reality-Based Therapy on Quality of Life of Patients with Subacute Stroke: A Three-Month Follow-Up Randomized Controlled Trial.

Objective: To evaluate the influence of conventional rehabilitation combined with virtual reality on improving quality of life related to post-stroke health. Design: Randomized controlled trial. Setting: Rehabilitation and neurology departments of a general hospital (Talavera de la Reina, Spain). Subjects: A total of 43 participants with subacute stroke. Intervention: Participants were randomized into experimental group (conventional treatment + virtual reality) and control (conventional treatment). Main measures: Health-related quality of life as measured by the EuroQoL-5 dimensions instrument (EQ-5D-5L) and EuroQoL visual analog scale (EQ-VAS). Results: A total of 23 patients in the experimental group (62.6 ± 13.5 years) and 20 in the control (63.6 ± 12.2 years) completed the study. In the experimental group, EQ-VAS score was 29.1 ± 12.8 at baseline, 86.5 ± 7.1 post-intervention, and 78.3 ± 10.3 at the three-month follow-up. The control group obtained scores of 25.5 ± 5.1, 57.0 ± 4.7, and 58.5 ± 5.9, respectively. We identified significant differences at the post-intervention and follow-up timepoints (p = 0.000) and a partial η2 of 0.647. In EQ-5D-5L, the severity of issues decreased after intervention in the experimental group, while pain and anxiety dimensions increased between post-intervention and follow-up. Conclusions: The conventional rehabilitative approach combined with virtual reality appears to be more effective for improving the perceived health-related quality of life in stroke survivors.

A Survey on the Effectiveness of Virtual Reality-based Therapy and Pain Management

Virtual reality refers to the technology used to create multi-sensory three-dimensional environments that can be navigated, manipulated, and interacted by a user. This paper’s objective is to categorize the most common areas that use virtual reality (VR) for managing pain (psychological and physical). To our knowledge, this is the first survey that summarizes all of these areas in one place. This paper reviews the conducted studies that used VR for psychological treatment, especially with phobias. Also, this paper summarizes the current literature on using virtual reality interventions for managing acute, chronic, and cancer pain. Based on the review, virtual reality shows great potential for controlling acute pain - such as pain associated with burn wound care. However, limited studies only investigated the impact of using virtual reality on patients with chronic pain. The findings indicated that VR distraction has a great impact on pain and distress related to cancer and its treatments. This paper also discusses the challenges and limitations of the current research. Notably, the identified studies recommend VR distraction as a promising adjunct for pain reduction and psychological treatment. However, further research needs to be conducted to determine under what conditions VR distraction will provide more analgesic effects.

Acute Hemodynamic Effects of Virtual Reality–Based Therapy in Patients of Cardiovascular Rehabilitation: A Cluster Randomized Crossover Trial

ObjectiveTo analyze the acute hemodynamic effects of adding virtual reality–based therapy (VRBT) using exergames for patients undergoing cardiac rehabilitation (CR). DesignCrossover trial. SettingOutpatient rehabilitation center. ParticipantsPatients (N=27) with a diagnosis of cardiovascular disease or cardiovascular risk factors. Mean age (years) ± SD was 63.4±12.7 and mean body mass index (kg/m2) ± SD was 29.0±4.0. InterventionsPatients performed 1 VRBT session and 1 CR session on 2 nonconsecutive days. Each session comprised an initial rest, warm-up, conditioning, and recovery. During warm-up, in the VRBT session, games were performed with sensors to reproduce the movements of avatars and, in the CR session, patients were required to reproduce the movements of the physiotherapists. In the conditioning phase for VRBT, games were also played with motion sensors, dumbbells, and shin guards. The CR session consisted of exercises performed on a treadmill. The intensity of training was prescribed by heart rate reserve (HRR; 40%-70%). Main Outcome MeasuresThe primary outcomes were heart rate, blood pressure, respiratory rate (RR), rating of perceived exertion (RPE), and peripheral oxygen saturation, evaluated before, during, and after the VRBT or CR session on 2 nonconsecutive days. The secondary outcome was to evaluate whether the patients achieved the prescribed HRR and the percentage of time they maintained this level during the VRBT session. ResultsVRBT produces a physiological similar pattern of acute hemodynamic effects in CR. However, there was greater magnitude of heart rate, RR, and RPE (P<.01) during the execution of VRBT and until 5 minutes of recovery, observed at the moments of rest, and 1, 3, and 5 minutes of recovery. ConclusionsAlthough the VRBT session produces similar physiological acute hemodynamic effects in CR, greater magnitudes of heart rate, RR, and RPE were observed during its execution and up to 5 minutes after the session.

EFEITO DA TERAPIA COM REALIDADE VIRTUAL NO EQUILÍBRIO DINÂMICO DE INDIVÍDUOS PÓS-ACIDENTE VASCULAR ENCEFÁLICO

The aim of this study was to analyze the effect of virtual reality-based (VR) therapy on balance training of patients after stroke. 10 hemiparetic participants received twelve individual physical therapy sessions using the VR therapeutic, through Nintendo Wii® Fit Plus and Wii Sports Resort™. The analysis revealed that the Dynamic Gait Index (DGI) instrument, responsible for evaluating the dynamic balance, obtained significant difference (p=0.0085) between the basal (17.30±3.59) and final (20.30±2.94) evaluation. The Penguin Slide game had no significance between the scores (p=0.918), but there was a moderate correlation between the DGI instrument (r=0.662; p=0.037). This study obtained favorable results related to dynamic balance and also suggests that VR therapy as in general influenced the improvement of dynamic balance in individuals with hemiparesis after stroke.

A Virtual Reality-based Radiation Therapy Education Program

A Virtual Reality-based Radiation Therapy Education Program

Kesan Realiti Visual Berasaskan Terapi ke Atas Ketahanan Berjalan dan Kualiti Hidup Penghidap Osteoarthritis Lutut

Despite being becoming popular and heavily used in rehabilitation, the evidence on the effectiveness of Virtual reality-based therapy (VRBT) among persons with knee osteoarthritis (OA) remains limited. The aim of this study was to determine the effects of VRBT on walking endurance and quality of life of older persons with knee OA in comparison to conventional exercise therapy. This was a randomised controlled trial involving 44 participants (mean age and standard deviation = 66.32 + 5.73 years) who received either a VRBT (experimental group, n=22) or a conventional exercise therapy (control group, n=22) for 45 minutes, twice per week for 12 weeks. The outcome of both therapies on walking endurance was measured using Six-minute Walk Test (6MWT), while quality of life was assessed using the Malay-version of Short Form-36 (SF-36). Analysis was done by ‘intention-to-treat’ approach, using Mixed Model ANOVA. A significant time-effect (p < 0.05), with large effect size between 0.54 and 1.0 were found for all outcomes following the therapies. An increase of 17% and 19% of 6MWT scores were obtained in experimental and control group, respectively. Meanwhile, the scores for the physical and mental components of the SF-36 increased by 37.8% and 19.4% in the experimental group, and 45.7% and 20.6% in the control group. However, no significant group and interaction effects were found for all outcomes. In conclusion, VRBT is comparable with c onventional exercise therapy in improving walking endurance and quality of life of persons with knee OA, and can be used as a therapy option for this population. DOI : http://dx.doi.org./10.17576/JSKM-2019-1702-13

Effects of virtual reality in body oscillation and motor performance of children with cerebral palsy: A preliminary randomized controlled clinical trial

Background and purposeVirtual reality is an adjuvant technique to rehabilitation of children with cerebral palsy (CP). It has been gaining prominence in this field because of its accessibility and great levels of motivation it promotes in treatment. However, there is a lack of studies addressing the effects of virtual reality-based therapy on activity levels regarding postural stability, especially considering the level of evidence presented by studies addressing this issue. Therefore, we aim to evaluate the effects of intervention in body sway and gross motor function of children with CP using an active video game. Materials and methodsIn this blind randomized controlled trial, fifteen children with CP, Gross Motor Function Classification System (GMFCS) I-II, regularly attending conventional physical therapy programs, were randomly assigned to an intervention (IG:n = 7) or to a control group (CG:n = 8). In both groups, children remained attending conventional therapy. In addition, IG underwent intervention using an active video game twice a week for 45 min and eight weeks. Standing body sway was assessed using a force plate, and Gross Motor Function Measure (GMFM) dimensions D (Standing) and E (Walking, Running and Jumping) were tested. ResultsFollowing the virtual reality-based intervention, the IG only showed significant improvements in the GMFM dimensions D (p = 0.021) and E (p = 0.008). Improvements were clinically significant (D = 10.8%; E = 14.0%). For the CG, no variable analyzed showed differences after eight weeks. ConclusionsIntervention using an active video game is a promising tool that can improve the gross motor function of children with CP, GMFCS I-II.

Effects of virtual reality based physical therapy interventions on balance and gait performances of chronic hemiparetic stroke patients - a literature review.

Background: Approximately 795.000 strokes occur each year in the United States of America. On average, every 40 seconds, an American suffers a stroke (AHA, 2014). Hemiparesis is a common post-stroke symptomatic condition (about 8/10 stroke survivors), with dramatic impact on balance, gait and activities of daily living. Approximately 2/3 of stroke survivors need an intensive rehabilitation provided by multidisciplinary teams, in which physiotherapy plays a significant role. Method: A systematic review was conducted in the PEDro database. Studies published after 2007 were searched. Results: Clinical trials including virtual rehabilitation interventions for stroke patients started to appear in the early 2000s. Meanwhile, the latest Cochrane systematic review titled “Virtual reality for stroke rehabilitation” includes 72 trials involving 2470 participants, showing an increasing therapeutically interest. The primary objective of this study is to clarify if virtual reality-based therapy can offer a genuine clinical alternative to conventional physical therapy in the treatment of chronic hemiparetic stroke patients, helping physiotherapists and individuals reach higher rehabilitation performance outcomes in terms of balance and ambulation. Conclusion: The three trials presented in this essay show that balance recovery benefits most from a combination of virtual reality-based and conventional physiotherapy. Moreover, virtual task-oriented exercises can be enjoyable and motivating, increasing patient compliance to rehabilitation.

Two models of virtual reality devices for therapeutics in persons with cerebral palsy

Virtual reality based therapy (VRBT) refers to the use of interactive simulations to present users with opportunities to perform neurorehabilitation in virtual environments that appear, sound, and less frequently, feel similar to real-world objects and events. This study compared the effects of 2 off-the-shelf gaming system devices on standing balance and weight shifting for persons with Cerebral Palsy (PWCP) following single event multilevel lever arm restoration and anti spasticity surgery (SEMLARASS). A prospective experimental study was conducted among 80 PWCP post SEMLARASS aged 5–20 years and randomly assigned into Group A (n = 40): received the VRBT with Xbox 360 with Kinect (XwK) and Group B (n = 40): received the VRBT with Nintendo Wii with Balance Board (WwB). The study duration was 5 weeks with 30 minutes of intervention per day for 6 days per week in each group. A total of 3 games (5 choices) were played per session supervised by a physiotherapist. Paediatric Balance Scale (PBS) and Dynamic Gait Index (DGI) were the primary outcome measures, performed at baseline, 5 weeks after the treatment and follow-ups after 1 month and 3 months. The additional outcomes measured were walking test, steadiness test, COG and single-leg standing test using the stabilometer of the Wii balance board. Both the groups improved significantly after the intervention. However, Group A showed significant difference in PBS (P < 0.01) and DGI (P < 0.05) when compared to group B. The obtained outcomes were maintained at 1 month and 3 months follow-up. The X box 360 had a better connect to the virtual in comparison to the Nintendo Wii as reported by the users. While both devices were found effective, VRBT with XwKwas superior toWwB for improving standing balance and weight shifting in CWCP after SEMLARASS.

Combining levodopa and virtual reality-based therapy for rehabilitation of the upper limb after acute stroke: pilot study Part II.

This study aimed to evaluate the safety and efficacy of a combination of levodopa and virtual reality (VR)-based therapy for the enhancement of upper limb recovery following acute stroke. This was a pilot single-blinded case series of acute stroke patients with upper extremity hemiparesis. Patients were randomised to standard care with concomitant administration of either levodopa alone (control group) or combination therapy consisting of VR-based motivational visuomotor feedback training with levodopa neuromodulation (VR group). Main clinical outcome measures were the Fugl-Meyer Upper Extremity (FM-UE) assessment and Action Research Arm Test (ARAT). Kinematic measurements of affected upper limb movement were evaluated as a secondary measure of improvement. Of 42 patients screened, four patients were enrolled in each of the two groups. Two patients dropped out from the control group during the trial. Patients receiving combination therapy had clinically significant improvements in FM-UE assessment scores of 16.5 points compared to a 3.0-point improvement among control patients. Similarly, ARAT scores of VR group patients improved by 15.3 points compared to a 10.0-point improvement in the control group. Corresponding improvements were noted in kinematic measures, including hand-path ratio, demonstrating that the quality of upper limb movement improved in the VR group. Our results suggest that VR-based therapy and pharmacotherapy may be combined for acute stroke rehabilitation. Bedside acquisition of kinematic measurements allows accurate assessment of the quality of limb movement, offering a sensitive clinical tool for quantifying motor recovery during the rehabilitation process after acute stroke.

Judging crowds’ size by ear and by eye in virtual reality

Judging the size of a group of people is an everyday task, on which many decisions are based. In the present study, we investigated whether judgment of size of different groups of people depended on whether they were presented through the auditory channel, through the visual channel, or through both auditory and visual channels. Groups of humanoids of different sizes (from 8 to 128) were presented within a virtual environment to healthy participants. They had to judge whether there was a lot of people in each group and rate their discomfort in relation to the stimuli with Subjective Units of Distress. Our groups of 96 and 128 virtual humans were judged as crowds regardless of their sensory presentation. The sensory presentation influenced participants’ judgment of virtual human group size ranging from 8 to 48. Moreover, while the quantity judgments in the auditory condition increased linearly with the group size, participants judged the quantity of people in a logarithmic manner in the two other sensory conditions. These results suggest that quantity judgment based on auditory information in a realistic context may often involve implicit arithmetic. Even though our participants were not phobic of crowds, our findings are of interest for the field of virtual reality-based therapy for diverse disorders because they indicate that quantity judgment can potentially be altered in a sensory-specific manner in patients with fear of crowds.

Impact of a virtual reality-based intervention on motor performance and balance of a child with cerebral palsy: a case study

OBJECTIVE: To verify the effect of an intervention protocol using virtual reality (VR) on the motor performance and balance of a child with cerebral palsy (CP).CASE DESCRIPTION: To comply with the proposed objectives, a 7-year old child with spastic hemiplegic cerebral palsy (CP), GMFCS level I, was submitted to a physiotherapy intervention protocol of 12 45-minute sessions, twice a week, using virtual reality-based therapy. The protocol used a commercially-available console (XBOX(r)360Kinect(r)) able to track and reproduce body movements on a screen. Prior to the intervention protocol, the child was evaluated using the Motor Development Scale (MDS) and the Pediatric Balance Scale (PBS) in order to assess motor development and balance, respectively. Two baseline assessments with a 2-week interval between each other were carried out for each tool. Then, the child was re-evaluated after the twelfth session. The results showed no changes in the two baseline scores. After the intervention protocol, the child improved his scores in both tools used: the PBS score increased by 3 points, reaching the maximal score, and the MDS increased from a much inferior motor performance to just an inferior motor performance.COMMENTS: The evidence presented in this case supports the use of virtual reality as a promising tool to be incorporated into the rehabilitation process of patients with neuromotor dysfunction.

Comparison of Virtual Reality Based Therapy With Customized Vestibular Physical Therapy for the Treatment of Vestibular Disorders

We examined outcomes in persons with vestibular disorders after receiving virtual reality based therapy (VRBT) or customized vestibular physical therapy (PT) as an intervention for habituation of dizziness symptoms. Twenty subjects with vestibular disorders received VRBT and 18 received PT. During the VRBT intervention, subjects walked on a treadmill within an immersive virtual grocery store environment, for six sessions approximately one week apart. The PT intervention consisted of gaze stabilization, standing balance and walking exercises individually tailored to each subject. Before, one week after, and at six months after the intervention, subjects completed self-report and balance performance measures. Before and after each VRBT session, subjects also reported symptoms of nausea, headache, dizziness, and visual blurring. In both groups, significant improvements were noted on the majority of self-report and performance measures one week after the intervention. Subjects maintained improvements on self report and performance measures at six months follow up. There were not between group differences. Nausea, headache, dizziness and visual blurring increased significantly during the VRBT sessions, but overall symptoms were reduced at the end of the six-week intervention. While this study did not find a difference in outcomes between PT and VRBT, the mechanism by which subjects with chronic dizziness demonstrated improvement in dizziness and balance function may be different.

Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury

Objective: To evaluate the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training.Design: A randomized controlled trial in which assessment and analysis were blinded.Setting: An inpatient rehabilitation facility.Intervention: Interventions included balance-based physical therapy using a Nintendo Wii, as monitored by a physical therapist, and receipt of one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym.Results: Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and BBS scores for measures taken beyond the baseline assessment.Conclusions: This study provides a modest level of evidence to support using commercially available VR gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation. Additional research of these types of interventions for the treatment of balance deficits is warranted.

New Directions in Virtual Reality-Based Therapy for Anxiety Disorders

This article critically discusses the new trends in virtual reality-based (psycho) therapy for anxiety disorders. After an initial brief presentation of anxiety disorders and their current traditional evidence-based treatments (e.g., cognitive-behavioral therapies; CBTs), current models of virtual reality-based therapy are presented and examined. The paper emphasizes that virtual reality-based therapy is not a new form of therapy, but a technological development in the current evidence-based therapies (e.g., virtual reality-based CBTs). New trends in virtual reality-based therapy are also presented. To date, research supports the efficacy of virtual reality-based CBTs for anxiety disorders. The paper also discusses advantages of virtual reality (VR) technologies in (1) clarifying theory/mechanisms of change; (2) potentially reducing costs and increasing access and (3) stimulating more ecological research in the CBT. The need for further studies using VR is also highlighted.

Neural Reorganization Accompanying Upper Limb Motor Rehabilitation from Stroke with Virtual Reality-Based Gesture Therapy

Background: Gesture Therapy is an upper limb virtual reality rehabilitation-based therapy for stroke survivors. It promotes motor rehabilitation by challenging patients with simple computer games representative of daily activities for self-support. This therapy has demonstrated clinical value, but the underlying functional neural reorganization changes associated with this therapy that are responsible for the behavioral improvements are not yet known. Objective: We sought to quantify the occurrence of neural reorganization strategies that underlie motor improvements as they occur during the practice of Gesture Therapy and to identify those strategies linked to a better prognosis. Methods: Functional magnetic resonance imaging (fMRI) neuroscans were longitudinally collected at 4 time points during Gesture Therapy administration to 8 patients. Behavioral improvements were monitored using the Fugl-Meyer scale and Motricity Index. Activation loci were anatomically labelled and translated to reorganization strategies. Strategies are quantified by counting the number of active clusters in brain regions tied to them. Results: All patients demonstrated significant behavioral improvements (P < .05). Contralesional activation of the unaffected motor cortex, cerebellar recruitment, and compensatory prefrontal cortex activation were the most prominent strategies evoked. A strong and significant correlation between motor dexterity upon commencing therapy and total recruited activity was found (r2 = 0.80; P < .05), and overall brain activity during therapy was inversely related to normalized behavioral improvements (r2 = 0.64; P < .05). Conclusions: Prefrontal cortex and cerebellar activity are the driving forces of the recovery associated with Gesture Therapy. The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm.