Multimodal Augmented Feedback for Functional Grasp Training Using a Smart Glove and Virtual Reality for Persons with Spinal Cord Injury

Spinal cord injury (SCI) can impair hand function needed for activities of daily living. Physical therapy is crucial to rehabilitating function but is time-and effort-intensive. Therefore, training approaches that facilitate greater engagement for faster motor learning are needed. In prior work, we showed how training with augmented feedback from an instrumented glove with computational intelligence to detect secure grasp could improve functional performance immediately. During training, feedback about secure grasp was provided with concurrent visual and audio (i.e., multimodal) cues. Furthermore, the cues were provided at progressively reduced time delays to induce a sense of agency (perception of control) as a cognitive basis to accelerate motor learning. In this study, we newly incorporated virtual reality (VR) with this glove system and training paradigm to enhance the augmented feedback and to assess its effects on persons with cervical-level incomplete SCI. Adding VR to the training regime significantly improved the performance of a grasp-and-place task by persons with SCI (n=6). Moreover, neural activity, as measured from scalp-surface electroencephalography (EEG), was significantly more pronounced after training with VR feedback. Performance improvement and increased neural activity suggest the potency for neuroplasticity and motor learning when adding VR enhancements to our training approach for clinical populations having severe neurological trauma such as SCI.