The Effects of Virtual Reality on the Upper Extremity Skills of Girls with Rett Syndrome: A Single Case Study
Pages 152-159
Kourtney Mraz, Grace Eisenberg, Pamela Diener, Gina Amadio, Matthew H. Foreman and Jack R. Engsberg

DOI: http://dx.doi.org/10.6000/2292-2598.2016.04.03.2

Published:19 October 2016

Abstract: Introduction: Rett Syndrome (RTT) is a genetic disorder primarily seen in females that inhibits the use of a girl’s hands in everyday activities. A girl with RTT spends the majority of her day engaged in stereotypical hand wringing/mouthing movements at midline of the body. The probable cause behind the neurological effects of RTT is a mutation in the gene that encodes for methyl-CpG protein 2 (MeCP2). The hand wringing/mouthing behaviors preclude a girl with RTT from using the upper extremities in purposeful tasks such as school work, play skills, and other activities of daily living.

Objectives: To develop a virtual reality (VR)-based therapeutic intervention that 1) decreases upper extremity stereotypies (repetitive movements that serve no function) that interfere with purposeful arm and hand use and 2) promotes purposeful, goal-directed arm function; improve upper extremity motor skills in girls with RTT.

Materials and Methods: Using FAAST Software and Microsoft Kinect sensor, one girl with RTT participated in a 12-week IVR intervention (1 hour/session, 3 sessions/week, 36 total hours). Pre- and post-assessments were administered to examine any changes in upper extremity function.

Results: The VR intervention led to improvements in use of the upper extremities to complete self-care activities, an increased number of reaches completed in a 15-minute period, and decreased time engaged in stereotypical hand movements.

Conclusion: Future work will add additional support to determine the effectiveness of virtual reality as an intervention for girls with RTT.

Personalized Virtual Reality for Upper Extremity Rehabilitation: Moving from the Clinic to a Home Exercise Program
Pages 160-169
Cherie Behar, Maxwell Lustick, Matthew H. Foreman, Jennifer Webb and Jack R. Engsberg

DOI: http://dx.doi.org/10.6000/2292-2598.2016.04.03.3

Published:19 October 2016 

Abstract: Introduction: Traditional rehabilitation does not provide adequate repetitions for maximal motor recovery in the clinic and home exercise programs (HEPs) have low compliance rates. Personalized virtual reality (PVR) is a promising low-cost therapeutic tool for improving compliance by incorporating the client's interests, abilities, and goals into a motivating and engaging intervention using internet games.

Objectives: The current study aimed to develop and refine a clinic-to-home PVR intervention, determine its feasibility and usability in an outpatient rehabilitation clinic and as a HEP, and examine its effects on motivation/engagement, compliance, motor repetitions, and functional motor performance.

Methods: The PVR system utilizes a Microsoft Kinect sensor to track the participants’ movements, free software to translate movements to keystrokes, and free internet games. The therapist matched participants’ interests to internet games, customized therapeutic movements for game play, and increased the movement thresholds for game activation as participants improved.

Two participants who had strokes resulting in upper extremity (UE) hemiplegia were recruited. The participants attended outpatient occupational therapy (OT) services twice weekly. Following training, the participants used the PVR system at home in place of their UE HEP. They continued to receive traditional OT once a week and clinic-PVR once a week for 5-8 weeks.

Results: The PVR intervention was successfully implemented in the clinic and the clients’ homes. PVR increased motivation and treatment compliance. The clients exhibited improvements in UE active range of motion, function, symptoms, and occupational performance.

Conclusion: Preliminary evidence suggests PVR can improve motivation, compliance, function, and occupational performance. However, larger scale studies and protocol refinement are necessary.