Enhancing Upper Extremity Rehabilitation in Neurodiverse Children: BCI-Mediated Neurofeedback and Virtual Reality for Improved Engagement and Training Quality - Summary Cerebral palsy (CP) is the leading neurological motor disorder in children, marked by sensory deficits and impaired fine motor control. CP leads to a progressive loss of function, significantly impacting functional independence and quality of life. Rehabilitation interventions have traditionally been centered on motor impairments; however, modern rehabilitation principles advocate for jointly addressing sensory and motor deficits in intensive, repetitive, and task-oriented training. Utilizing these principles, we developed a brain-computer interface (BCI) that aims to strengthen sensorimotor pathways by connecting cortical activity to an external device that can provide sensory stimuli and motor assistance simultaneously and thereby foster motor learning; we call it BCI-Neurofeedback. In this project, we will augment this system with virtual reality (VR) to create a multisensory immersive environment that engages the children in the motor learning process, making it more fun and motivating. VR provides a controlled training environment that can make a normally boring motor training, fun and motivating. In the stimulating environment of VR, the child would enjoy the normally repetitive learning process and repeat a high number of motor tasks enjoyably and independently, which increases the intensity and quality of training while minimizing therapists' involvement. Furthermore, the BCI component will enhance the training by engaging both sensory and motor components in controlling movement. Building on the success of BCI in stroke rehabilitation, our team is developing an engaging BCI system tailored to upper limb motor rehabilitation in children with CP. The BCI system must be intuitive and fun to apply to this population. We previously developed such a BCI system that utilizes naturally occurring changes in cortical activity while executing ankle dorsiflexion. This BCI system is easier to control than conventional methods where the participants often modulate their brain activity while imagining a movement. Our BCI system aims to temporally link cortical activity with applying neuromuscular electrical stimulation (NMES) to ankle muscles. NMES can provide sensory stimuli and motor assistance; it has been demonstrated to effectively induce lasting function improvement in both lower and upper limbs when employed in BCI-neurofeedback. In this project, we will modify our BCI-neurofeedback for training upper extremities and augment it with VR. Unlike previous efforts, our team designed a series of VR games based on a demonstrated effective therapy in training the upper limbs of CP, called Hand and Bimanual Intensive Therapy (HABIT). After conducting a series of VR camps, we demonstrated the efficacy of these games (HABIT-VR) in training the upper limbs of children with CP. Here we aim to augment our BCI system with HABIT-VR and demonstrate its effects on training upper limbs of children with CP through conducting similar VR camps.
