Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets

Virtual Reality in Improving Anticipatory Postural Adjustments to Step Initiation in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial

Background: Virtual reality (VR) has been suggested as a new therapeutic approach in various sectors of rehabilitation, including the treatment of patients with knee osteoarthritis (OA), and one of its treatment goals is to improve the gait pattern and walking ability of patients. Objective: This study aimed to evaluate if VR, along with conventional physiotherapy treatment (CT), has superior effects to kinesiotherapy alone on pain, physical capacity, balance, and the parameters of anticipatory postural adjustments (APAs) in patients with knee OA. Design: This study is a single-blind randomized controlled trial. Setting: Secondary care at Hospital SARAH Network of Rehabilitation Hospitals, Brazil. Participants: Forty participants (31 women and 9 men) with knee OA in at least one knee and able to ambulate independently. Intervention: A rehabilitation program (8 consecutive weeks, 50-minute session, twice a week). Patients were randomized into the intervention groups CT or VR. Main Outcome Measures: Primary-latency of APA, amplitude of APA, and time to reach the maximum acceleration amplitude. Secondary-balance control by Mini-Balance Evaluation Systems Test, pain, and physical capacity by Western Ontario and McMaster Universities Arthritis Index. Results: The results of the study showed that conventional treatment significantly improved pain intensity, physical capacity, and balance in individuals with knee OA; however, only the group that used VR showed improvement in the APA parameters. Conclusion: This study demonstrated that VR associated with conventional treatment improved APAs in patients with knee OA.

Facial and upper-limb movement abnormalities in individuals with psychotic-like experiences: a motion analysis study

Slow movements and irregular muscle contraction have been reported separately in different studies targeting individuals with psychotic-like experiences (PLEs). To date, it remains unknown whether these two movement abnormalities, possibly associated with hypo- and hyper-dopaminergia, respectively, co-existed in one sample with PLEs and interrelated in the early stage of psychotic progression. Therefore, this study was to examine if facial and upper-limb slow movements and irregular muscle contraction co-existed in individuals with PLEs, interrelated, and were associated with PLEs. A total of 26 individuals with PLEs, who were identified using the 16-item Prodromal Questionnaire, and 26 age- and gender-matched healthy controls received the facial and upper-limb movement measurement. A motion capture system was used to record the movement procedure and thus calculate kinematic variables that represented severity of slow movements and irregular muscle contraction. Results showed that facial and upper-limb slow movements and facial irregular muscle contraction existed in individuals with PLEs. For the total sample, slower facial movements were associated with less regular facial muscle contraction; slower upper-limb movements were associated with less regular upper-limb muscle contraction. Slower and less regular facial and upper-limb movements were associated with more severe PLEs. Compensatory changes in dopaminergic neural pathways in response to elevated dopamine might explain connection between slow movements and irregular muscle contraction. Because of the ability to detect facial and upper-limb movement abnormalities objectively and sensitively, motion analysis has great applicability to sensorimotor studies for people in the psychosis continuum.

Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review

Background

The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures.

Methods

MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health.

Results

Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data.

Conclusion

Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.

Identification of Clinical Measures to Use in a Virtual Concussion Assessment: Protocol for a Mixed Methods Study

BACKGROUND

Workplace concussions can have a significant impact on workers. The impact of concussion symptoms, combined with challenges associated with clinical environments that are loud, bright, and busy, create barriers to conducting effective in-person assessments. Although the opportunity for remote care in rural communities has long been recognized, the COVID-19 pandemic has catalyzed the transition to virtual assessments and care into the mainstream. With this rapid shift, many clinicians have been completing remote assessments. However, the approaches and measures used in these assessments have not yet been standardized. Furthermore, the psychometric properties of the assessments when completed remotely using videoconference have not yet been documented.

OBJECTIVE

Through this mixed methods study, we aim to (1) identify the concussion assessment measures clinicians are currently using in person and are most relevant to the following 5 physical domains: neurological examination (ie, cranial nerve, coordination, motor, and sensory skills), cervical spine, vestibular, oculomotor, and effort assessment; (2) document the psychometric properties of the measures identified; (3) identify measures that appear feasible in a virtual context; and (4) identify practical and technical barriers or challenges, facilitators, and benefits to conducting or engaging in virtual concussion assessments.

METHODS

This study will follow a sequential mixed methods design using a survey and Delphi approach, working groups with expert clinicians, and focus groups with experienced clinicians and people living with concussions. Our target sample sizes are 50 clinicians for the Delphi surveys, 4 clinician-participants for the working group, and 5-7 participants for each focus group (roughly 6-10 total groups being planned with at least two groups consisting of people living with concussions). The results from this study will inform the decision regarding the measures that should be included in a virtual assessment tool kit to be tested in a future planned prospective evaluation study.

RESULTS

The study is expected to be completed by January 2023.

CONCLUSIONS

This mixed methods study will document the clinical measures that are currently used in person and will identify those that are most relevant to assessing the physical domains impacted by concussions. Potential feasibility of using these measures in a virtual context will be explored.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40446.

Designing Virtual Reality Assisted Psychotherapy for Anxiety in Older Adults Living with Parkinson's Disease: Integrating Literature for Scoping

Objective: This review integrates literature to discuss the potential use of virtual reality (VR) in treatment of anxiety in Parkinson's disease (PD) and inform next steps.Methods: A systematic search was performed to identify studies of VR use in PD, using four databases. Data were reported in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analyzes extension for Scoping Reviews (PRISMA-ScR).Results: Thirty-two studies met the inclusion criteria with four VR studies from the same study group directly assessing the effects of anxiety on motor symptoms in PD. Primary studies implementing a VR protocol in PD identified focus areas of understanding and alleviating freezing of gait (FOG), balance training, and cognitive and motor rehabilitation, and informed design considerations.Conclusion: VR in PD studies suggested established feasibility. With appropriate design considerations, a VR based protocol could improve anxiety outcomes in PD.Clinical implications: VR in PD provides control of a patient's field of view, which can be exploited to induce specific responses, provide visual feedback, analysis of patient actions, and introduce safe challenges in the context of training. VR assisted Cognitive Behavioral Therapy (CBT) tailored to suit subtypes of anxiety disorders in PD have the potential to improve the efficacy and effectiveness of psychotherapy in PD.

An Instrumental Measure of Hand and Facial Movement Abnormalities in Patients With Schizophrenia

INTRODUCTION

Movement disorders have been suggested to be a cardinal component of schizophrenia. With increased research interests in this area, instrumental measures are needed. This study was to examine if the motion capture system was reliable in measuring hand and facial bradykinesia and dyskinesia and more sensitive to detecting movement differences between schizophrenia patients and healthy people than traditional rating scales.

METHODS

Sixteen schizophrenia patients and 20 control subjects were recruited. Hand and facial bradykinesia and dyskinesia were measured using the motion capture system and rated using the Extrapyramidal Symptom Rating Scale and the Abnormal Involuntary Movement Scale.

RESULTS

The system showed strong test-retest reliability and generated larger effect sizes of group differences than did the rating scales.

CONCLUSIONS

The results may support researchers and clinical practitioners to apply the system to sensitively measuring the hand and facial movement symptoms in schizophrenia patients, which contributes to gaining a deep understanding of movement issues in schizophrenia.

Exergaming as Part of the Telerehabilitation Can Be Adequate to the Outpatient Training: Preliminary Findings of a Non-randomized Pilot Study in Parkinson's Disease

Parkinson's disease is a long-term and progressive degenerative disorder of the nervous system, affecting primarily motor coordination, noticeable as a tremor in one hand. Recent studies reported on positive outcomes of intensive physiotherapy of upper extremities. We built a telerehabilitation system with virtual pick and place tasks for small scale hand movements, and designed a pilot study to find whether such exergaming as a telerehabilitation service provides comparable outcomes as an outpatient exergaming service. A non-randomized pilot trial was designed. Hospital outpatients (28/40) with Parkinson's disease were recruited. Those meeting the inclusion criteria were divided into two groups; seven outpatients were assigned to the home (H) group and 21 outpatients to the hospital (URI) group. Both groups received 10 days of exergaming over the course of 2 weeks, each daily session lasting a maximum of 1 h. Primary outcomes were clinical tests; Box and Blocks Test (BBT), Jebsen Hand Function Test (JHFT), and Unified Parkinson's Disease Rating Scale (UPDRS part III) were carried out before and after the study. Secondary outcomes were hand kinematics and exergaming results; number of successfully moved objects and task time. Statistical analysis was carried out to find significant (p < 0.05) differences and Cohen's U3 was used to determine effect sizes. The differences between the groups in gender (p = 0.781), age (p = 0.192), and duration of the disease (p = 0.195) were tested with Bartlett's test and no statistical differences were found with an F test. Both groups demonstrated statistically significant improvements in clinical test UDPRS III (p = 0.006 and p = 0.011) and the hospital group also in BBT (p = 0.002) and JHFT (p = 0.015) and with UDPRS III and JHFT even in favor of the home group (χ² = 5.08, p = 0.024, χ² = 7.76, p = 0.005). Nevertheless, the exergaming results show significant improvement after training (U3 > 0.86). Exergaming has already been suggested as an effective approach in the planning of rehabilitation tasks for persons with Parkinson's disease. We have prepared a pilot study demonstrating that exergaming at home with telerehabilitation support may provide comparable clinical outcomes. The study shall be followed by a randomized study with higher statistical power to provide clinical evidence. Nevertheless, carrying out even part of the rehabilitation program at home is crucial for the development of future telerehabilition clinical services. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03175107.

Video Game-Based Therapy on Balance and Gait of Patients with Stroke: A Systematic Review

Background: Stroke patients with motor, sensory and cognitive diseases can take profits from information and communication technologies—in particular, from the latest commercial video consoles, which are based on motion capture. These technologies are positioning themselves as complementary therapeutic tools for treating gait and balance disorders. In this paper, a systematic review of the effect of video game-based therapy on balance and gait in stroke patients is shown and compared with other types of treatments. Methods: A systematic review of prospective controlled clinical trials published in the main biomedical databases in English and Spanish between 2005 and 2020 was performed. The systematic review presented in this paper has been done following the Cochrane Manual recommendations and the PRISMA Declaration by two independent reviewers. Data about participants, intervention, outcome measurements and outcome measurement results were extracted. The quality of evidence of each study was assessed using Cochrane’s standard quality assessment format, which includes a description of the risk of bias. Additionally, the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of each paper. Results: A total of 18 papers, including 479 patients, were included in this systematic review, in which the use of video consoles (in combination with conventional rehabilitation or exclusively) was compared with conventional rehabilitation to treat balance or gait in post-stroke patients. In all studies, a tendency to improve balance was found in both intervention groups, finding, in 10 of 17 studies that analysed it, a better capacity in the experimental group that included video consoles compared to the conventional rehabilitation control group. Regarding gait, in six of seven studies that analysed it, improvements were found in both intervention groups, and these improvements were greater in the experimental group than compared to the control group in three of them. Conclusions: Commercial video game systems, in combination with conventional rehabilitation, have shown positive results on balance and gait in post-stroke patients. There were variations between the trials in terms of the video consoles used and the duration, frequency and number of sessions with commercial video games. Future studies should compare the effects of commercial video game treatments on balance and gait in stroke patients with a nonintervention group to know their real efficacy.

A comparison of the effects of plyometric and virtual training on physical and functional performance: a randomized, controlled, clinical trial

BACKGROUND

This study compared the effects of plyometric training (PT) and virtual training (VT) on physical and functional performance.

METHODS

Fifty-five moderately-trained women participated in this randomized, controlled, prospective study. The subjects were randomly assigned to VT (N.=20), PT (N.=18), and control (CG, N.=17) groups. The VT was performed using the Your Body Shape Fitness Evolved 2012^™ exergame in an Xbox360/Kinetic^™ environment. The PT was based on the methods used in previous studies. Both interventions were performed 3 times per week for 8 weeks. Participants in the CG were not submitted to any type of intervention. Physical performance (fitness and athleticism levels) was assessed using the Nike+ Kinetic Training^™ exergame in an Xbox360/Kinetic^™ environment. Functional performance was assessed using the shuttle run (SR), triple hop test (THT), and six-meter timed hop test (STHT).

RESULTS

Postintervention fitness and athleticism levels were significantly greater in VT (P<0.001 and P=0.009) and in PT (P<0.001 and P=0.003) than baselines values. Only VT postintervention fitness level was significantly greater compared to CG (P=0.03). Postintervention SR values were significantly lower than baselines values in all groups (P<0.001). VT (P=0.08) and PT (P=0.006) postintervention values were significantly lower compared to CG. Postintervention THT values were significantly greater than baselines values in VT and PT (P<0.001). VT (P=0.04 - dominant limb) and PT (P=0.003 - dominant limb; and P=0.03 - non-dominant limb) postintervention values were significantly greater compared to CG. Postintervention STHT values were significantly lower than baselines values in VT (P<0.001), PT (P<0.001) and CG (P=0.01-0.02). PT postintervention dominant (P=0.01) and non-dominant (P=0.03) limb values were significantly lower compared to CG.

CONCLUSIONS

Both VT and PT are beneficial for improving physical and functional performance. Therefore, VT might be a new tool that can be used for physical exercise practice and conditioning training in moderately-trained women.

Effects of different types of sensory signals on reaching performance in persons with chronic schizophrenia

Previous studies have reported movement abnormalities in persons with schizophrenia. This study aimed to examine the differences between persons with chronic schizophrenia and healthy control participants in reaching movement and the effects of sensory signals on reaching performance in persons with chronic schizophrenia. A counter-balanced repeated-measures design was employed. Twenty persons with schizophrenia and 20 age- and gender-matched control participants were recruited in this study. Reaching performance was measured in three types of sensory signal conditions (visual, auditory, and no signal), i.e., two externally triggered and one self-initiated movement were assessed in reaction time/inter-response interval, movement time, peak velocity, percentage of time in which peak velocity occurred, and movement units. The results revealed significant main effects of group in reaction time/inter-response interval (p = 0.003), movement time (p < 0.001), peak velocity (p < 0.001), and movement units (p < 0.001). The persons with chronic schizophrenia demonstrated slower response to signals and in self-initiated movement, increased movement time, and less forceful and less smooth movement compared to healthy control participants when performing the reaching task. The interaction effect between group and signal in reaction time/inter-response interval was also significant (p < 0.001). The inter-response interval for self-initiated reaching was the shortest in healthy controls. Conversely, the inter-response interval for self-initiated reaching was the longest in persons with schizophrenia. The main effect of the signal on movement time was significant (p < 0.001). The movement time of reaching was longer in response to the auditory signal than in response to visual or self-initiated. The differences in percentages of time in which peak velocity occurred between persons with schizophrenia and healthy controls (p > 0.01) and across the three conditions (p > 0.01) were non-significant. Neither duration of illness nor antipsychotic dosage was significantly associated with reaching performance (all p > 0.01). In conclusion, these findings indicate that reaching movement in persons with chronic schizophrenia is slower, less forceful, and less coordinated compared to healthy control participants. In addition, persons with chronic schizophrenia also had shorter inter-response interval for self-initiated movement and shorter movement time in auditory signal condition, independent of duration of illness and antipsychotic dosage.

Kinematic Validity of Reaching in a 2D Virtual Environment for Arm Rehabilitation After Stroke

Increasing evidence supports the use of virtual reality for stroke rehabilitation. However, movement performance and quality may be diminished by the attributes of the virtual environment (VE), which may be detrimental to motor relearning. Our aim was to determine whether reach-to-grasp movements made in a low-cost 2DVE were kinematically similar to those made in a comparable physical environment (PE) in healthy subjects and subjects with stroke. Subjects (healthy = 15, stroke = 22) made unilateral and bilateral reach-to-grasp movements in a 2DVE and a similar PE. Arm and trunk kinematics were recorded with an optoelectronic measurement system (23 markers; 120 Hz). Temporal and spatial characteristics of the endpoint trajectory, arm and trunk movement patterns were compared between environments and groups. In each group, hand positioning at object contact time and trunk displacement were unaffected by the environment. Compared to PE, in VE, unilateral movements were less smooth and time to peak velocity was prolonged. In healthy subjects, bilateral movements were simultaneous and symmetrical in both environments. In subjects with stroke, movements were less symmetrical in VE. Aside from differences in endpoint displacement between environments, movement quality variables were unaffected by the 2DVE. Thus, using a low-cost 2DVE may be a valid approach for sensorimotor rehabilitation following stroke.

Results From a Randomized Controlled Trial to Address Balance Deficits After Traumatic Brain Injury

OBJECTIVE

To evaluate the efficacy of an in-home 12-week physical therapy (PT) intervention that utilized a virtual reality (VR) gaming system to improve balance in individuals with traumatic brain injury (TBI).

SETTING

Home-based exercise program (HEP).

PARTICIPANTS

Individuals (N=63; traditional HEP n=32; VR n=31) at least 1 year post-TBI, ambulating independently within the home, not currently receiving PT services.

MAIN OUTCOME MEASURES

Primary: Community Balance and Mobility Scale (CB&M); Secondary: Balance Evaluation Systems Test (BESTest), Activities-Specific Balance Confidence Scale (ABC), Participation Assessment with Recombined Tools-Objective (PART-O).

RESULTS

No significant between-group differences were observed in the CB&M over the study duration (P=.9983) for individuals who received VR compared to those who received a HEP to address balance deficits after chronic TBI nor in any of the secondary outcomes: BESTest (P=.8822); ABC (P=.4343) and PART-O (P=.8822). However, both groups demonstrated significant improvements in CB&M and BESTest from baseline to 6, 12, and at 12 weeks follow-up (all P's <.001). Regardless of treatment group, 52% of participants met or exceeded the minimal detectable change of 8 points on the CB&M at 24 weeks and 38% met or exceeded the minimal detectable change of 7.81 points on the BESTest.

CONCLUSION

This study did not find that VR training was more beneficial than a traditional HEP for improving balance. However, individuals with chronic TBI in both treatment groups demonstrated improvements in balance in response to these interventions which were completed independently in the home environment.

Virtual Reality as a Vehicle to Empower Motor-Cognitive Neurorehabilitation

In this paper, we advocate the combination of four key ingredients that we believe are necessary to design long-lasting effective treatments for neurorehabilitation: (i) motor-cognitive training, (ii) evidence-based neuroscience principles, in particular those related to body perception, (iii) motivational games, and (iv) empowerment techniques. Then, we propose virtual reality (VR) as the appropriate medium to encompass all the requirements mentioned above. VR is arguably one of the most suitable technologies for neurorehabilitation able to integrate evidence-based neurorehabilitation techniques and neuroscience principles into motivating training approaches that promote self-management by empowering patients to own their recovery process. We discuss the advantages and challenges of such an approach on several exemplary applications and outline directions for future developments. We strongly believe that the combination of positive psychology and positive technology mediated by VR-based interventions can heavily impact the rehabilitation outcomes of motor-cognitive functions along all the stages of the rehabilitation path.

Effects of object size and distance on reaching kinematics in patients with schizophrenia

BACKGROUND/OBJECTIVE

Patients with schizophrenia not only have psychiatric symptoms, but also have movement problems, which might also be associated with their reduced quality of life. Little is known about how to improve their movement performance for patients. Manipulating object size and distance is common in occupational therapy practice to evaluate and optimize reaching performance in patients with physical disabilities, but effects of the manipulation in patients with schizophrenia remain unclear. The purpose of this study was to examine whether object size and distance could change performance of reaching kinematics in patients with mild schizophrenia.

METHODS

Twenty-nine patients with mild schizophrenia and 15 age- and gender-matched healthy controls were required to reach for, as quickly as possible, a small or large object that was placed at a near or far distance. We measured movement time, peak velocity, path length ratio, percentage of time to peak velocity, and movement units to infer movement speed, forcefulness, spatial efficiency (directness), control strategies, and smoothness.

RESULTS

Patients' reaching movements were slower (p = .017) and less direct (p = .007) than those of controls. A larger object induced faster (p = .016), more preprogrammed (p = .018), and more forceful (p = .010) movements in patients. A farther object induced slower, more feedback dependent, but more forceful and more direct movements (all p < .001).

CONCLUSION

The results of kinematic deficiencies suggest the need of movement training for patients with mild schizophrenia. Occupational therapists may grade or adapt reaching activities by changing object size and distance to enhance movement performance in patients with schizophrenia.

Powered wheelchair simulator development: implementing combined navigation-reaching tasks with a 3D hand motion controller

Background

Powered wheelchair (PW) training involving combined navigation and reaching is often limited or unfeasible. Virtual reality (VR) simulators offer a feasible alternative for rehabilitation training either at home or in a clinical setting. This study evaluated a low-cost magnetic-based hand motion controller as an interface for reaching tasks within the McGill Immersive Wheelchair (miWe) simulator.

Methods

Twelve experienced PW users performed three navigation-reaching tasks in the real world (RW) and in VR: working at a desk, using an elevator, and opening a door. The sense of presence in VR was assessed using the iGroup Presence Questionnaire (IPQ). We determined concordance of task performance in VR with that in the RW. A video task analysis was performed to analyse task behaviours.

Results

Compared to previous miWe data, IPQ scores were greater in the involvement domain (p < 0.05). Task analysis showed most of navigation and reaching behaviours as having moderate to excellent (K > 0.4, Cohen’s Kappa) agreement between the two environments, but greater (p < 0.05) risk of collisions and reaching errors in VR. VR performance demonstrated longer (p < 0.05) task times and more discreet movements for the elevator and desk tasks but not the door task.

Conclusions

Task performance showed poorer kinematic performance in VR than RW but similar strategies. Therefore, the reaching component represents a promising addition to the miWe training simulator, though some limitations must be addressed in future development.

Efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com Parkinson

O objetivo desta pesquisa foi verificar os efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com doença de Parkinson, antes e após o tratamento com aplicação do questionário da doença de Parkinson PDQ-39. Corresponde a um estudo experimental, do tipo ensaio clínico não controlado, de natureza quantitativa. O estudo envolveu 14 indivíduos, que passaram por 20 sessões individuais de tratamento distribuídas em duas sessões semanais, com duração entre 30 e 40 minutos cada. Na análise dos dados, foi utilizado o teste de Wilcoxon, para encontrar o valor da significância estatística p≤0,05. Os escores do Questionário da Doença de Parkinson-39 total e seus domínios diminuíram quando comparados aos do período da avaliação e da reavaliação dos pacientes. No entanto, os valores de p expressam que essa diminuição foi significativa especificamente para os domínios mobilidade, bem-estar emocional, estigma e cognição, e o escore do Questionário da Doença de Parkinson-39 total. Assim, os resultados demonstraram que a realidade virtual não imersiva contribuiu positivamente sobre a qualidade de vida desses indivíduos.

Virtual reality-based therapy for the treatment of balance deficits in patients receiving inpatient rehabilitation for traumatic brain injury

OBJECTIVE

To evaluate the feasibility and safety of utilizing a commercially available virtual reality gaming system as a treatment intervention for balance training.

DESIGN

A randomized controlled trial in which assessment and analysis were blinded.

SETTING

An inpatient rehabilitation facility.

INTERVENTION

Interventions included balance-based physical therapy using a Nintendo Wii, as monitored by a physical therapist, and receipt of one-on-one balance-based physical therapy using standard physical therapy modalities available for use in the therapy gym.

RESULTS

Participants in the standard physical therapy group were found to have slightly higher enjoyment at mid-intervention, while those receiving the virtual reality-based balance intervention were found to have higher enjoyment at study completion. Both groups demonstrated improved static and dynamic balance over the course of the study, with no significant differences between groups. Correlational analyses suggest a relationship exists between Wii balance board game scores and BBS scores for measures taken beyond the baseline assessment.

CONCLUSIONS

This study provides a modest level of evidence to support using commercially available VR gaming systems for the treatment of balance deficits in patients with a primary diagnosis of TBI receiving inpatient rehabilitation. Additional research of these types of interventions for the treatment of balance deficits is warranted.

Increasing speed to improve arm movement and standing postural control in Parkinson's disease patients when catching virtual moving balls

Research has shown that moving targets help Parkinson's disease (PD) patients improve their arm movement while sitting. We examined whether increasing the speed of a moving ball would also improve standing postural control in PD patients during a virtual reality (VR) ball-catching task. Twenty-one PD patients and 21 controls bilaterally reached to catch slow-moving and then fast-moving virtual balls while standing. A projection-based VR system connected to a motion-tracking system and a force platform was used. Dependent measures included the kinematics of arm movement (movement time, peak velocity), duration of anticipatory postural adjustments (APA), and center of pressure (COP) movement (movement time, maximum amplitude, and average velocity). When catching a fast ball, both PD and control groups made arm movements with shorter movement time and higher peak velocity, longer APA, as well as COP movements with shorter movement time and smaller amplitude than when catching a slow ball. The change in performance from slow- to fast-ball conditions was not different between the PD and control groups. The results suggest that raising the speed of virtual moving targets should increase the speed of arm and COP movements for PD patients. Therapists, however, should also be aware that a fast virtual moving target causes the patient to confine the COP excursion to a smaller amplitude. Future research should examine the effect of other task parameters (e.g., target distance, direction) on COP movement and examine the long-term effect of VR training.

A fast-moving target in the Valpar assembly task improved unimanual and bimanual movements in patients with schizophrenia

PURPOSE

To investigate the effects of target speed on unimanual and bimanual movements during a bimanual prehension and assembly task in patients with mild schizophrenia and healthy controls.

METHOD

Fifteen patients with schizophrenia and 15 age- and gender-matched healthy controls were instructed to reach and assemble spacers with both hands for a target that moved at two speeds: fast or slow. Dependent variables were movement kinematics: movement time, number of movement units and timing intervals between both hands.

RESULTS

A fast-moving target induced shorter movement times, fewer movement units and shorter timing intervals than did a slow-moving target for patients. Under the slow-target condition, patients had longer movement times and a longer timing interval during prehension, as well as longer movement times, more movement units and a longer timing interval during assembly than did controls. Under the fast-target condition, patients still had slower and less-synchronized prehension than did controls, but their assembly improved to a level similar to that of controls.

CONCLUSIONS

A fast-moving target induced faster, smoother and more synchronized movements than did a slow-moving target for patients with schizophrenia, especially during assembly.

IMPLICATIONS FOR REHABILITATION

A fast-moving target might elicit faster, smoother, and more synchronized movements than might a slow-moving target during a bimanual assembly task for patients with mild schizophrenia. The findings of impaired movement kinematics under the slow-target condition suggest that patients with schizophrenia need movement training.

Trunk-arm coordination in reaching for moving targets in people with Parkinson's disease: comparison between virtual and physical reality

We used a trunk-assisted prehension task to examine the effect of task (reaching for stationary vs. moving targets) and environmental constraints (virtual reality [VR] vs. physical reality) on the temporal control of trunk and arm motions in people with Parkinson's disease (PD). Twenty-four participants with PD and 24 age-matched controls reached for and grasped a ball that was either stationary or moving along a ramp 120% of arm length away. In a similar VR task, participants reached for a virtual ball that was either stationary or moving. Movement speed was measured as trunk and arm movement times (MTs); trunk-arm coordination was measured as onset interval and offset interval between trunk and arm motions, as well as a summarized index-desynchrony score. In both VR and physical reality, the PD group had longer trunk and arm MTs than the control group when reaching for stationary balls (p<.001). When reaching for moving balls in VR and physical reality, however, the PD group had lower trunk and arm MTs, onset intervals, and desynchrony scores (p<.001). For the PD group, VR induced shorter trunk MTs, shorter offset intervals, and lower desynchrony scores than did physical reality when reaching for moving balls (p<.001). These findings suggest that using real moving targets in trunk-assisted prehension tasks improves the speed and synchronization of trunk and arm motions in people with PD, and that using virtual moving targets may induce a movement termination strategy different from that used in physical reality.