Edorium Journal of

Disability and Rehabilitation

 
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Original Article
 
Goal-oriented feedback on motor behavior in virtual reality based stroke therapy: A case study using the rehabilitation gaming system
Sebastian Marwecki1, Belén Rubio Ballester1, Esther Duarte2, Paul F.M.J. Verschure1,3
1Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Pompeu Fabra, Roc Boronat, Barcelona, Spain
2Servei de Medicina Física I Rehabilitació, Hospitals del Mar I l´Esperança, Institut Hospital del Mar d´Investigacions Mèdiques, Barcelona, Spain
3ICREA, Institucio´ Catalana de Recerca i Estudis Avanc¸ats, Passeig Llui´s Companys, Barcelona, Spain.

Article ID: 100029D05SM2017
doi:10.5348/D05-2017-29-OA-5

Address correspondence to:
Paul Verschure
Plaça de la Mercè
Barcelona

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How to cite this article
Marwecki S, Ballester BR, Duarte E, Verschure PFMJ. Goal-oriented feedback on motor behavior in virtual reality based stroke therapy: A case study using the rehabilitation gaming system. Edorium J Disabil Rehabil 2017;3:36–45.


ABSTRACT

Aims: We address the role of short-term goals in virtual reality (VR) applications for motor relearning, which benefit stroke therapy.
Methods: We let stroke patients as well as healthy participants perform reaching tasks in a VR environment for motor rehabilitation, the so-called rehabilitation gaming system (RGS). During the task, patients were provided with feedback about one´s own performance (mastery goal), healthy participants additionally received feedback of others performances (ego goal). Measurements include protocols for motor learning and different kinetic variables (both stroke patients and healthy participants) as well as subscales of the intrinsic motivation inventory (IMI) (only healthy participants). As healthy participants showed lower fatigue levels, we could apply additional measurements.
Result: Both mastery goals and ego goals potentially enhance intrinsic motivation and adherence, as they show to foster task performance (e.g., response time in mastery goals decreased with p = 0.014 for healthy participants, for stroke patients with p = 0.011 in the first iteration) as well as perceived effort (p = 0.007 for mastery, p = 0.008 for ego goals). As a secondary outcome, by controlling task difficulty, motor learning does not change across conditions (p = 0.316 for stroke patients, p = 0.323 for healthy participants). This raises the question whether or not task difficulty alone fosters the effectivity of VR based therapy applications, i.e., motor learning, to which motivators such as short-term goals provide little trade-off.
Conclusion: Firstly, we suggest the implementation of mastery and ego goals in VR based stroke therapy, as adherence benefits from the motivational context they provide. Secondly, we argue towards simplicity regarding heuristics in therapeutic game design, which apparently often does not differ from conventional game design apart from setting the right level of challenge.

Keywords: Augmented feedback, Goal theory, Meaningful play, Motor relearning, Stroke rehabilitation, Virtual reality

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Acknowledgements
We would like to express their gratitude to all participants who took part in the study, especially the patients and their therapists at the rehabilitation center at the Hospital de l´Esperança in Barcelona.

Author Contributions
Sebastian Marwecki – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Belén Rubio Ballester – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Esther Duarte – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Paul F.M.J. Verschure – Substantial contributions to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest
Copyright
© 2017 Sebastian Marwecki et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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