Platform Technology for Extended Reality Biofeedback Training Under Operant Conditioning for Functional Limb...

Functional neurological disorder (FND), including functional movement disorders (FMDs), arises from disruptions in the perception-action cycle, where maladaptive cognitive learning processes reduce the sense of agency and motor control. FND significantly impacts quality of life, with patients often experiencing physical disability and psychological distress. Extended reality (XR) technologies present a novel therapeutic opportunity by leveraging biofeedback training to target sensory attenuation and amplification mechanisms, aiming to restore motor function and the sense of agency.

This study aims to coproduce and evaluate the usability of an XR technology platform for FND rehabilitation, focusing on functional limb weakness. The platform integrates biofeedback training with haptic and visual feedback to support motor relearning and control.

We propose to use an experience-based co-design framework to engage patients with FND, caregivers, and health care professionals in collaboratively designing the XR platform. Stakeholders can share their experiences through narrative interviews and co-design workshops, which can identify emotional touchpoints and prioritized patient-centered needs. Insights will be synthesized through qualitative analysis and used to guide the development of system requirements via quality function deployment, ensuring that the platform aligns with user needs. XR training tasks-virtual reality relaxation, XR position feedback, and XR force feedback-will be integrated as needed into a unified therapeutic game experience through 4-week Agile sprints. Usability will be assessed using the System Usability Scale and qualitative feedback, with themes analyzed in NVivo to identify key areas for subsequent improvement.

High usability scores (>85) were recorded for the XR position feedback tasks in the predesign study, reflecting excellent usability and participant satisfaction. However, the virtual reality relaxation and XR force feedback tasks exhibited interindividual variability, underscoring the need for personalization. Key themes included customization, comfort, accessibility, and XR technological quality, ensuring that the XR platform effectively addressed diverse patient needs. The predesign study highlighted the potential of XR technology for FMD rehabilitation by integrating biofeedback training into a patient-centered game design framework. Approaches such as experience-based co-design and quality function deployment can support coproduction by systematically addressing usability and accessibility challenges. Brain-based metrics may further strengthen this evaluation. Accordingly, this study will use portable brain imaging to capture dynamic functional connectivity in key brain regions, enabling personalized interventions.

Through coproduction and iterative refinement, this study aims to demonstrate the promise of personalized XR gaming technology as a scalable, at-home solution for FMD rehabilitation. In this context, personalization and accessibility are critical for optimizing usability and long-term clinical outcomes, paving the way for at-home implementation within the FND stepped care model.

PRR1-10.2196/70620.