Task or Virtual Reality Intervention for Improving UE Function

Potential participants will be screened for age, history of stroke, brain injury, or cerebral palsy, and having one functional arm and one poorly functioning arm by phone. Those who meet the basic criteria will be scheduled for an Intake Evaluation consisting of obtaining voluntary informed consent, complete a demographic survey, visual field testing, cognitive screening, perceptual testing, and an arm/hand function test. Participants who meet the inclusion criteria will be scheduled for a Preliminary Evaluation.

The Preliminary Evaluation will measure the current motor control ability, perception of level of disability, and amount of active and passive motion in the involved arm.

Participants will participate in the first form of intervention (randomly assigned) for three 30 minute sessions per week for 3 weeks (total of 9 sessions) and be re-evaluated using the same tests conducted during the Preliminary Evaluation with the addition of the arm/hand function test conducted during the initial screening.

Participants will participate in the second form of intervention for three 30 minute sessions per week for 3 weeks (total of 9 sessions) and be re-evaluated using the same tests conducted following the first intervention.

One month after completing the second form of intervention, participants will be re-evaluated using the same tests used following the second intervention and will also receive a semi-structured interview regarding their thoughts and experiences during the study and their perceptions of the outcomes.

• Virtual Reality (A) then Task (B) (Behavioral): Participants will use their intact arm to perform virtual reality tasks while perceiving a reflected virtual image of their paretic arm.
• Task (B) then Virtual Reality (A) (Behavioral): Participants will use their paretic arm to perform real tasks in a structured environment, with a practice and feedback schedule organized by a physical or occupational therapist, or graduate student.

Primary outcomes

• Change in Fugl-Meyer Assessment (UE portion) [1st week, 4 weeks, 8 weeks, 12 weeks]: Performance-based measure of arm impairment post stroke; a positive change in score indicates improvement
• Change in Box & Block Test [1st week, 4 weeks, 8 weeks, 12 weeks]: Measures unilateral gross manual dexterity; a positive change in score indicates improvement
• Change in Stroke Impact Scale 3.0 [1st week, 4 weeks, 8 weeks, 12 weeks]: Self-report health status measure; The Total Score and Subscale Scores range from 0 - 100 with higher scores indicating less perceived impact of the stroke on function and participation (positive change in scores indicate improvement)

Secondary outcomes

• Change in Active and Passive Range of Motion [1st week, 4 weeks, 8 weeks, 12 weeks]: Goniometric measures of active and passive range of motion of the elbow extension, wrist extension, and thumb radial abduction.
• Semi-structured interview [12 weeks]: Qualitative measure of the participant's perception of change in arm function after participating in the study.

Sex: All, ages: 18 Years to 89 Years

Inclusion Criteria:

* 18 - 89 years old
* One arm not fully functional due to a stroke, brain injury, or cerebral palsy
* More than 1 year since neurologic even that impaired arm function

Exclusion Criteria:

* Cognitive impairment
* visual field loss (homonymous hemianopsia)
* perceptual deficits (MVPT4 lower than 2 standard deviations from the norm)
* Seizure disorder
* Currently receiving rehabilitation services (PT or OT) for the involved arm.

• Nancy L Devine, PT, DPT, MS, Principal investigator, Idaho State University