Analysis of Different Device Interactions in a Virtual Reality Task in Individuals With Duchenne Muscular Dystrophy-A Randomized Controlled Trial

Bruna Leal de Freitas, Talita Dias da Silva, Tânia Brusque Crocetta, Thais Massetti, Luciano Vieira de Araújo, Shelly Coe, Helen Dawes, Fatima Aparecida Caromano, Carlos Bandeira de Mello Monteiro, Bruna Leal de Freitas, Talita Dias da Silva, Tânia Brusque Crocetta, Thais Massetti, Luciano Vieira de Araújo, Shelly Coe, Helen Dawes, Fatima Aparecida Caromano, Carlos Bandeira de Mello Monteiro

Abstract

There is a need to support individuals with Duchenne Muscular Dystrophy (DMD) to achieve optimal functionality in everyday life and with meaningful tasks and activities, throughout stages of the disease progression. Thus, technological developments have created an exciting opportunity for the use of affordable virtual reality (VR) systems with different kinds of interaction devices, providing an efficient and fun tool for enabling improvement in motor performance. Objective: To compare performance on a virtual task using interfaces with and without physical contact in order to identify functionality by using different devices in individuals with DMD. Methods: One hundred and twenty male individuals took part on this study: 60 with DMD with a mean age of 16 ± 5 (range 9-34 years old) and 60 without DMD in the control group (CG) matched by age. Participants were divided into three groups of 20 individuals each which performed a virtual task in three different interfaces: Kinect®, computer Touch Screen and Leap Motion®, in a cross over design in which all participants used all devices. Motor impairment in the DMD group was measured by using the Motor Function Measurement and Vignos scales. Results: All participants improved performance through practice, regardless of the interface used, although the DMD group had a continuous lower performance compared to the CG. In addition, the DMD group obtained a significant better performance with Leap Motion interface compared to the other interfaces, while the CG presented better performance on Touch Screen interface. Conclusion: Leap Motion provided better performance for individuals with DMD due to enablement of distal muscle function and ease of instrument adjustment using the virtual interface. Therefore, this type of interface should be encouraged for promoting functionality on general tasks using computer systems. Clinical Trial register number: NCT02891434.

Keywords: Duchenne Muscular Dystrophy; computer storage devices; functionality; learning; motor skills; virtual reality; virtual reality exposure therapy.

Figures

Figure 1
Figure 1
Graphic representation of an individual with DMD using the Touch Screen interface. (A) initial screen of the task, with 126 bubbles; (B) participant defines the area of the range zone by touching the screen for 10 s; (C) participant touches the first target bubble (defined by the researcher in the center of the bottom line of the range zone); (D) participant touches a bubble that appears at random (within the range zone); (E) participant returns to touch the target bubble; (F) some touches of the bubble are outside of the range zone, challenging the limits of the participant; (G) individual with Duchenne Muscular Dystrophy (DMD) during the task using the touch screen interface.
Figure 2
Figure 2
Graphic representation of an individual with DMD using the Kinect interface. (A) initial screen of the task, with 126 bubbles; (B) participant defines the area of the range zone for 10 s; (C) participant touches the first target bubble (defined by the researcher in the center of the bottom line of the range zone); (D) participant touches a bubble that appears at random (within the range zone); (E) participant returns to touch the target bubble; (F) some touches of the bubble are outside of the range zone, challenging the limits of the participant; (G) individual with Duchenne Muscular Dystrophy (DMD) during the task, using the Kinect interface. Some participants needed to support the upper limb on the arm of the wheelchair.
Figure 3
Figure 3
Graphic representation of an individual with DMD using the Leap Motion interface. (A) initial screen of the task, with 126 bubbles; (B) participant defines the area of the range zone for 10 s; (C) participant touches the first target bubble (defined by the researcher in the center of the bottom line of the range zone); (D) participant touches a bubble that appears at random (within the range zone); (E) participant returns to the bubble target; (F) some touches of a bubble are outside of the range zone, challenging the limits of the participant; (G) individual with Duchenne Muscular Dystrophy (DMD) during the task, using the Leap Motion interface (when necessary a wedge was used to adapt the lifting of the handle).
Figure 4
Figure 4
Outline of the experimental and control groups during the phases of acquisition, retention and transfer, and their interfaces. Abbreviations: n, number of participants; DMD, Duchenne muscular Dystrophy; CG, control group.
Figure 5
Figure 5
Number of bubbles touched by Duchenne Muscular Dystrophy (DMD) and the control group (CG) during the stages of motor learning.

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