Was tested in healthy subjects so it is your doctors and hospital responsibility to get this tested in stroke survivors. If they have done nothing on this in the past 4 years they need to be fired. Since that will never occur and still end up being way too expensive I'll just do action observation and mirror therapy. But our fucking failures of stroke associations should have already created thousands of hours of action observation videos.
Using Virtual Reality to Transfer Motor Skill Knowledge from One Hand to Another
Abstract
As far as acquiring motor skills is concerned, training by voluntary physical movement is superior to all other forms of training (e.g. training by observation or passive movement of trainee's hands by a robotic device). This obviously presents a major challenge in the rehabilitation of a paretic limb since voluntary control of physical movement is limited. Here, we describe a novel training scheme we have developed that has the potential to circumvent this major challenge. We exploited the voluntary control of one hand and provided real-time movement-based manipulated sensory feedback as if the other hand is moving. Visual manipulation through virtual reality (VR) was combined with a device that yokes left-hand fingers to passively follow right-hand voluntary finger movements. In healthy subjects, we demonstrate enhanced within-session performance gains of a limb in the absence of voluntary physical training. Results in healthy subjects suggest that training with the unique VR setup might also be beneficial for patients with upper limb hemiparesis by exploiting the voluntary control of their healthy hand to improve rehabilitation of their affected hand.
Introduction
Physical practice is the most efficient form of training. Although this approach is well established1, it is very challenging in cases where the basic motor capability of the training hand is limited2. To bypass this problem, a large and growing body of literature examined various indirect approaches of motor training.
One such indirect training approach uses physical practice with one hand to introduce performance gains in the other (non-practiced) hand. This phenomenon, known as cross-education (CE) or intermanual transfer, has been studied extensively 3,4,5,6,7,8,9 and used to enhance performance in various motor tasks 10,11,12. For instance, in sport skill settings, studies have demonstrated that training basketball dribbling in one hand transfers to increased dribbling capabilities in the other, untrained hand 13,14,15.
In another indirect approach, motor learning is facilitated through the use of visual or sensory feedback. In learning by observation, it has been demonstrated that significant performance gains can be obtained simply by passively observing someone else perform the task16,17,18,19,20. Similarly, proprioceptive training, in which the limb is passively moved, was also shown to improve performance on motor tasks 12,21,22,23,24,25,26.
Together, these lines of research suggest that sensory input plays an important role in learning. Here, we demonstrate that manipulating online sensory feedback (visual and proprioceptive) during physical training of one limb results in augmented performance gain in the opposite limb. We describe a training regime that yields optimal performance outcome in a hand, in the absence of its voluntary physical training. The conceptual novelty of the proposed method resides in the fact that it combines the three different forms of learning - namely, learning by observation, CE, and passive movement. Here we examined whether the phenomenon of CE, together with mirrored visual feedback and passive movement, can be exploited to facilitate learning in healthy subjects in the absence of voluntary physical movement of the training limb.
The concept in this setup differs from direct attempts to physically train the hand. At the methodological level - we introduce a novel setup including advanced technologies such as 3D virtual reality, and custom built devices that allow manipulating visual and proprioceptive input in a natural environmental setting. Demonstrating improved outcome using the proposed training has key consequences for real-world learning. For example, children use sensory feedback in a manner that is different from that of adults27,28,29 and in order to optimize motor learning, children may require longer periods of practice. The use of CE together with manipulated sensory feedback might reduce training duration. Furthermore, acquisition of sport skills might be facilitated using this kind of sophisticated training. Finally, this can prove beneficial for the development of a new approach for rehabilitation of patients with unilateral motor deficits such as stroke.
Protocol
The following protocol was conducted in accordance with guidelines approved by the Human Ethics Committee of Tel-Aviv University.The study includes 2 experiments – one using visual manipulation, and another combining visual with proprioceptive sensory manipulation. Subjects were healthy, right handed (according to the Edinburgh handedness questionnaire), with normal vision and no reported cognitive deficits or neurological problems. They were naïve to the purpose of the study and provided written informed consent to take part in the study.
1. Setting up the Virtual Reality environment
Have the subjects sit in a chair with their hands forward and palms facing down.
Put on the virtual reality (VR) headset with the head-mounted specialized 3D camera to provide online visual feedback of the real environment. Make sure the video from the camera is presented in the VR headset. NOTE: The video is presented by C# codebase custom software, built based on an open-source, cross-platform 3D rendering engine.
Put on the motion-sensing MR-compatible gloves that allow online monitoring of individual finger flexure in each hand. Ensure that the software embeds the virtual hands in a specific location in space such that the subjects see the virtual hands only when looking down towards the place where their real hands would normally be.
Throughout the entire experiment, make sure the software records the hand configuration provided by the gloves. NOTE: The embedded virtual hand movement is controlled by the same software that uses C-based application program interface (API) for accessing calibrated raw data and gesture information from the gloves including the angles between fingers' joints.
Place the subjects' hands in a specialized motion control device and strap the right and left fingers individually to the pistons. Make sure the subjects can move their right hand fingers separately. NOTE: The right hand finger pistons move a plunger on a potentiometer according to the degree of their flexion. This in turn controls a module that reads the location of every potentiometer on each finger of the right hand and powers motors that push/pull the corresponding left hand finger to the corresponding position.
Verify that voluntary movement of the left hand fingers is restricted by asking the subjects to move their left hand while it is located inside the device. NOTE: Since only the active (right) hand finger movement activates the motors, voluntary left hand finger movement is impossible when the device is turned on.
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