{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T14:34:27Z","timestamp":1775486067916,"version":"3.50.1"},"reference-count":88,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2020,7,4]],"date-time":"2020-07-04T00:00:00Z","timestamp":1593820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["16IRG26960017"],"award-info":[{"award-number":["16IRG26960017"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000183","name":"Army Research Office","doi-asserted-by":"publisher","award":["W911NNF-14-D-0005"],"award-info":[{"award-number":["W911NNF-14-D-0005"]}],"id":[{"id":"10.13039\/100000183","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K01HD091283"],"award-info":[{"award-number":["K01HD091283"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Severe impairment of limb movement after stroke can be challenging to address in the chronic stage of stroke (e.g., greater than 6 months post stroke). Recent evidence suggests that physical therapy can still promote meaningful recovery after this stage, but the required high amount of therapy is difficult to deliver within the scope of standard clinical practice. Digital gaming technologies are now being combined with brain\u2013computer interfaces to motivate engaging and frequent exercise and promote neural recovery. However, the complexity and expense of acquiring brain signals has held back widespread utilization of these rehabilitation systems. Furthermore, for people that have residual muscle activity, electromyography (EMG) might be a simpler and equally effective alternative. In this pilot study, we evaluate the feasibility and efficacy of an EMG-based variant of our REINVENT virtual reality (VR) neurofeedback rehabilitation system to increase volitional muscle activity while reducing unintended co-contractions. We recruited four participants in the chronic stage of stroke recovery, all with severely restricted active wrist movement. They completed seven 1-hour training sessions during which our head-mounted VR system reinforced activation of the wrist extensor muscles without flexor activation. Before and after training, participants underwent a battery of clinical and neuromuscular assessments. We found that training improved scores on standardized clinical assessments, equivalent to those previously reported for brain\u2013computer interfaces. Additionally, training may have induced changes in corticospinal communication, as indexed by an increase in 12\u201330 Hz corticomuscular coherence and by an improved ability to maintain a constant level of wrist muscle activity. Our data support the feasibility of using muscle\u2013computer interfaces in severe chronic stroke, as well as their potential to promote functional recovery and trigger neural plasticity.<\/jats:p>","DOI":"10.3390\/s20133754","type":"journal-article","created":{"date-parts":[[2020,7,6]],"date-time":"2020-07-06T09:49:11Z","timestamp":1594028951000},"page":"3754","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["A Virtual Reality Muscle\u2013Computer Interface for Neurorehabilitation in Chronic Stroke: A Pilot Study"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-254X","authenticated-orcid":false,"given":"Octavio","family":"Marin-Pardo","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher M.","family":"Laine","sequence":"additional","affiliation":[{"name":"Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miranda","family":"Rennie","sequence":"additional","affiliation":[{"name":"Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6380-6755","authenticated-orcid":false,"given":"Kaori L.","family":"Ito","sequence":"additional","affiliation":[{"name":"Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2679-2221","authenticated-orcid":false,"given":"James","family":"Finley","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA"},{"name":"Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5935-4215","authenticated-orcid":false,"given":"Sook-Lei","family":"Liew","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089, USA"},{"name":"Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA"},{"name":"Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1152\/jn.00762.2018","article-title":"A critical time window for recovery extends beyond one-year post-stroke","volume":"122","author":"Ballester","year":"2019","journal-title":"J. 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