Effectiveness of virtual reality as therapeutic complement in the rehabilitation of upper limbs in people with spinal cord injury

In the space of just a few years, the literature has advanced from articles which primarily described the potential benefits of using virtual reality technology, to articles that describe the development of actual working systems, testing of prototypes, and early clinical results with patients who have used some of these systems. A few findings appear to be solidly emerging from the virtual reality work to date, as they have appeared repeatedly in multiple studies by different research groups. These findings are that: (1) patients with disabilities appear capable of motor learning within virtual environments; (2) movements learned in VR by patients with disabilities transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; and (3) in the few studies that have compared motor learning in real versus virtual environments, some advantage for virtual reality training has been found in the most cases. However, the published clinical studies, for the most part, still consist of small studies without control groups, or with small samples of patient. Furthermore, at present these devices are not considered a treatment in themselves, but only new technologies tools that can be exploited to enhance motor retraining. Much work remains to be done to identify which types of patients will benefit most from these treatments, which system features are critical, and what types of training routines will work best. This understanding will be the key to designing appropriate virtual reality system features and successful treatment interventions combination. The main objective of this thesis was to assess the efficacy of the application of virtual reality-based therapy, as rehabilitation complement to upper limbs function in people with tetraplegia. Furthermore, we wanted to verify the capacity of virtual reality systems to detect upper limbs kinematic and functional changes