Item – Theses Canada

​
OCLC number
1190696992
Link(s) to full text
LAC copy
Author
Demers, Marika,
Title
Reaching, thinking, moving : virtual reality for upper limb rehabilitation
Degree
McGill University, 2019
Publisher
[Montreal] : McGill University Libraries, [2019]
Description
1 online resource
Notes
Thesis supervisor: Mindy Levin
Includes bibliographical references.
Abstract
"Virtual reality (VR) is a promising intervention for sensorimotor rehabilitation following a stroke. To date, increasing evidence supports the use of VR for paretic upper limb rehabilitation in chronic stroke. Still, evidence is limited in the sub-acute phase of stroke recovery, where most rehabilitation occurs. To address this gap, our research team developed a functional game-based VR intervention designed to remediate arm motor impairments in sub-acute stroke rehabilitation. Before the effectiveness of this VR-based intervention can be tested in a planned intervention study, it is crucial to determine the feasibility of the VR intervention with potential users. Specifically, it is necessary to determine the validity of movements made in a 2D VR environment by comparing motor performance and quality of movement variables of reaching movements made in the two environments. This is important to ensure that movements practiced in the virtual environment match real-life situations and to avoid reinforcing maladaptive compensatory movements. The overall aim of the thesis is to determine the feasibility of using a VR intervention as a therapeutic option for improving upper limb function in individuals who have had a stroke. This thesis is comprised of three manuscripts - one review paper and two experimental studies. The first manuscript is a mixed-methods study aimed at determining users' satisfaction and safety of incorporating the developed VR intervention as an adjunctive therapeutic option for sub-acute stroke rehabilitation. The main findings were that both clinicians and stroke subjects were highly satisfied with the VR intervention and perceived that it would be useful in clinical practice. The duration and intensity of a single session of VR were well tolerated and no adverse events occurred. The second manuscript is a structured review. The objective was to determine the extent to which upper limb movement quality is assessed by commonly used neurological outcome measures. This manuscript highlighted the need to incorporate the assessment of movement quality into clinical practice and research. The results suggested that most upper limb measures poorly capture how well a person moves, limiting their ability to distinguish recovery from compensation and to adequately track changes over time. Only one measure, the Reaching Performance Scale for Stroke, was found to assess both movement quality and motor performance. The use of observational kinematics with or without motion tracking technology could help to incorporate movement quality into clinical assessment. The third manuscript focuses on the kinematic validity of upper limb functional movements performed in the 2D VR environment, in healthy individuals and in individuals who have had a stroke with and without visual perceptual impairments. For unimanual reaching movements, movement speed, hand orientation when grasping the object and trunk kinematics were unaffected by the environment. However, in the virtual environment, unimanual reaches were less smooth and time to peak velocity was longer. These differences were more pronounced in individuals with stroke. Greater visual perceptual impairments resulted in longer movement duration and slower time to peak velocity in only in the virtual environment. For bilateral reach-to-grasp movements, healthy individuals made generally simultaneous and symmetrical movements in both environments. In contrast, movements in stroke subjects were less symmetrical in the virtual environment. The similarity of endpoint spatial variables and most movement quality variables made in the virtual and the physical environments suggest that using the low-cost 2D virtual environment may be a valid approach for sensorimotor rehabilitation following a stroke. This work supports the feasibility of using a low-cost VR intervention for supplementing stroke rehabilitation in individuals with a large spectrum impairments"--
Other link(s)
escholarship.mcgill.ca
escholarship.mcgill.ca
Subject
Physical & Occupational Therapy