title: Intervention to enhance skilled arm and hand movements after stroke: A feasibility study using a new virtual reality system.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Biokinesiology and Physical Therapy at the School of Dentistry, University of Southern California, Los Angeles, CA, USA. jcstewar@usc.edu
authors.forename: Jill Campbell
authors.initials: JC
authors.lastname: Stewart
authors.forename: Shih-Ching
authors.initials: SC
authors.lastname: Yeh
authors.forename: Younbo
authors.initials: Y
authors.lastname: Jung
authors.forename: Hyunjin
authors.initials: H
authors.lastname: Yoon
authors.forename: Maureen
authors.initials: M
authors.lastname: Whitford
authors.forename: Shu-Ya
authors.initials: SY
authors.lastname: Chen
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Margaret
authors.initials: M
authors.lastname: McLaughlin
authors.forename: Albert
authors.initials: A
authors.lastname: Rizzo
authors.forename: Carolee J
authors.initials: CJ
authors.lastname: Winstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014584:User-Computer Interface