Enhancing stroke rehabilitation through virtual reality social interaction: exploring drawing and guessing activities

Abstract Conventional stroke rehabilitation methods often overlook the importance of social settings, as survivors typically undergo therapy in isolation, disconnected from others. This lack of social interaction can significantly reduce motivation and engagement, ultimately hindering both physical recovery and the ability to reintegrate into society. This paper focus on the design and feasibility validation of a Virtual Reality (VR) social interaction framework for stroke rehabilitation, centered on an immersive drawing and guessing experience with progressive complexity. The multi-user virtual environment encourages participants to perform targeted gestures to support upper-limb rehabilitation while stimulating cognitive processes during the guessing phase. Additionally, healthcare professionals can observe participants in real time and provide support as needed. The framework was developed using a Human-Centered Design (HCD) methodology, incorporating feedback from stroke survivors and clinicians at a rehabilitation center. An initial field study with 10 participants showed that the drawing and guessing experience fostered motivation, social interaction, and that the drawing techniques required low physical effort, indicating suitability for rehabilitation. A follow-up study with 35 participants, conducted both in the lab and at the center showed that having a real-life object (physical pen) may enhance immersion and contribute to improved motor control during drawing tasks, while potentially supporting sensorimotor integration. There was also a high acceptance of the new guessing mode, being considered easy to use and intuitive. Social interaction remained strong throughout, reinforcing the framework’s positive impact on motivation, engagement, and social connection during stroke rehabilitation.