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Rodrigues-Baroni JM, Nascimento LR, Ada L, Teixeira-Salmela LF. Walking training associated with virtual reality-based training increases walking speed of individuals with chronic stroke: systematic review with meta-analysis. Braz J Phys Ther 2016; 18:502-12. [PMID: 25590442 PMCID: PMC4311594 DOI: 10.1590/bjpt-rbf.2014.0062] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/01/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To systematically review the available evidence on the efficacy of walking
training associated with virtual reality-based training in patients with stroke.
The specific questions were: Is walking training associated with virtual
reality-based training effective in increasing walking speed after stroke? Is this
type of intervention more effective in increasing walking speed, than non-virtual
reality-based walking interventions? METHOD: A systematic review with meta-analysis of randomized clinical trials was
conducted. Participants were adults with chronic stroke and the experimental
intervention was walking training associated with virtual reality-based training
to increase walking speed. The outcome data regarding walking speed were extracted
from the eligible trials and were combined using a meta-analysis approach. RESULTS: Seven trials representing eight comparisons were included in this systematic
review. Overall, the virtual reality-based training increased walking speed by
0.17 m/s (IC 95% 0.08 to 0.26), compared with placebo/nothing or non-walking
interventions. In addition, the virtual reality-based training increased walking
speed by 0.15 m/s (IC 95% 0.05 to 0.24), compared with non-virtual reality walking
interventions. CONCLUSIONS: This review provided evidence that walking training associated with virtual
reality-based training was effective in increasing walking speed after stroke, and
resulted in better results than non-virtual reality interventions.
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Affiliation(s)
| | - Lucas R Nascimento
- Faculty of Health Sciences, The University of Sydney, Sydney (NSW), Australia
| | - Louise Ada
- Faculty of Health Sciences, The University of Sydney, Sydney (NSW), Australia
| | - Luci F Teixeira-Salmela
- Departamento de Fisioterapia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Levac D, Glegg SMN, Sveistrup H, Colquhoun H, Miller PA, Finestone H, DePaul V, Harris JE, Velikonja D. A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation. BMC Health Serv Res 2016; 16:557. [PMID: 27716179 PMCID: PMC5052802 DOI: 10.1186/s12913-016-1807-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 09/30/2016] [Indexed: 12/20/2022] Open
Abstract
Background Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. Methods A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Results Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Conclusions Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1807-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Stephanie M N Glegg
- Therapy Department, Sunny Hill Health Centre for Children, 3644 Slocan Street, Vancouver, BC, V5M 3E8, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees (A121), Ottawa, ON, K1S 5S9, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Ave Toronto, Ontario, M5G 1V7, Canada
| | - Patricia A Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main St. West, Hamilton, ON, L8S 1C7, Canada
| | - Hillel Finestone
- Bruyere Research Institute, Élisabeth Bruyère Hospital, Bruyère Continuing Care, 43 Bruyère Street, Ottawa, ON, K1N 5C8, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Louise D. Acton Building, 31 George Street, Kingston, ON, K7L 3 N6, Canada
| | - Jocelyn E Harris
- School of Rehabilitation Science, McMaster University, IAHS Building Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Diana Velikonja
- Hamilton Health Sciences, Regional Rehabilitation Centre, 300 Wellington St. North, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine, McMaster Univerity, 12 Main Street West, Hamilton, ON, l8S 1C7, Canada
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Charrette AL, Lorenz LS, Fong J, O'Neil-Pirozzi TM, Lamson K, Demore-Taber M, Lilley R. Pilot study of intensive exercise on endurance, advanced mobility and gait speed in adults with chronic severe acquired brain injury. Brain Inj 2016; 30:1213-9. [PMID: 27466692 DOI: 10.1080/02699052.2016.1187766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Effects of high-intensity exercise on endurance, mobility and gait speed of adults with chronic moderate-to-severe acquired brain injury (ABI) were investigated. It was hypothesized that intensive exercise would be associated with improvements in impairment and activity limitation measures. PARTICIPANTS Fourteen adults with chronic ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device were studied. Eight presented with low ambulatory status. METHODS This was a single group pre- and post-intervention study. Participants received a 6-week exercise intervention for 60-90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Measures (6MWT, HiMAT and 10MWT) were collected at baseline, post-intervention and 6 weeks later. Repeated measures T-test and Wilcoxon Signed Ranks test were used. RESULTS Post-intervention improvements were achieved on average on all three measures, greater than minimal detectable change (MDC) for this population. Three participants transitioned from low-to-high ambulatory status and maintained the change 6 weeks later. DISCUSSION AND CONCLUSION People with chronic ABI can improve endurance, demonstrate the ability to do advanced gait and improve ambulatory status with 6 weeks of intensive exercise. Challenges to sustainability of exercise programmes for this population remain.
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Affiliation(s)
- Ann L Charrette
- a School of Physical Therapy , MCPHS University , Worcester , MA , USA.,b Supportive Living Inc Research Council , Lexington , MA , USA
| | - Laura S Lorenz
- b Supportive Living Inc Research Council , Lexington , MA , USA.,c Heller School for Social Policy and Management , Brandeis University , Waltham , MA , USA
| | - Jeffrey Fong
- d School of Pharmacy , MCPHS University , Worcester , MA , USA
| | - Therese M O'Neil-Pirozzi
- b Supportive Living Inc Research Council , Lexington , MA , USA.,e Department of Communication Sciences and Disorders , Northeastern University , Boston , MA , USA.,f Spaulding Rehabilitation Hospital , Department of Physical Medicine and Rehabilitation/Harvard Medical School , Boston , MA , USA
| | - Karen Lamson
- b Supportive Living Inc Research Council , Lexington , MA , USA.,g Library and Learning Resources , MCPHS University , Worcester , MA , USA
| | - Michelle Demore-Taber
- b Supportive Living Inc Research Council , Lexington , MA , USA.,h Brain Injury Services Program, Advocates , Framingham , MA , USA
| | - Ross Lilley
- b Supportive Living Inc Research Council , Lexington , MA , USA.,i AccesSportAmerica , Acton , MA , USA
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Lee BH. Clinical usefulness of augmented reality using infrared camera based real-time feedback on gait function in cerebral palsy: a case study. J Phys Ther Sci 2016; 28:1387-91. [PMID: 27190489 PMCID: PMC4868249 DOI: 10.1589/jpts.28.1387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/26/2015] [Indexed: 12/01/2022] Open
Abstract
[Purpose] This study investigated the effects of real-time feedback using infrared camera
recognition technology-based augmented reality in gait training for children with cerebral
palsy. [Subjects] Two subjects with cerebral palsy were recruited. [Methods] In this
study, augmented reality based real-time feedback training was conducted for the subjects
in two 30-minute sessions per week for four weeks. Spatiotemporal gait parameters were
used to measure the effect of augmented reality-based real-time feedback training.
[Results] Velocity, cadence, bilateral step and stride length, and functional ambulation
improved after the intervention in both cases. [Conclusion] Although additional follow-up
studies of the augmented reality based real-time feedback training are required, the
results of this study demonstrate that it improved the gait ability of two children with
cerebral palsy. These findings suggest a variety of applications of conservative
therapeutic methods which require future clinical trials.
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Affiliation(s)
- Byoung-Hee Lee
- Department of Physical Therapy, College of Health Science, Sahmyook University: 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Republic of Korea
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55
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Colomer C, Llorens R, Noé E, Alcañiz M. Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil 2016; 13:45. [PMID: 27169462 PMCID: PMC4864937 DOI: 10.1186/s12984-016-0153-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors. Methods Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory). Results Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating. Conclusions Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Roberto Llorens
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain. .,Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Av. Sos Baynat s/n, Univesity of Jaume I, Castellón, 12071, Spain
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Chang PFJ, Baxter MF, Rissky J. Effectiveness of Interventions Within the Scope of Occupational Therapy Practice to Improve Motor Function of People With Traumatic Brain Injury: A Systematic Review. Am J Occup Ther 2016; 70:7003180020p1-5. [PMID: 27089286 DOI: 10.5014/ajot.2016.020867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
After traumatic brain injury (TBI), many people experience significant motor function impairments. To help occupational therapy practitioners make informed decisions in choosing treatment strategies to improve clients' motor function, we undertook a systematic review and synthesized applicable findings of intervention studies. Of 2,306 articles identified in the literature search, we reviewed 47 full-text articles, of which 16 met approved criteria. We found moderate evidence that various exercise programs increase motor function and limited evidence that people with TBI can benefit from rehabilitation and computer-based programs. We offer implications for practice, education, and research.
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Affiliation(s)
- Pei-Fen J Chang
- Pei-Fen J. Chang, PhD, OTR, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston;
| | - Mary Frances Baxter
- Mary Frances Baxter, PhD, OT, FAOTA, is Associate Professor, School of Occupational Therapy, Texas Woman's University, Houston
| | - Jenna Rissky
- Jenna Rissky, MOT, was Graduate Student, Texas Woman's University, Houston, at the time of the study
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57
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Sheehy L, Taillon-Hobson A, Sveistrup H, Bilodeau M, Fergusson D, Levac D, Finestone H. Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial. BMC Neurol 2016; 16:42. [PMID: 27036515 PMCID: PMC4815206 DOI: 10.1186/s12883-016-0563-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/17/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients. Methods/Design This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10–12 sessions of 30–45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant’s group allocation. Discussion The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation. Trial Registration https://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014. Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.
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Affiliation(s)
- L Sheehy
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada
| | - A Taillon-Hobson
- Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada
| | - H Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada
| | - M Bilodeau
- School of Rehabilitation Sciences, University of Ottawa, Guindon Hall, 451 Smyth Road, Room 3071, Ottawa, ON, K1H 8M5, Canada.,Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada.,School of Human Kinetics, University of Ottawa, Montpetit Hall, Room 234, 125 University Private, Ottawa, ON, K1N 1A2, Canada
| | - D Fergusson
- Ottawa Hospital Research Institute, 501 Smyth Rd., Box 201B, Office L1298a, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd., Ottawa, ON, K1H 8M5, Canada.,Department of Surgery, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - D Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, 407-C Robinson Hall, 336 Huntington Ave., Boston, MA, 02115, USA
| | - H Finestone
- Bruyère Research Institute, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. .,Bruyère Continuing Care, 43 Bruyère St., Ottawa, ON, K1N 5C8, Canada. .,Faculty of Medicine, University of Ottawa, 505 Smyth Road, Rm. 1200, Ottawa, ON, K1H 8M2, Canada.
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58
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Attentional Demand of a Virtual Reality-Based Reaching Task in Nondisabled Older Adults. JOURNAL OF MOTOR LEARNING AND DEVELOPMENT 2016; 3:91-109. [PMID: 27004233 DOI: 10.1123/jmld.2014-0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Attention during exercise is known to affect performance; however, the attentional demand inherent to virtual reality (VR)-based exercise is not well understood. We used a dual-task paradigm to compare the attentional demands of VR-based and non-VR-based (conventional, real-world) exercise: 22 non-disabled older adults performed a primary reaching task to virtual and real targets in a counterbalanced block order while verbally responding to an unanticipated auditory tone in one third of the trials. The attentional demand of the primary reaching task was inferred from the voice response time (VRT) to the auditory tone. Participants' engagement level and task experience were also obtained using questionnaires. The virtual target condition was more attention demanding (significantly longer VRT) than the real target condition. Secondary analyses revealed a significant interaction between engagement level and target condition on attentional demand. For participants who were highly engaged, attentional demand was high and independent of target condition. However, for those who were less engaged, attentional demand was low and depended on target condition (i.e., virtual > real). These findings add important knowledge to the growing body of research pertaining to the development and application of technology-enhanced exercise for elders and for rehabilitation purposes.
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59
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Effects of sensory cueing in virtual motor rehabilitation. A review. J Biomed Inform 2016; 60:49-57. [PMID: 26826454 DOI: 10.1016/j.jbi.2016.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/27/2015] [Accepted: 01/18/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. METHODS Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. RESULTS Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. CONCLUSIONS Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings.
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60
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Glegg SMN, Holsti L, Stanton S, Hanna S, Velikonja D, Ansley B, Sartor D, Brum C. Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation. Disabil Rehabil Assist Technol 2016; 12:217-226. [PMID: 28508725 DOI: 10.3109/17483107.2015.1111944] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the impact of knowledge translation (KT) on factors influencing virtual reality (VR) adoption and to identify support needs of therapists. HYPOTHESES Intervention will be associated with improvements in therapists' perceived ease of use and self-efficacy, and an associated increase in intentions to use VR. METHOD Single group mixed-methods pre-test-post-test evaluation of convenience sample of physical, occupational and rehabilitation therapists (n=37) from two brain injury rehabilitation centres. ADOPT-VR administered pre/post KT intervention, consisting of interactive education, clinical manual, technical and clinical support. RESULTS Increases in perceived ease of use (p=0.000) and self-efficacy (p=0.001), but not behavioural intention to use VR (p=0.158) were found following KT, along with decreases in the frequency of perceived barriers. Post-test changes in the frequency and nature of perceived facilitators and barriers were evident, with increased emphasis on peer influence, organisational-level supports and client factors. Additional support needs were related to clinical reasoning, treatment programme development, technology selection and troubleshooting. CONCLUSIONS KT strategies hold potential for targeting therapists' perceptions of low self-efficacy and ease of use of this technology. Changes in perceived barriers, facilitators and support needs at post-test demonstrated support for repeated evaluation and multi-phased training initiatives to address therapists' needs over time. Implications for Rehabilitation Therapists' learning and support needs in integrating virtual reality extend beyond technical proficiency to include clinical decision-making and application competencies spanning the entire rehabilitation process. Phased, multi-faceted strategies may be valuable in addressing therapists' changing needs as they progress from novice to experienced virtual reality users. The ADOPT-VR is a sensitive measure to re-evaluate the personal, social, environmental, technology-specific and system-level factors influencing virtual reality adoption over time.
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Affiliation(s)
- Stephanie M N Glegg
- a Sunny Hill Health Centre for Children , Vancouver , BC , Canada.,b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Liisa Holsti
- b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Sue Stanton
- b Department of Occupational Science and Occupational Therapy , University of British Columbia , Vancouver , BC , Canada
| | - Steven Hanna
- c Department of Clinical Epidemiology & Biostatistics, and Department of Rehabilitation Science , McMaster University , Hamilton , ON , Canada
| | - Diana Velikonja
- d Department of Psychiatry and Behavioural Neurosciences, DeGroote School of Medicine , McMaster University , Hamilton , ON , Canada
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Peruzzi A, Cereatti A, Della Croce U, Mirelman A. Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: a pilot study. Mult Scler Relat Disord 2016; 5:91-6. [DOI: 10.1016/j.msard.2015.11.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 07/06/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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62
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McEwen D, Taillon-Hobson A, Bilodeau M, Sveistrup H, Finestone H. Two-week virtual reality training for dementia: Single case feasibility study. ACTA ACUST UNITED AC 2015; 51:1069-76. [PMID: 25437527 DOI: 10.1682/jrrd.2013.10.0231] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 03/26/2014] [Indexed: 11/05/2022]
Abstract
Persons with dementia (PWD) are known to have difficulty with participation and focus during physical activity. Virtual reality (VR) offers a unique medium for motor learning but has only been used previously for cognitive assessment for PWD. Our study had two objectives: (1) investigate the feasibility and safety of an exercise-based VR training program in PWD, and (2) investigate its effects on balance and mobility. The intervention consisted of daily (5 d/wk, 1 h each) VR training sessions for 2 wk for a single research participant. Clinical balance and mobility measures were assessed 1 wk prior to, during, 1 wk following, and 1 mo after the intervention. Postintervention interviews provided qualitative feedback from the participant and his caregivers. Results indicate that VR training is feasible, safe, and enjoyable for PWD. However, balance and mobility measures were unaffected. VR training is well tolerated in a single research participant with dementia and is an engaging medium for participation in exercise.
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Cuthbert JP, Staniszewski K, Hays K, Gerber D, Natale A, O'Dell D. Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury. Brain Inj 2014; 28:181-8. [PMID: 24456057 DOI: 10.3109/02699052.2013.860475] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training. DESIGN A randomized controlled trial in which assessment and analysis were blinded. SETTING An inpatient rehabilitation facility. INTERVENTION Interventions included balance-based physical therapy using a Nintendo Wii, as monitored by a physical therapist, and receipt of one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym. RESULTS Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and BBS scores for measures taken beyond the baseline assessment. CONCLUSIONS This study provides a modest level of evidence to support using commercially available VR gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation. Additional research of these types of interventions for the treatment of balance deficits is warranted.
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Gerber LH, Narber CG, Vishnoi N, Johnson SL, Chan L, Duric Z. The feasibility of using haptic devices to engage people with chronic traumatic brain injury in virtual 3D functional tasks. J Neuroeng Rehabil 2014; 11:117. [PMID: 25103113 PMCID: PMC4245766 DOI: 10.1186/1743-0003-11-117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary aim of this study was to assess the level of engagement in computer-based simulations of functional tasks, using a haptic device for people with chronic traumatic brain injury. The objectives were to design functional tasks using force feedback device and determine if it could measure motor performance improvement. METHODS A prospective crosssectional study was performed in a biomedical research facility. The testing environment consisted of a single, interactive, stylus-driven computer session navigating virtual scenes in 3D space. Subjects had a haptic training session (TRAIN) and then had three chances to perform each virtual task: (i) remove tools from a workbench (TOOL), (ii) compose 3 letter words (SPELL), (iii) manipulate utensils to prepare a sandwich (SAND), and (iv) tool use (TUSE). Main Outcome Measures included self-report of engagement in the activities, improved performance on simulated tasks and observer estimate as measured by time to completion or number of words completed from baseline, correlations among performance measures and self-reports of boredom, neuropsychological symptom inventory (NSI), and The Purdue Peg Motor Test (PPT). RESULTS Participants were 19 adults from the community with a 1 year history of non-penetrating traumatic brain injury (TBI) and were able to use computers. Seven had mild, 3 moderate and 9 severe TBIs. Mean score on the Boredom Proneness Scale (BPS): 107 (normal range 81-117); mean NSI:32; mean PPT 54 (normal range for assembly line workers >67). Responses to intervention: 3 (15%)subjects did not repeat all three trials of the tasks; 100% reported they were highly engaged in the interactions; 6 (30%) reported they had a high level of frustration with the tasks, but completed them with short breaks. Performance measures: Comparison of baseline to post training: TOOL time decreased by (mean) 60 sec; SPELL increased by 2.7 words; TUSE time decreased by (mean) 68 sec; and SAND time decreased by (mean) 72 sec. PPT correlated with TOOL (r=-0.65, p=0.016) and TUSE time (r=-0.6, p=0.014). SPELL correlated with Boredom score (r=0.41, p=0.08) and NSI (r=-.49, p=0.05). CONCLUSION People with chronic TBI of various ages and severity report being engaged in using haptic devices that interact with 3D virtual environments. Haptic devices are able to capture objective data that provide useful information about fine motor and cognitive performance.
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Affiliation(s)
- Lynn H Gerber
- />Center for the Study of Chronic Illness and Disability, George Mason University, 4400 University Dr., 22030 Fairfax, VA USA
| | - Cody G Narber
- />Department of Computer Science, George Mason University, 4400 University Dr., 22030 Fairfax, VA USA
| | - Nalini Vishnoi
- />Department of Computer Science, George Mason University, 4400 University Dr., 22030 Fairfax, VA USA
| | - Sidney L Johnson
- />Center for the Study of Chronic Illness and Disability, George Mason University, 4400 University Dr., 22030 Fairfax, VA USA
| | - Leighton Chan
- />Rehabilitation Medicine Department, Clinical Center, NIH, 9000 Rockville Pike, 20892 Bethesda, MD USA
| | - Zoran Duric
- />Department of Computer Science, George Mason University, 4400 University Dr., 22030 Fairfax, VA USA
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65
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Pietrzak E, Pullman S, McGuire A. Using Virtual Reality and Videogames for Traumatic Brain Injury Rehabilitation: A Structured Literature Review. Games Health J 2014; 3:202-14. [PMID: 26192369 DOI: 10.1089/g4h.2014.0013] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eva Pietrzak
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Pullman
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
| | - Annabel McGuire
- Centre for Australian Military and Veterans' Health, School of Population Health, The University of Queensland, Herston, Queensland, Australia
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66
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Trost Z, Parsons TD. Beyond Distraction: Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/jabr.12021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zina Trost
- Department of Psychology; University of North Texas
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67
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McEwen D, Taillon-Hobson A, Bilodeau M, Sveistrup H, Finestone H. Virtual Reality Exercise Improves Mobility After Stroke. Stroke 2014; 45:1853-5. [DOI: 10.1161/strokeaha.114.005362] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Exercise using virtual reality (VR) has improved balance in adults with traumatic brain injury and community-dwelling older adults. Rigorous randomized studies regarding its efficacy, safety, and applicability with individuals after stroke are lacking. The purpose of this study was to determine whether an adjunct VR therapy improves balance, mobility, and gait in stroke rehabilitation inpatients.
Methods—
A blinded randomized controlled trial studying 59 stroke survivors on an inpatient stroke rehabilitation unit was performed. The treatment group (n=30) received standard stroke rehabilitation therapy plus a program of VR exercises that challenged balance (eg, soccer goaltending, snowboarding) performed while standing. The control group (n=29) received standard stroke rehabilitation therapy plus exposure to identical VR environments but whose games did not challenge balance (performed in sitting). VR training consisted of 10 to 12 thirty-minute daily sessions for a 3-week period. Objective outcome measures of balance and mobility were assessed before, immediately after, and 1 month after training.
Results—
Confidence intervals and effect sizes favored the treatment group on the Timed Up and Go and the Two-Minute Walk Test, with both groups meeting minimal clinical important differences after training. More individuals in the treatment group than in the control group showed reduced impairment in the lower extremity as measured by the Chedoke McMaster Leg domain (
P
=0.04) immediately after training.
Conclusions—
This VR exercise intervention for inpatient stroke rehabilitation improved mobility-related outcomes. Future studies could include nonambulatory participants as well as the implementation strategies for the clinical use of VR.
Clinical Trial Registration—
URL:
http://www.ANZCTR.org.au/
. Unique identifier: ACTRN12613000710729.
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Affiliation(s)
- Daniel McEwen
- From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.)
| | - Anne Taillon-Hobson
- From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.)
| | - Martin Bilodeau
- From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.)
| | - Heidi Sveistrup
- From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.)
| | - Hillel Finestone
- From the Bruyère Research Institute, Ottawa, Ontario, Canada (D.M., A.T.-H., M.B., H.F.); School of Rehabilitation Sciences (D.M., M.B., H.S.), School of Human Kinetics (M.B., H.S., H.F.), and Faculty of Medicine (H.F.), University of Ottawa, Ottawa, Ontario, Canada; and Department of Physical Medicine and Rehabilitation, Elisabeth Bruyère Hospital, Ottawa, Ontario, Canada (H.F.)
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68
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Powell W, Simmonds MJ. Virtual Reality and Musculoskeletal Pain: Manipulating Sensory Cues to Improve Motor Performance During Walking. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 17:390-6. [DOI: 10.1089/cyber.2014.0061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Wendy Powell
- University of Portsmouth, Portsmouth, United Kingdom
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69
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Thomas S, Fazakarley L, Thomas PW, Brenton S, Collyer S, Perring S, Scott R, Galvin K, Hillier C. Testing the feasibility and acceptability of using the Nintendo Wii in the home to increase activity levels, vitality and well-being in people with multiple sclerosis (Mii-vitaliSe): protocol for a pilot randomised controlled study. BMJ Open 2014; 4:e005172. [PMID: 24812193 PMCID: PMC4028512 DOI: 10.1136/bmjopen-2014-005172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION The benefits of physical activity for people with multiple sclerosis (pwMS) have been recognised. However, exercise regimens can be difficult to maintain over the longer term and pwMS may face unique barriers to physical activity engagement. Pilot research suggests the Nintendo Wii can be used safely at home by pwMS with minimal mobility/balance issues and may confer benefits. We have developed a home-based physiotherapist supported Wii intervention ('Mii-vitaliSe') for pwMS that uses commercial software. This is a pilot study to explore the feasibility of conducting a full scale clinical and cost-effectiveness trial of Mii-vitaliSe. METHODS AND ANALYSIS 30 ambulatory, relatively inactive pwMS will be randomised to receive Mii-vitaliSe immediately, or after 6 months. Outcomes, measured at baseline and 6 and 12 months later, will include balance, gait, mobility, hand dexterity and self-reported physical activity levels, fatigue, self-efficacy, mood and quality of life. Interviews conducted on a purposive sample of participants will explore experiences of participation in the study and barriers and facilitators to using the Wii. Mean recruitment, adherence rate and standard deviations (SDs) of potential primary outcomes for the full trial will be estimated and precision summarised using 95% confidence intervals (CIs). Interview transcripts will be thematically analysed using a generic qualitative approach. ETHICS AND DISSEMINATION National Health Service (NHS; ref 12/SC/0420) and university ethical approvals have been obtained as has NHS Research and Development permission from the relevant trust. A home risk assessment will be undertaken for all potential participants. All adverse events will be closely monitored, documented and reported to the study Safety Monitoring Committee. At least one publication in a peer reviewed journal will be produced and research findings presented at a national and international conference. With service users, we will coproduce a summary of the findings for dissemination on our research unit's website and elsewhere. TRIAL REGISTRATION NUMBER ISRCTN 49286846.
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Affiliation(s)
- Sarah Thomas
- Clinical Research Unit, School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Louise Fazakarley
- School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Peter W Thomas
- Clinical Research Unit, School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK
| | - Sarah Brenton
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Sarah Collyer
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Steve Perring
- Medical Physics Department, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
| | - Rebecca Scott
- Physiotherapy Department, National Star College, Cheltenham, Gloucestershire, UK
| | - Kathleen Galvin
- Faculty of Health and Social Care, Hull University, Hull, Yorkshire, UK
| | - Charles Hillier
- Dorset Multiple Sclerosis Service, Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
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Cho GH, Hwangbo G, Shin HS. The Effects of Virtual Reality-based Balance Training on Balance of the Elderly. J Phys Ther Sci 2014; 26:615-7. [PMID: 24764645 PMCID: PMC3996433 DOI: 10.1589/jpts.26.615] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/21/2013] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The objective of this study was to determine the effects of virtual
reality-based balance training on balance of the elderly. [Methods] The subjects were 32
healthy elderly people aged between 65 and 80, who were divided into a VR (virtual
reality) training group (n=17) and a control group (n=15). The VR training group engaged
in a 30-minute exercise session using Wii Fit three times a week for eight weeks, while
the control group received no intervention. The balance of the two groups was measured
before and after the intervention. [Results] According to the Romberg Test conducted to
examine the effects of the training on balance, both the area covered by the body’s center
of pressure movement, and movement distances per unit area of the body’s center of
pressure envelope significantly decreased in the VR training group. Moreover, the two
groups showed significant differences in balance. [Conclusion] Virtual reality training is
effective at improving the balance of the healthy elderly. Thus, virtual reality training
can be proposed as a form of fall prevention exercise for the elderly.
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Affiliation(s)
- Gyeong Hee Cho
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Gak Hwangbo
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
| | - Hyung Soo Shin
- Department of Physical Therapy, Kyungwoon University, Republic of Korea
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71
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Ustinova KI, Perkins J, Leonard WA, Hausbeck CJ. Virtual reality game-based therapy for treatment of postural and co-ordination abnormalities secondary to TBI: a pilot study. Brain Inj 2014; 28:486-95. [PMID: 24702281 DOI: 10.3109/02699052.2014.888593] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The study objective was to test the efficacy of game-based virtual reality (VR) therapy as a mean of correcting postural and co-ordination abnormalities in individuals with traumatic brain injury (TBI). Therapy was done with interactive customized VR games and scenarios, utilizing an Xbox Kinect sensor. RESEARCH DESIGN The study was a pilot project using the structure of a phase II clinical trial. METHODS AND PROCEDURES Fifteen participants with mild-to-moderate chronic TBI-related balance and motor co-ordination impairments participated in 15 sessions, each lasting ∼50-55 minutes, scheduled 2-3 times a week over 5-6 consecutive weeks. Participants were evaluated at baseline, immediately after the final session and in a 1-month follow-up with a battery of clinical tests (measuring postural stability, gait and co-ordination) and movement performance parameters. Movement parameters included arm-leg co-ordination, dynamic stability and arm precision, calculated from kinematic data recorded with Xbox Kinect sensor. RESULTS Following therapy, most participants improved their static and dynamic postural stability, gait and arm movements. These effects persisted over the retention interval. CONCLUSIONS Results will be used to improve the VR program, with the goal of producing a cost-effective, accessible and easy to individualize therapeutic approach. The pilot data will be used for designing a larger scale clinical trial.
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Affiliation(s)
- K I Ustinova
- The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University , MI , USA and
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72
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Glegg SMN, Holsti L, Velikonja D, Ansley B, Brum C, Sartor D. Factors influencing therapists' adoption of virtual reality for brain injury rehabilitation. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2014; 16:385-401. [PMID: 23713844 DOI: 10.1089/cyber.2013.1506] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Virtual reality (VR) is an important emerging technology that is increasingly being introduced in health centers as a rehabilitation intervention. Quantitative research is needed to identify the factors influencing therapists' adoption of VR for brain injury rehabilitation, including barriers and facilitators to VR use, in order to inform successful implementation strategies. A measure based on the decomposed theory of planned behavior (DTPB) was developed and administered to 42 therapists; early psychometric properties are reported. Mean or median composite scores and correlations were calculated for each DTPB construct. Overall, therapists had positive attitudes toward VR, perceived it as being useful, and had positive intentions to use it more in the future. The self-efficacy composite yielded the lowest scores. The most significant barrier to adoption was time, while social influences and knowledge were the primary facilitators. Future research will explore the impact of knowledge translation interventions on these mediators of VR adoption.
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73
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Parsons TD, Trost Z. Virtual Reality Graded Exposure Therapy as Treatment for Pain-Related Fear and Disability in Chronic Pain. VIRTUAL, AUGMENTED REALITY AND SERIOUS GAMES FOR HEALTHCARE 1 2014. [DOI: 10.1007/978-3-642-54816-1_25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Singh DKA, Mohd Nordin NA, Aziz NAA, Lim BK, Soh LC. Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. BMC Neurol 2013; 13:199. [PMID: 24330250 PMCID: PMC4029492 DOI: 10.1186/1471-2377-13-199] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 12/04/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors. METHODS In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board. RESULTS Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements. CONCLUSION Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.
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Affiliation(s)
- Devinder Kaur Ajit Singh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Nor Azlin Mohd Nordin
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Noor Azah Abd Aziz
- Department of Family Medicine, Medical Faculty, University Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Beng Kooi Lim
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
| | - Li Ching Soh
- Physiotherapy Programme, School of Rehabilitation Sciences, Faculty of Health Sciences, Jalan Raja Muda Aziz, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Malaysia
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75
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McClanachan NJ, Gesch J, Wuthapanich N, Fleming J, Kuys SS. Feasibility of gaming console exercise and its effect on endurance, gait and balance in people with an acquired brain injury. Brain Inj 2013; 27:1402-8. [PMID: 24102295 DOI: 10.3109/02699052.2013.823654] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine feasibility of gaming console exercise and its effect on endurance, gait and balance in people following acquired brain injury (ABI). METHOD Twenty-one people following ABI were recruited to an 8-week randomized cross-over trial where 4 weeks of gaming console exercise in addition to usual therapy and 4 weeks of usual therapy alone were received. Feasibility measures included compliance, session duration and adverse events. Measures included endurance measured using a 6-minute walk test, spatiotemporal gait parameters (GAITRite) and balance using Balance Outcome Measure for Elder Rehabilitation (BOOMER). Motivation was measured using the Change Assessment Questionnaire. RESULTS Compliance with gaming console exercise was high (99%), the majority of sessions reached duration target (82%) and there were no adverse events. There were small, though non-significant increases in 6-minute walk distance (18 metres, 95% CI = -33 to 69), gait speed (0.11 m s(-1), 95% CI = -0.18 to 0.29) and balance compared to after usual therapy after gaming console exercise. CONCLUSIONS Gaming console exercise appears feasible in people with ABI. Four weeks of gaming console exercise in addition to usual therapy appears to result in similar improvements in endurance, gait and balance compared to usual therapy alone and may enhance active engagement in therapy.
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Affiliation(s)
- Nelson J McClanachan
- School of Health and Rehabilitation Sciences, University of Queensland , Australia
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Yoo HN, Chung E, Lee BH. The Effects of Augmented Reality-based Otago Exercise on Balance, Gait, and Falls Efficacy of Elderly Women. J Phys Ther Sci 2013; 25:797-801. [PMID: 24259856 PMCID: PMC3820389 DOI: 10.1589/jpts.25.797] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to determine the effects of augmented
reality-based Otago exercise on balance, gait, and falls efficacy of elderly women.
[Subjects] The subjects were 21 elderly women, who were randomly divided into two groups:
an augmented reality-based Otago exercise group of 10 subjects and an Otago exercise group
of 11 subjects. [Methods] All subjects were evaluated for balance (Berg Balance Scale,
BBS), gait parameters (velocity, cadence, step length, and stride length), and falls
efficacy. Within 12 weeks, Otago exercise for muscle strengthening and balance training
was conducted three times, for a period of 60 minutes each, and subjects in the
experimental group performed augmented reality-based Otago exercise. [Results] Following
intervention, the augmented reality-based Otago exercise group showed significant
increases in BBS, velocity, cadence, step length (right side), stride length (right side
and left side) and falls efficacy. [Conclusion] The results of this study suggest the
feasibility and suitability of this augmented reality-based Otago exercise for elderly
women.
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Affiliation(s)
- Ha-Na Yoo
- Department of Physical Therapy, Graduate School of Physical Therapy, Sahmyook University
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Rajaratnam BS, Gui KaiEn J, Lee JiaLin K, SweeSin K, Sim FenRu S, Enting L, Ang YiHsia E, KeatHwee N, Yunfeng S, Woo YingHowe W, Teo SiaoTing S. Does the Inclusion of Virtual Reality Games within Conventional Rehabilitation Enhance Balance Retraining after a Recent Episode of Stroke? Rehabil Res Pract 2013; 2013:649561. [PMID: 24024033 PMCID: PMC3759244 DOI: 10.1155/2013/649561] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 07/15/2013] [Accepted: 07/16/2013] [Indexed: 01/24/2023] Open
Abstract
This randomised controlled and double-blinded pilot study evaluated if interactive virtual reality balance related games integrated within conventional rehabilitation sessions resulted in more superior retraining of dynamic balance compared to CR after stroke. 19 subjects diagnosed with a recent episode of stroke were recruited from a local rehabilitation hospital and randomly assigned to either a control or an experimental group. Subjects in the control groups underwent 60 minutes of conventional rehabilitation while those in the experimental groups underwent 40 minutes of convention rehabilitation and 20 minutes of self-directed virtual reality balanced rehabilitation. Functional Reach Test, Timed Up and Go, Modified Barthel Index, Berg Balance Scale, and Centre of Pressure of subjects in both groups were evaluated before and on completion of the rehabilitation sessions. Results indicate that the inclusion of interactive virtual reality balance related games within conventional rehabilitation can lead to improved functional mobility and balance after a recent episode of stroke without increasing treatment time that requires more health professional manpower.
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Affiliation(s)
- B. S. Rajaratnam
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - J. Gui KaiEn
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - K. Lee JiaLin
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - Kwek SweeSin
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - S. Sim FenRu
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - Lee Enting
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - E. Ang YiHsia
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - Ng KeatHwee
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - Su Yunfeng
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - W. Woo YingHowe
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
| | - S. Teo SiaoTing
- Nanyang Polytechnic, School of Health Sciences (Allied Health) 569830, Singapore
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Dvorkin AY, Ramaiya M, Larson EB, Zollman FS, Hsu N, Pacini S, Shah A, Patton JL. A "virtually minimal" visuo-haptic training of attention in severe traumatic brain injury. J Neuroeng Rehabil 2013; 10:92. [PMID: 23938101 PMCID: PMC3750632 DOI: 10.1186/1743-0003-10-92] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 07/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background Although common during the early stages of recovery from severe traumatic brain injury (TBI), attention deficits have been scarcely investigated. Encouraging evidence suggests beneficial effects of attention training in more chronic and higher functioning patients. Interactive technology may provide new opportunities for rehabilitation in inpatients who are earlier in their recovery. Methods We designed a “virtually minimal” approach using robot-rendered haptics in a virtual environment to train severely injured inpatients in the early stages of recovery to sustain attention to a visuo-motor task. 21 inpatients with severe TBI completed repetitive reaching toward targets that were both seen and felt. Patients were tested over two consecutive days, experiencing 3 conditions (no haptic feedback, a break-through force, and haptic nudge) in 12 successive, 4-minute blocks. Results The interactive visuo-haptic environments were well-tolerated and engaging. Patients typically remained attentive to the task. However, patients exhibited attention loss both before (prolonged initiation) and during (pauses during motion) a movement. Compared to no haptic feedback, patients benefited from haptic nudge cues but not break-through forces. As training progressed, patients increased the number of targets acquired and spontaneously improved from one day to the next. Conclusions Interactive visuo-haptic environments could be beneficial for attention training for severe TBI patients in the early stages of recovery and warrants further and more prolonged clinical testing.
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Affiliation(s)
- Assaf Y Dvorkin
- Rehabilitation Institute of Chicago, 345 E, Superior Street, Chicago, IL 60611, USA.
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79
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Weiss PL, Sveistrup H, Rand D, Kizony R. Video capture virtual reality: A decade of rehabilitation assessment and intervention. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331909x12488667117339] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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80
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Schafer AY, Ustinova KI. Does use of a virtual environment change reaching while standing in patients with traumatic brain injury? J Neuroeng Rehabil 2013; 10:76. [PMID: 23866962 PMCID: PMC3733631 DOI: 10.1186/1743-0003-10-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 06/14/2013] [Indexed: 12/01/2023] Open
Abstract
Background Although numerous virtual reality applications have been developed for sensorimotor retraining in neurologically impaired individuals, it is unclear whether the virtual environment (VE) changes motor performance, especially in patients with brain injuries. To address this question, the movement characteristics of forward arm reaches during standing were compared in physical and virtual environments, presented at different viewing angles. Methods Fifteen patients with traumatic brain injuries (TBI) and 15 sex- and age-matched healthy individuals performed virtual reaches in a computer-generated courtyard with a flower-topped hedge. The hedge was projected on a flat screen and viewed in 3D format in 1 of 3 angles: 10° above horizon (resembling a real-world viewing angle), 50° above horizon, or 90° above horizon (directly overhead). Participants were instructed to reach with their dominant hand avatar and to touch the farthest flower possible without losing their balance or stepping. Virtual reaches were compared with reaches-to-point to a target in an equivalent physical environment. A set of kinematic parameters was used. Results Reaches by patients with TBI were characterized by shorter distances, lower peak velocities, and smaller postural displacements than reaches by control individuals. All participants reached ~9% farther in the VE presented at a 50° angle than they did in the physical environment. Arm displacement in the more natural 10° angle VE was reduced by the same 9-10% compared to physical reaches. Virtual reaches had smaller velocity peaks and took longer than physical reaches. Conclusion The results suggest that visual perception in the VE differs from real-world perception and the performance of functional tasks (e.g., reaching while standing) can be changed in TBI patients, depending on the viewing angle. Accordingly, the viewing angle is a critical parameter that should be adjusted carefully to achieve maximal therapeutic effect during practice in the VE.
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Affiliation(s)
- Amanda Y Schafer
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
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Dvorkin AY, Pacini S, Hsu N, Larson EB. Treatment challenges with profound behaviour disturbance after traumatic brain injury: A case report. Brain Inj 2013; 27:957-61. [DOI: 10.3109/02699052.2013.793399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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82
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Lloréns R, Colomer-Font C, Alcañiz M, Noé-Sebastián E. BioTrak virtual reality system: Effectiveness and satisfaction analysis for balance rehabilitation in patients with brain injury. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2012.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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83
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Review of the Status of Physical Activity Research for Individuals With Traumatic Brain Injury. Arch Phys Med Rehabil 2013; 94:1184-9. [DOI: 10.1016/j.apmr.2013.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/19/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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84
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Lloréns R, Colomer-Font C, Alcañiz M, Noé-Sebastián E. BioTrak: análisis de efectividad y satisfacción de un sistema de realidad virtual para la rehabilitación del equilibrio en pacientes con daño cerebral. Neurologia 2013; 28:268-75. [PMID: 22727272 DOI: 10.1016/j.nrl.2012.04.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 04/04/2012] [Accepted: 04/27/2012] [Indexed: 11/18/2022] Open
Affiliation(s)
- R Lloréns
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Valencia, Spain
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Glegg SMN, Tatla SK, Holsti L. The GestureTek virtual reality system in rehabilitation: a scoping review. Disabil Rehabil Assist Technol 2013; 9:89-111. [PMID: 23713408 DOI: 10.3109/17483107.2013.799236] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE To identify, to map out and to appraise research examining GestureTek virtual reality (VR) use for physical and cognitive rehabilitation and to highlight areas for future research. METHOD Scoping review methodology was used to systematically and comprehensively search the academic and grey literature for GestureTek-specific research. Consensus was achieved following two reviewers' independent inclusion screening, data extraction and appraisal. RESULTS Forty-four studies evaluated the utility and efficacy of the IREX, GX, VMall and Meal Maker software for rehabilitation across a range of populations, with few adverse events reported. Stroke and cerebral palsy research dominated, while geriatrics was largely overlooked. Efficacy research provided support for balance, mobility, upper extremity, cognitive, fitness and daily living skills outcomes for specific populations with effect sizes ranging from 0.19 to 3.34. Nevertheless, few strong quality or high-level studies are available, and no clear guidelines on optimal treatment characteristics exist. Outcomes of primary interest were at ICF body function and activity levels; evaluation of transfer of training across ICF levels is needed. CONCLUSIONS This literature provides preliminary evidence for the technology's efficacy for rehabilitation. Identified research gaps relate to study quality and design, treatment characteristics, populations and outcomes of interest, including transfer across ICF levels. IMPLICATIONS FOR REHABILITATION There is limited high-level evidence to support the use of the GestureTek virtual reality system for rehabilitation. Moderate to strong quality evidence exists primarily for the stroke and cerebral palsy populations, and primarily for balance, mobility and upper extremity outcomes. A lack of consistent outcome measures in this body of literature has created "silos" of research that cannot be quantitatively combined using a meta-analytic strategy.
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Affiliation(s)
- Stephanie M N Glegg
- Children's & Women's Health Centre of British Columbia , Vancouver, British Columbia , Canada
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Unsupervised Virtual Reality-Based Exercise Program Improves Hip Muscle Strength and Balance Control in Older Adults: A Pilot Study. Arch Phys Med Rehabil 2013; 94:937-43. [DOI: 10.1016/j.apmr.2012.12.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 11/06/2012] [Accepted: 12/11/2012] [Indexed: 11/18/2022]
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Borghese NA, Bottini G, Sedda A. Videogame based neglect rehabilitation: a role for spatial remapping and multisensory integration? Front Hum Neurosci 2013; 7:116. [PMID: 23565089 PMCID: PMC3613896 DOI: 10.3389/fnhum.2013.00116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 03/16/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- N A Borghese
- Laboratory of Applied Intelligent Systems, Computer Science Department, University of Milan Milan, Italy
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Wise EK, Hoffman JM, Powell JM, Bombardier CH, Bell KR. Benefits of Exercise Maintenance After Traumatic Brain Injury. Arch Phys Med Rehabil 2012; 93:1319-23. [DOI: 10.1016/j.apmr.2012.05.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/06/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
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Nolin P, Stipanicic A, Henry M, Joyal CC, Allain P. Virtual reality as a screening tool for sports concussion in adolescents. Brain Inj 2012; 26:1564-73. [PMID: 22775556 DOI: 10.3109/02699052.2012.698359] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE There is controversy surrounding the cognitive effects of sports concussion. This study aimed to verify whether the technique of virtual reality could aid in the identification of attention and inhibition deficits in adolescents. STUDY DESIGN A prospective design was used to assess 25 sports-concussed and 25 non-sports-concussed adolescents enrolled in a sport and education programme. METHODS AND PROCEDURES Participants were evaluated in immersive virtual reality via ClinicaVR: Classroom-CPT and in real life via the traditional VIGIL-CPT. MAIN OUTCOMES AND RESULTS The neuropsychological assessment using virtual reality showed greater sensitivity to the subtle effects of sports concussion compared to the traditional test, which showed no difference between groups. The results also demonstrated that the sports concussion group reported more symptoms of cybersickness and more intense cybersickness than the control group. CONCLUSIONS Sports concussion was associated with subtle deficits in attention and inhibition. However, further studies are needed to support these results.
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Affiliation(s)
- Pierre Nolin
- Laboratoire de Recherche Interdisciplinaire en Réalité Virtuelle, Département de Psychologie, Université du Québec à Trois-Rivières, Québec, Canada.
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A Game-Based Virtualized Reality Approach for Simultaneous Rehabilitation of Motor Skill and Confidence. ADVANCES IN HUMAN-COMPUTER INTERACTION 2012. [DOI: 10.1155/2012/213143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Virtualized reality games offer highly interactive and engaging user experience and therefore game-based approaches (GBVR) may have significant potential to enhance clinical rehabilitation practice as traditional therapeutic exercises are often repetitive and boring, reducing patient compliance. The aim of this study was to investigate if a rehabilitation training programme using GBVR could simultaneously improve both motor skill (MS) and confidence (CON), as they are both important determinants of daily living and physical and social functioning. The study was performed using a nondominant hand motor deficit model in nonambidextrous healthy young adults, whereby dominant and nondominant arms acted as control and intervention conditions, respectively. GBVR training was performed using a commercially available tennis-based game. CON and MS were assessed by having each subject perform a comparable real-world motor task (RWMT) before and after training. Baseline CON and MS for performing the RWMT were significantly lower for the nondominant hand and improved after GBVR training, whereas there were no changes in the dominant (control) arm. These results demonstrate that by using a GBVR approach to address a MS deficit in a real-world task, improvements in both MS and CON can be facilitated and such approaches may help increase patient compliance.
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91
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Meldrum D, Glennon A, Herdman S, Murray D, McConn-Walsh R. Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo Wii(®) Fit Plus. Disabil Rehabil Assist Technol 2011; 7:205-10. [PMID: 22117107 DOI: 10.3109/17483107.2011.616922] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim of this study was to investigate the usability of the Nintendo Wii Fit Plus(®) (NWFP) in the treatment of balance impairment in vestibular and other neurological disease. METHODS This was a cross-sectional, quasi-experimental study. Participants (n = 26; mean age 43 ± 14, M13:F13) with quantified balance impairment took part in a 30-minute session on the NWFP using exercises and games that challenge balance. Outcomes included the System Usability Scale (SUS), a numerical rating scale of enjoyment and a post treatment questionnaire. RESULTS The mean SUS score was high (mean 82 ± 18%) with only two participants rating below 50%. There was a negative correlation of age with SUS scores (r = -0.54; p = 0.004). Mean numerical rating scale score (/10) for enjoyment of the NWFP session was 8.4 ± 3. Of the participants, 88.5% said that they would like to use the NWFP in future treatment. Seventy-three percent reported more enjoyment and motivation than usual physiotherapy. No falls occurred during testing. CONCLUSIONS This study has quantified the usability of the NWFP as a treatment for balance impairment showing high levels of usability and enjoyment with no serious adverse effects. The results of this study may assist physiotherapists in devising novel balance rehabilitation programmes. [Box: see text].
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Affiliation(s)
- Dara Meldrum
- Royal College of Surgeons in Ireland, School of Physiotherapy, Dublin, Ireland.
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Ustinova KI, Leonard WA, Cassavaugh ND, Ingersoll CD. Development of a 3D immersive videogame to improve arm-postural coordination in patients with TBI. J Neuroeng Rehabil 2011; 8:61. [PMID: 22040301 PMCID: PMC3214849 DOI: 10.1186/1743-0003-8-61] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/31/2011] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame--Octopus. The game was developed using the basic principles of videogame design and previous experience of using videogames for rehabilitation of patients with acquired brain injuries. Unlike many other custom-designed virtual environments, Octopus included an actual gaming component with a system of multiple rewards, making the game challenging, competitive, motivating and fun. Effect of a short-term practice with the Octopus game on arm-postural coordination in patients with TBI was tested. METHODS The game was developed using WorldViz Vizard software, integrated with the Qualysis system for motion analysis. Avatars of the participant's hands precisely reproducing the real-time kinematic patterns were synchronized with the simulated environment, presented in the first person 3D view on an 82-inch DLP screen. 13 individuals with mild-to-moderate manifestations of TBI participated in the study. While standing in front of the screen, the participants interacted with a computer-generated environment by popping bubbles blown by the Octopus. The bubbles followed a specific trajectory. Interception of the bubbles with the left or right hand avatar allowed flexible use of the postural segments for balance maintenance and arm transport. All participants practiced ten 90-s gaming trials during a single session, followed by a retention test. Arm-postural coordination was analysed using principal component analysis. RESULTS As a result of the short-term practice, the participants improved in game performance, arm movement time, and precision. Improvements were achieved mostly by adapting efficient arm-postural coordination strategies. Of the 13 participants, 10 showed an immediate increase in arm forward reach and single-leg stance time. CONCLUSION These results support the feasibility of using the custom-made 3D game for retraining of arm-postural coordination disrupted as a result of TBI.
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Affiliation(s)
- Ksenia I Ustinova
- The Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, MI, USA.
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as new treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles are being rapidly adopted in clinical settings; however, there is currently little information about their effectiveness. OBJECTIVES To evaluate the effects of virtual reality and interactive video gaming on upper limb, lower limb and global motor function after stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (March 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), EMBASE (1980 to March 2010) and seven additional databases. We also searched trials registries, conference proceedings, reference lists and contacted key researchers in the area and virtual reality equipment manufacturers. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ('an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion') in adults after stroke. The primary outcomes of interest were: upper limb function and activity, gait and balance function and activity and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted all investigators to obtain missing information. MAIN RESULTS We included 19 trials which involved 565 participants. Study sample sizes were generally small and interventions and outcome measures varied, limiting the ability to which studies could be compared. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOMES results were statistically significant for arm function (standardised mean difference (SMD) 0.53, 95% confidence intervals (CI) 0.25 to 0.81 based on seven studies with 205 participants). There were no statistically significant effects for grip strength or gait speed. We were unable to determine the effect on global motor function due to insufficient numbers of comparable studies. SECONDARY OUTCOMES results were statistically significant for activities of daily living (ADL) outcome (SMD 0.81, 95% CI 0.39 to 1.22 based on three studies with 101 participants); however, we were unable to pool results for cognitive function, participation restriction and quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 34% (standard deviation (SD) 26, range 17 to 80) of participants screened were recruited. AUTHORS' CONCLUSIONS We found limited evidence that the use of virtual reality and interactive video gaming may be beneficial in improving arm function and ADL function when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength or gait speed. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term. Furthermore, there are currently very few studies evaluating the use of commercial gaming consoles (such as the Nintendo Wii).
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Affiliation(s)
- Kate E Laver
- Department of Rehabilitation and Aged Care, Flinders University, Repatriation General Hospitals, Daws Road, Daw Park, Adelaide, Australia, 5041
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Bland DC, Zampieri C, Damiano DL. Effectiveness of physical therapy for improving gait and balance in individuals with traumatic brain injury: a systematic review. Brain Inj 2011; 25:664-79. [PMID: 21561297 DOI: 10.3109/02699052.2011.576306] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The purpose of this review was to investigate the efficacy or effectiveness of non-aerobic exercise interventions to improve balance and gait in functionally mild-to-moderate individuals with TBI (those who demonstrate the ability or capacity to ambulate) and to provide evidence-based guidelines for clinical practice. METHODS The authors searched eight databases for papers including exercise interventions to improve gait and balance post-TBI. Twenty papers fully met inclusion criteria. The quality of studies was determined by the Physiotherapy Evidence Database (PEDro) scale and strength by Sackett's Levels of Evidence. RESULTS This study found limited evidence of the positive effects of balance, gait or the combination of both interventions in TBI rehabilitation. Most studies included small sample sizes with heterogeneous groups and the interventions were variable and lacked standardization. The outcome measures were variable and low in quality. CONCLUSIONS The state of evidence for gait and balance interventions in patients with mild-to-moderate TBI is surprisingly poor. Greater consideration and conformity in the choice of outcome measures and attention in the design and standardization treatment approaches are essential in future research to advance practice.
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Affiliation(s)
- Daniel C Bland
- Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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An intensive virtual reality program improves functional balance and mobility of adolescents with cerebral palsy. Pediatr Phys Ther 2011; 23:258-66. [PMID: 21829120 DOI: 10.1097/pep.0b013e318227ca0f] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine functional balance and mobility in adolescents with cerebral palsy classified at Gross Motor Function Classification System (GMFCS) level I following an intensive short-duration virtual reality (VR) intervention. METHODS Single-subject, multiple-baseline design with 4 adolescents. Outcomes included the Community Balance and Mobility Scale (CB&M), the 6-Minute Walk Test (6MWT), the Timed Up and Down Stairs, and the Gross Motor Function Measure Dimension E. Assessments were recorded 3 to 6 times at baseline, 5 times during intervention, and 4 times at follow-up. Daily 90-minute VR intervention was completed for 5 consecutive days. Visual, statistical, and clinical significance analyses were used. RESULTS Statistically significant improvements were shown in all adolescents on CB&M and 6MWT. True change was recorded in all for the CB&M and in 3 for the 6MWT. CONCLUSIONS Functional balance and mobility in adolescents with cerebral palsy classified at GMFCS level I improve with intense, short duration VR intervention, and changes are maintained at 1-month posttraining.
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Brütsch K, Schuler T, Koenig A, Zimmerli L, -Koeneke SM, Lünenburger L, Riener R, Jäncke L, Meyer-Heim A. Influence of virtual reality soccer game on walking performance in robotic assisted gait training for children. J Neuroeng Rehabil 2010; 7:15. [PMID: 20412572 PMCID: PMC2877051 DOI: 10.1186/1743-0003-7-15] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 04/22/2010] [Indexed: 01/19/2023] Open
Abstract
Background Virtual reality (VR) offers powerful therapy options within a functional, purposeful and motivating context. Several studies have shown that patients' motivation plays a crucial role in determining therapy outcome. However, few studies have demonstrated the potential of VR in pediatric rehabilitation. Therefore, we developed a VR-based soccer scenario, which provided interactive elements to engage patients during robotic assisted treadmill training (RAGT). The aim of this study was to compare the immediate effect of different supportive conditions (VR versus non-VR conditions) on motor output in patients and healthy control children during training with the driven gait orthosis Lokomat®. Methods A total of 18 children (ten patients with different neurological gait disorders, eight healthy controls) took part in this study. They were instructed to walk on the Lokomat in four different, randomly-presented conditions: (1) walk normally without supporting assistance, (2) with therapists' instructions to promote active participation, (3) with VR as a motivating tool to walk actively and (4) with the VR tool combined with therapists' instructions. The Lokomat gait orthosis is equipped with sensors at hip and knee joint to measure man-machine interaction forces. Additionally, subjects' acceptance of the RAGT with VR was assessed using a questionnaire. Results The mixed ANOVA revealed significant main effects for the factor CONDITIONS (p < 0.001) and a significant interaction CONDITIONS × GROUP (p = 0.01). Tests of between-subjects effects showed no significant main effect for the GROUP (p = 0.592). Active participation in patients and control children increased significantly when supported and motivated either by therapists' instructions or by a VR scenario compared with the baseline measurement "normal walking" (p < 0.001). Conclusions The VR scenario used here induces an immediate effect on motor output to a similar degree as the effect resulting from verbal instructions by the therapists. Further research needs to focus on the implementation of interactive design elements, which keep motivation high across and beyond RAGT sessions, especially in pediatric rehabilitation.
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Affiliation(s)
- Karin Brütsch
- Institute of Psychology, Division Neuropsychology, University of Zurich, Switzerland.
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Ustinova K, Perkins J, Szostakowski L, Tamkei L, Leonard W. Effect of viewing angle on arm reaching while standing in a virtual environment: potential for virtual rehabilitation. Acta Psychol (Amst) 2010; 133:180-90. [PMID: 20021998 DOI: 10.1016/j.actpsy.2009.11.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 11/08/2009] [Accepted: 11/14/2009] [Indexed: 10/20/2022] Open
Abstract
Functional arm movements, such as reaching while standing, are planned and executed according to our perception of body position in space and are relative to environmental objects. The angle under which the environment is observed is one component used in creating this perception. This suggests that manipulation of viewing angle may modulate whole body movement to affect performance. We tested this by comparing its effect on reaching in a virtually generated environment. Eleven young healthy individuals performed forward and lateral reaches in the virtual environment, presented on a flat screen in third-person perspective. Participants saw a computer-generated model (avatar) of themselves standing in a courtyard facing a semi-circular hedge with flowers. The image was presented in five different viewing angles ranging from seeing the avatar from behind (0 degrees), to viewing from overhead (90 degrees). Participants attempted to touch the furthest flower possible without losing balance or stepping. Kinematic data were collected to analyze endpoint displacement, arm-postural coordination and center of mass (COM) displacement. Results showed that reach distance was greatest with angular perspectives of approximately 45-77.5 degrees , which are larger than those used in analogous real world situations. Larger reaches were characterized by increased involvement of leg and trunk body segments, altered inter-segmental coordination, and decreased inter-segmental movement time lag. Thus a viewing angle can be a critical visuomotor variable modulating motor coordination of the whole body and related functional performance. These results can be used in designing virtual reality games, in ergonomic design, teleoperation training, and in designing virtual rehabilitation programs that re-train functional movement in vulnerable individuals.
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