Multiple sclerosis (MS) is a chronic inflammatory demyelinating illness of the central nervous system of unknown etiology, currently representing the most common neurological illness causing disability among young adults in Europe and North America [1]. Common symptoms include fatigue, visual disorders, problems affecting balance and coordination, sensitivity disorders, spasticity, cognitive and emotional disorders, speech disorders, problems affecting
the bladder and intestines, and sexual-related dysfunction [2].
Dexterity and activities of daily living (ADL) limitations on the upper limb (UL) represent one of the most common problems in patients with MS (4). After 15 years of disease evolution, the majority of those affected by MS report problems at the functional level in the hand, and patients are forced to make compensations or decrease activity in the functions that include the UL [3]. In addition, many studies link the decrease in independence in ADL with the loss of dexterity and manual coordination [3–5].
Despite the importance of UL performance in daily functional activities, it usually remains in the background in the rehabilitation of individuals with MS,
giving more prominence to the rehabilitation of the lower limbs and balance [3]. Furthermore, rehabilitation treatments for patients with MS are described as very lengthy and systematic, leading to loss of motivation and compliance [6].
As a result, in recent years, technology-based rehabilitation systems, such as virtual reality (VR), are promising and may be able to deliver a client-centered taskoriented rehabilitation without requiring a device or controller [7]. Several studies have addressed the positive effects of VR systems as being a complementary therapy to neurological rehabilitation [6, 8]. These novel approaches enhance patient motivation by enabling the practice of functional tasks in virtual surroundings, providing patient feedback concerning results, all of which is based on the repetition of ADLs, facilitating
motor learning and neuroplasticity through increased intensity during task-oriented training [6]. Thus, rehabilitation professionals have expanded the care of patients with MS, by including this technology as a complement to rehabilitation programs, achieving a higher treatment intensity at a sustainable cost [6]. However, few studies exist on the effects that VR has on the manual dexterity of patients with MS [6, 9].
Video games based on VR technology (i.e. Nintendo Wii, PlayStation Move, and Kinect plus XBOX 360) are emerging as valid tools used in neurorehabilitation for patients with MS. However, often these are either too difficult for patients or the games progress too quickly, failing to provide impairment-focused training or to specifically address patient needs [7]. Therefore, it is necessary to develop specific serious games for MS patients. Serious games are defined as games designed for a primary purpose other than that of pure entertainment, and which promote learning and behavior changes in MS patients. In this context, new low-cost markerless devices have emerged, such as the Leap Motion Controller (LMC) System®, which uses a sensor that captures the movement of the patient’s forearms and hands without the need to place sensors or devices on the body.
This generates a virtual image of the UL on a computer screen, and the patient is prompted to perform movements according to the functional task proposed. This system presents important advantages over other motion capture systems, namely thanks to its portability, ease of use, commercial availability, low cost, and non-invasive nature [7]. However, evidence is lacking to support the therapeutic use of LMC in the treatment of UL motor disorders in MS. Furthermore, to our knowledge, no specific serious games have been designed for MS patients using the LMC system.