This article is part of a series on Select Papers from the 2006 International Workshop on Virtual Reality in Rehabilitation, edited by Emily A Keshner, Patrice (Tamar) Weiss.

Research

Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system

Jill Campbell Stewart¹ , Shih-Ching Yeh² , Younbo Jung³ , Hyunjin Yoon² , Maureen Whitford¹ , Shu-Ya Chen¹ , Lei Li² , Margaret McLaughlin³ , Albert Rizzo⁴ and Carolee J Winstein^1,5

¹  Division of Biokinesiology and Physical Therapy at the School of Dentistry, University of Southern California, Los Angeles, CA, USA

²  Department of Computer Science, University of Southern California, Los Angeles, CA, USA

³  Annenburg School for Communication and Integrated Media Systems Center, University of Southern California, Los Angeles, CA, USA

⁴  Institute for Creative Technologies, University of Southern California, Los Angeles, CA, USA

⁵  Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

author email corresponding author email

Journal of NeuroEngineering and Rehabilitation 2007, 4:21doi:10.1186/1743-0003-4-21

Published:	23 June 2007

Abstract

Background

Rehabilitation programs designed to develop skill in upper extremity (UE) function after stroke require progressive practice that engage and challenge the learner. Virtual realty (VR) provides a unique environment where the presentation of stimuli can be controlled systematically for optimal challenge by adapting task difficulty as performance improves. We describe four VR tasks that were developed and tested to improve arm and hand movement skills for individuals with hemiparesis.

Methods

Two participants with chronic post-stroke paresis and different levels of motor severity attended 12 training sessions lasting 1 to 2 hours each over a 3-week period. Behavior measures and questionnaires were administered pre-, mid-, and post-training.

Results

Both participants improved VR task performance across sessions. The less impaired participant averaged more time on task, practiced a greater number of blocks per session, and progressed at a faster rate over sessions than the more impaired participant. Impairment level did not change but both participants improved functional ability after training. The less impaired participant increased the number of blocks moved on the Box & Blocks test while the more impaired participant achieved 4 more items on the Functional Test of the Hemiparetic UE.

Conclusion

Two participants with differing motor severity were able to engage in VR based practice and improve performance over 12 training sessions. We were able to successfully provide individualized, progressive practice based on each participant's level of movement ability and rate of performance improvement.