RGV stroke survivor makes strides in recovery through virtual reality gaming research at UTHealth Houston

Evan Cadena was 19 years old when he suffered an ischemic stroke in May 2023. (Photo courtesy of Janie Lazo)

Evan Cadena playing virtual reality games at his home in La Feria, Texas. (Photo courtesy of Janie Lazo)

Evan Cadena was 19 years old when he suffered an ischemic stroke in May 2023. It was the third time a stroke caused him to lose mobility in the right side of his body since he was 16, when doctors in the Rio Grande Valley found an arteriovenous malformation, or AVM, in his brain, a tangle of vessels that creates irregular connections between arteries and veins.

The strokes Evan suffered were a result of embolization surgeries he underwent in 2020, 2022, and 2023, during which doctors blocked blood flow to the AVM. Ischemic strokes are a possible complication of embolization but don’t always occur. 

In addition to suffering multiple strokes, Evan faced obstacles and complications that included pulmonary embolisms, or blood clots, in each of his lungs, a journey that led his doctors to affectionately refer to him as “the miracle kid.” 

Determined to find the best care and rehabilitation for her son, Evan’s mother, Janie Lazo, didn’t hesitate to make the six-hour drive from La Feria, Texas, to Houston when the AVM Alliance referred Evan to UTHealth Houston. 

“I will travel the world for Evan,” Janie said. “Anything that they say will help, I will move mountains to try and figure it out.” 

Evan was ultimately referred to Seema Aggarwal, PhD, APRN, AGNP-C, assistant professor in the Department of Internal Medicine at McGovern Medical School at UTHealth Houston, who in 2023 was leading research to study the possible benefits of virtual reality games for stroke survivors. 

“I was in the process of trying to think how we could get more rehab to people who live in rural areas or who can’t come in because of transportation issues,” Aggarwal said. “We have so many patients who go through rehab, but they want to continue. Rehab isn't exactly fun, and gaming is.” 

Across 10 to 12 sessions with a VR headset, Evan and other participants played a game called Job Simulator, in which they completed different tasks as an office assistant, chef, car mechanic, and store clerk. The tasks, which included answering the phone, making a sandwich, and baking, increased in difficulty over time. Aggarwal selected Job Simulator because it could be played while sitting down, expanding the benefits to more stroke survivors. 

As Evan played, the game was projected on a screen that could be viewed by Aggarwal, his mom, and occupational therapists. 

For Aggarwal, the results were astounding. Not only was Evan more motivated and engaged in his rehabilitation, but he was able to perform movements with his right arm while playing the game that his occupational therapist could not elicit when testing his arm before playing the game.

Aggarwal said Evan’s focus on the game, and not solely on improving his movement, may have helped him make that stride. 

“That’s the interesting thing with stroke,” Aggarwal said. “Yes, your arm is paralyzed, but it starts in the brain.” 

For Aggarwal, the research is also personal. In 2022, as she was recovering from surgery and radiation to treat her breast cancer, her son encouraged her to play VR games with him. Around the same time, her father suffered a stroke. As Aggarwal engaged in her own kind of rehab, she wondered if her father – or other stroke patients – could benefit from the games, too. 

“That was what prompted the whole study; we were really just thinking about my dad,” she said. 

At the end of the study, multiple participants purchased VR headsets to use at home, Aggarwal said. Evan owned a VR headset before the research, but it went mostly unused until he participated in Aggarwal’s study, his mom said. 

“Not only did he get more motivation to keep pushing, but it raised his spirit up a little bit more,” she said. 

Now, at 21, Evan continues to play VR games to build his strength. 

“I was a little agitated at times and still get agitated from time to time,” Evan said of his experience using the VR set for physical rehabilitation. 

But even through the physical challenges, his participation in Aggarwal’s research had a surprising second benefit: Gaining the physical strength to play games online has allowed Evan to reconnect with friends and bridge the social gap lost after his diagnoses as a teen. 

“I've been playing online VR and Xbox more often, and talking more,” Evan said. 

After seeing the progress among patients like Evan, Aggarwal is optimistic about continuing her research with VR by conducting randomized controlled trials that will hopefully support expanding the gaming approach to more stroke survivors.

“Evan was one of the few people in the study who drove a long distance to participate,” Aggarwal said. “That really struck me as how needed this was.”