Motor Improvement in Neurological Conditions (MINC): Using a virtual dolphin to improve arm function in chronic stroke.

The study consists of an immersive game where the patient has to control a dolphin on a 2D-screen with her arm. The system being used is the MindPod, designed by M-square health. Patients will train 20 times for 90 minutes time-on-task. The system is able to track the arm via a camera. Patients can be assigned to a group training 5 times a week (for 4 weeks), or another group training 3 times a week (for 6.67 weeks). Patients will wear an exoskeleton (EksoBionics) during training to provide anti-gravity support to their arms. This exoskeleton is like a backpack but then with arm supports. Training sessions will be supervised by researchers or trained students. Training takes place at ECU in Joondalup. Difficulty level of the game and the amount of support by the exoskeleton will be adjusted on individual needs, that is through observation of the patient and based on the patient their feedback and how they progress through the different levels of the game. This results in individualisation of the training, that is the training is tailored to the level of function of each individual. During the game, the patient has to catch fish with the dolphin and stay away from predators. If the level is too difficult, then the patient is not able to catch all fish, resulting in a game-over. When that happens we know that the difficulty level of the game has to get adjusted. There are 27 difficulty levels we can chose from. The exoskeleton is spring operated. We can chose 1 of 5 levels of spring stiffnesses, with higher spring levels providing more support. If the spring level is too low, then the patient will not be able to lift their arms up higher then 90 degrees of shoulder flexion. If that occurs, then we increase the spring level. Also, a higher spring level can be used if the patients indicates that she gets fatigued and is not able to lift up her arm to control the dolphin on the screen. We will assess the compliance by number of sessions completed per patient.