The role of Haptic Feedback on Upper Extremity Muscle Activity, Perceived Exertion, and Presence in VR-Based Exergames

Exergames based on virtual reality (VR) are widely adopted in upper extremity exercise and rehabilitation-related applications. However, VR-based strength training and the effect of haptic feedback remain underexplored. This study compared muscle activity and perceived exertion between conventional dumbbell exercise and VR-based training and examined the effects of different haptic vibration levels on muscle activity, perceived exertion, and presence of VR-based training. A within-subject design was employed with nine healthy female participants. Each participant completed two training conditions: conventional dumbbell exercise with weights of 1, 2, and 3 kg and VR-based exergames with three haptic vibration levels of 250, 240, and 230 Hz. Surface electromyography was used to assess muscle activity in the biceps brachii, triceps brachii, flexor carpi radialis, and extensor carpi radialis. Perceived exertion was rated using the Borg CR-10 scale, and presence was measured using the Barfield Presence Questionnaire. Data were analyzed using repeated-measures analysis of variance and nonparametric tests. The results showed that conventional training produced significantly higher and more load-sensitive muscle activity and perceived exertion than VR-based training. In the VR condition, the haptic vibration level significantly affected muscle activity, especially in the triceps brachii, but did not consistently affect perceived exertion or presence. In conclusion, controller-based vibrotactile feedback can modulate muscle activity during VR-based strength training but does not fully replicate the neuromuscular and perceptual demands of conventional resistance exercise. Therefore, the current VR-haptic system is better positioned as a low-load motor activation and engagement tool for early-stage rehabilitation than as a direct substitute for conventional progressive resistance training.

Exergames; Haptic feedback; Muscle activity; Strength training; Upper extremities

Ada, L., Dorsch, S., & Canning, C. G. (2006). Strengthening interventions increase strength and improve activity after stroke: A systematic review. Australian Journal of Physiotherapy, 52(4), 241–248. https://doi.org/10.1016/S0004-9514(06)70003-4

Akinnola, O. O., Vardakastani, V., & Kedgley, A. E. (2020). Identifying tasks to elicit maximum voluntary contraction in the muscles of the forearm. Journal of Electromyography and Kinesiology. https://doi.org/10.1016/j.jelekin.2020.102463

Albert, S. J., & Kesselring, J. (2012). Neurorehabilitation of stroke. Journal of Neurology, 259(5), 817–832. https://doi.org/10.1007/s00415-011-6247-y

Altukhaim, S., Sakabe, N., Nagaratnam, K., Mannava, N., Kondo, T., & Hayashi, Y. (2025). Immersive virtual reality enhanced reinforcement induced physical therapy (EVEREST). Displays, 87, 102962. https://doi.org/10.1016/j.displa.2024.102962

Alves, D., Matta, T., & Oliveira, L. (2018). Effect of shoulder position on triceps brachii heads activity in dumbbell elbow extension exercises. The Journal of Sports Medicine and Physical Fitness, 58(9), 1247–1252. https://doi.org/10.23736/S0022-4707.17.06849-9

American College of Sports Medicine. (2009). Progression models in resistance training for healthy adults. Medicine & Science in Sports & Exercise, 41(3), 687–708. https://doi.org/10.1249/MSS.0b013e3181915670

American Council on Exercise. (n.d.-a). Wrist curl – extension. ACE Fitness. https://www.acefitness.org/resources/everyone/exercise-library/29/wrist-curl-extension/

American Council on Exercise. (n.d.-b). Wrist curl – flexion. ACE Fitness. https://www.acefitness.org/resources/everyone/exercise-library/30/wrist-curl-flexion/

Amin, F., Waris, A., Syed, S., Amjad, I., Umar, M., Iqbal, J., & Gilani, S. O. (2024). Effectiveness of immersive virtual reality-based hand rehabilitation games for improving hand motor functions in subacute stroke patients. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 32, 2060–2069. https://doi.org/10.1109/TNSRE.2024.3405852

Argelaguet, F., & Andujar, C. (2013). A survey of 3D object selection techniques for virtual environments. Computers & Graphics, 37(3), 121–136. https://doi.org/10.1016/j.cag.2012.12.003

Badde, S., Navarro, K. T., & Landy, M. S. (2020). Modality-specific attention attenuates visual-tactile integration and recalibration effects by reducing prior expectations of a common source for vision and touch. Cognition, 197, 104170. https://doi.org/10.1016/j.cognition.2019.104170

Barbero, M., Merletti, R., & Rainoldi, A. (2012). Atlas of muscle innervation zones. Springer Milan. https://doi.org/10.1007/978-88-470-2463-2

Baren, J. V., & IJsselsteijn, W. (2004). Measuring presence: A guide to current measurement approaches (1st ed.). https://api.semanticscholar.org/CorpusID:16088453

Barker, R. N., Brauer, S., & Carson, R. (2009). Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke. Experimental Brain Research, 196(4), 483–496. https://doi.org/10.1007/s00221-009-1872-8

Bergevin, M., Steele, J., Garanderie, M. P. d. l., Feral-Basin, C., Marcora, S. M., Rainville, P., Caron, J. G., & Pageaux, B. (2023). Pharmacological blockade of muscle afferents and perception of effort: A systematic review with meta-analysis. Sports Medicine, 53(2), 415–435. https://doi.org/10.1007/s40279-022-01762-4

Bruun-Pedersen, J. R., Andersen, M. G., Clemmensen, M. M., Didriksen, M. K., Wittendorff, E. J., & Serafin, S. (2018). The effect of multimodal feedback on perceived exertion on a VR exercise setting. In Lecture notes in computer science (pp. 12–30). https://doi.org/10.1007/978-3-319-91584-5 2

Burdea, G. C. (2003). Virtual rehabilitation: Benefits and challenges. Methods of Information in Medicine, 42(5), 519–523. https://doi.org/10.1267/METH03050519

Cardinale, M., & Erskine, J. A. (2008). Vibration training in elite sport: Effective training solution or just another fad?. International Journal of Sports Physiology and Performance, 3(2), 232–239. https://doi.org/10.1123/ijspp.3.2.232

Chen, Y., Abel, K. T., Janecek, J. T., Chen, Y., Zheng, K., & Cramer, S. C. (2019). Home-based technologies for stroke rehabilitation: A systematic review. International Journal of Medical Informatics, 123, 11–22. https://doi.org/10.1016/j.ijmedinf.2018.12.001

Coratella, G., Tornatore, G., Longo, S., Toninelli, N., Padovan, R., Esposito, F., & Cè, E. (2023). Biceps brachii and brachioradialis excitation in biceps curl exercise: Different handgrips, different synergy. Sports, 11(3), 64. https://doi.org/10.3390/sports11030064

Corbetta, D., Sirtori, V., Castellini, G., Moja, L., & Gatti, R. (2015). Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database of Systematic Reviews, 2017 (9). https://doi.org/10.1002/14651858.CD004433.pub3

de Morree, H. M., Klein, C., & Marcora, S. M. (2012). Perception of effort reflects central motor command during movement execution. Psychophysiology, 49(9), 1242–1253. https://doi.org/10.1111/j.1469-8986.2012.01399.x

Düking, P., Holmberg, H.-C., & Sperlich, B. (2018). The potential usefulness of virtual reality systems for athletes: A short SWOT analysis. Frontiers in Physiology, 9. https://doi.org/10.3389/fphys.2018.00128

Dürümlü, N., Sözen, H., & Acaröz, S. (2026). Comparative analysis of the maximum voluntary isometric contraction of the biceps brachii and triceps brachii at different elbow angles. Journal of Exercise Therapy and Rehabilitation, 13(1), 48–56. https://doi.org/10.15437/jetr.1746892

Enoka, R. M., & Duchateau, J. (2017). Rate coding and the control of muscle force. Cold Spring Harbor Perspectives in Medicine, 7(10), a029702. https://doi.org/10.1101/cshperspect.a029702

Ernst, M. O., & Banks, M. S. (2002). Humans integrate visual and haptic information in a statistically optimal fashion. Nature, 415(6870), 429–433. https://doi.org/10.1038/415429a

Feigin, V. L., Abate, M. D., Abate, Y. H., Abd ElHafeez, S., Abd-Allah, F., Abdelalim, A., Abdelkader, A., Abdelmasseh, M., Abd-Elsalam, S., Abdi, P., Abdollahi, A., Abdoun, M., Abd-Rabu, R., Abdulah, D. M., Abdullahi, A., Abebe, M., Zuñiga, R. A. A., Abhilash, E. S., Abiodun, O. O., et al. (2024). Global, regional, and national burden of stroke and its risk factors, 1990–2021: A systematic analysis for the global burden of disease study 2021. The Lancet Neurology, 23(10), 973–1003. https://doi.org/10.1016/S1474-4422(24)00369-7

Feigin, V. L., Owolabi, M. O., Abd-Allah, F., Akinyemi, R. O., Bhattacharjee, N. V., Brainin, M., Cao, J., Caso, V., Dalton, B., Davis, A., Dempsey, R., Duprey, J., Feng, W., Ford, G. A., Gall, S., Gandhi, D., Good, D. C., Hachinski, V., & Zago?d?on, P. (2023). Pragmatic solutions to reduce the global burden of stroke: A World Stroke Organization–Lancet Neurology Commission. The Lancet Neurology, 22(12), 1160–1206. https://doi.org/10.1016/S1474-4422(23)00277-6

Folkerts, M. A., Hijmans, J. M., Elsinghorst, A. L., Mulderij, Y., Murgia, A., & Dekker, R. (2017). Effectiveness and feasibility of eccentric and task-oriented strength training in individuals with stroke. NeuroRehabilitation, 40(4), 459–471. https://doi.org/10.3233/NRE-171433

Frasie, A., Bertrand-Charette, M., Compagnat, M., Bouyer, L. J., & Roy, J.-S. (2024). Validation of the Borg CR10 scale for the evaluation of shoulder perceived fatigue during work-related tasks. Applied Ergonomics, 116, 104200. https://doi.org/10.1016/j.apergo.2023.104200

Fuentes del Toro, S., & Aranda-Ruiz, J. (2025). The impact of normalization procedures on surface electromyography (sEMG) data integrity: A study of bicep and tricep muscle signal analysis. Sensors, 25(9), 2668. https://doi.org/10.3390/s25092668

Gibbs, J. K., Gillies, M., & Pan, X. (2022). A comparison of the effects of haptic and visual feedback on presence in virtual reality. International Journal of Human-Computer Studies, 157, 102717. https://doi.org/10.1016/j.ijhcs.2021.102717

Griffin, L., & Cafarelli, E. (2005). Resistance training: Cortical, spinal, and motor unit adaptations. Canadian Journal of Applied Physiology, 30(3), 328–340. https://doi.org/10.1139/h05-125

Halperin, I., & Vigotsky, A. D. (2024). An integrated perspective of effort and perception of effort. Sports Medicine, 54(8), 2019–2032. https://doi.org/10.1007/s40279-024-02055-8

Handler, A., & Ginty, D. D. (2021). The mechanosensory neurons of touch and their mechanisms of activation. Nature Reviews Neuroscience, 22(9), 521–537. https://doi.org/10.1038/s41583-021-00489-x

Hermens, H. J., Freriks, B., Disselhorst-Klug, C., & Rau, G. (2000). Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology, 10(5), 361–374. https://doi.org/10.1016/S1050-6411(00)00027-4

Hiroyuki, A., Kaoru, H., Mami, T., Tomokazu, T., Futoshi, W., Yuhei, M., Reina, I., Akira, T., & Toshiyuki, F. (2025). Effects of home-based virtual reality upper extremity rehabilitation in persons with chronic stroke: A randomized controlled trial. Journal of NeuroEngineering and Rehabilitation, 22(1), 20. https://doi.org/10.1186/s12984-025-01564-5

Huang, Q., Jiang, X., Jin, Y., Wu, B., Vigotsky, A. D., Fan, L., Gu, P., Tu, W., Huang, L., & Jiang, S. (2024). Immersive virtual reality-based rehabilitation for subacute stroke: A randomized controlled trial. Journal of Neurology, 271(3), 1256–1266. https://doi.org/10.1007/s00415-023-12060-y

Huber, S. K., Knols, R. H., Arnet, P., & de Bruin, E. D. (2022). Motor-cognitive intervention concepts can improve gait in chronic stroke, but their effect on cognitive functions is unclear: A systematic review with meta-analyses. Neuroscience & Biobehavioral Reviews, 132, 818–837. https://doi.org/10.1016/j.neubiorev.2021.11.013

Jo, S., Jang, H., Kim, H., & Song, C. (2024). 360° immersive virtual reality-based mirror therapy for upper extremity function and satisfaction among stroke patients: A randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 60(2). https://doi.org/10.23736/S1973-9087.24.08275-3

Johansson, R. S., & Flanagan, J. R. (2009). Coding and use of tactile signals from the fingertips in object manipulation tasks. Nature Reviews Neuroscience, 10(5), 345–359. https://doi.org/10.1038/nrn2621

Kang, H., Kang, T., & Wallraven, C. (2023). Putting vision and touch into conflict: Results from a multimodal mixed reality setup. IEEE Transactions on Visualization and Computer Graphics, 29(12), 5224–5234. https://doi.org/10.1109/TVCG.2022.3207241

Kassuba, T., Klinge, C., Hölig, C., Röder, B., & Siebner, H. R. (2013). Vision holds a greater share in visuo-haptic object recognition than touch. NeuroImage, 65, 59–68. https://doi.org/10.1016/j.neuroimage.2012.09.054

Kelly-Hayes, M., Beiser, A., Kase, C. S., Scaramucci, A., D’Agostino, R. B., & Wolf, P. A. (2003). The influence of gender and age on disability following ischemic stroke: The Framingham study. Journal of Stroke and Cerebrovascular Diseases, 12(3), 119–126. https://doi.org/10.1016/S1052-3057(03)00042-9

Kim, G., Okamoto, S., & Maruyama, H. (2023). Weight illusion caused by sinusoidal vibration correlates with grip force adjustment. Applied Sciences, 13(4), 2717. https://doi.org/10.3390/app13042717

Krol, P., Piecha, M., Slomka, K., Sobota, G., Plak, A., & Juras, G. (2011). The effect of whole-body vibration frequency and amplitude on the myoelectric activity of vastus medialis and vastus lateralis. Journal of Sports Science and Medicine, 169–174.

Kurzweg, M., Weiss, Y., Ernst, M. O., Schmidt, A., & Wolf, K. (2024). Survey on haptic feedback through sensory illusions in interactive systems. ACM Computing Surveys, 56(8), 1–39. https://doi.org/10.1145/3648353

Ling, Y., ter Meer, L. P., Yumak, Z., & Veltkamp, R. C. (2017). Usability test of exercise games designed for rehabilitation of elderly patients after hip replacement surgery: Pilot study. JMIR Serious Games, 5(4), e19. https://doi.org/10.2196/games.7969

Long, J., Shen, L., Cai, Q., Xiao, S., & Chen, Z. (2023). Novel approach to transfer of coordination skills to the paretic hand by improving the efficiency of cortical network. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 31, 326–334. https://doi.org/10.1109/TNSRE.2022.3221738

McManus, L., de Vito, G., & Lowery, M. M. (2020). Analysis and biophysics of surface EMG for physiotherapists and kinesiologists: Toward a common language with rehabilitation engineers. Frontiers in Neurology, 11. https://doi.org/10.3389/fneur.2020.576729

Mildren, R. L., Peters, R. M., Hill, A. J., Blouin, J.-S., Carpenter, M. G., & Inglis, J. T. (2017). Frequency characteristics of human muscle and cortical responses evoked by noisy Achilles tendon vibration. Journal of Applied Physiology, 122(5), 1134–1144. https://doi.org/10.1152/japplphysiol.00908.2016

Mologne, M. S., Hu, J., Carrillo, E., Gomez, D., Yamamoto, T., Lu, S., Browne, J. D., & Dolezal, B. A. (2022). The efficacy of an immersive virtual reality exergame incorporating an adaptive cable resistance system on fitness and cardiometabolic measures: A 12-week randomized controlled trial. International Journal of Environmental Research and Public Health, 20(1), 210. https://doi.org/10.3390/ijerph20010210

Montag, E. (n.d.). Chapter 3: Psychophysics, perception, and decision making. Rochester Institute of Technology. Retrieved August 13, 2025, from https://www.cis.rit.edu/people/faculty/montag/vandplite/pages/chap 3/ch3p1.html

Moore, A. R., & Butler, B. A. S. (2024). Immersive virtual reality decreases work rate and manipulates attentional focus during self-regulated vigorous exercise. Research Quarterly for Exercise and Sport, 95(4), 963–973. https://doi.org/10.1080/02701367.2024.2356893

Moosavi, M. S., Raimbaud, P., Guillet, C., Plouzeau, J., & Merienne, F. (2023). Weight perception analysis using pseudo-haptic feedback based on physical work evaluation. Frontiers in Virtual Reality, 4. https://doi.org/10.3389/frvir.2023.973083

Muñoz-Novoa, M., Kristoffersen, M. B., Sunnerhagen, K. S., Naber, A., Ortiz-Catalan, M., & Alt Murphy, M. (2025). Myoelectric pattern recognition with virtual reality and serious gaming improves upper limb function in chronic stroke: A single case experimental design study. Journal of NeuroEngineering and Rehabilitation, 22(1), 6. https://doi.org/10.1186/s12984-025-01541-y

Nanay, B. (2018). Multimodal mental imagery. Cortex, 105, 125–134. https://doi.org/10.1016/j.cortex.2017.07.006

Navea, R. F., Talde, V. M., Armintia, F. L., dela Cruz, S. M., Medina, G., & Decena, A. (2025). Gamified shoulder rehabilitation for mild stroke patients using virtual reality. International Journal of Technology, 16(1), 146–159. https://doi.org/10.14716/ijtech.v16i1.7365

Nekar, D. M., Lee, D.-Y., Hong, J.-H., Kim, J.-S., Kim, S.-G., Nam, Y.-G., & Yu, J.-H. (2023). Effects of pseudo-weight resistance training using mixed-reality technology on muscle activation in healthy adults: A preliminary study. Applied Sciences, 13(18), 10021. https://doi.org/10.3390/app131810021

Nichols-Larsen, D. S., Clark, P. C., Zeringue, A., Greenspan, A., & Blanton, S. (2005). Factors influencing stroke survivors’ quality of life during subacute recovery. Stroke, 36(7), 1480–1484. https://doi.org/10.1161/01.STR.0000170706.13595.4f

Octavia, J. R., & Natasha, L. (2017). Design of a mobile game application to support hand rehabilitation of stroke patients in Indonesia. International Journal of Technology, 8(2), 250–261. https://doi.org/10.14716/ijtech.v8i2.6167

Pujiartati, D. A., Ananta, M. F., Muslim, K., Setiawati, N. L. P. L. S., & Iridiastadi, H. (2020). Effect of virtual reality usage on postural stability. Journal of Physics: Conference Series, 1517(1), 012026. https://doi.org/10.1088/1742-6596/1517/1/012026

Pujiartati, D. A., Salsabila, M. N., Muslim, K., Yassierli, Y., & Akbar, S. (2024). The development of a virtual reality-based training system for prosthetic foot users: Effects on motion sickness and postural stability. Industrial Engineering & Management Systems, 23(1), 103–111. https://doi.org/10.7232/iems.2024.23.1.103

Rexrode, K. M., Madsen, T. E., Yu, A. Y. X., Carcel, C., Lichtman, J. H., & Miller, E. C. (2022). The impact of sex and gender on stroke. Circulation Research, 130(4), 512–528. https://doi.org/10.1161/CIRCRESAHA.121.319915

Roman-Liu, D., & Bartuzi, P. (2018). Influence of type of MVC test on electromyography measures of biceps brachii and triceps brachii. International Journal of Occupational Safety and Ergonomics, 24(2), 200–206. https://doi.org/10.1080/10803548.2017.1353321

Rosa, M., Martins, R., & Loureiro, N. (2024). The effects of different types of external load equipment on muscle activation comparing two bench press exercises variations. International Journal of Strength and Conditioning, 4(1). https://doi.org/10.47206/ijsc.v4.i1.254

Rubio-Arias, J. Á., Verdejo-Herrero, A., Andreu-Caravaca, L., & Ramos-Campo, D. J. (2024). Impact of immersive virtual reality games or traditional physical exercise on cardiovascular and autonomic responses, enjoyment and sleep quality: A randomized crossover study. Virtual Reality, 28(1), 64. https://doi.org/10.1007/s10055-024-00981-6

Saal, H. P., & Bensmaia, S. J. (2014). Touch is a team effort: Interplay of submodalities in cutaneous sensibility. Trends in Neurosciences, 37(12), 689–697. https://doi.org/10.1016/j.tins.2014.08.012

Samad, M., Gatti, E., Hermes, A., Benko, H., & Parise, C. (2019). Pseudo-haptic weight. Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems, 1–13. https://doi.org/10.1145/3290605.3300550

Schwarz, A., Cardon, G., Chastin, S., Stragier, J., de Marez, L., & DeSmet, A. (2021). Does dynamic tailoring of a narrative-driven exergame result in higher user engagement among adolescents? Results from a cluster-randomized controlled trial. International Journal of Environmental Research and Public Health, 18(14), 7444. https://doi.org/10.3390/ijerph18147444

Silva, A. D., & Laje, R. (2024). Perturbation context in paced finger tapping tunes the error-correction mechanism. Scientific Reports, 14 (1), 27473. https://doi.org/10.1038/s41598-024-78786-5

Skvortsov, D., Lobunko, D., Lobunko, A., Belonovskaya, N., & Ivanova, G. (2025). Wrist function test and its use to assess treatment efficacy in ischemic stroke survivors—A pilot study. Diagnostics, 15(7), 840. https://doi.org/10.3390/diagnostics15070840

Song, Y.-H., & Lee, H.-M. (2021). Effect of immersive virtual reality-based bilateral arm training in patients with chronic stroke. Brain Sciences, 11(8), 1032. https://doi.org/10.3390/brainsci11081032

Souron, R., Besson, T., Millet, G. Y., & Lapole, T. (2017). Acute and chronic neuromuscular adaptations to local vibration training. European Journal of Applied Physiology, 117(10), 1939–1964. https://doi.org/10.1007/s00421-017-3688-8

Stellmacher, C., Bonfert, M., Kruijff, E., & Schöning, J. (2022). Triggermuscle: Exploring weight perception for virtual reality through adaptive trigger resistance in a haptic VR controller. Frontiers in Virtual Reality, 2. https://doi.org/10.3389/frvir.2021.754511

Stewart, T. H., Villaneuva, K., Hahn, A., Ortiz-Delatorre, J., Wolf, C., Nguyen, R., Bolter, N. D., Kern, M., & Bagley, J. R. (2022). Actual vs. perceived exertion during active virtual reality game exercise. Frontiers in Rehabilitation Sciences, 3. https://doi.org/10.3389/fresc.2022.887740

Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 2018(7). https://doi.org/10.1002/14651858.CD008449.pub3

Ujitoko, Y., & Ban, Y. (2021). Survey of pseudo-haptics: Haptic feedback design and application proposals. IEEE Transactions on Haptics, 14(4), 699–711. https://doi.org/10.1109/TOH.2021.3077619

van Wegen, M., Herder, J. L., Adelsberger, R., Pastore-Wapp, M., van Wegen, E. E. H., Bohlhalter, S., Nef, T., Krack, P., & Vanbellingen, T. (2023). An overview of wearable haptic technologies and their performance in virtual object exploration. Sensors, 23(3), 1563. https://doi.org/10.3390/s23031563

Veldema, J., & Jansen, P. (2020). Resistance training in stroke rehabilitation: Systematic review and meta-analysis. Clinical Rehabilitation, 34 (9), 1173–1197. https://doi.org/10.1177/0269215520932964

Veras, M., Labbé, D. R., Furlano, J., Zakus, D., Rutherford, D., Pendergast, B., & Kairy, D. (2023). A framework for equitable virtual rehabilitation in the metaverse era: Challenges and opportunities. Frontiers in Rehabilitation Sciences, 4. https://doi.org/10.3389/fresc.2023.1241020

Vigotsky, A. D., Halperin, I., Lehman, G. J., Trajano, G. S., & Vieira, T. M. (2018). Interpreting signal amplitudes in surface electromyography studies in sport and rehabilitation sciences. Frontiers in Physiology, 8. https://doi.org/10.3389/fphys.2017.00985

Weiss, P. L., Keshner, E. A., & Levin, M. F. (2014). Virtual reality for physical and motor rehabilitation. Springer New York. https://doi.org/10.1007/978-1-4939-0968-1

Weiss, P. L., Kizony, R., Feintuch, U., & Katz, N. (2006). Virtual reality in neurorehabilitation. In Textbook of neural repair and rehabilitation (pp. 182–197). Cambridge University Press. https://doi.org/10.1017/CBO9780511545078.015

World Health Organization. (2024). World health statistics 2024: Monitoring health for the sdgs, sustainable development goals (Report). https://www.who.int/publications/i/item/9789240094703

Yagiz, G., Akaras, E., Kubis, H.-P., & Owen, J. A. (2022). The effects of resistance training on architecture and volume of the upper extremity muscles: A systematic review of randomised controlled trials and meta-analyses. Applied Sciences, 12 (3), 1593. https://doi.org/10.3390/app12031593