Inducing Visuomotor Adaptation Using Virtual Reality Gaming with a Virtual Shift as a Treatment for Unilateral Spatial Neglect

Abstract

Unilateral spatial neglect after stroke is characterized by reduced responses to stimuli on the contralesional side, causing significant impairments in self-care and safety. Conventional visuomotor adaptation (VMA) with prisms that cause a lateral shift of the visual scene can decrease neglect symptoms but is not engaging according to patients. Performing VMA within a virtual reality (VR) environment may be more engaging but has never been tested. To determine if VMA can be elicited in a VR environment, healthy subjects (n=7) underwent VMA that was elicited by either wearing prisms that caused an optical shift, or by application of a virtual shift of the hand cursor within the VR environment. A low cost VR system was developed by coupling the Kinect v2 gaming sensor to online games via the Flexible Action and Articulated Skeleton Toolkit (FAAST) software. The adaptation phase of training consisted of a reaching task in online games or in a custom target pointing program. Following the adaptation phase the optical or virtual shift was removed and participants were assessed during the initial portion of the de-adaptation phase for the presence of an after-effect on their reaching movements, with lateral reaching errors indicating the successful induction of VMA. Results show that practicing reaching in a VR environment with a virtual shift lead to a horizontal after-effect similar to conventional prism adaptation. The results demonstrate that VMA can be elicited in a VR environment and suggest that VR gaming therapy could be used to improve recovery from unilateral spatial neglect.

From real to virtual prism adaptation therapy: a systematic review on benefits and challenges of a new potential rehabilitation approach

“…Indeed, we found only two studies focusing on patients with neglect ( Table 1 ). Carter et al (2016) explored whether visuomotor adaptation (VMA) can be induced in neurologically intact individuals through a VR game that alters the integration between motor actions and visual feedback. Their study introduces a novel approach to VMA using VR in a low-immersion setting, expanding the potential for therapeutic use.…”

Virtual reality-based sensorimotor adaptation shapes subsequent spontaneous and naturalistic stimulus-driven brain activity

“…Importantly, the hemispheric laterality found in the connectivity modulations implies that this tool can be used, at least partially, to re-balance aberrant connectivity in neglect patients via compensatory mechanisms in the left DMN-attentional networks connectivity and the right visual cortex (Crottaz-Herbette et al ., 2017a; Robineau et al ., 2019). Unlike standard PA, our novel VRPA setup was designed to reproduce naturalistic ecological conditions – with the participant’s hand embodied as a virtual hand, and three-dimensional hand and target movements promoting natural behaviour (e.g., Carter et al ., 2016). Hence, the VR setup have enabled us to tap into sensorimotor mechanisms that are more ecological than during standard PA (reaching to dynamic objects), thus potentially resulting in better transfer to real-life behaviour (Fortis et al ., 2010; Champod et al ., 2018).…”

Virtual Reality in the Rehabilitation of Cognitive Impairment after Stroke

“…Our research group has recently developed a prismatic adaptation protocol using virtual reality [71] that is based on the idea of applying a shift between true hand position and the position of a hand-held controller whose image is perceived in the VR environment [72]. Similar applications have been proposed by other authors [73,74].…”