A meta-analysis and systematic literature review of virtual reality rehabilitation programs

Virtual Reality-Based Immersive Rehabilitation for Cognitive- and Behavioral-Impairment-Related Eating Disorders: A VREHAB Framework Scoping Review

Virtual reality (VR) technology is one of the promising directions for rehabilitation, especially cognitive rehabilitation. Previous studies demonstrated successful rehabilitation in motor, cognitive, and sensorial functions using VR. The objective of this review is to summarize the current designs and evidence on immersive rehabilitation interventions using VR on cognitive- or behavioral-related eating disorders, which was mapped using a VREHAB framework. Two authors independently searched electronic databases, including PubMed, Web of Science, Scopus, CINAHL, EMBASE, and Cochrane Library. Ten (n = 10) articles were eligible for review. Treatments for anorexia nervosa and binge eating disorder/bulimia nervosa were reported through enhanced/experimental cognitive behavior therapy (ECT), cue exposure therapy (CET), and body exposure therapy (BET) via the virtual environment. Some studies reported that the VR effects were superior or comparable to traditional treatments, while the effects may last longer using VR technology. In addition, VR was perceived as acceptable and feasible among patients and therapists and could be valuable for supplementing existing therapies, relieving manpower and caregiver burdens. Future studies may consider incorporating haptic, smell, and biofeedback to improve the experience, and thus the effects of the treatments for the users.

Effect of home-based virtual reality training and telerehabilitation on balance in individuals with Parkinson disease, multiple sclerosis, and stroke: a systematic review and meta-analysis

OBJECTIVE

In the last decade, there is a growing interest in the use of virtual reality for rehabilitation in clinical and home settings. The aim of this systematic review is to do a summary of the current evidence on the effect of home-based virtual reality training and telerehabilitation on postural balance in individuals with central neurological disorders.

METHODS

Literature was searched in PubMed, Web of Science, PEDro, ScienceDirect, and MEDLINE. Randomized controlled trials (RCTs) evaluating the effect of home-based virtual reality (VR) training and telerehabilitation (TR) on postural balance in patients with Parkinson's disease, Multiple sclerosis or stroke. Studies were imported to EndNote and Excel to perform two screening phases by four reviewers. Risk of bias was assessed using PEDro scale and Cochrane assessment tool for risk of bias. Synthesis of the data on comparative outcomes was performed using RevMan software.

RESULTS

Seven RCTs were included, with all three pathologies represented. VR and TR consisted of a training device (e.g., Nintendo Wii or Xbox 360) and a monitoring device (e.g., Skype or Microsoft Kinect). Five studies used the Berg Balance Scale (BBS) for measuring postural balance. Across studies, there was an improvement in BBS scores over time in both experimental and control groups, and the effect remained at follow-up for both groups. However, there was no significant difference between  groups post-intervention (MD = 0.74, p = 0.45).

CONCLUSION

Home-based VR and TR can be used as prolongation to conventional therapy.

The Development and Realization of Digital Panorama Media Technology Based on VR Technology

The purpose of this paper is to understand the digital 3D multimedia panoramic visual communication technology based on virtual reality. Firstly, the key concepts and characteristics of virtual reality are introduced, including the development and application of digital three-dimensional panorama technology. Then, according to the theoretical research, some basic knowledge of 3D panoramic image Mosaic is introduced, including camera image modeling, image sharing, and image exchange. Finally, with the development of the virtual tour at the College of Normal University, the hardware of panoramic technology and the demand of panoramic image search have been expanded in the application. The design of panoramic Mosaic, panoramic image generation, and virtual tour school construction considers real-world issues. The innovation of this paper lies in that will be used by SketchUp8.0 software builds the geometry of 3d virtual scene and by the cylindrical panoramic images based on image of building 3 d virtual scene organic unifies in together and makes a panoramic image can be as the change of seasons in the real scene and real-time change, enhance the sense of the reality of the system and user immersive.

A systematic review on the usability of robotic and virtual reality devices in neuromotor rehabilitation: patients' and healthcare professionals' perspective

BACKGROUND

The application of virtual reality (VR) and robotic devices in neuromotor rehabilitation has provided promising evidence in terms of efficacy, so far. Usability evaluations of these technologies have been conducted extensively, but no overviews on this topic have been reported yet.

METHODS

A systematic review of the studies on patients' and healthcare professionals' perspective through searching of PubMed, Medline, Scopus, Web of Science, CINAHL, and PsychINFO (2000 to 2021) was conducted. Descriptive data regarding the study design, participants, technological devices, interventions, and quantitative and qualitative usability evaluations were extracted and meta-synthetized.

RESULTS

Sixty-eight studies were included. VR devices were perceived as having good usability and as a tool promoting patients' engagement and motivation during the treatment, as well as providing strong potential for customized rehabilitation sessions. By contrast, they suffered from the effect of learnability and were judged as potentially requiring more mental effort. Robotics implementation received positive feedback along with high satisfaction and perceived safety throughout the treatment. Robot-assisted rehabilitation was considered useful as it supported increased treatment intensity and contributed to improved patients' physical independence and psychosocial well-being. Technical and design-related issues may limit the applicability making the treatment difficult and physically straining. Moreover, cognitive and communication deficits were remarked as potential barriers.

CONCLUSIONS

Overall, VR and robotic devices have been perceived usable so far, reflecting good acceptance in neuromotor rehabilitation programs. The limitations raised by the participants should be considered to further improve devices applicability and maximise technological rehabilitation effectiveness.

TRIAL REGISTRATION

PROSPERO registration ref. CRD42021224141 .

A pilot randomised control trial of the efficacy of stability-based training with visualisation for people with chronic ankle instability

Chronic ankle instability (CAI) is associated with recurring symptoms that inhibit daily activity. Stability-based rehabilitative training is recommended for CAI. Visualisation (VIS) produces real-time feedback using motion capture and virtual reality. This pilot study aimed to determine the feasibility, adherence, safety, and efficacy of incorporating VIS into stability training for people with CAI. Efficacy was examined through effect of VIS training on dynamic stability, perception of stability, and rehabilitative experience. Individuals with CAI completed a 4-week stability-based training programme with VIS, or without visualisation (NO-VIS). Participants completed the Star Excursion Balance Test (SEBT) and Cumberland Ankle Instability Tool (CAIT) prior to, and after training. Enjoyment of training was recorded using the Physical Activity Enjoyment Scale (PACES-8). Of 17 participants (VIS = 10, NO-VIS = 7), there were 2 drop outs (VIS = 1, NO-VIS = 1). No adverse events were reported, and participant drop-out was due to injury unrelated to the study. The VIS group showed a significantly greater increase in average SEBT reach distance (d = 1.7, p = 0.02). No significant differences were reported for the CAIT or PACES-8. This study supports the feasibility and safety of stability-based training with VIS in those with CAI. The enhanced performance outcome on the SEBT suggests VIS may enhance stability-based training.

The effects of virtual soccer game on balance, gait function, and kick speed in chronic incomplete spinal cord injury: a randomized controlled trial

STUDY DESIGN

Participant-blinded comparative pre-post randomized controlled trial.

OBJECTIVE

To evaluate the effects of virtual soccer game on balance, gait function, and kick speed in individuals with spinal cord injuries.

SETTING

Forty participants with incomplete spinal cord injury (SCI) were included.

METHODS

The participants were randomized into either an experimental group (EG) or a control group for treatment 3 days/week over 4 weeks. The clinical outcomes included the results of the chair stand test (CST), timed up-and-go (TUG) test, and 10 m walking test (10MWT). The virtual reality (VR) content outcome measure was kick speed.

RESULTS

The independent t-test results indicated that the participants in the EG exhibited superior performances in the CST, TUG test, 10MWT, and kick speed test (all P < 0.05).

CONCLUSIONS

Our results provide novel, promising clinical evidence that VR rehabilitation improves both dynamic and static balance and reduces the risk of falls in patients with incomplete SCI of Asia impairment scale grades C-D.

Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson's Disease with Cognitive Impairment: A Proof-of-Concept Study

BACKGROUND

Emerging evidence has indicated the positive effects of repetitive transcranial magnetic stimulation (rTMS) on patients with Parkinson's disease (PD) for the treatment of mild cognitive impairment (MCI).

OBJECTIVE

Investigating whether combining virtual reality (VR) training with rTMS can further enhance cognitive improvement induced by rTMS treatment.

METHODS

We randomly assigned 40 patients with PD and MCI into three groups, namely the rTMS-VR group (n = 13), rTMS group (n = 11), and sham rTMS group (n = 16). rTMS was administered as 10 consecutive sessions of intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex. In the rTMS-VR group, VR training was administered immediately after each rTMS session. Cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Montreal Cognitive Assessment (MoCA) at baseline, immediately after intervention, and at 3-month follow-up.

RESULTS

Compared with the rTMS group, the rTMS-VR group exhibited significantly more improvements in total and delayed memory scores of the RBANS and the visuospatial/executive function score of the MoCA after intervention (p = 0.000∼0.046) and the delayed memory score of the RBANS at 3-month follow-up (p = 0.028).

CONCLUSION

The integrated rTMS-VR protocol achieved a superior outcome in global cognitive function, more effectively enhancing working memory and visuospatial executive function than did the rTMS protocol alone. The combination of VR and rTMS can be an effective regimen for improving the cognitive function of patients with PD.

Effects of immersive virtual nature on nature connectedness: A systematic review protocol

Objective

Nature Connectedness, an individual’s cognitive, affective, and behavioral connection with the natural world, has been linked to various health and well-being outcomes. As Nature Connectedness can be elicited and strengthened through direct contact with nature, in the past decade studies have investigated whether similar effects can be achieved through technologies that simulate highly immersive and realistic experiences of nature, such as Immersive Virtual Nature. This protocol describes the methodology for a systematic review that will summarize the existing evidence on the effects of Immersive Virtual Nature on Nature Connectedness in non-clinical populations.

Methods

The review will be conducted following the guidelines of Preferred Reporting Items for Systematic Reviews and MetaAnalyses. Terms such as “immersive virtual environment,” “natural setting*,” and “contact with nature” were searched in Scopus, WebOfScience, GoogleScholar, Medline, and GreenFILE (22–28 November 2021). Papers in English, describing experimental studies, with or without control/comparison, and testing the effects of Immersive Virtual Nature interventions on Nature Connectedness outcomes in non-clinical populations were included. The risk of bias will be assessed using Cochrane’s Risk of Bias 2 for randomized studies, and the Risk Of Bias In Non-randomized Studies - of Interventions. The data synthesis will be performed through meta-analysis, assuming that the Cochrane Consumers and Communication Group guidelines are met.

Conclusion

The findings will be relevant for understanding the potential and challenges of Immersive Virtual Nature as a tool to promote health and well-being in the general population, providing information on the consistency and limitations of the existing literature and recommendations for future research.

Experiences of Stroke Survivors and Clinicians With a Fully Immersive Virtual Reality Treadmill Exergame for Stroke Rehabilitation: A Qualitative Pilot Study

Use of VR-games is considered a promising treatment approach in stroke rehabilitation. However, there is little knowledge on the use and expectations of patients and health professionals regarding the use of treadmill walking in a fully immersive virtual environment as a rehabilitation tool for gait training for stroke survivors. The objectives of the current study were to determine whether stroke survivors can use fully immersive VR utilizing modern HMDs while walking on a treadmill without adverse effects, and to investigate the experiences of stroke survivors and clinicians after testing with focus on acceptability and potential utilization in rehabilitation. A qualitative research design with semi-structured interviews was used to collect data. Five stroke survivors and five clinicians participated in the study and tested a custom-made VR-game on the treadmill before participating in individual semi-structured interview. Data were analyzed through thematic analysis. The analysis of the interview data identified two main categories: (1) experiencing acceptability through safety and motivation, and (2) implementing fully immersive VR in rehabilitation. Both stroke survivors' and clinicians enjoyed the treadmill-based VR-game and felt safe when using it. The stroke survivors experienced motivation for exercising and achievement by fulfilling tasks during the gaming session as the VR-game was engaging. The clinicians found additional motivation by competing in the game. Both groups saw a potential for use in gait rehabilitation after stroke, on the premise of individual adaptation to each patient's needs, and the technology being easy to use. The findings from this qualitative study suggest that a fully immersive treadmill-based VR-game is acceptable and potentially useful as part of gait rehabilitation after stroke, as it was positively received by both stroke survivors and clinicians working within stroke rehabilitation. The participants reported that they experienced motivation in the game through safety, engagement and achievement. They also saw the potential of implementing such a setup in their own rehabilitation setting. Elements that enable safety and engaging experience are important to maintain when using a fully immersive VR-game in stroke rehabilitation.

Pushing open the door to reality: On facilitating the transitions from virtual to real environments

The recent rise of virtual reality technology has led researchers to investigate how to adapt transitions to virtual environments. Transitions play a key role in facilitating the return to reality, which is of particular importance when the virtual world is far more agreeable than the real world. In the present study, the efficacy of a door transition - an almost "transparent" door falling out the top of the virtual environment and controlled by the user - was evaluated and compared to two basic transitions: a direct transition and a fading transition. Participants reported a strong preference for the door transition that was evaluated as being smoother, more controllable, and greatly facilitated the return to reality. Moreover, the results showed that the door transition triggered no greater sickness in participants than the two other types of transition.

Virtual functional mobility test: A potential novel tool for assessing mobility of individuals with Parkinson's disease in a multitask condition

There are few instruments available for evaluating functional mobility during multitasking in people with Parkinson's Disease (PD). Virtual Reality is a potentially tool capable of aiding in the evaluation of functional mobility. The purpose of this study is to verify the potential of the Virtual Functional Mobility Test (VFMT) as a clinical tool to assess functional mobility of people with PD during multitasking condition. 25 people with PD and 25 people without PD, matched for age and sex, were recruited. Participants were evaluated through the Trail Making Test, Timed "UP and GO" test, Timed "UP and GO" test in dual task condition and through the VFMT, composed of 1) a simple task, and 2) a complex task. The VFMT and clinical tests were sensitive to differentiate the groups, except the trail making test part B (p = 0.332) and complex task (p = 0.052). Strong correlations were observed between parts A and B of the trail making test (r = 0.75) and complex task (r = 0.72); Moderate correlations between Timed Up and Go test and Timed Up and Go test in dual task condition with simple task (r = 0.47) and complex task (r = 0.55), respectively, were found. The complex task and simple task showed excellent and moderate reliability intra-rater, respectively. It was concluded that the novel VFMT is feasible, sensible, reliable and has potential as an instrument for the evaluation of functional mobility during multitasking in people with PD.

Evaluation of Incision Margin and Radiotherapy Adjustment in Breast Cancer-Conserving Surgery Based on VR Pathology 3D Reconstruction

At present, the incidence of breast cancer is high worldwide and the most effective way to treat breast cancer is surgery. This study mainly explores the application of pathological three-dimensional reconstruction based on VR technology in the evaluation of the margins of breast-conserving surgery and the adjustment of radiotherapy for breast cancer. In the process of making pathological large slices, the slice markers are counted and the upper and outer cutting edges are located and placed in a large embedding box to prevent tissue deformation. ACDSEE6.0 is used to convert the aligned image BMP format into JPG format, the JPG images of each breast are cropped in batches under the same range and size, and then 3DDOCTOR1.0 is imported to edit the images. The boundary edit tool is activated to segment the target area layer by layer to create a boundary data set of the target structure. The stored file is opened and 3D rendering simple surface and volume rendering on the computer is run to display the surface data 3D display and the volume data 3D display. During VR image processing, the data are imported into the VR image workstation and the Radio Dexter software system is used for image adjustment, trimming, and sequence extraction. Then, the preliminary processed CT and MRI data are displayed in pairs. Through multiplane comparison, manual or automatic fusion tools are used to reduce the gap between image sequences. The surgical process is simulated under VR: by changing the window size and viewing angle; using virtual electric drills, cutting tools, and other virtual instruments; ad selecting the operating microscope perspective; and simulating steps such as breast opening, visual field exposure, and tumor resection. The breast tomographic image was reconstructed in multiple planes, and two-dimensional images of any plane could be observed. 10 cases showed high-density shadows and 5 cases showed isodensity shadows. This research contributes to the precise treatment of breast-conserving surgery.

Methodological and institutional considerations for the use of 360-degree video and pet animals in human subject research: An experimental case study from the United States

Head-mounted virtual-reality headsets and virtual-reality content have experienced large technological advances and rapid proliferation over the last years. These immersive technologies bear great potential for the facilitation of the study of human decision-making and behavior in safe, perceptually realistic virtual environments. Best practices and guidelines for the effective and efficient use of 360-degree video in experimental research is also evolving. In this paper, we summarize our research group's experiences with a sizable experimental case study on virtual-reality technology, 360-degree video, pet animals, and human participants. Specifically, we discuss the institutional, methodological, and technological challenges encountered during the implementation of our 18-month-long research project on human emotional response to short-duration 360-degree videos of human-pet interactions. Our objective in this paper is to contribute to the growing body of research on 360-degree video and to lower barriers related to the conceptualization and practice of research at the intersection of virtual-reality experiences, 360-degree video, live animals, and human behavior. Practical suggestions for human-subject researchers interested in utilizing virtual-reality technology, 360-degree videos, and pet animals as a part of their research are discussed.

Effect of Virtual Reality Exercises on the Cognitive Status and Dual Motor Task Performance of the Aging Population

Aging is a global phenomenon affecting numerous developed and developing countries. During this process, the functional state of the body, especially the cognitive state, declines. This research investigated the impact of virtual reality exercises on the cognitive status and dual-task performance in the elderly of Tabriz city, Iran. Forty men with a mean age of 71.5 were selected and assigned to either the experimental (n = 20) or control groups (n = 20). Both groups completed the Mini-Mental State Examination for cognitive status. The pre-test was performed through the Timed Up and Go test (TUG) along with a countdown of numbers. Then, the experimental group practiced virtual driving for six weeks, while the control group received no treatment. After the treatment, both groups completed the post-test. At each stage, the test was performed as a dual motor task as well. Data were analyzed using the paired t-test and the independent sample t-test to show the intra-group and inter-group differences, respectively. The results showed a significant improvement in the cognitive status and dual-task performance of the elderly men after the six-week training period, which was also significant compared to the control group. Virtual reality driving can be used to improve the cognitive status and dual task performance of elderly men.

Can Immersive Virtual Reality Videogames Help Parkinson's Disease Patients? A Case Study

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson’s disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53–71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75–80%). Post-gaming GEQ scores were 3.3–4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects.

Effectiveness of Virtual Reality Interventions for Adolescent Patients in Hospital Settings: Systematic Review

Background

Given the high level of interest and increasing familiarity with virtual reality among adolescents, there is great potential to use virtual reality to address adolescents’ unique health care delivery needs while in hospital. While there have been reviews on the use of virtual reality for specific health conditions and procedures, none to date have reviewed the full scope of virtual reality hospital interventions for adolescents who are often combined with children as a homogenous group, despite the fact that adolescents experience virtual environments different from children.

Objective

The aim of this review was to systematically identify available evidence regarding the use of virtual reality interventions for adolescent patients in hospital settings to evaluate effectiveness, suitability, and safety and identify opportunities for future research.

Methods

PubMed, PsycINFO, Medline, and Scopus databases were searched using keywords and phrases. Retrieved abstracts (n=1525) were double screened, yielding 276 articles for full-text screening. Of these, 8 articles met inclusion criteria. Data were extracted to a standardized coding sheet, and a narrative synthesis was performed due to the heterogeneity of the studies.

Results

Four RCTs and 4 single-case reports were identified for inclusion, all of which aimed to reduce pain or anxiety. The scenarios targeted were burn pain, venipuncture, chemotherapy, preoperative anxiety, and palliative care. Three out of 4 RCTs found significant reductions in pain or anxiety outcomes measures when using virtual reality compared to standard care or other distraction techniques; however, only 1 study combined self-reported experiences of pain or anxiety with any physiological measures. Single-case reports relied primarily upon qualitative feedback, with patients reporting reduced pain or anxiety and a preference for virtual reality to no virtual reality.

Conclusions

Virtual reality can provide a safe and engaging way to reduce pain and anxiety in adolescents while in hospital, particularly when virtual reality software is highly immersive and specifically designed for therapeutic purposes. As VR becomes more accessible and affordable for use in hospitals, larger and more diverse studies that capitalize on adolescents’ interest in and aptitude for virtual reality, and on the full range of capabilities of this emerging technology, are needed to build on these promising results.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020198760; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020198760

The application of artificial intelligence and virtual reality in the auxiliary teaching of American science fiction literature

In order to improve the teaching effect of American science fiction literature, based on artificial intelligence virtual reality technology, this paper constructs an auxiliary teaching system of intelligent American science fiction literature. Moreover, this paper analyzes the time complexity and space complexity of constructing point cloud spatial topological relations and finding the nearest k neighboring points. Simultaneously, this paper uses CUDA to find k nearest neighbors on the GPU, analyzes the point cloud denoising technology, uses the KD-tree to construct the point cloud topology in the DBSCAN-based denoising method, searches for the k nearest neighbors to complete the mark of the core point and the boundary point. In addition, this paper combines artificial intelligence virtual technology and intelligent algorithms to construct the framework of the auxiliary teaching system of American science fiction literature, and analyze its functional modules. Finally, this paper designs experiments to verify the performance of the model. The research results show that the system constructed in this paper can meet the needs of auxiliary teaching of American science fiction literature.

Evaluating the Accuracy of Virtual Reality Trackers for Computing Spatiotemporal Gait Parameters

Ageing, disease, and injuries result in movement defects that affect daily life. Gait analysis is a vital tool for understanding and evaluating these movement dysfunctions. In recent years, the use of virtual reality (VR) to observe motion and offer augmented clinical care has increased. Although VR-based methodologies have shown benefits in improving gait functions, their validity against more traditional methods (e.g., cameras or instrumented walkways) is yet to be established. In this work, we propose a procedure aimed at testing the accuracy and viability of a VIVE Virtual Reality system for gait analysis. Seven young healthy subjects were asked to walk along an instrumented walkway while wearing VR trackers. Heel strike (HS) and toe off (TO) events were assessed using the VIVE system and the instrumented walkway, along with stride length (SL), stride time (ST), stride width (SW), stride velocity (SV), and stance/swing percentage (STC, SWC%). Results from the VR were compared with the instrumented walkway in terms of detection offset for time events and root mean square error (RMSE) for gait features. An absolute offset between VR- and walkway-based data of (15.3 ± 12.8) ms for HS, (17.6 ± 14.8) ms for TOs and an RMSE of 2.6 cm for SW, 2.0 cm for SL, 17.4 ms for ST, 2.2 m/s for SV, and 2.1% for stance and swing percentage were obtained. Our findings show VR-based systems can accurately monitor gait while also offering new perspectives for VR augmented analysis.

The role of mirror mechanism in the recovery, maintenance, and acquisition of motor abilities

While it is well documented that the motor system is more than a mere implementer of motor actions, the possible applications of its cognitive side are still under-exploited, often remaining as poorly organized evidence. Here, we will collect evidence showing the value of action observation treatment (AOT) in the recovery of impaired motor abilities for a vast number of clinical conditions, spanning from traumatological patients to brain injuries and neurodegenerative diseases. Alongside, we will discuss the use of AOT in the maintenance of appropriate motor behavior in subjects at risk for events with dramatic physical consequences, like fall prevention in elderly people or injury prevention in sports. Finally, we will report that AOT can help to tune existing motor competencies in fields requiring precise motor control. We will connect all these diverse dots into the neurophysiological scenario offered by decades of research on the human mirror mechanism, discussing the potentialities for individualization. Empowered by modern technologies, AOT can impact individuals' safety and quality of life across the whole lifespan.

Biofeedback Applied to Interactive Serious Games to Monitor Frailty in an Elderly Population

This article proposes an example of a multiplatform interactive serious game, which is an additional tool and assistant used in the rehabilitation of patients with musculoskeletal system problems. In medicine, any actions and procedures aimed at helping the rehabilitation of patients should entail the most comfortable, but at the same time, effective approach. Regardless of how these actions are orientated, whether for rehabilitation following surgery, fractures, any problems with the musculoskeletal system, or just support for the elderly, rehabilitation methods undoubtedly have good goals, although often the process itself can cause all kinds of discomfort and aversion among patients. This paper presents an interactive platform which enables a slightly different approach to be applied in terms of routine rehabilitation activities and this will help make the process more exciting. The main feature of the system is that it works in several ways: for normal everyday use at home, or for more in-depth observation of various biological parameters, such as heart rate, temperature, and so on. The basic component of the system is the real-time tracking system of the body position, which constitutes both a way to control the game (controller) and a means to analyze the player’s activity. As for the closer control of rehabilitation, the platform also provides the opportunity for medical personnel to monitor the player in real time, with all the data obtained from the game being used for subsequent analysis and comparison. Following several laboratory tests and feedback analysis, the progress indicators are quite encouraging in terms of greater patient interest in this kind of interaction, and effectiveness of the developed platform is also on average about 30–50% compared to conventional exercises, which makes it more attractive in terms of patient support.

Construction of network open teaching platform of analytical chemistry based on facial recognition and artificial intelligence

The theoretical and experimental teaching part of analytical chemistry is relatively boring, so it is difficult to improve the teaching results of analytical chemistry through the traditional network teaching mode. In this paper, based on the actual situation and based on the facial recognition algorithm, this paper uses artificial intelligence algorithm to build an open network teaching platform for analytical chemistry. Moreover, this paper improves the traditional adaptive genetic algorithm, and introduces a directional perturbation operator to non-linearize the adaptive adjustment probability. In algorithm design and simulation experiments, an improved genetic algorithm based on t distribution is used as an example to prove the effectiveness of the method in this paper. The platform constructed in this article is mainly applied to the teaching of analytical chemistry. The teaching of analytical chemistry includes theoretical teaching and experimental teaching. In addition, according to the actual needs of teaching, this article conducts research and analysis on the platform through theoretical teaching and experimental teaching. The research results show that the constructed teaching platform has good performance.

Space reconstruction of audiovisual media based on artificial intelligence and virtual reality

In the electronic age, the changes in the mirror space constructed by movies are also brought about by changes in the media. Cinematic space is a four-dimensional space illusion including time created by the use of light and shadow, color, perspective, sound, and the movement of characters and cameras. It is not a real four-dimensional space, but a reflection and reproduction of the real space. With the goal of improving the accuracy of spatially coded structured light 3D reconstruction, this paper conducts in-depth research on several key technologies that affect the reconstruction accuracy and makes corresponding innovations and improvements. Moreover, this paper respectively proposes an adaptive structured light spatial coding algorithm based on geometric features and a color structured light decoding algorithm based on color shift technology. In addition, this paper implements a spatially coded structured light three-dimensional reconstruction system and calibration system. The simulation research shows that the method in this paper has certain reliability.

Simulation of public art communication in colleges based on smart cloud platform and artificial intelligence algorithm

Public art communication in colleges and universities needs to be launched with the support of artificial intelligence systems. According to the current situation of public art communication in colleges and universities, this paper builds a smart cloud platform for public art communication in colleges and universities with the support of artificial intelligence algorithms. Moreover, this paper introduces the bandwidth offset coefficient to judge the change of network throughput, introduces the slice download rate difference to first judge the consistency change trend of bandwidth, and then further proposes the calculation method of bandwidth prediction value by situation. In addition, this paper proposes a flexible transmission mechanism based on smart collaborative networks. Through in-depth perception of network status and component behavior, this mechanism implements the selection of the optimal path in the network according to the current network status and user service requirements to complete the transmission of service resources. If the current transmission path fails, the mechanism should ensure the continuity and reliability of the service. The research results show that the system constructed in this paper has good performance and can be applied to practice.

Three-dimensional image art design based on dynamic image detection and genetic algorithm

The three-dimensional intelligent simulation of image art design is an important means of current image art design, which is affected by many factors. The traditional 3D intelligent simulation technology has certain defects, which leads to certain defects in 3D artwork. This paper builds a three-dimensional art design system based on dynamic image detection and genetic algorithm. The system simulates the actual dehazing method, and this paper proposes a dehazing algorithm suitable for this system and proposes to use bilateral filtering instead of median filtering. Because bilateral filtering has good edge retention, it can eliminate the blockiness caused by median filtering. Moreover, this paper uses FMM (Fast Marching Method) algorithm to repair the image. In order to verify the performance of the model, this paper conducts quantitative evaluation through system simulation and user satisfaction survey methods. The research results show that the method proposed in this paper has a certain effect and can be applied to practice.

Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses

Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.

Converging Robotic Technologies in Targeted Neural Rehabilitation: A Review of Emerging Solutions and Challenges

Recent advances in the field of neural rehabilitation, facilitated through technological innovation and improved neurophysiological knowledge of impaired motor control, have opened up new research directions. Such advances increase the relevance of existing interventions, as well as allow novel methodologies and technological synergies. New approaches attempt to partially overcome long-term disability caused by spinal cord injury, using either invasive bridging technologies or noninvasive human-machine interfaces. Muscular dystrophies benefit from electromyography and novel sensors that shed light on underlying neuromotor mechanisms in people with Duchenne. Novel wearable robotics devices are being tailored to specific patient populations, such as traumatic brain injury, stroke, and amputated individuals. In addition, developments in robot-assisted rehabilitation may enhance motor learning and generate movement repetitions by decoding the brain activity of patients during therapy. This is further facilitated by artificial intelligence algorithms coupled with faster electronics. The practical impact of integrating such technologies with neural rehabilitation treatment can be substantial. They can potentially empower nontechnically trained individuals-namely, family members and professional carers-to alter the programming of neural rehabilitation robotic setups, to actively get involved and intervene promptly at the point of care. This narrative review considers existing and emerging neural rehabilitation technologies through the perspective of replacing or restoring functions, enhancing, or improving natural neural output, as well as promoting or recruiting dormant neuroplasticity. Upon conclusion, we discuss the future directions for neural rehabilitation research, diagnosis, and treatment based on the discussed technologies and their major roadblocks. This future may eventually become possible through technological evolution and convergence of mutually beneficial technologies to create hybrid solutions.

Immersive virtual reality health games: a narrative review of game design

BACKGROUND

High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games.

METHODS

We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design.

FINDINGS

We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies.

CONCLUSION

HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.

Immersive augmented reality system for the training of pattern classification control with a myoelectric prosthesis

BACKGROUND

Hand amputation can have a truly debilitating impact on the life of the affected person. A multifunctional myoelectric prosthesis controlled using pattern classification can be used to restore some of the lost motor abilities. However, learning to control an advanced prosthesis can be a challenging task, but virtual and augmented reality (AR) provide means to create an engaging and motivating training.

METHODS

In this study, we present a novel training framework that integrates virtual elements within a real scene (AR) while allowing the view from the first-person perspective. The framework was evaluated in 13 able-bodied subjects and a limb-deficient person divided into intervention (IG) and control (CG) groups. The IG received training by performing simulated clothespin task and both groups conducted a pre- and posttest with a real prosthesis. When training with the AR, the subjects received visual feedback on the generated grasping force. The main outcome measure was the number of pins that were successfully transferred within 20 min (task duration), while the number of dropped and broken pins were also registered. The participants were asked to score the difficulty of the real task (posttest), fun-factor and motivation, as well as the utility of the feedback.

RESULTS

The performance (median/interquartile range) consistently increased during the training sessions (4/3 to 22/4). While the results were similar for the two groups in the pretest, the performance improved in the posttest only in IG. In addition, the subjects in IG transferred significantly more pins (28/10.5 versus 14.5/11), and dropped (1/2.5 versus 3.5/2) and broke (5/3.8 versus 14.5/9) significantly fewer pins in the posttest compared to CG. The participants in IG assigned (mean ± std) significantly lower scores to the difficulty compared to CG (5.2 ± 1.9 versus 7.1 ± 0.9), and they highly rated the fun factor (8.7 ± 1.3) and usefulness of feedback (8.5 ± 1.7).

CONCLUSION

The results demonstrated that the proposed AR system allows for the transfer of skills from the simulated to the real task while providing a positive user experience. The present study demonstrates the effectiveness and flexibility of the proposed AR framework. Importantly, the developed system is open source and available for download and further development.

Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial

Background

Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce.

Objective

The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs.

Methods

This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility.

Results

In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies.

Conclusions

Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD.

Trial Registration

ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345

Telerehabilitation in response to constrained physical distance: an opportunity to rethink neurorehabilitative routines

Ensuring proper dosage of treatment and repetition over time is a major challenge in neurorehabilitation. However, a requirement of physical distancing to date compromises their achievement. While mostly associated to COVID-19, physical distancing is not only required in a pandemic scenario, but also advised for several clinical conditions (e.g. immunocompromised individuals) or forced for specific social contexts (e.g. people living in remote areas worldwide). All these contexts advocate for the implementation of alternative healthcare models. The objective of this perspective is to highlight the benefits of remote administration of rehabilitative treatment, namely telerehabilitation, in counteracting physical distancing barriers in neurorehabilitation. Sustaining boosters of treatment outcome, such as compliance, sustainability, as well as motivation, telerehabilitation may adapt to multiple neurological conditions, with the further advantage of a high potential for individualization to patient's or pathology's specificities. The effectiveness of telerehabilitation can be potentiated by several technologies available to date: virtual reality can recreate realistic environments in which patients may bodily operate, wearable sensors allow to quantitatively monitor the patient's performance, and signal processing may contribute to the prediction of long-term dynamics of patient recovery. Telerehabilitation might spark its advantages far beyond the mere limitation of physical distancing effects, mitigating criticalities of daily neurorehabilitative practice, and thus paving the way to the envision of mixed models of care, where hospital-based procedures are complementarily integrated with telerehabilitative ones.

Effects of an external focus of attention and target occlusion on performance in virtual reality

The use of virtual reality as a training mechanism continues to gain popularity as equipment becomes more readily available. It is important to not only understand the relationship between virtual reality training and motor learning, but to understand the extent to which practice manipulations enhance performance in virtual reality. One common practice manipulation is adopting an external focus of attention, which has been shown to facilitate motor learning in a variety tasks. The purposes of the present study were to investigate the effectiveness of an external focus of attention and the effects of target occlusion times in virtual reality. Fifty-six participants performed a single-leg long jump during baseline, training, and retention and were randomly assigned to either an external or control group. During baseline and retention, all participants performed the task in both a virtual reality (VR) and real world (RW) environments. Training was all done in VR where participants were provided an external focus cue or no cue. Results revealed that individuals jumped significantly further in RW than VR in both baseline and retention (p < .001). During training, the external group jumped significantly further than control (p < .05). These results suggest that the adoption of an external focus improves performance during training. However, we did not see a benefit of an external focus in retention. These findings should be taken into consideration when using virtual reality as a training tool when performance must be transferred to a real world environment.

A Systematic Review of Virtual Reality Interfaces for Controlling and Interacting with Robots

There is a significant amount of synergy between virtual reality (VR) and the field of robotics. However, it has only been in approximately the past five years that commercial immersive VR devices have been available to developers. This new availability has led to a rapid increase in research using VR devices in the field of robotics, especially in the development of VR interfaces for operating robots. In this paper, we present a systematic review on VR interfaces for robot operation that utilize commercially available immersive VR devices. A total of 41 papers published between 2016–2020 were collected for review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Papers are discussed and categorized into five categories: (1) Visualization, which focuses on displaying data or information to operators; (2) Robot Control and Planning, which focuses on connecting human input or movement to robot movement; (3) Interaction, which focuses on the development of new interaction techniques and/or identifying best interaction practices; (4) Usability, which focuses on user experiences of VR interfaces; and (5) Infrastructure, which focuses on system architectures or software to support connecting VR and robots for interface development. Additionally, we provide future directions to continue development in VR interfaces for operating robots.

Healthcare Professionals' Acceptance of Digital Cognitive Rehabilitation

With technological possibilities in healthcare steadily increasing, more tools for digital cognitive rehabilitation become available. Acceptance of such technological advances is crucial for successful implementation. Therefore, we examined technology acceptance specifically for this form of rehabilitation in a sample of healthcare providers involved in cognitive rehabilitation. An adjusted version of the Technology Acceptance Model (TAM) questionnaire was used, including the subscales for perceived usefulness, perceived ease of use, subjective norm (toward use), and intention to use, which all contribute to actual use of a specific technology. Results indicate a generally favorable attitude toward the use of digital cognitive rehabilitation and positive responses toward the TAM constructs. Only for subjective norm, a neutral mean response was found, indicating that this could pose a potential obstacle toward implementation. Potential differences between subgroups of different age, gender, and professional background were assessed. Age and gender did not affect the attitude toward digital cognitive rehabilitation. Occupational therapists showed lower scores than healthcare psychologists and physiatrists with regard to perceived usefulness, possibly linked to a difference in operational and managerial tasks. The findings of his study stimulate further implementation of digital cognitive rehabilitation, where the role of subjective norms should be specifically considered.

Acceptance of a Virtual Reality Headset Designed for Fall Prevention in Older Adults: Questionnaire Study

BACKGROUND

Falls are a common phenomenon among people aged 65 and older and affect older adults' health, quality of life, and autonomy. Technology-based intervention programs are designed to prevent the occurrence of falls and their effectiveness often surpasses that of more conventional programs. However, to be effective, these programs must first be accepted by seniors.

OBJECTIVE

Based on the technology acceptance model, this study aimed to examine the acceptance among older adults before a first use of a virtual reality headset (VRH) used in an intervention program designed to prevent falls.

METHODS

A sample of 271 French older adults (mean age 73.69 years, SD 6.37 years) voluntarily and anonymously filled out a questionnaire containing the focal constructs (perceived usefulness, perceived enjoyment, perceived ease of use, intention to use, fall-related self-efficacy, and self-avoidance goals) adapted to the VRH, which was designed to prevent falls.

RESULTS

The results of the structural equation modeling analysis showed that intention to use the VRH was positively predicted by perceived usefulness, perceived enjoyment, and perceived ease of use. Perceived usefulness of the VRH was also negatively predicted by fall-related self-efficacy (ie, the perceived level of confidence of an individual when performing daily activities without falling) and positively predicted by self-avoidance goals (ie, participating in a physical activity to avoid physical regression).

CONCLUSIONS

A better understanding of the initial acceptance among older adults of this VRH is the first step to involving older adults in intervention programs designed to prevent falls using this kind of device.

Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence

This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.

Commercial head-mounted display virtual reality for upper extremity rehabilitation in chronic stroke: a single-case design study

Background

Rehabilitation is crucial for maximizing recovery after stroke. Rehabilitation activities that are fun and rewarding by themselves can be more effective than those who are not. Gamification with virtual reality (VR) exploits this principle. This single-case design study probes the potential for using commercial off-the-shelf, room-scale head-mounted virtual reality for upper extremity rehabilitation in individuals with chronic stroke, the insights of which can inform further research.

Methods

A heterogeneous volunteer sample of seven participants living with stroke were recruited through advertisement. A single-case design was employed with a 5-week baseline (A), followed by a 10-week intervention (B) and a 6-month follow-up. Upper extremity motor function was assessed with validated kinematic analysis of drinking task. Activity capacity was assessed with Action Research Arm Test, Box and Block Test and ABILHAND questionnaire. Assessments were done weekly and at follow-up. Playing games on a VR-system with head-mounted display (HTC Vive) was used as rehabilitation intervention. Approximately 300 games were screened and 6 tested. Visual analysis and Tau-U statistics were used to interpret the results.

Results

Visual analysis of trend, level shift and overlap as well as Tau-U statistics indicated improvement of Action Research Arm Test in six participants. Four of these had at least a moderate Tau-U score (0.50–0.92), in at least half of the assessed outcomes. These four participants trained a total of 361 to 935 min. Two out of four participants who were able to perform the drinking task, had the highest training dose (> 900 min) and showed also improvements in kinematics. The predominant game played was Beat Saber. No serious adverse effects related to the study were observed, one participant interrupted the intervention phase due to a fall at home.

Conclusions

This first study of combining commercial games, a commercial head-mounted VR, and commercial haptic hand controls, showed promising results for upper extremity rehabilitation in individuals with chronic stroke. By being affordable yet having high production values, as well as being an easily accessible off-the-shelf product, this variant of VR technology might facilitate widespread adaption. Insights garnered in this study can facilitate the execution of future studies.

Trial registration The study was registered at researchweb.org (project number 262331, registered 2019-01-30, https://www.researchweb.org/is/vgr/project/262331) prior to participant enrolment.

Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial

OBJECTIVE

To assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS).

DESIGN

Single-blinded, randomized, controlled trial.

SETTING

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences.

PARTICIPANTS

PwMS (N=39), randomized into VR (n=19) and control (n=20) groups.

INTERVENTION

The VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks.

MAIN OUTCOME MEASURES

Limits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up.

RESULTS

At both post intervention and follow-up, TUG^cognitive and DTCs on the TUG were significantly lower and the 10-m walk^cognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up.

CONCLUSIONS

Both the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.

The Effect of Virtual Reality on the Ability to Perform Activities of Daily Living, Balance During Gait, and Motor Function in Parkinson Disease Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

The study aimed to evaluate the effect of virtual reality on balance, motor function, gait, and the ability to perform activities of daily living in patients with Parkinson disease.

METHODS

We searched Cochran Central Register of Controlled Trials, Embase, PubMed, Wanfang Data, VIP Database, and China National Knowledge Infrastructure from their inception to June 2019. Two authors independently screened articles for inclusion, extracted data, and evaluated quality.

RESULTS

Twelve randomized clinical trials involving 360 patients were included. It demonstrated that virtual reality can improve balance, measured by the Berg Balance Scale (fixed model weighted mean difference = 2.28, 95% CI = 1.39 to 3.16, P < 0.00001); strengthen motor function, assessed by the Timed Up and Go test (fixed model weighted mean difference = -1.66, 95% CI = -2.74 to 0.58, P = 0.003); enhance gait ability, assessed by the 10-Meter Walk Test Time (fixed model weighted mean difference = 0.13, 95% CI = 0.02 to 0.24, P = 0.02) in patients with Parkinson disease. It also showed that virtual reality can improve individuals' ability to perform activities of daily living, assessed by modified Barthel Index (fixed model weighted mean difference = 2.93, 95% CI = 0.8 to 5.06, P = 0.007).

CONCLUSIONS

The findings suggest that virtual reality rehabilitation may be valuable in improving the balance, motor function, gait, and ability to perform activities of daily living in patients with Parkinson disease.

Virtual reality in neurorehabilitation: a review of its effects on multiple cognitive domains

INTRODUCTION

Neurological diseases frequently cause adult-onset disability and have increased the demand for rehabilitative interventions. Neurorehabilitation has been progressively relying on computer-assisted programs and, more recently, on virtual reality (VR). Current reviews explore VR-based neurorehabilitation for assessing and treating the most common neurological pathologies. However, none of them explored specifically the impact of VR on multiple cognitive domains.

AREAS COVERED

The present work is a review of 6 years of literature (2015-2020) on VR in neurorehabilitation with the purpose of analyzing its effects on memory, attention, executive functions, language, and visuospatial ability.

EXPERT OPINION

Our review suggests that VR-based neurorehabilitation showed encouraging results for executive functions and visuospatial abilities particularly for both acute and neurodegenerative conditions. Conversely, memory, and attention outcomes are conflicting, and language did not show significant improvements following VR-based rehabilitation. Within five years, it is plausible that VR-based intervention would be provided in standalone and mobile-based platforms that won't need a PC to work, with reduced latency and improved user interaction.