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. 2007 Jun 23;4:21.
doi: 10.1186/1743-0003-4-21.

Intervention to Enhance Skilled Arm and Hand Movements After Stroke: A Feasibility Study Using a New Virtual Reality System

Free PMC article

Intervention to Enhance Skilled Arm and Hand Movements After Stroke: A Feasibility Study Using a New Virtual Reality System

Jill Campbell Stewart et al. J Neuroeng Rehabil. .
Free PMC article


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.


Figure 1
Figure 1
'Pinch' Task. A) View of starting position for 'Pinch' including PHANToM device configuration used to calibrate the coordinate system in the virtual environment. Index finger and thumb were held 7 cm apart and parallel to the table. B) View of 'Pinch' scene. Initially, the task required the subject to pick up a cube and place it into a window on the back wall of an enclosed room. Due to technical difficulties, the task was modified. In the new version, the participant picks the object up from the floor, lifts it to a specified height, and places it back on the floor with control. Haptic feedback is provided to both fingers via the PHANToM devices such that the participant has the sense of lifting a real object with mass. There were 10 trials per block; each trial was configured using 8 parameters: cube width (20–40 mm); cube height (20–40 mm); cube length (20–40 mm); mass (50–150 g); dynamic friction (0.5–1.0); static friction (0.5–1.0); stiffness (0.5–1.0); and lift height (20–80 mm). A maximum of 30 seconds was allowed for each trial.
Figure 2
Figure 2
'Reaching' Task. A) View of 'Reaching' scene. Each practice block contains 20 cubes (1 cube = 1 trial) presented in relation to each participant's shoulder position. A "virtual hand" corresponds to the location and movement of the paretic hand via a magnetic marker placed either in the palmar surface of a glove or directly onto the dorsum of the hand at the 3rd metacarpal head. Both visual and auditory feedback indicates successful collision of the "virtual hand" with a cube. B) Interface for practice trial configuration. Pitch angle, yaw angle, and percentage of arm length (distance from the acromion to the radial styloid with the elbow extended) were chosen for each cube within a practice block. Practice blocks were designed to address reaching ability using arm lengths ranging from 10% to 120%. A similar interface was used to develop 'Ball Shooting' practice blocks.
Figure 3
Figure 3
'Rotation' Task. The virtual environment consists of two cube configurations that are identical in composition but different in orientation. The participant rotates and laterally moves the green cubes to superimpose them onto the static blue cubes by matching their orientation. Movement of the green cubes is controlled by a magnetic marker attached to a cylinder held in the paretic hand or directly onto the dorsum of the hand at the 3rd metacarpal head. Blocks were configured to require progressively greater amounts of supination ranging from 15° to 150° (from a start position of full pronation). Each practice block contained 20 trials, 10 requiring supination and 10 requiring pronation. A maximum of 60 seconds was allowed for each trial.

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