Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke.

Reaching and grasping parameters with and without haptic feedback were characterized in people with chronic post-stroke behaviors. Twelve (67 ± 10 years) individuals with chronic stroke and arm/hand paresis (Fugl-Meyer Assessment-Arm: ≥ 46/66 pts) participated. Three dimensional (3-D) temporal and spatial kinematics of reaching and grasping movements to three objects (can: cylindrical grasp; screwdriver: power grasp; pen: precision grasp) in a physical environment (PE) with and without additional haptic feedback and a 3-D virtual environment (VE) with haptic feedback were recorded. Participants reached, grasped and transported physical and virtual objects using similar movement strategies in all conditions. Reaches made in VE were less smooth and slower compared to the PE. Arm and trunk kinematics were similar in both environments and glove conditions. For grasping, stroke subjects preserved aperture scaling to object size but used wider hand apertures with longer delays between times to maximal reaching velocity and maximal grasping aperture. Wearing the glove decreased reaching velocity. Our results in a small group of subjects suggest that providing haptic information in the VE did not affect the validity of reaching and grasping movement. Small disparities in movement parameters between environments may be due to differences in perception of object distance in VE. Reach-to-grasp kinematics to smaller objects may be improved by better 3-D rendering. Comparable kinematics between environments and conditions is encouraging for the incorporation of high quality VEs in rehabilitation programs aimed at improving upper limb recovery.

Comparison of grasping movements made by healthy subjects in a 3-dimensional immersive virtual versus physical environment.

Virtual reality (VR) technology is being used with increasing frequency as a training medium for motor rehabilitation. However, before addressing training effectiveness in virtual environments (VEs), it is necessary to identify if movements made in such environments are kinematically similar to those made in physical environments (PEs) and the effect of provision of haptic feedback on these movement patterns. These questions are important since reach-to-grasp movements may be inaccurate when visual or haptic feedback is altered or absent. Our goal was to compare kinematics of reaching and grasping movements to three objects performed in an immersive three-dimensional (3D) VE with haptic feedback (cyberglove/grasp system) viewed through a head-mounted display to those made in an equivalent physical environment (PE). We also compared movements in PE made with and without wearing the cyberglove/grasp haptic feedback system. Ten healthy subjects (8 women, 62.1±8.8years) reached and grasped objects requiring 3 different grasp types (can, diameter 65.6mm, cylindrical grasp; screwdriver, diameter 31.6mm, power grasp; pen, diameter 7.5mm, precision grasp) in PE and visually similar virtual objects in VE. Temporal and spatial arm and trunk kinematics were analyzed. Movements were slower and grip apertures were wider when wearing the glove in both the PE and the VE compared to movements made in the PE without the glove. When wearing the glove, subjects used similar reaching trajectories in both environments, preserved the coordination between reaching and grasping and scaled grip aperture to object size for the larger object (cylindrical grasp). However, in VE compared to PE, movements were slower and had longer deceleration times, elbow extension was greater when reaching to the smallest object and apertures were wider for the power and precision grip tasks. Overall, the differences in spatial and temporal kinematics of movements between environments were greater than those due only to wearing the cyberglove/grasp system. Differences in movement kinematics due to the viewing environment were likely due to a lack of prior experience with the virtual environment, an uncertainty of object location and the restricted field-of-view when wearing the head-mounted display. The results can be used to inform the design and disposition of objects within 3D VEs for the study of the control of prehension and for upper limb rehabilitation.

Virtual reality environments to enhance upper limb functional recovery in patients with hemiparesis.

Impairments in reaching and grasping have been well-documented in patients with post-stroke hemiparesis. Patients have deficits in spatial and temporal coordination and may use excessive trunk displacement to assist arm transport during performance of upper limb tasks. Studies of therapeutic effectiveness have shown that repetitive task-specific practice may improve motor function outcomes. Movement retraining may be optimized when done in virtual reality (VR) environments. Environments created with VR technology can incorporate elements essential to maximize motor learning, such as repetitive and varied task practice, performance feedback and motivation. Haptic technology can also be incorporated into VR environments to enhance the user's sense of presence and to make motor tasks more ecologically relevant to the participant. As a first step in the validation of the use of VR environments for rehabilitation, it is necessary to demonstrate that movements made in virtual environments are similar to those made in equivalent physical environments. This has been verified in a series of studies comparing pointing and reaching/grasping movements in physical and virtual environments. Because of the attributes of VR, rehabilitation of the upper limb using VR environments may lead to better rehabilitation outcomes than conventional approaches.

Grip aperture scaling to object size in chronic stroke.

Decreased dexterity in chronic stroke survivors results in diminished hand use and impacts quality of life. We studied reach-and-grasp coordination and aperture scaling during reach to grasp using different grasp types and object sizes (33-55 mm). Chronic stroke survivors with hand paresis and controls grasped cylinders with the whole hand or fingertips. Three stroke subjects with more severe hand paresis had disrupted reach/ grasp coordination and used compensatory strategies for arm transport and/or grasping. Nine stroke subjects with less severe paresis scaled aperture to cylinder diameter (p < .001) but had slower movements, used excessive trunk movement, and had prolonged deceleration times. Relative time to maximal grip aperture (TMA) occurred earlier in stroke subjects and in both groups when grasping the small cylinder (p < .002). Despite deficits in reach and grasp, chronic stroke survivors with mild to moderate hand paresis may retain grip aperture scaling to object size for different grasp types.