Background: The consequences of multiple sclerosis are problems related to movement of extremities, coordination and vision. Heretofore frequent treatment with additional medications can change the course of the disease. Motor relearning of small range movements are important to support daily living activities. We have designed a virtual environment for pick and place task. The user hand and finger movements were tracked with a small infrared camera. The primary objective of the study was to examine the influence of size and behavior of virtual cubes on motor control, motivation and functional performance. The secondary objective was to examine the changes of heart rate and intensity of the task due to the different size and behavior of the virtual objects. Methods: In the randomized study 84/107 eligible inpatients with multiple sclerosis participated. They were randomized into 4 groups by computer random function; group 1 - small and bouncing, group 2 - small and non-bouncing, group 3 - big and bouncing and group 4 - big and non-bouncing virtual cubes. Each participant took 50 sessions, each up to 2 min in approximately 14 days. Before commencement of the study the participants took visual-spatial and cognitive tests. The participants’ subjective experiences was assessed daily with Intrinsic Motivation Inventory. Box and Blocks Test was carried out before and after the study. Results: In the study the group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s). The group 1 was the slowest (88.9 SD 28.2 s), but with high interest/enjoyment rate and pressure/tension at high heart rate. There were substantial differences in intrinsic motivation between the 1st and the last session within the groups (Cohen's U3 < 0.3 or > 0.8). Kinematic analysis showed differences between the groups (average manipulation time p = 0.008, inserted cubes p = 0.004).Conclusions: The size and behavior of virtual objects may be crucial for the motivation of participants with equal visual-spatial and cognitive capabilities while maintaining effort and keep trying to improve their performance. Furthermore, the clinical outcomes can confirm the effectiveness of the approach.Trial registration: The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12/02/2020, https://clinicaltrials.gov/ct2/show/NCT04266444

BackgroundThe consequences of multiple sclerosis are problems related to movement of extremities, coordination and vision. Heretofore frequent treatment with additional medications can change the course of the disease. Motor relearning of small range movements are important to support daily living activities. We have designed a virtual environment for pick and place task. The user hand and finger movements were tracked with a small infrared camera. The primary objective of the study was to examine the influence of size and behavior of virtual cubes on motor control, motivation and functional performance. The secondary objective was to examine the changes of heart rate and intensity of the task due to the different size and behavior of the virtual objects.MethodsIn the randomized study 84/107 eligible inpatients with multiple sclerosis participated. They were randomized into 4 groups by computer random function; group 1 - small and bouncing, group 2 - small and non-bouncing, group 3 - big and bouncing and group 4 - big and non-bouncing virtual cubes. Each participant took 50 sessions, each up to 2 min in approximately 14 days. Before commencement of the study the participants took visual-spatial and cognitive tests. The participants’ subjective experiences was assessed daily with Intrinsic Motivation Inventory. Box and Blocks Test was carried out before and after the study.ResultsIn the study the group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s). The group 1 was the slowest (88.9 SD 28.2 s), but with high interest/enjoyment rate and pressure/tension at high heart rate. There were substantial differences in intrinsic motivation between the 1st and the last session within the groups (Cohen's U3 < 0.3 or > 0.8). Kinematic analysis showed differences between the groups (average manipulation time p = 0.008, inserted cubes p = 0.004).ConclusionsThe size and behavior of virtual objects may be crucial for the motivation of participants with equal visual-spatial and cognitive capabilities while maintaining effort and keep trying to improve their performance. Furthermore, the clinical outcomes can confirm the effectiveness of the approach.Trial registration: The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12 February 2020, https://clinicaltrials.gov/ct2/show/NCT04266444

The consequences of multiple sclerosis are problems with limb movement, coordination, and vision. Heretofore a combination of therapy and additional medications can alter the course of the disease and reduce upper extremity disability. We developed a virtual environment for pick-and-place tasks as a supportive tool to address the problem of challenging task in occupational therapy. The primary objective of the study was to investigate the influence of size and bounce on proximal and fine motor performance and intrinsic motivation. The secondary objective was to examine how the absence of challenge may decrease intrinsic motivation and heart rate. The randomized trial involved 84/107 eligible inpatients with multiple sclerosis. They were divided into 4 groups by computer randomization: Group 1 small and bouncing, Group 2 small and non-bouncing, Group 3 large and bouncing, and Group 4 large and non-bouncing virtual cubes. Each participant completed 50 sessions of up to 2 min each in approximately 14 days. Before commencement of the study the participants completed visuospatial and cognitive tests. Participants' subjective experiences were assessed daily using the intrinsic motivation inventory. Before and after the study, the box and block test and the 9-hole peg test were administered. Kinematic analysis showed significant differences between groups (average manipulation time p = 0.008, inserted cubes p = 0.004). Group 4 was the most successful (inserted cubes > 9) and the fastest (63.4 SD 25.8 s), but had low pressure/tension and heart rate. Group 1 was the slowest (88.9 SD 28.2 s) but had increased interest/enjoyment in the task under higher pressure/tension. There were substantial differences in intrinsic motivation between the 1st and last sessions within groups (Cohen's U3 < 0.3 or > 0.8). The size and behavior of virtual objects may be important for training proximal movements and fine motor skills in people with multiple sclerosis. Furthermore, the demonstrated approach proved to be effective and may reduce upper extremity disability in the long term if intrinsic motivation can be sustained longer with a challenging task.Trial registration The small scale randomized pilot trial has been registered at ClinicalTrials.gov Identifier: NCT04266444, 12/02/2020, https://clinicaltrials.gov/ct2/show/NCT04266444.