Limb loading enhances skill transfer between augmented and physical reality tasks during limb loss rehabilitation

BACKGROUND: Virtual and augmented reality (AR) have become popular modalities for training myoelectric prosthesis control with upper-limb amputees. While some systems have shown moderate success, it is unclear how well the complex motor skills learned in an AR simulation transfer to completing the same tasks in physical reality. Limb loading is a possible dimension of motor skill execution that is absent in current AR solutions that may help to increase skill transfer between the virtual and physical domains. METHODS: We implemented an immersive AR environment where individuals could operate a myoelectric virtual prosthesis to accomplish a variety of object relocation manipulations. Intact limb participants were separated into three groups, the load control (CG(LD); [Formula: see text] ), the AR control (CG(AR); [Formula: see text] ), and the experimental group (EG; [Formula: see text] ). Both the CG(AR) and EG completed a 5-session prosthesis training protocol in AR while the CG(LD) performed simple muscle training. The EG attempted manipulations in AR while undergoing limb loading. The CG(AR) attempted the same manipulations without loading. All participants performed the same manipulations in physical reality while operating a real prosthesis pre- and post-training. The main outcome measure was the change in the number of manipulations completed during the physical reality assessments (i.e. completion rate). Secondary outcomes included movement kinematics and visuomotor behavior. RESULTS: The EG experienced a greater increase in completion rate post-training than both the CG(AR) and CG(LD). This performance increase was accompanied by a shorter motor learning phase, the EG’s performance saturating in less sessions of AR training than the CG(AR). CONCLUSION: The results demonstrated that limb loading plays an important role in transferring complex motor skills learned in virtual spaces to their physical reality analogs. While participants who did not receive limb loading were able to receive some functional benefit from AR training, participants who received the loading experienced a greater positive change in motor performance with their performance saturating in fewer training sessions.