Enhancing transfer of motor skill learning from virtual to physical environments in children with cerebral palsy – Funded by the NIH Mentored Research Scientist Career Development (K01) Program
Rehabilitation for children with cerebral palsy (CP), the most common cause of pediatric disability and a significant public health burden, often involves motion-controlled games in virtual environments, but this approach suffers from poor transfer of skill improvement to real world situations. The proposed research aims to identify the mechanisms underlying this major treatment drawback by exploring whether virtual environments that promote adaptive variability in movement patterns in children with CP will enhance transfer to a real-life skill. This will provide beneficial insights into the mechanisms underlying skill improvement and transfer in virtual environments for children with atypical development, which will enhance children’s physical well-being and inform future interventions aiming to prevent and reduce the burden of cerebral palsy using virtual reality-based interventions.
From virtual reality to real life skill: enhancing potential of virtual environments for rehabilitation in children with cerebral palsy – Funded by the Charles H. Hood Foundation Child Health Research Awards Program
Children with cerebral palsy (CP), a common physical disability, have problems with movement and balance that limit their participation in daily functional activities. Physical therapists help them learn new movement skills using interventions that motivate children to practice repeatedly. Virtual reality video games are attractive treatment options in this regard because they challenge movement skills in a motivating virtual environment. However, despite promising evidence that children with CP can gain skill from practicing in virtual environments, a major issue is that these skills have shown limited transfer to the real world. This means that children aren’t necessarily any better at functional real-life activities after taking part in this therapy. It is important to determine how we might better promote transfer from virtual environments to real life skills.
To explore these questions, we designed a new task that takes place in either a physical environment, a two-dimensional (2D) flat screen virtual environment or a three-dimensional (3D) head mounted display virtual environment. We will have school-aged children with CP practice the task in either the physical environment, 2D or the 3D virtual environment, and measure how their movement skills change as they practice, and how well what they have learnt transfers to an unpracticed real-life task. We believe that children who practice in the 3D virtual environment will be best able to transfer skills because this environment is most like real-life.
This research is necessary because video games in virtual environments are being used frequently in physical therapy and because new 3D head-mounted displays will soon be low cost and widely-accessible, so we should understand whether they offer advantages over 2D flat-screen displays. Our study is the first to explore mechanisms that may enhance transfer from virtual reality to real life skills in children with CP. The results will help researchers design better virtual environments and assist physical therapists in understanding which virtual environments most improve the movement skills of children with CP. Ultimately, this will enhance the quality of physical therapy treatments that use these tools and promote optimal functional outcomes for children with CP and other developmental disabilities.
Influence of virtual environment complexity on motor learning in children with cerebral palsy: Implications for virtual reality use in rehabilitation (Co-PI, Dr. Nathan Ward, Tufts University) – Funded by the Tufts Clinical and Translational Science Institute Pilot Studies Program
Motion-controlled video games in virtual environments are popular alternative physical therapy interventions for balance skill learning in children with cerebral palsy (CP). Virtual environments (VEs) feature enriched aesthetics that deliver complex stimulation designed to maximize engagement and adherence, features which are lacking in traditional approaches. However, 50% of children with CP have attentional impairments that hinder motor learning. The cognitive demands of interacting with enriched VEs may explain the current inconclusive evidence base for learning balance skills. To explore this issue, we propose a scaled approach emphasizing elements overlooked in previous research: adequate power and paradigm feasibility. Specifically, we will use multi-faceted, innovative recruitment strategies to build a recruitment database. Secondly, we will systematically evaluate the feasibility of our approach and will gather estimates required to power a federally-funded subsequent study. Our paradigm explores whether environmental enrichment enhances or impairs motor learning in children with CP by randomly assigning children to practice the same balance task in either a complex VE with enhanced audiovisual stimuli or a simplified control VE. We will administer standardized measures of attention and balance before acquisition, retention and transfer trials. Additionally, we will measure subjective (self-report) and objective (neurophysiological) measures of cognitive workload and engagement during acquisition. This project will position us to obtain federal funding to rigorously explore how changes in cognitive workload and engagement interact with children’s attention and impact motor learning in VEs. Findings from this bench-to-bedside translational program will enhance the efficacy of this promising alternative to traditional physical therapy interventions..
Development of the Fun Interactive Therapy Board (FITBoard) – Funded by the Deborah Munroe Noonan Memorial Research Fund
Students in the lab have developed the FITBoard (Fun, Interactive Therapy Board): a low-cost, modular media controller for children with disabilities. The FITBoard is a toy consisting of a laptop, an Arduino Mega, a MaKey Makey, and custom modular pieces that can be assembled by a parent or therapist in different ways. Each piece can contain a variety of touch-based interfaces that control sounds, videos, or games. Children can use head, body, arm or leg movements to engage with the FITBoard. Feedback and reward mechanisms can be configured to interest, age and cognitive abilities. In addition, the FITBoard can be used to engage the child during maintenance of weight-bearing prone, sitting or standing positions. The FITBoard is currently being evaluated for feasibility by therapists and clients at Franciscan Hospital for Children and Spaulding Rehabilitation Institute.
Development of a sensor-enabled app to track movement, energy expenditure and motivation during home-based video game play for children with disabilities
Virtual reality active video games (AVGs) are popular physical therapy interventions for children with hemiplegic cerebral palsy (CP) because they can motivate children to engage in repetitive arm movement. However, adherence to home-based AVG exercises is low because therapists have no way of monitoring game play. The purpose of our research is to develop the prototype for a sensor-enabled smartphone app that tracks arm movement, measures energy expenditure and captures children’s self-reported motivation to facilitate child-therapist communication.
Does engagement influence skill acquisition in a virtual environment?
Virtual reality (VR) can be used to promote skill acquisition. Challenging, aesthetically-pleasing virtual environments may enhance engagement and learning. The purpose of this study is to pilot test the impact of task difficulty level and engagement on skill acquisition of a novel postural reaching VR task.
Exploring the role of narrative feedback in a virtual environment for motor learning in typically developing children and children with cerebral palsy – Funded by a Northeastern Tier 1 Interdisciplinary Research Grant
This study explores how providing narrative feedback in a virtual environment might affect children’s motor learning of a virtual balance task.
Exploring the Interaction between Errorful versus Errorless Learning and Autonomy Supportive versus Autonomy Controlling Practice Conditions in a Virtual Environment
In our study, we replicate the sequence learning errorful versus errorless learning conditions described in Lee et al.’s (2015) paper but we use a stepping task, and we add the element of exploring autonomy supportive vs autonomy controlling practice conditions.
REACH (Robots Encouraging Action in Children) Robot
Students are prototyping a low-cost robot that is controlled by hand motions using the Leap sensor. The purpose of the robot is to use as a therapy device for upper extremity rehabilitation. The robot can grasp and release objects; as such, we will build a game using physical objects that can be played with the robot.