Validation of a Gamified Eye-hand Coordination Tool for Post-stroke Upper Limb Assessment Using Tobii EyeX and Leap Motion: A Pilot Study.

BACKGROUND

Eye-hand coordination is an important component of accurate upper limb movement and is frequently compromised following stroke, leading to persistent functional impairments. Existing methods for the assessment and training of eye -hand coordination are resource-intensive and largely limited to research environments. Therefore, affordable sensor-based technologies may represent a feasible and engaging approach for clinical stroke rehabilitation.

PURPOSE: To evaluate the feasibility and concurrent validity of a gamified eye-hand coordination system using Tobii EyeX and Leap Motion for assessing visuomotor performance in individuals with chronic stroke, and to explore its associations with validated clinical outcome measures.

METHODS

Prospective, single-group, longitudinal pilot study conducted at a physiotherapy rehabilitation center in Jodhpur, India. Fifteen community-dwelling individuals with chronic stroke (≥1 year post-event), aged 45 -70 years, underwent 10 weeks of standard physiotherapy, supplemented with biweekly gamified sessions using the HandEye system. Outcome measures included the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and HandEye game scores. Statistical analyses included repeated measures analysis of variance (ANOVA), Friedman tests, Spearman correlations, and linear fixed-effects modeling.

RESULTS

Participants demonstrated significant improvements in FMA-UE (mean change = +6.86), BBT (+10.2 blocks), and HandEye scores (+4.62 points) over the 10-week period (p < .001 for all). Strong correlations were observed between HandEye scores and BBT (ρ = 0.726, p < .001), and moderate correlations with FMA-UE (ρ = 0.349, p = .019). Fixed-effects modeling revealed a significant association between HandEye scores and FMA-UE (β = 0.59, p < .001), though not with BBT. System performance remained stable across sessions, with <5% missing data for gaze and hand tracking.

CONCLUSION

The HandEye system integrating Tobii EyeX and Leap Motion provides a low-cost, feasible approach for assessing visuomotor function in stroke rehabilitation settings. Strong associations with manual dexterity suggest potential as an adjunct assessment tool. However, limitations in study design, low training dosage, and unvalidated sensor accuracy necessitate larger randomized trials for clinical validation.