Assessing the use of immersive virtual reality, mouse and touchscreen in pointing and dragging-and-dropping tasks among young, middle-aged and older adults

Perceptions of Patients With Stroke Regarding an Immersive Virtual Reality-Based Exercise System for Upper Limb Rehabilitation: Questionnaire and Interview Study

BACKGROUND

With substantial resources allocated to develop virtual reality (VR)-based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence.

OBJECTIVE

This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises.

METHODS

A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns.

RESULTS

The questionnaire results revealed that the patients' perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony.

CONCLUSIONS

Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology's success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology.

Effects on older adult Women's precision, strength and flexibility from resistance training and handicrafts practice

INTRODUCTION

As individuals age, they experience a gradual decline in strength, flexibility, and precision control. While resistance training has shown positive effects on aging, little is known about how beneficial handicrafts could be in effectively promoting motor improvements in aging. This study aimed to compare manual precision, manual grip strength, and upper limb flexibility among three groups of older adult women: (a) regular practitioners of resistance training, (b) regular practitioners of handicrafts, and (c) insufficiently active participants who did not engage in either regular resistance training or handicraft practice.

METHODS

A total of 30 women (mean age = 67.86, SD = 7.01) were divided equally into the three groups (n = 10 per group). The participants were asked to perform a manual manipulative precision test, a manual grip strength test, and an upper limb flexibility test.

RESULTS

The participants in the resistance training group exhibited superior precision and strength compared to those in the handicraft group, as well as better precision, strength, and flexibility compared to the control group participants. The handicraft group demonstrated better precision and upper limb flexibility compared to the control group.

CONCLUSION

Therefore, while resistance training was particularly beneficial for improving these motor skills, engaging in handicrafts also proved to be an effective means of maintaining and/or enhancing certain important motor abilities.

Usability evaluation of augmented reality visualizations on an optical see-through head-mounted display for assisting machine operations

This study explores the effect of using different visual information overlays and guiding arrows on a machine operation task with an optical see-through head-mounted display (OST-HMD). Thirty-four participants were recruited in the experiment. The independent variables included visual information mode (text, animation, and mixed text and animation) and the use of guiding arrows (with and without arrows). In addition, gender difference was also an objective of this study. The task performance indicators were determined based on task completion time and error counts as well as subjective measures (system usability scale, NASA task load index, and immersion scale). This study used the mixed analysis of variance design to evaluate the main and interaction effects. The results showed that males performed better when using the mixed text and animation mode. Females performed better when using the text mode. In addition, using the mixed text and animation mode demonstrated the best outcome in system usability scale and NASA task load index. For the use of guiding arrows, the task completion time was reduced and the system usability scale, NASA task load index, and immersion scale showed positive effects.

Effects of error rates and target sizes on neck and shoulder biomechanical loads during augmented reality interactions

Augmented reality (AR) interactions have been associated with increased biomechanical loads on the neck and shoulders. To provide a better understanding of the factors that may impact such biomechanical loads, this repeated-measures laboratory study evaluated the effects of error rates and target sizes on neck and shoulder biomechanical loads during two standardized AR tasks (omni-directional pointing and cube placing). Twenty participants performed the two AR tasks with different error rates and target sizes. During the tasks, angles, moments, and muscle activity in the neck and shoulders were measured. The results showed that the target sizes and error rates significantly affected angles, moments, and muscle activity in the neck and shoulder regions. Specifically, the presence of errors increased neck extension, shoulder flexion angles and associated moments. Muscle activity in the neck (splenius capitis) and shoulder (anterior and medial deltoids) also increased when the errors were introduced. Moreover, interacting with larger targets resulted in greater neck extension moments and shoulder abduction angles along with higher muscle activity in the splenius capitis and upper trapezius muscles. These findings indicate the importance of reducing errors and incorporating appropriate target sizes in the AR interfaces to minimize risks of musculoskeletal discomfort and injuries in the neck and shoulders.

A passive upper-limb exoskeleton reduced muscular loading during augmented reality interactions

The aim of this study was to evaluate a passive upper-limb exoskeleton as an ergonomic control to reduce the musculoskeletal load in the shoulders associated with augmented reality (AR) interactions. In a repeated-measures laboratory study, each of the 20 participants performed a series of AR tasks with and without a commercially-available upper-limb exoskeleton. During the AR tasks, muscle activity (anterior, middle, posterior deltoid, and upper trapezius), shoulder joint postures/moment, and self-reported discomfort were collected. The results showed that the exoskeleton significantly reduced muscle activity in the upper trapezius and deltoid muscle groups and self-reported discomfort. However, the shoulder postures and task performance measures were not affected by the exoskeleton during the AR interactions. Given the significant decrease in muscle activity and discomfort without compromising task performance, a passive exoskeleton can be an effective ergonomic control measure to reduce the risks of developing musculoskeletal discomfort or injuries in the shoulder regions.

Effectiveness, safety and patients' perceptions of an immersive virtual reality-based exercise system for poststroke upper limb motor rehabilitation: A proof-of-concept and feasibility randomized controlled trial

Objective

This study aimed to examine the effectiveness, safety and patients' perceptions of an immersive virtual reality (VR)-based exercise system for poststroke upper limb rehabilitation.

Methods

A proof-of-concept, 2-week randomized controlled trial was conducted. Fifty stroke patients were randomly assigned to either use the immersive VR-based exercise system to perform upper limb exercises for 2 weeks (intervention) or play commercial games (control). Effectiveness, safety and patients' perceptions of the exercise system were assessed at baseline and at 1- and 2-week follow-ups.

Results

Intention-to-treat analysis revealed that after 2 weeks, statistically significant improvements in shoulder flexion active range of motion (AROM), shoulder abduction AROM, perceived upper limb motor function and quality of life (QoL) were observed in one or both groups, but not between the groups. Per-protocol analysis showed that after 2 weeks: (i) statistically significant improvement in shoulder abduction AROM was obtained in the intervention group, and the difference in the mean changes between the groups was statistically significant; (ii) statistically significant improvements in coordination/speed (Fugl-Meyer Assessment for Upper Extremity), shoulder flexion AROM, perceived upper limb motor function and QoL were obtained in one or both groups, but not between the groups.

Conclusions

The immersive VR-based exercise system is a potentially effective, safe and acceptable approach for supporting poststroke motor rehabilitation. These findings can serve as a basis for larger-scale studies on the application of VR for poststroke exercises.

Effectiveness of Using Virtual Reality-Supported Exercise Therapy for Upper Extremity Motor Rehabilitation in Patients With Stroke: Systematic Review and Meta-analysis of Randomized Controlled Trials

Background

In recent years, efforts have been made to implement virtual reality (VR) to support the delivery of poststroke upper extremity motor rehabilitation exercises. Therefore, it is important to review and analyze the existing research evidence of its effectiveness.

Objective

Through a systematic review and meta-analysis of randomized controlled trials, this study examined the effectiveness of using VR-supported exercise therapy for upper extremity motor rehabilitation in patients with stroke.

Methods

This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CINAHL Plus, MEDLINE, Web of Science, Embase, and Cochrane Library databases were searched on December 31, 2021. Changes in outcomes related to impairments in upper extremity functions and structures, activity limitations, and participation restrictions in life situations from baseline to after intervention, after intervention to follow-up assessment, and baseline to follow-up assessment were examined. Standardized mean differences (SMDs) were calculated using a random-effects model. Subgroup analyses were performed to determine whether the differences in treatment outcomes depended on age, stroke recovery stage, VR program type, therapy delivery format, similarities in intervention duration between study groups, intervention duration in VR groups, and trial length.

Results

A total of 42 publications representing 43 trials (aggregated sample size=1893) were analyzed. Compared with the control groups that used either conventional therapy or no therapy, the intervention groups that used VR to support exercise therapy showed significant improvements in upper extremity motor function (Fugl-Meyer Assessment-Upper Extremity; SMD 0.45, 95% CI 0.21-0.68; P<.001), range of motion (goniometer; SMD 1.01, 95% CI 0.50-1.52; P<.001), muscle strength (Manual Muscle Testing; SMD 0.79, 95% CI 0.28-1.30; P=.002), and independence in day-to-day activities (Functional Independence Measure; SMD 0.23, 95% CI 0.06-0.40; P=.01, and modified Rankin Scale; SMD 0.57, 95% CI 0.01-1.12; P=.046). Significant subgroup differences were observed in hand dexterity (Box and Block Test), spasticity (Ashworth Scale or modified Ashworth Scale), arm and hand motor ability (Wolf Motor Function Test and Manual Function Test), hand motor ability (Jebsen Hand Function Test), and quality of life (Stroke Impact Scale). There was no evidence that the benefits of VR-supported exercise therapy were maintained after the intervention ended.

Conclusions

VR-supported upper extremity exercise therapy can be effective in improving motor rehabilitation results. Our review showed that of the 12 rehabilitation outcomes examined during the course of VR-based therapy, significant improvements were detected in 2 (upper extremity motor function and range of motion), and both significant and nonsignificant improvements were observed in another 2 (muscle strength and independence in day-to-day activities), depending on the measurement tools or methods used.

Trial Registration

PROSPERO CRD42021256826; https://tinyurl.com/2uarftbh

A longitudinal examination of tablet self-management technology acceptance by patients with chronic diseases: Integrating perceived hand function, perceived visual function, and perceived home space adequacy with the TAM and TPB

BACKGROUND

Health information technologies (HITs) are increasingly being used to support the self-management of chronic diseases. However, patients' initial or continued acceptance of such technologies is not always achieved.

OBJECTIVE

The aim of this study was to develop a theory-driven HIT acceptance model to examine factors affecting acceptance of HIT (measured by behavioral intention; BI) for disease self-management among patients with chronic diseases, in which we also focused on three additional, previously unexplored factors related to perceived hand function (PHF), perceived visual function (PVF), and perceived space adequacy (PSA) and a longitudinal scrutinization of changes in the effects of these factors on acceptance over time.

METHODS

The theoretical basis of our acceptance model was drawn from the technology acceptance model and the theory of planned behavior. The model was further extended by including patients' PHF, PVF (related to patients with chronic diseases who are mostly elderly), and PSA (related to the patients' home environment). The model was tested in the context of type 2 diabetes and hypertension self-management via a touchscreen tablet-based system over a 24-week period. A questionnaire was administered at four time points (baseline and 8, 16, and 24 weeks after implementation) to collect data from 151 patients with coexisting type 2 diabetes and hypertension. We tested the model at each time point using partial least squares structural equation modeling.

RESULTS

Perceived usefulness of the self-management system influenced BI directly at 8 and 24 weeks and indirectly at 8, 16, and 24 weeks. Perceived ease of use indirectly affected BI at 8, 16, and 24 weeks. Attitude directly affected BI at 8, 16, and 24 weeks. Perceived behavioral control directly influenced BI at baseline and 8 and 16 weeks. Subjective norms indirectly influenced BI at 8, 16, and 24 weeks. PHF and PVF indirectly influenced BI over the entire study period. PSA influenced BI directly at 16 weeks and indirectly at 8, 16, and 24 weeks.

CONCLUSION

The effects of the proposed factors in our model on patient-focused HIT acceptance changed over a longer time period, emphasizing the importance of further investigation of the longitudinal mechanisms influencing technology acceptance behavior. It is recommended that healthcare practitioners consider such changes when implementing comparable technologies. Moreover, beyond technology attributes, the characteristics, needs, and limitations of older adults and elderly patient users and their home environments should also be considered in the design and implementation of patient-focused HIT systems for chronic disease self-management at home.

Influence of body visualization in VR during the execution of motoric tasks in different age groups

Virtual reality (VR) has become a common tool and is often considered for sport-specific purposes. Despite the increased usage, the transfer of VR-adapted skills into the real-world (RW) has not yet been sufficiently studied, and it is still unknown how much of the own body must be visible to complete motoric tasks within VR. In addition, it should be clarified whether older adults also need to perceive their body within VR scenarios to the same extent as younger people extending the usability. Therefore, younger (18-30 years old) and elderly adults (55 years and older) were tested (n = 42) performing a balance-, grasping- and throwing task in VR (HMD based) accompanied with different body visualization types in VR and in the RW having the regular visual input of body's components. Comparing the performances between the age groups, the time for completion, the number of steps (balance task), the subjective estimation of difficulty, the number of errors, and a rating system revealing movements' quality were considered as examined parameters. A one-way ANOVA/Friedmann with repeated measurements with factor [body visualization] was conducted to test the influence of varying body visualizations during task completion. Comparisons between the conditions [RW, VR] were performed using the t-Tests/Wilcoxon tests, and to compare both age groups [young, old], t-Tests for independent samples/Mann-Whitney-U-Test were used. The analyses of the effect of body visualization on performances showed a significant loss in movement's quality when no body part was visualized (p < .05). This did not occur for the elderly adults, for which no influence of the body visualization on their performance could be proven. Comparing both age groups, the elderly adults performed significantly worse than the young age group in both conditions (p < .05). In VR, both groups showed longer times for completion, a higher rating of tasks' difficulty in the balance and throwing task, and less performance quality in the grasping task. Overall, the results suggest using VR for the elderly with caution to the task demands, and the visualization of the body seemed less crucial for generating task completion. In summary, the actual task demands in VR could be successfully performed by elderly adults, even once one has to reckon with losses within movement's quality. Although more different movements should be tested, basic elements are also realizable for elderly adults expanding possible areas of VR applications.

Meta-analysis of the effects of game types and devices on older adults-video game interaction: Implications for video game training on cognition

Video game training can effectively improve the cognition of older adults. However, whether video game types and game devices influence the training effects of video games remains controversial. This meta-analysis aimed to access and evaluate the effects of video game types and game devices in video game training on the cognition of older adults. Interestingly, results indicated that mouse/keyboard was superior over other video game devices on perceptual-motor function. The effect size (Hedge's g) for perceptual-motor function decreased by 1.777 and 1.722 when the video game training device changed from mouse/keyboard to driving simulator and motion controller. The effects of cognitive training game and conventional video game were moderated by session length. More well-designed studies are required to clarify the unique efficacy of video game types and devices for older adults with video game training.

Freehand interaction with large displays: Effects of body posture, interaction distance and target size on task performance, perceived usability and workload

The past decade has seen increasing popularity of large display-based freehand interaction. This study examined the effects of body posture, interaction distance and target size on freehand interaction with a large display. Participants performed pointing and dragging tasks by freehand interaction with a large display under sitting and standing postures and at different interaction distances. Targets in both small and large sizes were examined. Results showed that interaction distance yielded a significant effect on error rate, but the effect differed by task type. Little measurable difference was found in interaction performance, perceived usability and workload between sitting and standing postures. There were significant interaction effects between posture and interaction distance on perceived workload. Larger target size led to higher efficiency and accuracy in pointing tasks, but reduced accuracy in dragging tasks. This study provided implications that are likely to improve the design and deployment of large display-based freehand interaction techniques.

Effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

The study sought to examine the effects of technology-supported exercise programs on the knee pain, physical function, and quality of life of individuals with knee osteoarthritis and/or chronic knee pain by a systematic review and meta-analysis of randomized controlled trials.

MATERIALS AND METHODS

We searched MEDLINE, EMBASE, CINAHL Plus, and the Cochrane Library from database inception to August 2020. A meta-analysis and subgroup analyses, stratified by technology type and program feature, were conducted.

RESULTS

Twelve randomized controlled trials were reviewed, all of which implemented the programs for 4 weeks to 6 months. Telephone, Web, mobile app, computer, and virtual reality were used to deliver the programs. The meta-analysis showed that these programs were associated with significant improvements in knee pain (standardized mean difference [SMD] = -0.29; 95% confidence interval [CI], -0.48 to -0.10; P = .003) and quality of life (SMD = 0.25; 95% CI, 0.04 to 0.46; P = .02) but not with significant improvement in physical function (SMD = 0.22; 95% CI, 0 to 0.43; P = .053). Subgroup analyses showed that some technology types and program features were suggestive of potential benefits.

CONCLUSIONS

Using technology to deliver the exercise programs appears to offer benefits. The technology types and program features that were associated with health values have been identified, based on which suggestions are discussed for the further research and development of such programs.

Evaluation of the biomechanical stress in the neck and shoulders during augmented reality interactions

This study aimed to characterize the biomechanical stresses in the neck and shoulder, self-reported discomfort, and usability by different target distance or size during augmented reality (AR) interactions. In a repeated-measures laboratory-based study, 20 participants (10 males) performed three standardized AR tasks (3-dimensional (3-D) cube, omni-directional pointing, and web-browsing tasks) with three target distances (0.3, 0.6, and 0.9 m from each participant denoted by near, middle, far targets) for the 3-D cube and omni-directional pointing tasks or three target sizes: small (30% smaller than default), medium (default: 1.0 × 1.1 m), and large (30% larger than default) for the web-browsing task. Joint angle, joint moment, muscle activity, self-reported discomfort and comfort in the neck and shoulders; and subjective usability ratings were measured. The results showed that shoulder angle (flexion and abduction), shoulder moment (flexion), middle deltoid muscle activity significantly increased as the target distance increased during the 3-D cube task (p's < 0.001). Self-reported neck and shoulder discomfort significantly increased after completing each task (p's < 0.001). The participants preferred the near to middle distance (0.3-0.6 m) or the medium to large window size due to task easiness (p's < 0.005). The highest task performance (speed) was occurred at the near distance or the large window size during the 3-D cube and web-browsing tasks (p's < 0.001). The results indicate that AR interactions with the far target distance (close to maximum reach envelop) may increase the risk for musculoskeletal discomfort in the shoulder regions. Given the increased usability and task performance, the near to middle distance (less than 0.6 m) or the medium to large window size (greater than 1.0 × 1.1 m) would be recommended for AR interactions.

The effects of target location on musculoskeletal load, task performance, and subjective discomfort during virtual reality interactions

The objective of this study was to evaluate the effect of different target locations on musculoskeletal loading and task performance during virtual reality (VR) interactions. A repeated-measures laboratory study with 20 participants (24.2 ± 1.5 years; 10 males) was conducted to compare biomechanical exposures (joint angle, moment, and muscle activity in the neck and shoulder), subjective discomfort, and task performance (speed and accuracy) during two VR tasks (omni-directional pointing and painting tasks) among different vertical target locations (ranged from 15° above to 30° below eye height). The results showed that neck flexion/extension angle and moment, shoulder flexion angle and moment, shoulder abduction angle, muscle activities of neck and shoulder muscles, and subjective discomfort in the neck and shoulder significantly varied by target locations (p's < 0.001). The target locations at 15° above and 30° below eye height demonstrated greater shoulder flexion (up to 52°), neck flexion moment (up to 2.7Nm), anterior deltoid muscle activity, and subjective discomfort in the neck and shoulder as compared to the other locations. This result indicates that excessive vertical target locations should be avoided to reduce musculoskeletal discomfort and injury risks during VR interactions. Based on relatively lower biomechanical exposures and trade-off between neck and shoulder postures, vertical target location between eye height and 15° below eye height could be recommended for VR use.

The accuracy of the frontal extent in stereoscopic environments: A comparison of direct selection and virtual cursor techniques

This experiment investigated the accuracy of distance judgment and perception of the frontal extent in a stereoscopic environment. Eight virtual targets were projected in a circular arrangement with two center-to-center target distances (18 cm and 36 cm) and three target sizes (0.6 cm, 1.5 cm, and 3.7 cm). Fourteen participants judged the positions of virtual targets presented at a distance of 90 cm from them by employing two different interaction techniques: the direct selection technique and the virtual cursor technique. The results showed overall higher accuracy with the virtual cursor technique than with the direct selection technique. It was also found that the target size significantly affected the frontal extent accuracy. In addition, significant interactions between technique and center-to-center target distance were observed. The direct selection technique was more accurate at the 18 cm center-to-center target distance along the horizontal (x) and vertical (y) axes, while the virtual cursor technique was more accurate for the 36 cm center-to-center target distance along the y axis. During the direct selection, estimations tended to converge to the center of the virtual space; however, this convergence was not observed in the virtual cursor condition. The accuracy of pointing estimations suffered on the left side of participants. These findings could provide direction for virtual reality developers in selecting proper interaction techniques and appropriately positioning virtual targets in stereoscopic environments.