Abstract — Virtual reality (VR) has enormous potential as an adjunct in therapy. VR has many of the parameters shown to be effective in motor learning. It induces brain plasticity and benefits may be transferable to the physical world. We describe a novel approach to the rehabilitation of the upper limb using video-capture virtual reality technology.

I. INTRODUCTION HILDREN with cerebral palsy have restricted movement in one or more limbs. Consequently their interaction with the environment is often both limited

and abnormal. For more typical movement patterns to emerge, training needs to be repetitive, motivating, specific, and meaningful [1]. The provision of feedback is also a necessary element for consolidating learning [2]. Virtual reality environments (VE) are important adjuncts to therapy since they can incorporate these parameters. Previous studies have demonstrated that cortical reorganization, indicative of learning, occurs after training in a VE [3] and that motor gains transfer to functional activities in the physical environment [4]. We describe an application of games played in virtual reality using a commercially available video-capture technology (IREX, GestureTek, Toronto, Ont). The IREX system was adapted to emphasize unilateral arm movement such that the hand and forearm interact with the virtual environment in place of the full body as in earlier work [5].

To emphasize reaching activities, the user is seated at a table in front of a 15 cm computer screen. A green background is placed on the table and the arm is held a few centimeters above the table. To encourage sagittal instead of coronal arm movements, the system’s camera is secured on top of the computer screen and directed downward towards the user’s arm. (Fig.1). Applications include playing soccer, breaking balloons, and snowboarding. For example, in the soccer application, the forearm and hand are used to stop the balls from entering the goal. Balls can originate from anywhere on the screen. When the ball is touched with any part of the hand or arm, a thud sound is heard and the ball is prevented from entering the net. Participants receive feedback in the form of a game score about the number of successful saves versus the number of goals scored. The adapted system is currently used in a randomized trial to improve reaching in children with cerebral palsy.

Manuscript received June 30, 2008. Affiliations: Guberek, Schneiberg, McKinley and Levin are with the School of Physical and Occupational Therapy, McGill University and the Center for Interdisciplinary Research in Rehabilitation (CRIR); Sveistrup is with the Faculty of Health Sciences, University of Ottawa. (e-mail: mindy.levin@mcgill.ca).

II. CONCLUSION

According to parent/caregiver reports in the study currently underway, children exposed to the VE tended to use their affected upper limb more spontaneously than before. Children and therapists looked forward to their sessions but were sometimes frustrated by software difficulties. Although not all games were adaptable for upper limb applications, we were able to identify and adapt a subset of games for use in the training study. Children with more severe physical impairment limiting arm supination/pronation had more difficulty playing certain games (i.e., snowboard). Overall the system was user-friendly and enjoyable and has the capacity to meet general upper limb rehabilitation goals of increasing the frequency of use of the affected limb.

ACKNOWLEDGMENT

Technical: Christian Beaudoin and Valeri Goussev. Supported by the Canadian Institutes of Health Research.

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[2] R. Schmidt and T. Lee, Motor Control and Learning, 4th ed., Champaign, IL: Human Kinetics, 2005

[3] S.H.You, et al., “Virtual Reality-Induced Cortical Reorganization and Associated Locomotor Recovery in Chronic Stroke: An Experimenter-Blind Randomized Study”, Stroke, 2005, vol. 36, pp. 1166-1171

[4] A. Viau, A.G. Feldman, B.J. McFadyen, M.F. Levin, “Reaching in reality and virtual reality: A comparison of movement kinematics in healthy subjects and in adults with hemiparesis,” J. NeuroEngineering Rehabil, 1:11, 2004

[5] Bryanton C, Brien M, McLean J, McCormick A, Sveistrup H. Feasibility, motivation and selective motor control: Virtual reality compared to conventional home exercise in children with cerebral palsy, Cyberpsychology & Behavior, 9(2), 123-128, 2006.

Application of Virtual Reality in Upper Limb Rehabilitation Rhona Guberek, Sheila Schneiberg, Heidi Sveistrup, Patricia McKinley and Mindy F. Levin

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Fig. 1. Image of a child playing soccer game with left hand.

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