Motor Improvement in Neurological Conditions (MINC): Feasibility of using a virtual dolphin to influence arm function and cognition in multiple sclerosis.

The study consists of an immersive game where the patient has to control a dolphin on a 2D-screen with their arm. The system being used is the MindPod, designed by M-square health. The MindPod is able to track the movement of the patient's arm via a camera. Patients will train 24 times for up to 60 minutes time-on-task (2 times per week for 12 weeks). Training sessions will be supervised by researchers or trained students. Training takes place at ECU in Joondalup or MSWA in Wilson. 3D movements of the arm control the movement of a virtual dolphin, swimming through different ocean scenes with various task goals including chasing and eating fish, eluding attacks, and performing jumps. Tasks are designed to promote movement in all planes throughout the active ranges of motion, and titrated based on successful completion of progressive levels of difficulty. The difficulty level of the game 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. 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. During each session we will determine fatigue levels with a visual analogue scale (VAS). If participants feel fatigued, for example classified on a 10-point as a visual analogue scale of 8 or higher , they will be offered an anti-gravity vest (Ekso Bionics, Richmond, CA) to allow participants to exercise for 60 minutes despite fatigue. The supervisor adjusts the level of support such that the target rate of perceived exertion (RPE) ranges between 5 and 8. The level of support can be adjusted by either changing the stiffness of the springs in the exoskeleton or removing the exoskeleton altogether.