Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol

Frank Behrendt, Corina Schuster-Amft, Frank Behrendt, Corina Schuster-Amft

Abstract

Introduction: In the recent past, training systems using an interactive virtual environment have been introduced to neurorehabilitation. Such systems can be applied to encourage purposeful limb movements and will increasingly be used at home by the individual patient. Therefore, an integrated valid and reliable assessment tool on the basis of such a system to monitor the recovery process would be an essential asset.

Objectives: The aim of the study is to evaluate usability, feasibility and validity of the digital version of the Action Research Arm Test using the Bi-Manu-Trainer system as a platform. Additionally, the feasibility and usability of the implementation of action observation and motor imagery tasks into the Bi-Manu-Trainer software will be evaluated.

Patients and methods: This observational study is planned as a single-arm trial for testing the new assessment and the action observation and motor imagery training module. Therefore, 75 patients with Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury or Guillain-Barré syndrome will be included. 30 out of the 75 patients will additionally take part in a 4-week training on the enhanced Bi-Manu-Trainer system. Primary outcomes will be the score on the System Usability Scale and the correlation between the conventional and digital Action Research Arm Test scores. Secondary outcomes will be hand dexterity, upper limb activities of daily living and quality of life.

Hypothesis: We hypothesise that the digital Action Research Arm Test assessment is a valid and essential tool and that it is feasible to incorporate action observation and motor imagery into Bi-Manu-Trainer practice. The results are expected to give recommendations for necessary modifications and might also contribute knowledge concerning the application of action observation and motor imagery tasks using a training system such as the Bi-Manu-Trainer.

Trial registration number: NCT03268304; Pre-results.

Keywords: multiple sclerosis; parkinson’s disease; rehabilitation medicine; stroke.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Virtual reality training system setup (Bi-Manu-Trainer, Reha Stim Medtec AG). The model wears wireless hand gloves with movement sensors attached. The screen displays real-time hand and finger positions.
Figure 2
Figure 2
Study overview: T0, pre-training; T1, measurement after eight training sessions; T2, measurement after eight further training sessions; FU, measurement after 2-month follow-up period. Project 1—Integration of the Action Research Arm Test into the BMT system; Project 2—action observation and motor imagery as integral part of the BMT training. BMT, Bi-Manu-Trainer; FU, follow-up.

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