The Virtual Occupational Therapy Assistant (VOTA) leverages advances in human motion tracking, multi-user virtual environments, and Voice over Internet Protocol (VoIP) technology to provide cost effective clinical rehabilitation and teletherapy options for the approximately three quarters of a million individuals in the United States affected by stroke each year. The system, consisting of web browser-based software and a desktop USB computer peripheral, will enable patients to practice activities of daily living (ADLs) as part of an in-patient, skilled nursing, outpatient, or home health treatment program. At the core of the proposed application is a high-fidelity computer-generated environment in which a patient's real-world upper extremity (UE) pose is mirrored by their virtual character. In both therapist-supervised and independent practice, a desktop motion tracking system will permit realistic interactions in scenarios spanning personal hygiene, dressing, eating, meal preparation, shopping, laundry, cleaning, telephone use, medication management, fire safety, and dangerous situation awareness. In home health usage, the system will permit the therapist to work with a remotely located patient, promoting continuity of care and saving travel-associated time and cost. Problem to be addressed: By enabling at-home practice of virtual ADLs and remote interaction between therapist and patient, VOTA addresses critical challenges of (1) reducing cost through elimination of the time and expense associated with patient/therapist travel; (2) increasing access to remote and underserved areas; (3) enhancing cortical reorganization through physical practice and mental imagery. Long-Term Goal: Improve stroke rehabilitation outcomes through effective and efficient delivery of care. Phase I Summary: Barron Associates, in partnership with the University of Virginia (UVA) School of Medicine, UVA-HealthSouth Rehabilitation Hospital, and Designing Digitally, Inc., will develop and test a prototype desktop UE motion tracking USB computer peripheral and web-based virtual worlds application software based on ecologically valid environments and activities on an OT Island. Design efforts will focus on system usability and the experience of providers and patients. In the latter half of the effort, UVA-HealthSouth therapists will conduct a pilot study to assess the correlation of VOTA-derived performance scores to clinically accepted measures of ADL functionality as well as system usability/likelihood of use by patients. These efforts will providea solid basis of knowledge for subsequent Phase II design of the VOTA commercial product and human participant trials of the effectiveness of VOTA therapy in both clinical and home health settings. Commercial Opportunity: Participation by HealthSouth, the nation's largest provider of rehabilitative healthcare services, provides a springboard for the introduction of subscription-based access to web-based VOTA software and sale of the desktop UE motion tracking computer peripheral. PUBLIC HEALTH RELEVANCE: The Virtual Occupational Therapy Assistant (VOTA) is a virtual reality-based telerehabilitation system enabling functional practice of activities of daily living through a conventional web browser and a desktop motion tracking USB computer peripheral. Proposed development addresses important public health concerns by (1) enabling remote interaction between patient and therapist during online functional training; (2) reducing cost through elimination of the time and expense associated with patient/therapist travel; (3) increasing access to remote and underserved areas; (4) enhancing cortical reorganization through physical practice and mental imagery; and (5) providing reliable tracking mechanisms for patient activity and functional status.