# Cognitive-based Rehabilitation Platform of Hand Grasp after Spinal Cord Injury using Virtual Reality and Instrumented Wearables

> **NIH VA I21** · JAMES J PETERS VA  MEDICAL CENTER · 2021 · —

## Abstract

PROJECT SUMMARY
Spinal cord injury (SCI) at the cervical level impairs hand function and the ability to engage the environment. As
a result, the ability to perform activities of daily living can be severely compromised, directly leading to reduced
quality of life. Physical therapy is still the primary pathway to restore functional abilities after SCI. The physical
rehabilitation process requires commitment by the participant to achieve meaningful gains in function.
Rehabilitation approaches that are cognitively engaging can facilitate greater commitment to practice and
improved movement learning. We propose to develop innovative platforms that utilize virtual reality (VR) and
instrumented wearables that enhance cognitive factors during motor learning of hand grasp and reach after SCI.
These factors include greater sense of agency, or perception of control, and multi-sensory feedback. Sense
of agency is implicated with greater movement control, and various sensory feedback modalities (visual, audio,
and haptic) are proven effective in movement training. However, these factors are not well considered in
traditional physical therapy approaches. We have developed two novel cognitive-based platforms for
rehabilitating grasp and reach function. We propose to test each platform in Veterans with chronic SCI at the
cervical level. In Aim 1, we will investigate how our first platform, the “cognition” glove, may improve functional
grasp. This glove includes force and flex sensors that provide inputs to a machine learning algorithm trained to
predict when secure grasp is achieved. The glove alerts the user of secure grasp through onboard sensory
modules providing visual (LED), audio (beeper), and tactile (vibrator) feedback. During training, feedback is
provided at gradually shorter time-intervals to progressively induce agency based on the neuroscience principle
of ‘intentional binding’. This principle suggests that with greater agency, one perceives their action (i.e., secure
grasp) is more coupled in time to a sensory consequence (i.e., glove feedback). Our glove is user-ready, and
now has compatibility with customized VR applications to provide enhanced sensory feedback through engaging
and customized visual and sound alerts. We hypothesize that enhanced feedback in VR will produce even
greater improvements in grasp performance than onboard feedback alone. In Aim 2, we investigate how
Veterans with SCI may learn greater arm muscle control during virtual reaching. We have developed a “sensory”
brace that provides isometric resistance to one arm to elicit electromyography (EMG) patterns that can drive a
virtual arm. The person receives visual feedback from VR and muscle tendon haptic feedback from the brace
during training. Tendon stimulation can elicit movement sensations that modulate muscle activation patterns.
The VR feedback will provide conscious movement training cues while vibration feedback will subconsciously
elicit more distinct EMG patterns bas...

## Key facts

- **NIH application ID:** 10121046
- **Project number:** 1I21RX003582-01
- **Recipient organization:** JAMES J PETERS VA  MEDICAL CENTER
- **Principal Investigator:** NOAM Y. HAREL
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2020-12-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10121046

## Citation

> US National Institutes of Health, RePORTER application 10121046, Cognitive-based Rehabilitation Platform of Hand Grasp after Spinal Cord Injury using Virtual Reality and Instrumented Wearables (1I21RX003582-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10121046. Licensed CC0.

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