Stroke is the leading cause of adult disability in the United States with currently 7.6 million Americans over the age of 20 years old report having had a stroke. Neurorehabilitation is focused on intensive repetitive motions that target simple actions to improve motor function. Neurorehabilitation is also associated with self-directed home exercises that lack feedback and can be monotonous, leading to decreased motivation and negatively impact high-intensity therapy [1]. Therefore, there is a need for more engaging, home-based therapy that provides valuable feedback. A way to address the limitations of neurorehabilitation is through virtual reality (VR) technology. VR allows for tasks to be performed in a virtual environment that uses less physical space and can be performed in various clinical and home-based settings.

The purpose of this dissertation is to understand and build upon the existing knowledge about the impact of VR use for stroke neurorehabilitation by focusing on the gross motor and mirror therapy domains of rehabilitation. This dissertation investigates the cortical motor cortex activation, neuromuscular activations and motor outputs of VR use for individuals with chronic stroke. The first three aims focus on comparing the realworld Box and Block Test (BBT) to a VR-based BBT Simulation for a chronic stroke case study, a young healthy population, and a chronic stroke population. Finally, the fourth aim is the application of the VR system using VR-based mirror therapy within a chronic stroke population.

The dissertation results indicate no difference in motor cortex activations or laterality index for the case study, young healthy, and chronic stroke participants when performing the BBT in VR. There is also no difference in neuromuscular outcomes for the chronic stroke participants although the young healthy increased wrist flexor and wrist extensor activations within VR. However, BBT scores, are significantly higher in the real-world BBT compared to the VR BBT for all populations. The VR mirror therapy demonstrates possible differences in motor strategies between conditions. Therefore, the results emphasize the importance of somatosensory input for clinically driven VR simulations in chronic stroke.