Virtual Reality Offers Healthy Challenge to HABIT Camp Participants

Entering his teenage years, Connor Strobel started to find traditional therapies for his cerebral palsy less and less appealing. The games and challenges presented by those sessions didn’t pack the same luster.

But two years ago, Strobel found Hand Arm Bimanual Intensive Training Virtual Reality camp at the Munroe-Meyer Institute.

The camp uses virtual reality gaming to net similar results to traditional HABIT camp, which is designed to allow children with cerebral palsy and other conditions to work on using both hands to complete a task in the form of play.

Strobel, now 15, doesn’t see the camp as just another therapy session.

“I feel like I’m in a dream,” he said during his first session of camp. “I wake up every morning and it’s time for video games.”

This summer, Strobel tackled another 10-day session at MMI — this time with an added element. Strobel was one of four campers to participate using brain-computer interface (BCI).

By wearing a sensor cap, camp facilitators could see the regions of Strobel’s brain and could track the intention to move his upper limbs. They could then deliver gentle stimulation to Strobel’s weaker arm, encouraging movement.

The stimulation is delivered as a tingling sensation, similar to the pins and needles feeling of your hands or feet falling asleep, said Ahad Behboodi, PhD, assistant professor in the University of Nebraska at Omaha’s Department of Biomechanics.

Sensor caps help camp facilitators track brain activity and intent to move limbs. Facilitators can then administer gentle stimulation to encourage movement in participants’ weaker arm.

To be effective, campers need to repeat the same motion over and over. The virtual reality element is key in helping them from getting bored or fatigued, said Dr. Behboodi, who designed and implemented the BCI aspect of camp.

The goal of using BCI, he said, is to see better connection between the brain and the muscles.

“We want a healthy level of challenge — both physically and mentally — to get them to the next level from where they started at camp,” Dr. Behboodi said.

The MMI team will compare results of campers during the BCI-VR camp and the VR camp alone, said Andrea Cunha, PhD, assistant professor in the MMI Department of Physical Therapy. They measure and compare how both camps can help participants with the use of their arms and hands, such as bimanual coordination, dexterity and participation in daily activities.

“We use clinical measures to see how they use both hands together,” Dr. Cunha said. “Our goal is not only to make sure we’re getting similar or better results, but also to understand how we can best support children.”

Drs. Behboodi and Cunha received a three-year grant from the National Institutes of Health to continue the project.

The work builds on previous MMI work with VR games and includes key contributions from Ryan Thomas, clinical research associate, and Elizabeth Fortin, DPT.

Virtual reality games are designed to get campers to use both arms.

Individuals with cerebral palsy often have a weaker side. Camp is designed to get participants using both hands equally through the virtual reality games, but also in making snacks and playing on the playground.

“They get very good at doing things with one hand,” Dr. Cunha said. “At the beginning of camp, we have to prompt them to use that non-dominant hand in the games. As time passes, you see the use of that hand coming naturally.”

At his first HABIT VR camp in 2023, Strobel received plenty of reminders to use both hands as he played different video games.

Those reminders came fewer and farther between during this session. Strobel used both hands as he manipulated the handsets to shoot rockets at blocky looking aliens.

Strobel has gained more independence in the two years between HABIT VR camp sessions, his mother Heidi Reagan said.

He can tackle everyday tasks, such as using a shower chair or combing his own hair.

And during the last school year, he learned to use a power assist on his manual wheelchair to help him better steer through the halls. Now he’s graduated to using a power chair.

While all of Strobel’s therapies have helped with finding mobility in his weaker arm, HABIT camp helped to teach him how to better use his right hand, Reagan said.

“It gave him the ingenuity and totally boosted his confidence,” she said. “It came at a time when he needed it. It’s taught him how to benefit his daily life.”

Camp can also provide relief for parents and caregivers. In addition to HABIT VR camp, MMI offers summer and winter camps through the recreational therapy, physical therapy and occupational therapy departments.

Reagan said she always hoped to give her son a typical summer camp experience. HABIT VR camp has given Strobel the opportunity to follow his interests and connect with his peers.

MMI’s HABIT Virtual Reality Camp is similar to a traditional HABIT Camp, which is designed to get participants to use both hands to