The Size and Behavior of Virtual Objects have influence on Functional Exercise and Motivation of Persons with Multiple Sclerosis: a randomized study

Abstract

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