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Booth ATC, van der Krogt MM, Buizer AI, Steenbrink F, Harlaar J. The validity and usability of an eight marker model for avatar-based biofeedback gait training. Clin Biomech (Bristol, Avon) 2019; 70:146-152. [PMID: 31499394 DOI: 10.1016/j.clinbiomech.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/18/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Virtual reality presents a platform for therapeutic gaming, and incorporation of immersive biofeedback on gait may enhance outcomes in rehabilitation. Time is limited in therapeutic practice, therefore any potential gait training tool requires a short set up time, while maintaining clinical relevance and accuracy. The aim of this study was to develop, validate, and establish the usability of an avatar-based application for biofeedback-enhanced gait training with minimal set up time. METHODS A simplified, eight marker model was developed using eight passive markers placed on anatomical landmarks. This allowed for visualisation of avatar-based biofeedback on pelvis kinematics, hip and knee sagittal angles in real-time. Retrospective gait analysis data from typically developing children (n = 41) and children with cerebral palsy (n = 25), were used to validate eight marker model. Gait outcomes were compared to the Human Body Model using statistical parametric mapping. Usability for use in clinical practice was tested in five clinical rehabilitation centers with the system usability score. FINDINGS Gait outcomes of Human Body Model and eight marker model were comparable, with small differences in gait parameters. The discrepancies between models were <5°, except for knee extension where eight marker model showed significantly less knee extension, especially towards full extension. The application was considered of 'high marginal acceptability' (system usability score, mean 68 (SD 13)). INTERPRETATION Gait biofeedback can be achieved, to acceptable accuracy for within-session gait training, using an eight marker model. The application may be considered usable and implemented for use in patient populations undergoing gait training.
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Affiliation(s)
- A T C Booth
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Netherlands; Department of Clinical Applications and Research, Motek Medical B.V., Amsterdam, Netherlands.
| | - M M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Netherlands
| | - A I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Netherlands
| | - F Steenbrink
- Department of Clinical Applications and Research, Motek Medical B.V., Amsterdam, Netherlands
| | - J Harlaar
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam Movement Sciences, Netherlands; Department Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
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102
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Bevilacqua R, Maranesi E, Riccardi GR, Di Donna V, Pelliccioni P, Luzi R, Lattanzio F, Pelliccioni G. Non-Immersive Virtual Reality for Rehabilitation of the Older People: A Systematic Review into Efficacy and Effectiveness. J Clin Med 2019; 8:E1882. [PMID: 31694337 PMCID: PMC6912349 DOI: 10.3390/jcm8111882] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 01/17/2023] Open
Abstract
: Objective: the objective of this review is to analyze the advances in the field of rehabilitation through virtual reality, while taking into account non-immersive systems, as evidence have them shown to be highly accepted by older people, due to the lowest "cibersikness" symptomatology. DATA SOURCES a systematic review of the literature was conducted in June 2019. The data were collected from Cochrane, Embase, Scopus, and PubMed databases, analyzing manuscripts and articles of the last 10 years. STUDY SELECTION we only included randomized controlled trials written in English aimed to study the use of the virtual reality in rehabilitation. We selected 10 studies, which were characterized by clinical heterogeneity. DATA EXTRACTION quality evaluation was performed based on the Physioterapy Evidence Database (PEDro) scale, suggested for evidence based review of stroke rehabilitation. Of 10 studies considered, eight were randomized controlled trials and the PEDro score ranged from four to a maximum of nine. DATA SYNTHESIS VR (Virtual Reality) creates artificial environments with the possibility of a patient interaction. This kind of experience leads to the development of cognitive and motor abilities, which usually positively affect the emotional state of the patient, increasing collaboration and compliance. Some recent studies have suggested that rehabilitation treatment interventions might be useful and effective in treating motor and cognitive symptoms in different neurological disorders, including traumatic brain injury, multiple sclerosis, and progressive supranuclear palsy. CONCLUSIONS as it is shown by the numerous studies in the field, the application of VR has a positive impact on the rehabilitation of the most predominant geriatric syndromes. The level of realism of the virtual stimuli seems to have a crucial role in the training of cognitive abilities. Future research needs to improve study design by including larger samples, longitudinal designs, long term follow-ups, and different outcome measures, including functional and quality of life indexes, to better evaluate the clinical impact of this promising technology in healthy old subjects and in neurological patients.
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Affiliation(s)
| | - Elvira Maranesi
- Scientific Direction, IRCCS INRCA, 60129 Ancona, Italy; (R.B.); (F.L.)
| | | | - Valentina Di Donna
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60100 Ancona, Italy; (G.R.R.); (V.D.D.)
| | | | - Riccardo Luzi
- Medical Direction, IRCCS INRCA, 60100 Ancona, Italy;
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103
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Vision-based serious games and virtual reality systems for motor rehabilitation: A review geared toward a research methodology. Int J Med Inform 2019; 131:103909. [DOI: 10.1016/j.ijmedinf.2019.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/19/2019] [Accepted: 06/17/2019] [Indexed: 02/03/2023]
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104
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Reinkensmeyer DJ. JNER at 15 years: analysis of the state of neuroengineering and rehabilitation. J Neuroeng Rehabil 2019; 16:144. [PMID: 31744511 PMCID: PMC6864952 DOI: 10.1186/s12984-019-0610-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/16/2019] [Indexed: 11/10/2022] Open
Abstract
On JNER's 15th anniversary, this editorial analyzes the state of the field of neuroengineering and rehabilitation. I first discuss some ways that the nature of neurorehabilitation research has evolved in the past 15 years based on my perspective as editor-in-chief of JNER and a researcher in the field. I highlight increasing reliance on advanced technologies, improved rigor and openness of research, and three, related, new paradigms - wearable devices, the Cybathlon competition, and human augmentation studies - indicators that neurorehabilitation is squarely in the age of wearability. Then, I briefly speculate on how the field might make progress going forward, highlighting the need for new models of training and learning driven by big data, better personalization and targeting, and an increase in the quantity and quality of usability and uptake studies to improve translation.
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Affiliation(s)
- David J Reinkensmeyer
- Department of Mechanical and Aerospace Engineering, University of California at Irvine, California, USA. .,Department of Anatomy and Neurobiology, University of California at Irvine, California, USA. .,Department of Biomedical Engineering, University of California at Irvine, California, USA. .,Department of Physical Medicine and Rehabilitation, University of California at Irvine, California, USA.
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105
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Virtual Reality and Noninvasive Brain Stimulation in Stroke: How Effective Is Their Combination for Upper Limb Motor Improvement?-A Meta-Analysis. PM R 2019; 10:1261-1270. [PMID: 30503233 DOI: 10.1016/j.pmrj.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/06/2018] [Accepted: 10/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Efforts to augment post-stroke upper limb (UL) motor improvement include the use of newer interventions such as noninvasive brain stimulation (NIBS) and task practice in virtual reality environments (VEs). Despite increasing interest in using a combination of these 2 interventions, the effectiveness of this combination to enhance UL motor improvement outcomes has not been examined. OBJECTIVE To evaluate the effectiveness of a combination of NIBS and task practice in a VE to augment post-stroke UL motor improvement. METHODS We conducted a systematic search of the published literature using standard methodology. The Down and Black checklist and the Physiotherapy Evidence Database Research Organization Scale were used to assess study quality. We compared changes in UL impairment and activity levels between active stimulation and sham or other interventions using standardized mean differences and derived a summary effect size. RESULTS We retrieved 5 studies that examined the role of a combination of NIBS and task practice in a VE to optimize UL motor improvement. These 5 studies included 3 randomized controlled trials, 1 cross-sectional study, and 1 crossover study. There was level 1a evidence that the combination was beneficial in subacute stroke. There was level 1b evidence that provision of real stimulation was not superior to sham stimulation in chronic stroke. Effect sizes favoring the combination were moderate for improvements in UL impairment and small for activity levels. CONCLUSIONS Preliminary evidence supports the effectiveness of this combination in subacute stroke. Emergent questions need to be addressed to derive maximum benefit of this combination to augment post-stroke UL motor improvement. LEVEL OF EVIDENCE I.
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106
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The Influence of Forest Resting Environments on Stress Using Virtual Reality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183263. [PMID: 31491931 PMCID: PMC6765889 DOI: 10.3390/ijerph16183263] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/27/2019] [Accepted: 09/01/2019] [Indexed: 12/16/2022]
Abstract
To explore the effects of different types of forest environments for forest therapy, this study focused on forest resting environments. Seven representative forest resting environments found in field research in Beijing were used as independent variables and were shown to subjects by a virtual reality (VR) video. Stress level was used as the dependent variable, and blood pressure, heart rate, salivary amylase, and the Brief Profile of Mood States (BPOMS) were used as physiological and psychological indicators. A between-subjects design was used in the experiment. A total of 96 subjects were randomly assigned to each environment type, and only one type of forest resting environment was observed. Through the relevant sample t-test and one-way analysis of variance, the pre- and post-test data of the indicators were analyzed. This study found that all the seven different types of forest resting environments can produce stress relief effects to some extent. Different types of forest resting environments have different effects on relieving stress. The most natural environment does not have the most significant effect on stress relief. A water landscape has a positive effect on the relief of stress. The conclusions of this study are conducive to the better use of the forest environment for forest therapy services.
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107
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Mazzini NA, Almeida MGR, Pompeu JE, Polese JC, Torriani-Pasin C. A combination of multimodal physical exercises in real and virtual environments for individuals after chronic stroke: study protocol for a randomized controlled trial. Trials 2019; 20:436. [PMID: 31311595 PMCID: PMC6636041 DOI: 10.1186/s13063-019-3396-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Multimodal physical exercises already have well-established benefits for the post-stroke population that influence gait functional capacity, balance, gait, cognition, and quality of life. This type of intervention can be performed in both real and virtual environments. Considering the characteristics of both environments, it is questioned to what extent the combination of interventions in real and virtual environments could result in improvement in post-stroke impairments. Methods/design We will conduct a randomized clinical trial with three groups: a real multimodal group (RMG), a virtual multimodal group (VMG), and a combined multimodal group (CMG). It was estimated that we will need a sample of 36 participants (12 per group). RMG individuals will only perform multimodal physical exercises in a real environment two times per week for 60 min per session for 15 weeks. VMG individuals will perform exercises of the same duration over the same time frame but only in a virtual environment. CMG individuals will hold a weekly session in a real environment and another weekly session in virtual environment. The primary outcome measure will be health-related quality of life, evaluated using the Stroke Impact Scale; effects on cognition (Montreal Cognitive Assessment), balance (Berg Balance Scale), mobility (Timed Up & Go), self-selected gait speed (10-meter walk test), and gait functional capacity (6-min walk test) will be investigated as secondary outcome measures. Participants will be evaluated before the beginning of the intervention, immediately after the end of the intervention, and at 1-month follow-up without exercise. If the data meet the assumptions of the parametric analysis, the results will be evaluated by analysis of variance (3 × 3) for the group factor, with repeated measures while taking into account the time factor. The post hoc Tukey test will be used to detect differences (α = 0.05). Discussion This study represents the first clinical trial to include three groups considering physical exercise in real and virtual environments, isolated and combined, that counterbalances the intensity and volume of training in all groups. This study also includes a control of progression in all groups along the 15-week intervention. The outcome measures are innovative because, according to International Classification of Functioning, Disability and Health, activity and participation are the targets for effectiveness evaluation. Trial registration Combinação de exercícios físicos multimodais em ambientes real e virtual para indivíduos pós acidente vascular cerebral crônico, RBR-4pt72m. Registered on 29 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3396-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalia Araujo Mazzini
- Motor Behavior Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | | | - José Eduardo Pompeu
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Janaine Cunha Polese
- Department of Physical Therapy, Medical Sciences College of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Camila Torriani-Pasin
- Motor Behavior Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil.
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108
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Hülsmann F, Frank C, Senna I, Ernst MO, Schack T, Botsch M. Superimposed Skilled Performance in a Virtual Mirror Improves Motor Performance and Cognitive Representation of a Full Body Motor Action. Front Robot AI 2019; 6:43. [PMID: 33501059 PMCID: PMC7805859 DOI: 10.3389/frobt.2019.00043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
Feedback is essential for skill acquisition as it helps identifying and correcting performance errors. Nowadays, Virtual Reality can be used as a tool to guide motor learning, and to provide innovative types of augmented feedback that exceed real world opportunities. Concurrent feedback has shown to be especially beneficial for novices. Moreover, watching skilled performances helps novices to acquire a motor skill, and this effect depends on the perspective taken by the observer. To date, however, the impact of watching one's own performance together with full body superimposition of a skilled performance, either from the front or from the side, remains to be explored. Here we used an immersive, state-of-the-art, low-latency cave automatic virtual environment (CAVE), and we asked novices to perform squat movements in front of a virtual mirror. Participants were assigned to one of three concurrent visual feedback groups: participants either watched their own avatar performing full body movements or were presented with the movement of a skilled individual superimposed on their own performance during movement execution, either from a frontal or from a side view. Motor performance and cognitive representation were measured in order to track changes in movement quality as well as motor memory across time. Consistent with our hypotheses, results showed an advantage of the groups that observed their own avatar performing the squat together with the superimposed skilled performance for some of the investigated parameters, depending on perspective. Specifically, for the deepest point of the squat, participants watching the squat from the front adapted their height, while those watching from the side adapted their backward movement. In a control experiment, we ruled out the possibility that the observed improvements were due to the mere fact of performing the squat movements—irrespective of the type of visual feedback. The present findings indicate that it can be beneficial for novices to watch themselves together with a skilled performance during execution, and that improvement depends on the perspective chosen.
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Affiliation(s)
- Felix Hülsmann
- Computer Graphics and Geometry Processing, Bielefeld University, Bielefeld, Germany.,Social Cognitive Systems, Bielefeld University, Bielefeld, Germany
| | - Cornelia Frank
- Neurocognition and Action, Bielefeld University, Bielefeld, Germany
| | - Irene Senna
- Applied Cognitive Psychology, Ulm University, Ulm, Germany
| | - Marc O Ernst
- Applied Cognitive Psychology, Ulm University, Ulm, Germany
| | - Thomas Schack
- Neurocognition and Action, Bielefeld University, Bielefeld, Germany
| | - Mario Botsch
- Computer Graphics and Geometry Processing, Bielefeld University, Bielefeld, Germany
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109
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Keshner EA, Weiss PT, Geifman D, Raban D. Tracking the evolution of virtual reality applications to rehabilitation as a field of study. J Neuroeng Rehabil 2019; 16:76. [PMID: 31226995 PMCID: PMC6588867 DOI: 10.1186/s12984-019-0552-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/14/2019] [Indexed: 11/23/2022] Open
Abstract
Background Application of virtual reality (VR) to rehabilitation is relatively recent with clinical implementation very rapidly following technological advancement and scientific discovery. Implementation is often so rapid that demonstrating intervention efficacy and establishing research priorities is more reactive than proactive. This study used analytical tools from information science to examine whether application of VR to rehabilitation has evolved as a distinct field of research or is primarily a methodology in core disciplines such as biomedical engineering, medicine and psychology. Methods The analysis was performed in three-stages: 1) a bibliographic search in the ISI Web of Science database created an initial corpus of publications, 2) the corpus was refined through topic modeling, and 3) themes dominating the corpus from the refined search results were identified by topic modeling and network analytics. This was applied separately to each of three time periods: 1996 to 2005 (418 publications), 2006 to 2014 (1454 publications), and 2015 to mid-2018 (1269 publications). Results Publication rates have continuously increased across time periods with principal topics shifting from an emphasis on computer science and psychology to rehabilitation and public health. No terminology specific to the field of VR-based rehabilitation emerged; rather a range of central concepts including “virtual reality”, “virtual gaming”, “virtual environments”, “simulated environments” continue to be used. Communities engaged in research or clinical application of VR form assemblages distinguished by a focus on physical or psychological rehabilitation; these appear to be weakly linked through tele-rehabilitation. Conclusions Varying terms exemplify the main corpus of VR-based rehabilitation and terms are not consistent across the many scientific domains. Numerous distinguishable areas of research and clinical foci (e.g., Tele-rehabilitation, Gait & Balance, Cognitive Rehabilitation, Gaming) define the agenda. We conclude that VR-based rehabilitation consists of a network of scientific communities with a shared interest in the methodology rather than a directed and focused research field. An interlinked team approach is important to maintain scientific rigor and technological validity within this diverse group. Future studies should examine how these interdisciplinary communities individually define themselves with the goals of gathering knowledge and working collectively toward disseminating information essential to associated research communities.
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Affiliation(s)
- Emily A Keshner
- Department of Physical Therapy, College of Public Health, Temple University, Ritter Annex Room 683, 1301 Cecil B. Moore Ave, Philadelphia, PA, 19122, USA.
| | - Patrice Tamar Weiss
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dorit Geifman
- Faculty of Management, University of Haifa, Haifa, Israel
| | - Daphne Raban
- Faculty of Management, University of Haifa, Haifa, Israel
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110
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Martinez-Martin E, Cazorla M. Rehabilitation Technology: Assistance from Hospital to Home. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2019; 2019:1431509. [PMID: 31281333 PMCID: PMC6589308 DOI: 10.1155/2019/1431509] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/28/2019] [Indexed: 11/18/2022]
Abstract
Rehabilitation is essential for disabled people to achieve the highest level of functional independence, reducing or preventing impairments. Nonetheless, this process can be long and expensive. This fact together with the ageing phenomenon has become a critical issue for both clinicians and patients. In this sense, technological solutions may be beneficial since they reduce the costs and increase the number of patients per caregiver, which makes them more accessible. In addition, they provide access to rehabilitation services for those facing physical, financial, and/or attitudinal barriers. This paper presents the state of the art of the assistive rehabilitation technologies for different recovery methods starting from in-person sessions to complementary at-home activities.
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Affiliation(s)
| | - Miguel Cazorla
- RoViT, University of Alicante, P.O. Box 99, 03080 Alicante, Spain
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111
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Choi HS, Shin WS, Bang DH. Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial. Med Sci Monit 2019; 25:3271-3278. [PMID: 31050660 PMCID: PMC6511112 DOI: 10.12659/msm.914095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror. Material/Methods A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test. Results Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group. Conclusions We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.
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Affiliation(s)
- Ho-Suk Choi
- Department of Physical Therapy, Collage of Health and Medical Science, Daejeon University, Daejeon, South Korea
| | - Won-Seob Shin
- Department of Physical Therapy, Collage of Health and Medical Science, Daejeon University, Daejeon, South Korea
| | - Dae-Hyouk Bang
- Department of Physical Therapy, Collage of Health and Medical Science, Daejeon University, Daejeon, South Korea
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112
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Tanioka R, Sugimoto H, Yasuhara Y, Ito H, Osaka K, Zhao Y, Kai Y, Locsin R, Tanioka T. Characteristics of Transactive Relationship Phenomena among Older adults, Care Workers as Intermediaries, and the Pepper Robot with Care Prevention Gymnastics Exercises. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:46-49. [DOI: 10.2152/jmi.66.46] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ryuichi Tanioka
- Graduate student, Tokushima Bunri University, Tokushima, Japan
| | | | - Yuko Yasuhara
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirokazu Ito
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Kyoko Osaka
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yueren Zhao
- Department of Psychiatry, School of Medicine, Fujita Health University, Aichi, Japan
| | - Yoshihiro Kai
- Department of Mechanical Engineering, School of Engineering, Tokai University, Kanagawa, Japan
| | - Rozzano Locsin
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tetsuya Tanioka
- Department of Nursing, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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113
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de Rooij IJM, van de Port IGL, Visser-Meily JMA, Meijer JWG. Virtual reality gait training versus non-virtual reality gait training for improving participation in subacute stroke survivors: study protocol of the ViRTAS randomized controlled trial. Trials 2019; 20:89. [PMID: 30696491 PMCID: PMC6352452 DOI: 10.1186/s13063-018-3165-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/22/2018] [Indexed: 11/29/2022] Open
Abstract
Background A stroke often results in gait impairments, activity limitations and restricted participation in daily life. Virtual reality (VR) has shown to be beneficial for improving gait ability after stroke. Previous studies regarding VR focused mainly on improvements in functional outcomes. As participation in daily life is an important goal for rehabilitation after stroke, it is of importance to investigate if VR gait training improves participation. The primary aim of this study is to examine the effect of VR gait training on participation in community-living people after stroke. Methods/design The ViRTAS study comprises a single-blinded, randomized controlled trial with two parallel groups. Fifty people between 2 weeks and 6 months after stroke, who experience constraints with walking in daily life, are randomly assigned to the virtual reality gait training (VRT) group or the non-virtual reality gait training (non-VRT) group. Both training interventions consist of 12 30-min sessions in an outpatient rehabilitation clinic during 6 weeks. Assessments are performed at baseline, post intervention and 3 months post intervention. The primary outcome is participation measured with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). Secondary outcomes are subjective physical functioning, functional mobility, walking ability, walking activity, fatigue, anxiety and depression, falls efficacy and quality of life. Discussion The results of the study provide insight into the effect of VR gait training on participation after stroke. Trial registration Netherlands National Trial Register, Identifier NTR6215. Registered on 3 February 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3165-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ilona J M de Rooij
- Revant Rehabilitation Centres, Breda, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Jan-Willem G Meijer
- Revant Rehabilitation Centres, Breda, The Netherlands.,Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
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114
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Yeo E, Chau B, Chi B, Ruckle DE, Ta P. Virtual Reality Neurorehabilitation for Mobility in Spinal Cord Injury: A Structured Review. INNOVATIONS IN CLINICAL NEUROSCIENCE 2019; 16:13-20. [PMID: 31037223 PMCID: PMC6450679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Objective: The goal of this review was to evaluate the evidence regarding the use of virtual reality (VR) therapy for improvement of mobility in patients with spinal cord injury (SCI). Methods: A comprehensive literature search was conducted utilizing PubMed, CINAHL, EMBASE, and PsycINFO databases in April 2018. The phrase "virtual reality" and a combination of "spinal cord injury," "tetraplegia," "quadriplegia," or "paraplegia" were used as search terms. References included selected articles were reviewed as well. Articles were filtered based on the following inclusion criteria: 1) written in English, 2) peer-reviewed, 3) VR used for patients with SCI, and 4) changes in motor function evaluated. Main outcome measurements: Common outcomes of mobility assessment used in the studies included the Functional Reach Test (FRT), Functional Independence Measure (FIM), Limit of Stability (LOS), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Walking Index for Spinal Cord Injury II (WISCI II) scale. Results: Seven of the nine reviewed articles were case series, while two were randomized, controlled trials. Reviewed literature demonstrated significant benefit in FRT, BBS, gait speed, muscle strength, SCIM, and WISCI-II using VR therapy. Voluntary muscle control improvement was also observed. However, no significant differences were found with regard to finehand motor movement. Conclusion: This literature review demonstrated mostly positive outcomes for the use of VR for SCI rehabilitation but were limited in quality and scope. Larger, multicenter trials are still needed.
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Affiliation(s)
- Elizabeth Yeo
- Ms. Yeo, Dr. Chau, Mr. Chi, and Dr. Ta are with the Department of Physical Medicine & Rehabilitation at Loma Linda University Health Department in Loma Linda, California
- Mr. Ruckle is with Loma Linda University School of Medicine in Loma Linda, California
| | - Brian Chau
- Ms. Yeo, Dr. Chau, Mr. Chi, and Dr. Ta are with the Department of Physical Medicine & Rehabilitation at Loma Linda University Health Department in Loma Linda, California
- Mr. Ruckle is with Loma Linda University School of Medicine in Loma Linda, California
| | - Bradley Chi
- Ms. Yeo, Dr. Chau, Mr. Chi, and Dr. Ta are with the Department of Physical Medicine & Rehabilitation at Loma Linda University Health Department in Loma Linda, California
- Mr. Ruckle is with Loma Linda University School of Medicine in Loma Linda, California
| | - David E Ruckle
- Ms. Yeo, Dr. Chau, Mr. Chi, and Dr. Ta are with the Department of Physical Medicine & Rehabilitation at Loma Linda University Health Department in Loma Linda, California
- Mr. Ruckle is with Loma Linda University School of Medicine in Loma Linda, California
| | - Phillip Ta
- Ms. Yeo, Dr. Chau, Mr. Chi, and Dr. Ta are with the Department of Physical Medicine & Rehabilitation at Loma Linda University Health Department in Loma Linda, California
- Mr. Ruckle is with Loma Linda University School of Medicine in Loma Linda, California
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115
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Martelli D, Xia B, Prado A, Agrawal SK. Gait adaptations during overground walking and multidirectional oscillations of the visual field in a virtual reality headset. Gait Posture 2019; 67:251-256. [PMID: 30388606 DOI: 10.1016/j.gaitpost.2018.10.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Virtual reality (VR) has been used to study locomotor adaptability during balance-demanding tasks by exploring how humans react and adapt to the virtual environment (VE) and discordant sensorimotor stimulations. Previous research primarily focused on treadmill walking and little is known regarding the propensity for gait adaptations during overground walking and over time. RESEARCH QUESTION To what extent healthy young adults modify and adapt gait during overground walking in a VE and with continuous multidirectional perturbations of the visual field while wearing a VR headset? METHODS Twelve healthy young adults walked for 6 min on an instrumented walkway in four different conditions: RE, VE, and VE with antero-posterior (AP) and medio-lateral (ML) pseudo-random oscillations of the visual field. For each condition, stride length (SL), stride width (SW), stride time (ST) and their variability (SLV, SWV, and STV) were calculated using one-minute walking intervals. A 2-way repeated-measures ANOVA was performed to determine the main and interaction effects of the walking conditions and time. RESULTS Participants took shorter SL and showed higher SWV while walking in the VE. Perturbations of the visual field resulted in reduced SL, larger SW, and higher stride variability (i.e., SLV, SWV, and STV). The response was anisotropic, such that effects were more pronounced during the ML compared to AP perturbations. Over time, participants adapted to the VE and the visual perturbations by increasing SL and reducing SW, SLV, STV, and ST (only during VE and ML conditions). SWV did not adapt over time. SIGNIFICANCE The paper provided first evidence for visuomotor adaptations during unperturbed overground walking and during visual perturbations while wearing a VR headset. It represents an initial investigation that may help the development of new VR methods for early detection and remediation of gait deficits in more ecological conditions.
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Affiliation(s)
- Dario Martelli
- Department of Mechanical Engineering, Columbia University, New York, United States.
| | - Boxi Xia
- Department of Mechanical Engineering, Columbia University, New York, United States
| | - Antonio Prado
- Department of Mechanical Engineering, Columbia University, New York, United States
| | - Sunil K Agrawal
- Department of Mechanical Engineering, Columbia University, New York, United States; Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, United States.
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116
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Baur K, Schättin A, de Bruin ED, Riener R, Duarte JE, Wolf P. Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games. J Neuroeng Rehabil 2018; 15:107. [PMID: 30454009 PMCID: PMC6245892 DOI: 10.1186/s12984-018-0449-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework. METHODS A systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training. RESULTS Thirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode. CONCLUSIONS The multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player's skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players' game conditions.
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Affiliation(s)
- Kilian Baur
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland. .,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland.
| | - Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland, Leopold-Ruzicka-Weg 4, Zurich, 8093, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden, Alfred Nobels Alle 23, Huddinge, 141 83, Sweden
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland
| | - Jaime E Duarte
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland.,MyoSwiss AG, Lengghalde 5, Zürich, CH-8008, Switzerland
| | - Peter Wolf
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Tannenstrasse 1, Zurich, 8092, Switzerland.,Spinal Cord Injury Center, University Hospital Balgrist, University of Zurich, Zurich, Switzerland, Forchstrasse 340, Zurich, 8008, Switzerland
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Lopes JM. Is virtual reality really effective in Parkinson's disease? ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:642-643. [PMID: 30365632 DOI: 10.1590/0004-282x20180079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/02/2018] [Indexed: 11/21/2022]
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118
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Spiegel JS. The Ethics of Virtual Reality Technology: Social Hazards and Public Policy Recommendations. SCIENCE AND ENGINEERING ETHICS 2018; 24:1537-1550. [PMID: 28942536 DOI: 10.1007/s11948-017-9979-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
This article explores four major areas of moral concern regarding virtual reality (VR) technologies. First, VR poses potential mental health risks, including Depersonalization/Derealization Disorder. Second, VR technology raises serious concerns related to personal neglect of users' own actual bodies and real physical environments. Third, VR technologies may be used to record personal data which could be deployed in ways that threaten personal privacy and present a danger related to manipulation of users' beliefs, emotions, and behaviors. Finally, there are other moral and social risks associated with the way VR blurs the distinction between the real and illusory. These concerns regarding VR naturally raise questions about public policy. The article makes several recommendations for legal regulations of VR that together address each of the above concerns. It is argued that these regulations would not seriously threaten personal liberty but rather would protect and enhance the autonomy of VR consumers.
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Affiliation(s)
- James S Spiegel
- Taylor University, 236 West Reade Ave., Upland, IN, 46989, USA.
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119
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Janeh O, Bruder G, Steinicke F, Gulberti A, Poetter-Nerger M. Analyses of Gait Parameters of Younger and Older Adults During (Non-)Isometric Virtual Walking. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2018; 24:2663-2674. [PMID: 29990158 DOI: 10.1109/tvcg.2017.2771520] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Understanding real walking in virtual environments (VEs) is important for immersive experiences, allowing users to move through VEs in the most natural way. Previous studies have shown that basic implementations of real walking in virtual spaces, in which head-tracked movements are mapped isometrically to a VE, are not estimated as entirely natural. Instead, users estimate a virtual walking velocity as more natural when it is slightly increased compared to the user's physical locomotion. However, these findings have been reported in most cases only for young persons, e.g., students, whereas older adults are clearly underrepresented in such studies. Recently, virtual reality (VR) has received significant public and media attention. Therefore, it appears reasonable to assume that people at different ages will have access to VR, and might use this technology more and more in application scenarios such as rehabilitation or training. To better understand how people at different ages walk and perceive locomotion in VR, we have performed a study to investigate the effects of (non-)isometric mappings between physical movements and virtual motions in the VE on the walking biomechanics across generations, i.e., younger and older adults. Three primary domains (pace, base of support and phase) of spatio-temporal parameters were identified to evaluate gait performance. The results show that the older adults walked very similar in the real and VE in the pace and phasic domains, which differs from results found in younger adults. In contrast, the results indicate differences in terms of base of support domain parameters for both groups while walking within a VE and the real world. For non-isometric mappings, we found in both younger and older adults an increased divergence of gait parameters in all domains correlating with the up- or down-scaled velocity of visual self-motion feedback. The results provide important insights into the design of future VR applications for older adults in domains ranging from medicine and psychology to rehabilitation.
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120
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Fragkou D, Gkrimas G, Pyrgeli M. Therapeutic interventions for trunk and improvement of posture in children with cerebral palsy: a review of the literature. ACTA ACUST UNITED AC 2018. [DOI: 10.15406/mojor.2018.10.00434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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121
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Lopes JBP, Duarte NDAC, Lazzari RD, Oliveira CS. Virtual reality in the rehabilitation process for individuals with cerebral palsy and Down syndrome: A systematic review. J Bodyw Mov Ther 2018; 24:479-483. [PMID: 33218550 DOI: 10.1016/j.jbmt.2018.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/07/2018] [Accepted: 05/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Childhood neurological diseases result in neuromotor impairment, which affects selective motor control, compromising the acquisition of motor skills and functional independence. The positive results achieved with virtual reality are believed to be related to training in an interactive environment that provides a broad range of activities and scenarios with multiple sensory channels, enabling the creation of exercises at an intensity based on individual need. Therefore, a review was conducted to answer the following question: What are the possible effects of virtual reality for the pediatric population, specifically children with cerebral palsy and Down syndrome? OBJECTIVE The objective of the present study was to conduct a systematic review of the literature to determine the possible effects of virtual reality therapy in children with cerebral palsy and Down's syndrome. METHODS The PubMed, Bireme, Scielo and PEDro electronic databases were searched in the period from January to March 2016 using the following keywords: Down syndrome and virtual reality, virtual reality and cerebral palsy, virtual reality and neuropediatrics, and Down's syndrome and virtual reality. Only randomized controlled trials published in English in the previous 10 years (2007-2016) that addressed the specific purpose of this review and achieved a score of at least 4 points on the PEDro methodological quality scale were eligible for inclusion. RESULTS The initial research led to the retrieval of 214 articles, which were analyzed considering the inclusion criteria. Eighteen articles were submitted to an appraisal of methodological quality using the PEDro scale, only five of which received a score of four or more points and were described in the present review. Three of the studies selected analyzed children with cerebral palsy and two analyzed children with Down syndrome. Despite the different physiopathological characteristics of the two conditions, the authors employed similar therapeutic methods and evaluations. The results of the studies demonstrated that virtual reality training either alone or combined with motor training leads to improvements in sensory-motor functions and can be used as a complement to other successful rehabilitation interventions in the two populations. CONCLUSION Based on the results of the studies included in the present systematic review, despite differences in the characteristics of each population, the objectives and methods proposed by the authors were similar and virtual reality demonstrated promising effects for individuals with cerebral palsy and Down syndrome.
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Affiliation(s)
| | | | - Roberta Delasta Lazzari
- Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, Brazil
| | - Claudia Santos Oliveira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de, São Paulo, Brazil; University Center of Anápolis, Goias, Brazil.
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Corriveau Lecavalier N, Ouellet É, Boller B, Belleville S. Use of immersive virtual reality to assess episodic memory: A validation study in older adults. Neuropsychol Rehabil 2018; 30:462-480. [PMID: 29807474 DOI: 10.1080/09602011.2018.1477684] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Virtual reality (VR) allows for the creation of ecological environments that could be used for cognitive assessment and intervention. This study comprises two parts that describe and assess an immersive VR task, the Virtual Shop, which can be used to measure episodic memory. Part 1 addresses its applicability in healthy older adults by measuring presence, motivation, and cybersickness symptoms. Part 2 addresses its construct validity by investigating correlations between performance in the VR task and on a traditional experimental memory task, and by measuring whether the VR task is sensitive to age-related memory differences. Fifty-seven older and 20 younger adults were assessed in the Virtual Shop, in which they memorised and fetched 12 familiar items. Part 1 showed high levels of presence, higher levels of motivation for the VR than for the traditional task, and negligible cybersickness symptoms. Part 2 indicates that memory performance in the VR task is positively correlated with performance on a traditional memory task for both age groups, and age-related differences were found on the VR and traditional memory tasks. Thus, the use of VR is feasible in older adults and the Virtual Shop is a valid task to assess and train episodic memory in this population.
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Affiliation(s)
- Nick Corriveau Lecavalier
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Canada
| | - Émilie Ouellet
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Canada
| | - Benjamin Boller
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Canada
| | - Sylvie Belleville
- Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada.,Department of Psychology, University of Montreal, Montreal, Canada
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123
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Hussain N, Alt Murphy M, Sunnerhagen KS. Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality. Front Neurol 2018; 9:300. [PMID: 29867717 PMCID: PMC5954035 DOI: 10.3389/fneur.2018.00300] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. Objective To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Methods Sixty-seven participants with moderate (32–57 points) or mild (58–65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg—SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. Results The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider’s web) close to the target indicating deficits in movement precision. Conclusion The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. Trial registration details The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.
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Affiliation(s)
- Netha Hussain
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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124
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Rose T, Nam CS, Chen KB. Immersion of virtual reality for rehabilitation - Review. APPLIED ERGONOMICS 2018; 69:153-161. [PMID: 29477323 DOI: 10.1016/j.apergo.2018.01.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 01/10/2018] [Accepted: 01/21/2018] [Indexed: 05/14/2023]
Abstract
Virtual reality (VR) shows promise in the application of healthcare and because it presents patients an immersive, often entertaining, approach to accomplish the goal of improvement in performance. Eighteen studies were reviewed to understand human performance and health outcomes after utilizing VR rehabilitation systems. We aimed to understand: (1) the influence of immersion in VR performance and health outcomes; (2) the relationship between enjoyment and potential patient adherence to VR rehabilitation routine; and (3) the influence of haptic feedback on performance in VR. Performance measures including postural stability, navigation task performance, and joint mobility showed varying relations to immersion. Limited data did not allow a solid conclusion between enjoyment and adherence, but patient enjoyment and willingness to participate were reported in care plans that incorporates VR. Finally, different haptic devices such as gloves and controllers provided both strengths and weakness in areas such movement velocity, movement accuracy, and path efficiency.
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Affiliation(s)
- Tyler Rose
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA
| | - Chang S Nam
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA.
| | - Karen B Chen
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC 27695, USA.
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125
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Massetti T, Fávero FM, Menezes LDCD, Alvarez MPB, Crocetta TB, Guarnieri R, Nunes FLS, Monteiro CBDM, Silva TDD. Achievement of Virtual and Real Objects Using a Short-Term Motor Learning Protocol in People with Duchenne Muscular Dystrophy: A Crossover Randomized Controlled Trial. Games Health J 2018; 7:107-115. [PMID: 29608336 DOI: 10.1089/g4h.2016.0088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate whether people with Duchenne muscular dystrophy (DMD) practicing a task in a virtual environment could improve performance given a similar task in a real environment, as well as distinguishing whether there is transference between performing the practice in virtual environment and then a real environment and vice versa. METHODS Twenty-two people with DMD were evaluated and divided into two groups. The goal was to reach out and touch a red cube. Group A began with the real task and had to touch a real object, and Group B began with the virtual task and had to reach a virtual object using the Kinect system. RESULTS ANOVA showed that all participants decreased the movement time from the first (M = 973 ms) to the last block of acquisition (M = 783 ms) in both virtual and real tasks and motor learning could be inferred by the short-term retention and transfer task (with increasing distance of the target). However, the evaluation of task performance demonstrated that the virtual task provided an inferior performance when compared to the real task in all phases of the study, and there was no effect for sequence. CONCLUSIONS Both virtual and real tasks promoted improvement of performance in the acquisition phase, short-term retention, and transfer. However, there was no transference of learning between environments. In conclusion, it is recommended that the use of virtual environments for individuals with DMD needs to be considered carefully.
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Affiliation(s)
- Thais Massetti
- 1 Faculty of Medicine, University of São Paulo , São Paulo, Brazil
| | - Francis Meire Fávero
- 2 Paulista School of Medicine, Federal University of São Paulo , UNIFESP, São Paulo, Brazil
| | | | | | | | | | - Fátima L S Nunes
- 4 School of Arts, Sciences and Humanities, University of São Paulo , EACH-USP, São Paulo, Brazil
| | | | - Talita Dias da Silva
- 2 Paulista School of Medicine, Federal University of São Paulo , UNIFESP, São Paulo, Brazil
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Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:834-842.e4. [PMID: 29453980 DOI: 10.1016/j.apmr.2018.01.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic). DESIGN Randomized controlled trial. SETTING Hospital facility for intensive rehabilitation. PARTICIPANTS Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58). INTERVENTIONS The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks. MAIN OUTCOME MEASURES Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes). RESULTS Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes. CONCLUSIONS The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology.
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Kim K, Choi B, Lim W. The efficacy of virtual reality assisted versus traditional rehabilitation intervention on individuals with functional ankle instability: a pilot randomized controlled trial. Disabil Rehabil Assist Technol 2018; 14:276-280. [PMID: 29385840 DOI: 10.1080/17483107.2018.1429501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Virtual reality (VR) training, a virtual environment commonly generated by computer systems, may enhance the therapeutic efficacy of functional rehabilitation programmes. The aim of this study was to investigate the efficacy of a VR assisted intervention (VRAI) versus traditional rehabilitation intervention (TRI) on functional ankle instability (FAI). METHODS A single-blind randomized controlled study was conducted with 10 subjects for each group. The VRAI was conducted with the Nintendo Wii Fit Plus, whilst the TRI was conducted with a series of exercises with theraband. The muscle strength change of the two groups and the difference between pre and post interventions for each group were compared. RESULTS The VRAI group had less improvement in the muscle strength of all ankle motions than did the TRI group (p > .05). The VRAI group had a greater improvement in muscle strength of plantar flexion than other motions, whilst the TRI group had an improvement in muscle strength of all ankle motions (p < .05). CONCLUSIONS The effects of VR training for the condition of FAI were not comparable to conventional training. However, VR training may be added to the conventional training programme as an optional for the condition of FAI. Implications for Rehabilitation Functional ankle instability (FAI) is subjective feelings of ankle instability resulting from proprioceptive and neuromuscular deficits in which individuals may experience "giving way" condition of the ankle. Therapeutic applications of virtual reality (VR) may be comparable to traditional rehabilitation interventions (TRI) in the rehabilitation of individuals with FAI. However, there is no definitive evidence for the issue. Integrating low-cost VR into functional rehabilitation programme can provide insight into an issue of whether it can be replaced with traditional therapeutic approaches. Although, the efficacy of VR application on strengthening muscles is unable to compare to traditional strengthening programmes, it may be considered an optional treatment based on the proprioceptive improvements.
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Affiliation(s)
- Kijong Kim
- a Department of Physical Therapy , Cheongam College , Suncheon , Republic of Korea
| | - Bongsam Choi
- b Department of Physical Therapy, College of Health and Welfare , Woosong University , Daejeon , Republic of Korea.,c Advanced Institute of Convergence Sports Rehabilitation , Woosong University , Daejeon , Republic of Korea
| | - Wootaek Lim
- b Department of Physical Therapy, College of Health and Welfare , Woosong University , Daejeon , Republic of Korea.,c Advanced Institute of Convergence Sports Rehabilitation , Woosong University , Daejeon , Republic of Korea
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128
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Ghai S, Ghai I, Effenberg AO. "Low road" to rehabilitation: a perspective on subliminal sensory neuroprosthetics. Neuropsychiatr Dis Treat 2018; 14:301-307. [PMID: 29398914 PMCID: PMC5775748 DOI: 10.2147/ndt.s153392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Fear can propagate parallelly through both cortical and subcortical pathways. It can instigate memory consolidation habitually and might allow internal simulation of movements independent of the cortical structures. This perspective suggests delivery of subliminal, aversive and kinematic audiovisual stimuli via neuroprosthetics in patients with neocortical dysfunctions. We suggest possible scenarios by which these stimuli might bypass damaged neocortical structures and possibly assisting in motor relearning. Anticipated neurophysiological mechanisms and methodological scenarios have been discussed in this perspective. This approach introduces novel perspectives into neuropsychology as to how subcortical pathways might be used to induce motor relearning.
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Affiliation(s)
- Shashank Ghai
- Institute of Sports Science, Leibniz University Hannover, Hannover
| | - Ishan Ghai
- School of Life Sciences, Jacobs University, Bremen, Germany
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Tomita Y, Rodrigues MRM, Levin MF. Upper Limb Coordination in Individuals With Stroke: Poorly Defined and Poorly Quantified. Neurorehabil Neural Repair 2017; 31:885-897. [DOI: 10.1177/1545968317739998] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. The identification of deficits in interjoint coordination is important in order to better focus upper limb rehabilitative treatment after stroke. The majority of standardized clinical measures characterize endpoint performance, such as accuracy, speed, and smoothness, based on the assumption that endpoint performance reflects interjoint coordination, without measuring the underlying temporal and spatial sequences of joint recruitment directly. However, this assumption is questioned since improvements of endpoint performance can be achieved through different degrees of restitution or compensation of upper limb motor impairments based on the available kinematic redundancy of the system. Confusion about adequate measurement may stem from a lack a definition of interjoint coordination during reaching. Methods and Results. We suggest an operational definition of interjoint coordination during reaching as a goal-oriented process in which joint degrees of freedom are organized in both spatial and temporal domains such that the endpoint reaches a desired location in a context-dependent manner. Conclusions. In this point-of-view article, we consider how current approaches to laboratory and clinical measures of coordination comply with our definition. We propose future study directions and specific research strategies to develop clinical measures of interjoint coordination with better construct and content validity than those currently in use.
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Affiliation(s)
- Yosuke Tomita
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Marcos R. M. Rodrigues
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Mindy F. Levin
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Menon S, Zhu J, Goyal D, Khatib O. Haptic fMRI: Reliability and performance of electromagnetic haptic interfaces for motion and force neuroimaging experiments. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:3930-3935. [PMID: 29060757 DOI: 10.1109/embc.2017.8037716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Haptic interfaces compatible with functional magnetic resonance imaging (Haptic fMRI) promise to enable rich motor neuroscience experiments that study how humans perform complex manipulation tasks. Here, we present a large-scale study (176 scans runs, 33 scan sessions) that characterizes the reliability and performance of one such electromagnetically actuated device, Haptic fMRI Interface 3 (HFI-3). We outline engineering advances that ensured HFI-3 did not interfere with fMRI measurements. Observed fMRI temporal noise levels with HFI-3 operating were at the fMRI baseline (0.8% noise to signal). We also present results from HFI-3 experiments demonstrating that high resolution fMRI can be used to study spatio-temporal patterns of fMRI blood oxygenation dependent (BOLD) activation. These experiments include motor planning, goal-directed reaching, and visually-guided force control. Observed fMRI responses are consistent with existing literature, which supports Haptic fMRI's effectiveness at studying the brain's motor regions.
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131
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Russo M, De Luca R, Naro A, Sciarrone F, Aragona B, Silvestri G, Manuli A, Bramanti A, Casella C, Bramanti P, Calabrò RS. Does body shadow improve the efficacy of virtual reality-based training with BTS NIRVANA?: A pilot study. Medicine (Baltimore) 2017; 96:e8096. [PMID: 28930852 PMCID: PMC5617719 DOI: 10.1097/md.0000000000008096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aim of the present study was to evaluate whether the presence of body shadows during virtual reality (VR) training with BTS NIRVANA (BTs-N) may lead to a better functional recovery. METHODS We enrolled 20 poststroke rehabilitation inpatients, who underwent a neurocognitive-rehabilitative training consisting of 24 sessions (3 times a week for 8 weeks) of BTs-N. All the patients were randomized into 2 groups: semi-immersive virtual training with (S-IVTS group) or without (S-IVT group) body shadows. Each participant was evaluated before (T0) and immediately (T1) after the end of the training (Trial Registration Number: NCT03095560). RESULTS The S-IVTS group showed a greater improvement in visuo-constructive skills and sustained attention, as compared with the S-IVT group. The other measures showed nonsignificant within-group and between-group differences. CONCLUSION Our results showed that body shadow may represent a high-priority class of stimuli that act by "pushing" attention toward the body itself. Further studies are needed to clarify the role of body shadow in promoting the internal representation construction and thus self-recognition.
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132
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Abedtash H, Holden RJ. Systematic review of the effectiveness of health-related behavioral interventions using portable activity sensing devices (PASDs). J Am Med Inform Assoc 2017; 24:1002-1013. [PMID: 28339620 PMCID: PMC6259669 DOI: 10.1093/jamia/ocx006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/14/2016] [Accepted: 12/30/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Portable activity sensing devices (PASDs) have received significant interest as tools for objectively measuring activity-related parameters and promoting health-related outcomes. Studies of PASDs suggest the potential value of integrating them with behavioral interventions to improve intermediate and downstream clinical outcomes. OBJECTIVES This systematic review describes and evaluates evidence from controlled studies of interventions using PASDs on their effectiveness in health-related outcomes. Study quality was also assessed. METHODS A systematic literature search was performed of MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, and CINAHL databases. We included English-language papers of controlled trials through 2015 reporting the effectiveness of PASDs in improving health-related outcomes in any population. We extracted and analyzed data on study characteristics including design, target population, interventions, and findings. RESULTS Seventeen trials met the inclusion criteria from a total of 9553 unique records. Study objectives varied greatly, but most sought to increase physical activity. Studies with a "passive" intervention arm using a PASD with minimal behavioral support generally did not demonstrate effectiveness in improving health-related outcomes. Interventions integrating PASDs with multiple behavioral change techniques were more likely to be effective, particularly for intermediate outcomes such as physical activity and weight loss. Trials had small sample sizes but were generally free of bias, except for blinding and selection bias. CONCLUSION There is insufficient evidence to draw a conclusion about the general health-related benefits of PASD interventions. PASD interventions may improve intermediate outcomes when coupled with multiple behavioral change techniques. Devices alone or with minimal behavioral change support are insufficient to change health-related outcomes.
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Affiliation(s)
- Hamed Abedtash
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
| | - Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA
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Gil-Gómez JA, Manzano-Hernández P, Albiol-Pérez S, Aula-Valero C, Gil-Gómez H, Lozano-Quilis JA. USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems. SENSORS 2017; 17:s17071589. [PMID: 28686174 PMCID: PMC5539644 DOI: 10.3390/s17071589] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 11/16/2022]
Abstract
New emerging technologies have proven their efficacy in aiding people in their rehabilitation. The tests that are usually used to evaluate usability (in general) or user satisfaction (in particular) of this technology are not specifically focused on virtual rehabilitation and patients. The objective of this contribution is to present and evaluate the USEQ (User Satisfaction Evaluation Questionnaire). The USEQ is a questionnaire that is designed to properly evaluate the satisfaction of the user (which constitutes part of usability) in virtual rehabilitation systems. Forty patients with balance disorders completed the USEQ after their first session with ABAR (Active Balance Rehabilitation), which is a virtual rehabilitation system that is designed for the rehabilitation of balance disorders. Internal consistency analysis and exploratory factor analysis were carried out to identify the factor structure of the USEQ. The six items of USEQ were significantly associated with each other, and the Cronbach alpha coefficient for the questionnaire was 0.716. In an analysis of the principal components, a one-factor solution was considered to be appropriate. The findings of the study suggest that the USEQ is a reliable questionnaire with adequate internal consistency. With regard to patient perception, the patients found the USEQ to be an easy-to-understand questionnaire with a convenient number of questions.
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Affiliation(s)
- José-Antonio Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| | | | - Sergio Albiol-Pérez
- Aragón Health Research Institute (IIS Aragón), Universidad de Zaragoza, Ciudad Escolar, 44003 Teruel, Spain.
| | | | - Hermenegildo Gil-Gómez
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
| | - José-Antonio Lozano-Quilis
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
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Kimel-Naor S, Gottlieb A, Plotnik M. The effect of uphill and downhill walking on gait parameters: A self-paced treadmill study. J Biomech 2017; 60:142-149. [PMID: 28757238 DOI: 10.1016/j.jbiomech.2017.06.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/14/2017] [Accepted: 06/16/2017] [Indexed: 11/28/2022]
Abstract
It has been shown that gait parameters vary systematically with the slope of the surface when walking uphill (UH) or downhill (DH) (Andriacchi et al., 1977; Crowe et al., 1996; Kawamura et al., 1991; Kirtley et al., 1985; McIntosh et al., 2006; Sun et al., 1996). However, gait trials performed on inclined surfaces have been subject to certain technical limitations including using fixed speed treadmills (TMs) or, alternatively, sampling only a few gait cycles on inclined ramps. Further, prior work has not analyzed upper body kinematics. This study aims to investigate effects of slope on gait parameters using a self-paced TM (SPTM) which facilitates more natural walking, including measuring upper body kinematics and gait coordination parameters. Gait of 11 young healthy participants was sampled during walking in steady state speed. Measurements were made at slopes of +10°, 0° and -10°. Force plates and a motion capture system were used to reconstruct twenty spatiotemporal gait parameters. For validation, previously described parameters were compared with the literature, and novel parameters measuring upper body kinematics and bilateral gait coordination were also analyzed. Results showed that most lower and upper body gait parameters were affected by walking slope angle. Specifically, UH walking had a higher impact on gait kinematics than DH walking. However, gait coordination parameters were not affected by walking slope, suggesting that gait asymmetry, left-right coordination and gait variability are robust characteristics of walking. The findings of the study are discussed in reference to a potential combined effect of slope and gait speed. Follow-up studies are needed to explore the relative effects of each of these factors.
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Affiliation(s)
- Shani Kimel-Naor
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Amihai Gottlieb
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Ramat Gan, Israel; Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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135
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Calabrò RS, Naro A, Russo M, Leo A, De Luca R, Balletta T, Buda A, La Rosa G, Bramanti A, Bramanti P. The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial. J Neuroeng Rehabil 2017; 14:53. [PMID: 28592282 PMCID: PMC5463350 DOI: 10.1186/s12984-017-0268-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/01/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training (RAGT) devices, including Lokomat, for the treatment of lower limb paresis. Virtual reality (VR) has proved to be a valuable tool to improve neurorehabilitation training. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis of motor function recovery induced by the association between RAGT (by using Lokomat device) and VR (an animated avatar in a 2D VR) by studying electroencephalographic (EEG) oscillations. METHODS Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were randomized into two groups. One group performed 40 sessions of Lokomat with VR (RAGT + VR), whereas the other group underwent Lokomat without VR (RAGT-VR). The outcomes (clinical, kinematic, and EEG) were measured before and after the robotic intervention. RESULTS As compared to the RAGT-VR group, all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment. Moreover, they showed stronger event-related spectral perturbations in the high-γ and β bands and larger fronto-central cortical activations in the affected hemisphere. CONCLUSIONS The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance. EEG data suggest that the use of VR may entrain several brain areas (probably encompassing the mirror neuron system) involved in motor planning and learning, thus leading to an enhanced motor performance. TRIAL REGISTRATION Retrospectively registered in Clinical Trials on 21-11-2016, n. NCT02971371 .
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Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Antonino Leo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | - Antonio Buda
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
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136
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Khurana M, Walia S, Noohu MM. Study on the Effectiveness of Virtual Reality Game-Based Training on Balance and Functional Performance in Individuals with Paraplegia. Top Spinal Cord Inj Rehabil 2017; 23:263-270. [PMID: 29339902 DOI: 10.1310/sci16-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To determine whether there is any difference between virtual reality game-based balance training and real-world task-specific balance training in improving sitting balance and functional performance in individuals with paraplegia. Methods: The study was a pre test-post test experimental design. There were 30 participants (28 males, 2 females) with traumatic spinal cord injury randomly assigned to 2 groups (group A and B). The levels of spinal injury of the participants were between T6 and T12. The virtual reality game-based balance training and real-world task-specific balance training were used as interventions in groups A and B, respectively. The total duration of the intervention was 4 weeks, with a frequency of 5 times a week; each training session lasted 45 minutes. The outcome measures were modified Functional Reach Test (mFRT), t-shirt test, and the self-care component of the Spinal Cord Independence Measure-III (SCIM-III). Results: There was a significant difference for time (p = .001) and Time × Group effect (p = .001) in mFRT scores, group effect (p = .05) in t-shirt test scores, and time effect (p = .001) in the self-care component of SCIM-III. Conclusions: Virtual reality game-based training is better in improving balance and functional performance in individuals with paraplegia than real-world task-specific balance training.
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Affiliation(s)
| | - Shefali Walia
- ISIC Institute of Rehabilitation Sciences, New Delhi, India
| | - Majumi M Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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137
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Labbé D, Poldma T, Fichten C, Havel A, Kehayia E, Mazer B, McKinley P, Rochette A, Swaine B. Rehabilitation in the real-life environment of a shopping mall. Disabil Rehabil 2017; 40:848-855. [PMID: 28129514 DOI: 10.1080/09638288.2016.1277394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The aim of this study was to explore how shopping malls could be used during rehabilitation and to identify the facilitators and barriers to their use. METHOD Two focus groups, conducted with 15 rehabilitation professionals from various disciplines and working with people with disabilities of all ages were structured around two topics: (i) The usage of malls for rehabilitation and (ii) Factors that facilitate or limit rehabilitation professionals' use of the mall as an environment for clinical assessment and/or intervention. RESULTS The thematic analysis revealed that shopping malls were used to achieve several rehabilitation goals targeting physical and cognitive skills, psychological health and socialization. This real-life environment is motivating and helps foster independence and normalization. Factors affecting mall use during rehabilitation included personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners). CONCLUSION Shopping malls may be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities. Implications for rehabilitation To ensure successful community reintegration, clients could be trained at some point during their rehabilitation, to perform activities in real-life settings, such as a shopping mall. Shopping malls appear to enable the attainment of rehabilitation goals targeting a variety of skills. This real-life environment appears to be motivating and helps foster independence and normalization. Factors felt to affect mall use during rehabilitation include personal factors (e.g. clients' personality and level of readiness) and environmental factors (e.g. clinical context, accessibility of the mall and social attitudes of store owners). The shopping mall may be an untapped resource as it appears to be a relevant rehabilitation assessment and treatment environment that could contribute to optimizing community integration of people with disabilities.
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Affiliation(s)
- Delphine Labbé
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,b Department of Psychology , Université de Québec à Montréal , Montréal , Canada
| | - Tiiu Poldma
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,c Faculté de l'Aménagement , Université de Montréal , Montréal , Canada
| | - Catherine Fichten
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,d Adaptech Research Network , Montréal , Canada.,e Department of Psychiatry , McGill University , Montréal , Canada
| | - Alice Havel
- d Adaptech Research Network , Montréal , Canada
| | - Eva Kehayia
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,f School of Physical and Occupational Therapy, McGill University , Montréal , Canada
| | - Barbara Mazer
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,f School of Physical and Occupational Therapy, McGill University , Montréal , Canada
| | - Patricia McKinley
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,f School of Physical and Occupational Therapy, McGill University , Montréal , Canada
| | - Annie Rochette
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,g École de réadaptation, Université de Montréal , Montréal , Canada
| | - Bonnie Swaine
- a Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montréal , Canada.,g École de réadaptation, Université de Montréal , Montréal , Canada
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Khan A, Biddiss E. Musical Stairs: A motivational therapy tool for children with disabilities featuring automated detection of stair-climbing gait events via inertial sensors. Med Eng Phys 2017; 40:95-102. [PMID: 28110887 DOI: 10.1016/j.medengphy.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 11/28/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
Abstract
Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed of two foot-mounted inertial sensors, a step detection algorithm, and an auditory feedback response. In Phase 1, we establish its clinical feasibility via a Wizard-of-Oz AB/BA cross-over design with 17 children, aged 4-6 years, having diverse diagnoses and gait abilities. Self-, therapist- and blinded-observer reports indicated increased motivation with auditory feedback. Phase 2 describes the construction of a database comprised of synchronized video and inertial data associated with 1568 steps up and down stairs completed by 26 children aged 4-6 years with diverse diagnoses and gait. Lastly, in Phase 3, data from 18 children in the database were used to train a rule-based step detection algorithm based on local minima in the acceleration profile and the foot's swing angle. A step detection rate of 96% [SD=3%] and false positive rate of 6% [SD=5%] were achieved with an independent test set (n=8). Recommendations for future development and evaluation are discussed.
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Affiliation(s)
- Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario M4G 1R8, Canada.
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, Ontario M4G 1R8, Canada; The Institute of Biomaterials and Biomedical Engineering, University of Toronto, 164 College St, Toronto, Ontario M5S 3G9, Canada.
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Miller HL, Bugnariu N, Patterson RM, Wijayasinghe I, Popa DO. Development of a novel visuomotor integration paradigm by integrating a virtual environment with mobile eye-tracking and motion-capture systems. ... INTERNATIONAL CONFERENCE ON VIRTUAL REHABILITATION. INTERNATIONAL CONFERENCE ON VIRTUAL REHABILITATION 2017; 2017. [PMID: 29876370 DOI: 10.1109/icvr.2017.8007481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Visuomotor integration (VMI), the use of visual information to guide motor planning, execution, and modification, is necessary for a wide range of functional tasks. To comprehensively, quantitatively assess VMI, we developed a paradigm integrating virtual environments, motion-capture, and mobile eye-tracking. Virtual environments enable tasks to be repeatable, naturalistic, and varied in complexity. Mobile eye-tracking and minimally-restricted movement enable observation of natural strategies for interacting with the environment. This paradigm yields a rich dataset that may inform our understanding of VMI in typical and atypical development.
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Affiliation(s)
- Haylie L Miller
- Departments of Physical Therapy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Nicoleta Bugnariu
- Departments of Physical Therapy, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Rita M Patterson
- Family Medicine, University of North Texas Health Science Center, Fort Worth, Texas, USA
| | - Indika Wijayasinghe
- Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
| | - Dan O Popa
- Department of Electrical and Computer Engineering, University of Louisville, Louisville, Kentucky, USA
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140
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Lee GH. Effects of Virtual Reality Exercise Program on Balance, Emotion and Quality of Life in Patients with Cognitive Decline. ACTA ACUST UNITED AC 2016. [DOI: 10.18857/jkpt.2016.28.6.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Geun-Ho Lee
- Department of Neurology, College of Medicine, Dankook University, Cheonan, Korea
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141
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Levac DE, Glegg SMN, Sveistrup H, Colquhoun H, Miller P, Finestone H, DePaul V, Harris JE, Velikonja D. Promoting Therapists' Use of Motor Learning Strategies within Virtual Reality-Based Stroke Rehabilitation. PLoS One 2016; 11:e0168311. [PMID: 27992492 PMCID: PMC5167266 DOI: 10.1371/journal.pone.0168311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/30/2016] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Therapists use motor learning strategies (MLSs) to structure practice conditions within stroke rehabilitation. Virtual reality (VR)-based rehabilitation is an MLS-oriented stroke intervention, yet little support exists to assist therapists in integrating MLSs with VR system use. METHOD A pre-post design evaluated a knowledge translation (KT) intervention incorporating interactive e-learning and practice, in which 11 therapists learned how to integrate MLSs within VR-based therapy. Self-report and observer-rated outcome measures evaluated therapists' confidence, clinical reasoning and behaviour with respect to MLS use. A focus group captured therapists' perspectives on MLS use during VR-based therapy provision. RESULTS The intervention improved self-reported confidence about MLS use as measured by confidence ratings (p <0.001). Chart-Stimulated Recall indicated a moderate level of competency in therapists' clinical reasoning about MLSs following the intervention, with no changes following additional opportunities to use VR (p = .944). On the Motor Learning Strategy Rating Instrument, no behaviour change with respect to MLS use was noted (p = 0.092). Therapists favoured the strategy of transferring skills from VR to real-life tasks over employing a more comprehensive MLS approach. CONCLUSION The KT intervention improved therapists' confidence but did not have an effect on clinical reasoning or behaviour with regard to MLS use during VR-based therapy.
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Affiliation(s)
- Danielle E. Levac
- Department of Physical Therapy, Movement Sciences and Rehabilitation, Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
| | - Stephanie M. N. Glegg
- Therapy Department, Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Miller
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hillel Finestone
- Physiatry, Élisabeth Bruyère Hospital and Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Jocelyn E. Harris
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Velikonja
- Regional Rehabilitation Center, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Carneiro MIS, Oliveira DMD, Maciel ABDR, Cardoso ACDA, Teichrieb V, Monte-Silva K. Applicability of a motor rehabilitation system in stroke victims. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: The recovery of stroke patients is long and boring due to the repetitive nature of the exercises used and the length of treatment. Thus, we started using virtual reality as an alternative and, because of its advantages, health professionals are adapting video games for physical therapy. However, there are some limitations, such as the fact that games are designed for entertainment and not for therapeutic purposes. Objective: In order to mitigate gaps in assistive devices for physical therapy, this study describes the development and applicability of a computer support system for motor rehabilitation - Ikapp - in stroke victims. Methods: Twenty-seven stroke patients filled out a socioeconomic questionnaire, tested Ikapp during five minutes and answered a usability and satisfaction questionnaire about handling the tool. The chi-square test was used to analyze any association between sociodemographic factors and the features of the system. Results: The Ikapp system can be an excellent device to assist neurological rehabilitation of stroke patients, as participants questionnaires showed that 85.2% were satisfied in regard to motivation and inclusion of Ikapp in physiotherapy and 77.8% relative to ease of interaction with the tool. Conclusion: The Ikapp system proved to be an easy-to-use and accessible computer support system for patients with functional limitations.
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143
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Effect of Virtual Reality Training on Balance and Gait Ability in Patients With Stroke: Systematic Review and Meta-Analysis. Phys Ther 2016; 96:1905-1918. [PMID: 27174255 DOI: 10.2522/ptj.20160054] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/01/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Virtual reality (VR) training is considered to be a promising novel therapy for balance and gait recovery in patients with stroke. PURPOSE The aim of this study was to conduct a systematic literature review with meta-analysis to investigate whether balance or gait training using VR is more effective than conventional balance or gait training in patients with stroke. DATA SOURCES A literature search was carried out in the databases PubMed, Embase, MEDLINE, and Cochrane Library up to December 1, 2015. STUDY SELECTION Randomized controlled trials that compared the effect of balance or gait training with and without VR on balance and gait ability in patients with stroke were included. DATA EXTRACTION AND SYNTHESIS Twenty-one studies with a median PEDro score of 6.0 were included. The included studies demonstrated a significant greater effect of VR training on balance and gait recovery after stroke compared with conventional therapy as indicated with the most frequently used measures: gait speed, Berg Balance Scale, and Timed "Up & Go" Test. Virtual reality was more effective to train gait and balance than conventional training when VR interventions were added to conventional therapy and when time dose was matched. LIMITATIONS The presence of publication bias and diversity in included studies were limitations of the study. CONCLUSIONS The results suggest that VR training is more effective than balance or gait training without VR for improving balance or gait ability in patients with stroke. Future studies are recommended to investigate the effect of VR on participation level with an adequate follow-up period. Overall, a positive and promising effect of VR training on balance and gait ability is expected.
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144
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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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145
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Broeren J, Rydmark M, Björkdahl A, Sunnerhagen KS. Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke. Neurorehabil Neural Repair 2016; 21:180-9. [PMID: 17312093 DOI: 10.1177/1545968306290774] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs). Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later. Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs. Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.
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Affiliation(s)
- Jurgen Broeren
- Rehabilitation Medicine Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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146
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Kiper P, Szczudlik A, Venneri A, Stozek J, Luque-Moreno C, Opara J, Baba A, Agostini M, Turolla A. Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview. J Neurol Sci 2016; 369:141-148. [PMID: 27653881 DOI: 10.1016/j.jns.2016.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023]
Abstract
Computational approaches for modelling the central nervous system (CNS) aim to develop theories on processes occurring in the brain that allow the transformation of all information needed for the execution of motor acts. Computational models have been proposed in several fields, to interpret not only the CNS functioning, but also its efferent behaviour. Computational model theories can provide insights into neuromuscular and brain function allowing us to reach a deeper understanding of neuroplasticity. Neuroplasticity is the process occurring in the CNS that is able to permanently change both structure and function due to interaction with the external environment. To understand such a complex process several paradigms related to motor learning and computational modeling have been put forward. These paradigms have been explained through several internal model concepts, and supported by neurophysiological and neuroimaging studies. Therefore, it has been possible to make theories about the basis of different learning paradigms according to known computational models. Here we review the computational models and motor learning paradigms used to describe the CNS and neuromuscular functions, as well as their role in the recovery process. These theories have the potential to provide a way to rigorously explain all the potential of CNS learning, providing a basis for future clinical studies.
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Affiliation(s)
- Pawel Kiper
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy.
| | - Andrzej Szczudlik
- Jagiellonian University Medical College, ul. Sw. Anny 12, 31-008 Krakow, Poland
| | - Annalena Venneri
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
| | - Joanna Stozek
- The University of Physical Education, Al. Jana Pawla II 78, 31-571 Krakow, Poland
| | - Carlos Luque-Moreno
- Department of Physical Therapy, The University of Seville, C/Avicena S/N, 41009 Seville, Spain; Motion Analysis Laboratory, Virgen del Rocio Hospital, Avda. Manuel Siurot S/N, 41013 Seville, Spain
| | - Jozef Opara
- Academy of Physical Education, ul. Mikolowska 72a, 40-065 Katowice, Poland
| | - Alfonc Baba
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Michela Agostini
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
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147
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Merians AS, Poizner H, Boian R, Burdea G, Adamovich S. Sensorimotor Training in a Virtual Reality Environment: Does It Improve Functional Recovery Poststroke? Neurorehabil Neural Repair 2016; 20:252-67. [PMID: 16679503 DOI: 10.1177/1545968306286914] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To investigate the effectiveness of computerized virtual reality (VR) training of the hemiparetic hand of patients poststroke using a system that provides repetitive motor reeducation and skill reacquisition. Methods. Eight subjects in the chronic phase poststroke participated in a 3-week program using their hemiparetic hand in a series of interactive computer games for 13 days of training, weekend breaks, and pretests and posttests. Each subject trained for about 2 to 2.5 h per day. Outcome measures consisted of changes in the computerized measures of thumb and finger range of motion, thumb and finger velocity, fractionation (the ability to move fingers independently), thumb and finger strength, the Jebsen Test of Hand Function, and a Kinematic reach to grasp test. Results. Subjects as a group improved in fractionation of the fingers, thumb and finger range of motion, and thumb and finger speed, retaining those gains at the 1-week retention test. Transfer of these improvements was demonstrated through changes in the Jebsen Test of Hand Function and a decrease after the therapy in the overall time from hand peak velocity to the moment when an object was lifted from the table. Conclusions. It is difficult in current service delivery models to provide the intensity of practice that appears to be needed to effect neural reorganization and functional changes poststroke. Computerized exercise systems may be a way to maximize both the patients’ and the clinicians’ time. The data in this study add support to the proposal to explore novel technologies for incorporation into current practice.
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Affiliation(s)
- Alma S Merians
- Graduate Program in Physical Therapy, University of Medicine and Dentistry of New Jersey, School of Health Related Professions, Newark, NJ 07107, USA.
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148
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Gibbons EM, Thomson AN, de Noronha M, Joseph S. Are virtual reality technologies effective in improving lower limb outcomes for patients following stroke – a systematic review with meta-analysis. Top Stroke Rehabil 2016; 23:440-457. [DOI: 10.1080/10749357.2016.1183349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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149
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Martín-Ruiz ML, Máximo-Bocanegra N, Luna-Oliva L. A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy. SENSORS 2016; 16:444. [PMID: 27023561 PMCID: PMC4850958 DOI: 10.3390/s16040444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
Abstract
The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children’s oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.
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Affiliation(s)
- María-Luisa Martín-Ruiz
- Department of Telematic and Electronic Engineering, Technical University of Madrid, Madrid 28031, Spain.
| | - Nuria Máximo-Bocanegra
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain.
| | - Laura Luna-Oliva
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences Rey Juan Carlos University, Alcorcón, Madrid 28922, Spain.
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150
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Zhang W, Ma W, Brandao M, Kaber DB, Bloomfield P, Swangnetr M. Biometric validation of a virtual reality-based psychomotor test for motor skill training. Assist Technol 2016; 28:233-241. [PMID: 27011301 DOI: 10.1080/10400435.2016.1165758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Psychomotor tests have been applied in clinical therapy and laboratory research as tools for evaluating motor and cognitive skills. Some studies have developed computerized versions of such tests using virtual reality (VR) systems with haptic interface controls. These systems allow for increased flexibility in test delivery and accuracy in performance assessment. In this study, a VR-based computer simulation of the block design (BD) test (a standardized psychomotor task as part of an adult IQ test) was developed and compared with the physical version of the test. Performance was evaluated based on four types of muscle activation collected using electromyography (EMG), time spent in completing the task, and subjective ratings of workload. Results verified the VR-based task as physically comparable to the conventional BD test. The validated computerized psychomotor task may be applied for both experimental and clinical use in future studies.
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Affiliation(s)
- Wenjuan Zhang
- a Edward P. Fitts Department of Industrial and Systems Engineering , North Carolina State University , Raleigh , North Carolina , USA
| | - Wenqi Ma
- b Strategic Research, Advanced Product Development & Sales , Johnson Controls, Inc ., Holland , Michigan , USA
| | - Maicom Brandao
- a Edward P. Fitts Department of Industrial and Systems Engineering , North Carolina State University , Raleigh , North Carolina , USA
| | - David B Kaber
- a Edward P. Fitts Department of Industrial and Systems Engineering , North Carolina State University , Raleigh , North Carolina , USA
| | - Peter Bloomfield
- c Department of Statistics , North Carolina State University , Raleigh , North Carolina , USA
| | - Manida Swangnetr
- d Research Center in Back, Neck, Other Joint Pain and Human Performance , Khon Kaen University , Khon Kaen , Thailand
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