To offer engaging neurorehabilitation training to neurologic patients, motor tasks are often visualized in virtual reality (VR). Recently introduced head-mounted displays (HMDs) allow to realistically mimic the body of the user from a first-person perspective (i.e., avatar) in a highly immersive VR environment. In this immersive environment, users may embody avatars with different body characteristics. Importantly, body characteristics impact how people perform actions. Therefore, alternating body perceptions using immersive VR may be a powerful tool to promote motor activity in neurologic patients. However, the ability of the brain to adapt motor commands based on a perceived modified reality has not yet been fully explored. To fill this gap, we “tricked the brain” using immersive VR and investigated if multisensory feedback modulating the physical properties of an embodied avatar influences motor brain networks and control. Ten healthy participants were immersed in a virtual environment using an HMD, where they saw an avatar from first-person perspective. We slowly transformed the surface of the avatar (i.e., the “skin material”) from human to stone. We enforced this visual change by repetitively touching the real arm of the participant and the arm of the avatar with a (virtual) hammer, while progressively replacing the sound of the hammer against skin with stone hitting sound via loudspeaker. We applied single-pulse transcranial magnetic simulation (TMS) to evaluate changes in motor cortical excitability associated with the illusion. Further, to investigate if the “stone illusion” affected motor control, participants performed a reaching task with the human and stone avatar. Questionnaires assessed the subjectively reported strength of embodiment and illusion. Our results show that participants experienced the “stone arm illusion.” Particularly, they rated their arm as heavier, colder, stiffer, and more insensitive when immersed with the stone than human avatar, without the illusion affecting their experienced feeling of body ownership. Further, the reported illusion strength was associated with enhanced motor cortical excitability and faster movement initiations, indicating that participants may have physically mirrored and compensated for the embodied body characteristics of the stone avatar. Together, immersive VR has the potential to influence motor brain networks by subtly modifying the perception of reality, opening new perspectives for the motor recovery of patients.

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BACKGROUND: Current robot-aided training allows for high-intensity training but might hamper the transfer of learned skills to real daily tasks. Many of these tasks, e.g., carrying a cup of coffee, require manipulating objects with complex dynamics. Thus, the absence of somatosensory information regarding the interaction with virtual objects during robot-aided training might be limiting the potential benefits of robotic training on motor (re)learning. We hypothesize that providing somatosensory information through the haptic rendering of virtual environments might enhance motor learning and skill transfer. Furthermore, the inclusion of haptic rendering might increase the task realism, enhancing participants' agency and motivation. Providing arm weight support during training might also enhance learning by limiting participants' fatigue. METHODS: We conducted a study with 40 healthy participants to evaluate how haptic rendering and arm weight support affect motor learning and skill transfer of a dynamic task. The task consisted of inverting a virtual pendulum whose dynamics were haptically rendered on an exoskeleton robot designed for upper limb neurorehabilitation. Participants trained with or without haptic rendering and with or without weight support. Participants' task performance, movement strategy, effort, motivation, and agency were evaluated during baseline, short- and long-term retention. We also evaluated if the skills acquired during training transferred to a similar task with a shorter pendulum. RESULTS: We found that haptic rendering significantly increases participants' movement variability during training and the ability to synchronize their movements with the pendulum, which is correlated with better performance. Weight support also enhances participants' movement variability during training and reduces participants' physical effort. Importantly, we found that training with haptic rendering enhances motor learning and skill transfer, while training with weight support hampers learning compared to training without weight support. We did not observe any significant differences between training modalities regarding agency and motivation during training and retention tests. CONCLUSION: Haptic rendering is a promising tool to boost robot-aided motor learning and skill transfer to tasks with similar dynamics. However, further work is needed to find how to simultaneously provide robotic assistance and haptic rendering without hampering motor learning, especially in brain-injured patients. Trial registration https://clinicaltrials.gov/show/NCT04759976.

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In immersive virtual reality, the own body is often visually represented by an avatar. This may induce a feeling of body ownership over the virtual limbs. Importantly, body ownership and the motor system share neural correlates. Yet, evidence on the functionality of this neuroanatomical coupling is still inconclusive. Findings from previous studies may be confounded by the congruent vs. incongruent multisensory stimulation used to modulate body ownership. This study aimed to investigate the effect of body ownership and congruency of information on motor performance in immersive virtual reality. We aimed to modulate body ownership by providing congruent vs. incongruent visuo-tactile stimulation (i.e., participants felt a brush stroking their real fingers while seeing a virtual brush stroking the same vs. different virtual fingers). To control for congruency effects, unimodal stimulation conditions (i.e., only visual or tactile) with hypothesized low body ownership were included. Fifty healthy participants performed a decision-making (pressing a button as fast as possible) and a motor task (following a defined path). Body ownership was assessed subjectively with established questionnaires and objectively with galvanic skin response (GSR) when exposed to a virtual threat. Our results suggest that congruency of information may decrease reaction times and completion time of motor tasks in immersive virtual reality. Moreover, subjective body ownership is associated with faster reaction times, whereas its benefit on motor task performance needs further investigation. Therefore, it might be beneficial to provide congruent information in immersive virtual environments, especially during the training of motor tasks, e.g., in neurorehabilitation interventions.@en

Despite recent advances in robot-assisted training, the benefits of haptic guidance on motor (re)learning are still limited. While haptic guidance may increase task performance during training, it may also decrease participants' effort and interfere with the perception of the environment dynamics, hindering somatosensory information crucial for motor learning. Importantly, haptic guidance limits motor variability, a factor considered essential for learning. We propose that Model Predictive Controllers (MPC) might be good alternatives to haptic guidance since they minimize the assisting forces and promote motor variability during training. We conducted a study with 40 healthy participants to investigate the effectiveness of MPCs on learning a dynamic task. The task consisted of swinging a virtual pendulum to hit incoming targets with the pendulum ball. The environment was haptically rendered using a Delta robot. We designed two MPCs: the first MPC—end-effector MPC—applied the optimal assisting forces on the end-effector. A second MPC—ball MPC—applied its forces on the virtual pendulum ball to further reduce the assisting forces. The participants' performance during training and learning at short- and long-term retention tests were compared to a control group who trained without assistance, and a group that trained with conventional haptic guidance. We hypothesized that the end-effector MPC would promote motor variability and minimize the assisting forces during training, and thus, promote learning. Moreover, we hypothesized that the ball MPC would enhance the performance and motivation during training but limit the motor variability and sense of agency (i.e., the feeling of having control over their movements), and therefore, limit learning. We found that the MPCs reduce the assisting forces compared to haptic guidance. Training with the end-effector MPC increases the movement variability and does not hinder the pendulum swing variability during training, ultimately enhancing the learning of the task dynamics compared to the other groups. Finally, we observed that increases in the sense of agency seemed to be associated with learning when training with the end-effector MPC. In conclusion, training with MPCs enhances motor learning of tasks with complex dynamics and are promising strategies to improve robotic training outcomes in neurological patients.

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