{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T01:29:30Z","timestamp":1793669370110,"version":"4.5.1"},"posted":{"date-parts":[[2026,9,6]]},"group-title":"Rehabilitation Medicine and Physical Therapy","reference-count":42,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"funder":[{"award":["NIH R01 HD104637"],"award-info":[{"award-number":["NIH R01 HD104637"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,11,2]]},"abstract":"<jats:p>Introduction: Approximately 40-80% of individuals post-stroke fail to use their paretic arm despite sufficient capacity, a phenomenon known as arm nonuse. This behavior arises from an interaction between cognitive and motor factors, necessitating evaluation approaches that capture the impact of complex task demands on arm nonuse. This study evaluated the validity, reliability, and usability of a virtual reality-based arm nonuse (VR-NonUse) tool designed to measure arm choice during naturalistic reaching under varying cognitive and motor demands.\nMethods: Fifty-one individuals with stroke and 23 controls completed the VR-NonUse assessment across three conditions varying in cognitive and motor demand. Arm choice was assessed on each trial. Usability and tolerability were evaluated. Concurrent validity was examined by assessing associations between paretic arm choice on the VR-NonUse tool and established nonuse assessments. Discriminant validity was evaluated by comparing these associations with a motor impairment measure. Construct validity was examined by determining the effects of cognitive and motor demand on paretic arm choice. Internal consistency reliability was assessed using a split-half reliability analysis with Spearman-Brown correction.\nResults: The VR-NonUse tool was usable, well-tolerated, and demonstrated high internal-consistency reliability. Paretic arm choice on the VR-NonUse tool was associated with established nonuse measures, and more strongly related to nonuse than to motor impairment, supporting concurrent and discriminant validity. Higher cognitive demand reduced paretic arm choice, supporting construct validity. A brief cognitively demanding condition yielded a robust index of nonuse. \nDiscussion: The VR-NonUse tool is a reliable, valid, and practical assessment of arm nonuse in chronic stroke.<\/jats:p>","DOI":"10.64898\/2026.09.02.26361445","type":"posted-content","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:40:20Z","timestamp":1788756020000},"source":"Crossref","is-referenced-by-count":0,"title":["A Valid and Reliable Virtual Reality Tool for Assessment of Arm Nonuse Post-Stroke"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1051-2686","authenticated-orcid":false,"given":"Rachana","family":"Gangwani","sequence":"first","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shauna","family":"Zodrow","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"DeAngelis","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxim","family":"Karrenbach","sequence":"additional","affiliation":[{"name":"Department of Electrical and Computer Engineering, Carnegie Mellon University, Pittsburgh, PA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5154-7773","authenticated-orcid":false,"given":"Shailesh","family":"Kantak","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2421-5455","authenticated-orcid":false,"given":"Laurel J","family":"Buxbaum","sequence":"additional","affiliation":[{"name":"Jefferson Moss Rehabilitation Research Institute, Thomas Jefferson University, Elkins Park, PA & Department of Rehabilitation Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026091110001730000_2026.09.02.26361445v2.1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/18.1.43"},{"key":"2026091110001730000_2026.09.02.26361445v2.2","doi-asserted-by":"publisher","DOI":"10.1901\/jeab.1994.61-281"},{"key":"2026091110001730000_2026.09.02.26361445v2.3","doi-asserted-by":"publisher","DOI":"10.1177\/1545968316680493"},{"key":"2026091110001730000_2026.09.02.26361445v2.4","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2018.1481605"},{"key":"2026091110001730000_2026.09.02.26361445v2.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.arrct.2020.100048"},{"key":"2026091110001730000_2026.09.02.26361445v2.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2014.07.039"},{"key":"2026091110001730000_2026.09.02.26361445v2.7","doi-asserted-by":"publisher","DOI":"10.1177\/1545968320913554"},{"key":"2026091110001730000_2026.09.02.26361445v2.8","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.804211"},{"key":"2026091110001730000_2026.09.02.26361445v2.9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph191811707"},{"key":"2026091110001730000_2026.09.02.26361445v2.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12984-025-01661-5"},{"key":"2026091110001730000_2026.09.02.26361445v2.11","doi-asserted-by":"publisher","DOI":"10.1080\/09602010443000047"},{"key":"2026091110001730000_2026.09.02.26361445v2.12","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00593.2014"},{"key":"2026091110001730000_2026.09.02.26361445v2.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-024-06939-z"},{"key":"2026091110001730000_2026.09.02.26361445v2.14","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2025.2547619"},{"key":"2026091110001730000_2026.09.02.26361445v2.15","unstructured":"Taub E , DeLuca S and Crago JE . 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