Training Upper Limbs of Neurodiverse Children by Connecting Brain Activities to a Virtual Reality Based Game

Dysfunction in sensory, perceptual, and motor systems can lead to movement impairment, resulting in limitations in functional activities for children with cerebral palsy (CP). These limitations may be due to deficits in motor planning and execution. Previous investigations suggest that running a camp that uses VR software based on hand-arm bimanual Intensive Training (HABIT) improves motor planning and execution deficits in children with CP. The purpose of this study is to 1) develop a VR-augmented BrainComputer Interface Neurofeedback (BCI-NFT) for upper extremity motor rehabilitation of children with CP that can reliably deliver cortically linked neurofeedback to their forearm muscles and 2) compare the impact of BCI HABIT-VR and HABIT-VR on cortical activity and upper limb function in children with CP. Children who are 6-17 years old will be eligible for this study. Before starting the study, upper extremity motor function will be assessed with a set of clinical tests. Children with motor planning and execution deficits will receive 40 hours of either HABIT-VR or standard BCI-HABIT-VR (4 hours per day, 5 days/week, for two consecutive weeks), during which performance of the tasks and their movements will be tracked through 3-D motion tracking of the VR system. Two assessment sessions, before and after each camp, will be conducted to examine the outcome. The functional outcomes include Assistive Hand Assessment (AHA) to measure upper limb function, Box and Block Tests (BBT) to measure upper limb dexterity, and EEG recordings to measure changes in the cortical activity.

Inclusion criteria

• Children with cerebral palsy

• Aged 6 to 17
• Unilateral and bilateral cerebral palsy (Hemiplegic or Diplegic cerebral palsy)
• Manual Ability Classification System Score (MACS) between I-IV.
• Gross Motor Function Classification System (GMFCS) levels ranging from I to III.
• Ability to follow verbal instructions
• Typically developing children

• Aged 6 to 17
• Good physical health
• Ability to follow verbal instructions

Exclusion criteria

• Children with cerebral palsy

• Other conditions leading to the inability to move the upper extremity or handle objects
• Visual impairments preventing the performance of intervention and testing tasks
• Received an intensive therapeutic intervention involving upper extremities, botulinum toxin in an upper extremity within the past 6 months, or any upper extremity surgery in the past year
• Typically developing children

• Chronic illnesses or medical conditions that could impact their development
• Significant behavioral or emotional issues that could indicate developmental disorders or psychological conditions
• Diagnosed developmental disorders [e.g., autism, Attention-deficit/hyperactivity disorder (ADHD), learning disabilities]