Augmented reality for hand function rehabilitation: Assessing perceptions of feasibility and meaningfulness among individuals with cervical spinal cord injury

Background: Creating high-quality, home-based rehabilitation tools is integral for hand function recovery among individuals living with cervical spinal cord injury (cSCI). Specifically, the effectiveness of home-based exercises is limited by compliance issues and a lack of guidance and performance feedback. Using augmented reality (AR) headsets can provide a solution because the technology can specifically track hand postures while interacting with real objects and in the real environment. Thus, the current study sought to 1) develop an AR application that provided grasping guidance and feedback and 2) assess its perceived feasibility and meaningfulness among individuals with cSCI. Methods: 15 individuals with cSCI (AIS: A-D, Neurological Level of Injury: C3-C7) tried a custom AR rehabilitation application while performing hand exercises with real objects in a clinical setting. The application was designed to track joints, provide visual guidance of object-specific grasping postures, and provide visual and score-based feedback. After trying the system, participants completed structured questionnaires (i.e., the System Usability Scale and one custom questionnaire) and one 30-minute semi-structured interview to assess perceived meaningfulness and feasibility of the system in the context of home-based rehabilitation. The questionnaires were analysed descriptively and the qualitative interviews were analysed using thematic and summative content analyses. Results: From the questionnaires, participants had an overall positive perception of the application and perceived the system as usable with a mean System Usability Scale score of 76/100. Further, the thematic analysis revealed two main themes: Perceived Therapeutic Value (subthemes: removing rehabilitation barriers, quality of the guidance and feedback, motivation) and Building a Usable and Tailored Experience (subthemes: feasibility considerations, suggestions and refinement). Conclusions: Overall, individuals with cSCI perceived that the AR system provided useful grasping guidance and feedback and was meaningful towards their rehabilitation. Further, individuals with cSCI provided suggestions to increase the usability and meaningfulness of the application which will be incorporated in future iterations of the system. Thus, the current study demonstrates the potential to increase the dosage of high-quality, home-based rehabilitation for individuals with cSCI.