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Such systems can be applied to encourage purposeful limb movements and will increasingly be used at home by the individual patient. Therefore, an integrated valid and reliable assessment tool on the basis of such a system to monitor the recovery process would be an essential asset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of the study is to evaluate usability, feasibility and validity of the digital version of the Action Research Arm Test using the Bi-Manu-Trainer system as a platform. Additionally, the feasibility and usability of the implementation of action observation and motor imagery tasks into the Bi-Manu-Trainer software will be evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This observational study is planned as a single-arm trial for testing the new assessment and the action observation and motor imagery training module. Therefore, 75 patients with Parkinson\u2019s disease, multiple sclerosis, stroke, traumatic brain injury or Guillain-Barr\u00e9 syndrome will be included. 30 out of the 75 patients will additionally take part in a 4-week training on the enhanced Bi-Manu-Trainer system. Primary outcomes will be the score on the System Usability Scale and the correlation between the conventional and digital Action Research Arm Test scores. Secondary outcomes will be hand dexterity, upper limb activities of daily living and quality of life.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>We hypothesise that the digital Action Research Arm Test assessment is a valid and essential tool and that it is feasible to incorporate action observation and motor imagery into Bi-Manu-Trainer practice. The results are expected to give recommendations for necessary modifications and might also contribute knowledge concerning the application of action observation and motor imagery tasks using a training system such as the Bi-Manu-Trainer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT03268304\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\">NCT03268304<\/jats:ext-link>\n                      ; Pre-results.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-019646","type":"journal-article","created":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T08:57:02Z","timestamp":1531731422000},"page":"e019646","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol"],"prefix":"10.1136","volume":"8","clinical-trial-number":[{"clinical-trial-number":"nct03268304","registry":"10.18810\/clinical-trials-gov","type":"preResults"},{"clinical-trial-number":"nct03268304","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Frank","family":"Behrendt","sequence":"first","affiliation":[{"name":"Research Department, Reha Rheinfelden, Rheinfelden, Switzerland"},{"name":"University Children\u2019s Hospital Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corina","family":"Schuster-Amft","sequence":"additional","affiliation":[{"name":"Research Department, Reha Rheinfelden, Rheinfelden, Switzerland"},{"name":"Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland"},{"name":"Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,16]]},"reference":[{"key":"2025120523322107000_8.7.e019646.1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-15-1"},{"key":"2025120523322107000_8.7.e019646.2","doi-asserted-by":"publisher","DOI":"10.3109\/17483107.2011.574310"},{"key":"2025120523322107000_8.7.e019646.3","doi-asserted-by":"publisher","DOI":"10.1177\/193229681100500215"},{"key":"2025120523322107000_8.7.e019646.4","first-page":"CD008349","article-title":"Virtual reality for stroke rehabilitation","volume":"11","author":"Laver","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"2025120523322107000_8.7.e019646.5","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1093\/gerona\/glq201","article-title":"Virtual reality for gait training: can it induce motor learning to enhance complex walking and reduce fall risk in patients with Parkinson\u2019s disease?","volume":"66","author":"Mirelman","year":"2011","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2025120523322107000_8.7.e019646.6","doi-asserted-by":"publisher","DOI":"10.1002\/mds.25670"},{"key":"2025120523322107000_8.7.e019646.7","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5334\/tohm.192","article-title":"Virtual reality feedback cues for improvement of gait in patients with Parkinson\u2019s disease","volume":"4","author":"Badarny","year":"2014","journal-title":"Tremor Other Hyperkinet Mov"},{"key":"2025120523322107000_8.7.e019646.8","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1589\/jpts.27.2057","article-title":"Effect of virtual reality games on stroke patients' balance, gait, depression, and interpersonal relationships","volume":"27","author":"Song","year":"2015","journal-title":"J Phys Ther Sci"},{"key":"2025120523322107000_8.7.e019646.9","doi-asserted-by":"publisher","DOI":"10.1179\/1743132815Y.0000000013"},{"key":"2025120523322107000_8.7.e019646.10","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1089\/g4h.2014.0013","article-title":"Using virtual reality and videogames for traumatic brain injury rehabilitation: a structured literature review","volume":"3","author":"Pietrzak","year":"2014","journal-title":"Games Health J"},{"key":"2025120523322107000_8.7.e019646.11","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-007-0239-1"},{"key":"2025120523322107000_8.7.e019646.12","doi-asserted-by":"crossref","unstructured":"Schuster-Amft C , Eng K , Suica Z , et al . 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