As discussed previously, an ideal (combination of) treatment(s) would address both motor function and sensory function in the affected body parts. An option for hemiplegia rehabilitation would be a combination of electrical stimulation and task-oriented mirror therapy and mental imagery. The ability of electrical stimulation to both improve motor function and delay the atrophy of unused muscle tissue will contribute to repairing the motor function of the affected area, and mirror therapy, specifically task-oriented mirror therapy (which has been proven to be significantly more effective than simple mirror therapy [12]) can rewire neural connection to the affected limb(s) by activating mirror neurons and improving both motor and sensory functions [11]. Mental imagery can also improve motor function when combined with other forms of treatment. A blend of all 3 treatments in varying intensity levels and for varying periods of time depending on the patient’s condition is likely to make them regain at least some motor and sensory function. This treatment plan is easily accessible, as all that is needed is a mirror, electrical stimulation equipment, and trained caretakers, all found in or within reach of most nursing homes and care centers. The treatment is also engaging as mirror therapy allows the patient to imagine their paralyzed limb.

The design goal of our project is creating a “NeuroAcuStim Rehab Aid” that uses electrical simulation in combination with Chinese acupuncture to help patients regain mobility and promote the rehabilitation process [16]. The device will target key acupoints in the body through controlled electrical stimulation or shock wave therapy to reduce disability and enhance the function recovery of the affected limb [16]. Electro acupoint stimulation uses electrical currents to stimulate specific acupoints to promote nerve conduction and muscle activity. Our design uses this because it can help reconnect the nervous system and promote muscle contraction and relaxation. The choice to begin treatment with either electrical stimulation or electroacupuncture depends on an assessment from the patient’s doctor. Based on the doctor’s analysis of how severe the hemiplegia is, the patient will first undergo a base treatment of electrical stimulation. If the hemiplegia is not too severe or there is not a trained acupuncturist available, the patient will receive a round of electrical stimulation that includes a therapeutic massage on the areas that have lost motor function. Afterwards, based on the doctor’s assessment of patient improvement from electrical stimulation and initial condition, the patient will then connect with the VR game, either with a headset or with a massage chair-like set up. The game will provide an immersive and engaging environment, where patients experience mirror therapy and mental imagery. If the patient plays the VR game in a chair-like set up, they will also experience low electrical stimulation with therapeutic massage components from the chair.

This device will be tailored to allow for any changes in size and for any replacement of parts that the patient may need. For example, it will have adjustable straps, buckles, and fasteners to secure the device and provide a comfortable fit to ultimately match the natural curves of the human body. When it comes to specifics of the device, installing the stimulation on the correct acupuncture points is necessary to ensure safety and comfort. For the materials being used in the stimulation, the needles need to be conductive, insulating, and biocompatible, so any material with good conductivity such as electrodes, conductive cloths, or conductive rubbers will be used. To ensure that only certain areas receive the current from the needles, the device needs insulating materials like medical silicone. With this specific insulating material, it also helps with the patients’ contact comfort and safety so there are no reactions or irritation on the skin. Since the device needs to be flexible at numerous joints, the soft, durable conductive material that is used are medical silicone wires that are high in elasticity and conductivity. The device itself will be controlled by a smart panel that connects to a mobile device to monitor it and adjust the massage techniques, intensity, and duration of the needles. The overall device will be lightweight and durable to ensure that longevity is increased as well as optimal comfort [17-20].

In recent studies, the utilization of acupuncture in individuals who have suffered a stroke has been acknowledged for the efficiency and safety of restoring partial neurological function and improving limb functionality. Compared to traditional methods of acupuncture, the use of electroacupuncture is more effective with neurological deficits in hemiplegic patients. The acupoint stimulation of traditional Chinese medicine stays consistent with the muscles and the nerve pathways and helps with promoting muscle contraction, nerve recovery, and overall movement recovery. While wearing the device, a therapeutic massage is provided to revitalize the muscle and nerve control centers to help with movement even when it is not possible. Since this device is user friendly, has peak design, and a perfect combination of electrical stimulation and acupuncture, the device assists in regaining mobility in the limbs and advances the rehabilitation process overall.

This connection between current treatments uses a screen image that can create a realistic scene of activities or game images where whenever a movement is made in VR, the patient will get a taste of the feeling with the acupuncture. The alignment of both vision and movement using this tactic activates the regions in the brain that promote rewiring of neural networks related to movements. Even though there are no physical benefits of this idea, the patient will experience pleasure and a sense of accomplishment, which is necessary in the rehabilitation process to make a patient want to continue. After long-term training with VR alongside our design, the patient’s muscles can slowly be restored so that the recurrence and aggravation that comes with hemiplegia can be prevented.

Combining both NeuroAcuStim Rehab Aid and VR is a technological advancement as well as a new psychological experience that allows hemiplegic patients to recover in a more entertaining and positive way. The emotional experience that patients receive from using this future development promotes the motor function of the brain to help with regaining some movement. More importantly, it helps with depression and reduces anxiety induced by hemiplegia through simulating beautiful images and games, so the overall recovery can be increased and improved mentally as well. By using virtual reality and the assistive device designed, the rehabilitation environment for hemiplegic patients can become more rich, interesting, and personalized for what a patient wants to get out of their treatment. Overall, a positive outlook on recovery can come from combining virtual reality and NeuroAcuStim Rehab, which is something that many hemiplegic patients are lacking while only using the current treatments [17-20].