Enhanced feedback during training in virtual versus real world environments

Virtual Reality (VR) is a newly emerging methodology for rehabilitation. However, there is little evidence of the effectiveness of training in a virtual environment (VIE) compared to training in a real-world physical environment (PE) regarding the improvement in upper limb impairment and functional levels post-stroke. Our study aims to answer this question. We will contrast training in each of the environments at the arm motor impairment and function levels as well as at the kinematic level. Arm motor training is done in either a fully immersive 3D VE resembling the interior of an elevator with 6 targets placed in different parts of the arm workspace (created using SoftImage XSI on a CAREN simulation system and viewed with a head mounted display) or in a physical environment of similar dimensions. Chronic stroke survivors make pointing movements to the six targets (72 trials/session, 10 sessions, 2 weeks) in either the VIE or the PE. Feedback is provided in the form of knowledge of results and knowledge of performance. Evaluations of arm impairment and function are carried out using standardized clinical scales before and after training. In addition, kinematic evaluation of joint ranges of motion (elbow extension, shoulder horizontal adduction, shoulder flexion) and trunk forward displacement are done. Preliminary results indicate that patients training in the VE improve joint ranges and tend to use less compensatory trunk movement. Results of this study will allow us to determine the added benefit of using VR as a training environment for recovery of the upper limb in stroke survivors.