1
|
Morifuji M, Higashi S, Ebihara S, Nagata M. Ingestion of β-nicotinamide mononucleotide increased blood NAD levels, maintained walking speed, and improved sleep quality in older adults in a double-blind randomized, placebo-controlled study. GeroScience 2024:10.1007/s11357-024-01204-1. [PMID: 38789831 DOI: 10.1007/s11357-024-01204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
The study evaluated how ingestion of nicotinamide mononucleotide (NMN) for 12 weeks by older adults affected blood nicotinamide adenine dinucleotide (NAD +) levels and physical function, particularly walking function. Information concerning sleep, and stress was also collected as secondary endpoints. In this randomized, placebo-controlled, double-blind, parallel-group comparison study, 60 participants were randomly allocated into a placebo group or NMN group. Members of the NMN group consumed 250 mg/day NMN for 12 weeks. Motor function tests, blood NAD metabolite analysis, and questionnaires were conducted at the start of the study and 4 and 12 weeks after intake. This trial was registered at umin.ac.jp/ctr as UMIN000047871 on June 22nd, 2022.At primary outcome, at both 4 weeks and 12 weeks, the NMN and placebo groups had no significant differences in a stepping test. At secondary outcomes, after 12 weeks of NMN intake, the NMN group had a significantly shorter 4-m walking time than the placebo group as well as significantly higher blood levels of NAD + and its metabolites. A significant negative correlation was observed between the change in the 4-m walking time and the change in blood NAD + , N1-methyl-2-pridone-5-carboxamide (2-PY), and N1-methyl-4-pridone-3-carboxamide (4-PY) at 12 weeks. The NMN group had improved sleep quality at 12 weeks relative to the placebo group as evidenced by lower scores for "Daytime dysfunction" and "Global PSQI" on the Pittsburgh Sleep Questionnaire. No adverse effects related to test substance consumption were observed. Together, these results indicate that NMN intake could increase blood NAD + levels, maintain walking speed, and improve sleep quality in older adults. Interventions involving NMN aimed at maintaining walking speed could contribute to extended healthy life expectancy.
Collapse
Affiliation(s)
- Masashi Morifuji
- Wellness Science Labs, Meiji Holdings Co., Ltd, 1-29-1 Nanakuni, Hachioji, Tokyo, 192-0919, Japan.
| | - Seiichiro Higashi
- Wellness Science Labs, Meiji Holdings Co., Ltd, 1-29-1 Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| | - Shukuko Ebihara
- Chiyoda Paramedical Care Clinic, 3-3-10 Nihonbashi Hongokucho, Chuo-Ku, Tokyo, 103-0021, Japan
| | - Masashi Nagata
- Wellness Science Labs, Meiji Holdings Co., Ltd, 1-29-1 Nanakuni, Hachioji, Tokyo, 192-0919, Japan
| |
Collapse
|
2
|
Abd El-Kafy EM, Alayat MS, Subahi MS, Badghish MS. C-Mill Virtual Reality/Augmented Reality Treadmill Training for Reducing Risk of Fall in the Elderly: A Randomized Controlled Trial. Games Health J 2024. [PMID: 38563663 DOI: 10.1089/g4h.2023.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Objective: Falling is considered one of the major problems that may affect the elderly, leading to multiple health issues. Walking adaptability to environmental demands is essential for safe walking in the elderly. The aim of this study was to evaluate the efficacy of virtual reality (VR)/augmented reality (AR) treadmill training on balance performance and the risk of falls in the elderly. Materials and Methods: Sixty Saudi elderly individuals of both genders, aged between 60 and 70 years, participated in the study. The participants were categorized into two groups: the experimental and the control groups. Both groups received 1 hour of training: 30 minutes of conventional exercises and 30 minutes of gait training on the C-Mill VR/AR treadmill. The experimental group used the C-Mill treadmill with VR and AR games therapy. The control group had gait training on the C-Mill treadmill without VR and AR. The training for both groups was conducted for 6 successive weeks/three times a week. The changes in the scores of the following variables were recorded at baseline, after 6 weeks of training, and 4 weeks after the completion of training. These variables involved the time needed for completing the Timed Up and Go (TUG) test, overall stability indices of the Fall Risk (FR) test and Limit of Stability (LOS) test evaluated using the Biodex Balance System (BBS), and the time required for completing the LOS test. Results: Both groups demonstrated significant improvement in all measured variables immediately post-training, and this improvement persisted for 4 weeks after completing the training. The experimental group exhibited greater improvement in the recorded values of all measured variables compared with the control group following the training. Conclusions: This study concluded that C-Mill VR/AR treadmill training is effective in improving balance control and reducing the fall risk in the elderly.
Collapse
Affiliation(s)
- Ehab Mohamed Abd El-Kafy
- Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohamad Salaheldien Alayat
- Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Moayad Saleh Subahi
- Department of Medical Rehabilitation Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | | |
Collapse
|
3
|
You D, Hasley Bin Ramli S, Ibrahim R, Hibatullah Bin Romli M, Li Z, Chu Q, Yu X. A thematic review on therapeutic toys and games for the elderly with Alzheimer's disease. Disabil Rehabil Assist Technol 2024:1-13. [PMID: 38299880 DOI: 10.1080/17483107.2023.2299713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Alzheimer's disease (AD) is a common and devastating neurological ailment that affects millions of the elderly worldwide. Therapeutic toys and games have emerged as potential non-pharmacological interventions for AD. However, despite a growing number of documents on the subject, research on the future direction of therapeutic toys and games for AD remains scarce. To address this gap, this study aims to (1) map the future trends of therapeutic toys and games for AD and (2) identify the categories and design characteristics. MATERIALS AND METHODS Using a thematic review framework, a systematic literature search was conducted in two electronic databases (Scopus and WoS) using established criteria. Thematic analysis was done using ATLAS.ti 23 to identify prominent themes, patterns and trends. RESULTS A total of 180 documents were found. Twenty-five articles met the inclusion criteria. A thematic review of these 25 articles identified 13 initial codes, which were been clustered into four themes: detection and evaluation; intervention; toy/game category; and design characteristics. The word "Cognitive" appears most frequently in documents according to word cloud. CONCLUSIONS Therapeutic toys and games are used to detect and as an intervention for AD. Most of the current studies focused on specific cognitive functions. More research is needed about play therapy for neuropsychiatric symptoms. This thematic review also proposed a conceptual framework for designing toys and games tailored to the needs of the elderly with AD, offering valuable insights to future researchers focusing on this domain.
Collapse
Affiliation(s)
- Donggui You
- Industrial Design Department, Faculty of Design and Architecture, University Putra Malaysia, Serdang, Malaysia
- Department of Art Design & Creative Industries, Nanfang College, Guangzhou, China
| | - Saiful Hasley Bin Ramli
- Industrial Design Department, Faculty of Design and Architecture, University Putra Malaysia, Serdang, Malaysia
| | - Rahimah Ibrahim
- Department of Human Development & Family Studies, Faculty of Human Ecology, University Putra Malaysia, Serdang, Malaysia
| | - Muhammad Hibatullah Bin Romli
- Department of Rehabilitation Medicine, Faculty of Medicine and Health Science, University Putra Malaysia, Serdang, Malaysia
| | - Ziming Li
- Industrial Design Department, Faculty of Design and Architecture, University Putra Malaysia, Serdang, Malaysia
| | - Qingqing Chu
- Industrial Design Department, Faculty of Design and Architecture, University Putra Malaysia, Serdang, Malaysia
| | - Xinxin Yu
- Industrial Design Department, Faculty of Design and Architecture, University Putra Malaysia, Serdang, Malaysia
| |
Collapse
|
4
|
Yalfani A, Abedi M, Raeisi Z, Asgarpour A. The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial. J Back Musculoskelet Rehabil 2024; 37:761-770. [PMID: 38217579 DOI: 10.3233/bmr-230260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. OBJECTIVE This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. METHODS Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. RESULTS The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001). CONCLUSION According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.
Collapse
Affiliation(s)
- Ali Yalfani
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Mitra Abedi
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Zahra Raeisi
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Arak University, Arak, Iran
| | - Azadeh Asgarpour
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| |
Collapse
|
5
|
Sun PC, Kao CY, Kao CL, Wei SH. Interactive Game-Based Platform System for Assessing and Improving Posture Control in the Elderly. Bioengineering (Basel) 2023; 10:1291. [PMID: 38002415 PMCID: PMC10669706 DOI: 10.3390/bioengineering10111291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 11/26/2023] Open
Abstract
Inadequate response to balance perturbations lead to posture instability in the elderly. The fall risks are increased by a reduced capacity to control the center of pressure (COP) displacement within the safety limit of the supporting base. This study developed an interactive evaluation and training platform. The system incorporated a computerized program with instantaneous force plate evaluation. Ten young subjects underwent a baseline evaluation and twenty-nine community-dwelling elderly received pre- and post-intervention testing. The ability to reach the stability limit was assessed by measuring the maximum voluntary excursion of the COP in anterior-posterior and medial-lateral directions. Functional mobility tests including Berg Balance Scale, Timed-Up-and-Go and functional reach were used as functional outcomes. The experimental group (n = 15) received a 40 min intervention three times a week for six weeks. The interactive game-based training focused on multi-directional weight shifting by tracing a COPcontrolled target to challenge an individual's stability limit. The control group (n = 14) maintained daily activities as usual. The young group revealed a superior COP displacement through active ankle control than the elderly, especially in the anterior-posterior direction. The experimental group improved their COP displacement control more in the medial-lateral direction due to the predominant side-to-side gameplay movement. The functional outcome measures were also significantly improved after training. Using the COPcontrolled game-based program, the stability limit was challenged to facilitate dynamic posture control by an incremental increase in self-initiated perturbations. The platform system could assist in transferring the immediate training effects into daily functional mobility in the elderly.
Collapse
Affiliation(s)
- Pi-Chang Sun
- Department of Rehabilitation Medicine, Taipei City Hospital, Taipei City 11556, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| | - Chen-Yang Kao
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| | - Chung-Lan Kao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei City 11217, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei City 11221, Taiwan
| |
Collapse
|
6
|
Melo RS, Lemos A, Delgado A, Raposo MCF, Ferraz KM, Belian RB. Use of Virtual Reality-Based Games to Improve Balance and Gait of Children and Adolescents with Sensorineural Hearing Loss: A Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2023; 23:6601. [PMID: 37514897 PMCID: PMC10385194 DOI: 10.3390/s23146601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population. OBJECTIVE The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL. METHODS A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes. RESULTS Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; p = 0.37; I2 = 0%). CONCLUSION Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.
Collapse
Affiliation(s)
- Renato S Melo
- Post-Graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife 50670-901, PE, Brazil
- Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife 50670-901, PE, Brazil
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife 50740-560, PE, Brazil
- Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife 50740-560, PE, Brazil
| | - Andrea Lemos
- Post-Graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife 50670-901, PE, Brazil
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife 50740-560, PE, Brazil
| | - Alexandre Delgado
- Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Recife 50070-550, PE, Brazil
| | | | - Karla Mônica Ferraz
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife 50740-560, PE, Brazil
- Laboratory of Pediatric Studies (LEPed), Universidade Federal de Pernambuco (UFPE), Recife 50740-560, PE, Brazil
| | - Rosalie Barreto Belian
- Post-Graduate Program on Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife 50670-901, PE, Brazil
- Laboratory of Informatics in Health, Laboratório de Imunopatologia Keizo Asami (LIKA), Recife 50670-901, PE, Brazil
- Department of Medicine, Universidade Federal de Pernambuco (UFPE), Recife 50670-901, PE, Brazil
| |
Collapse
|
7
|
Janhunen M, Löppönen A, Walker S, Punsár T, Katajapuu N, Cheng S, Paloneva J, Pamilo K, Luimula M, Korpelainen R, Jämsä T, Heinonen A, Aartolahti E. Movement characteristics during customized exergames after total knee replacement in older adults. Front Sports Act Living 2022; 4:915210. [PMID: 35966111 PMCID: PMC9363837 DOI: 10.3389/fspor.2022.915210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction There is limited understanding of how older adults can reach kinematic goals in rehabilitation while performing exergames and conventional exercises, and how similar or different the kinematics during exergaming are when compared with conventional therapeutic exercise with similar movement. The aim of this study was to describe the movement characteristics performed during exercise in custom-designed exergames and conventional therapeutic exercises among patients who have undergone unilateral total knee replacement (TKR). In addition, the secondary aim was to assess the relation of these exercise methods, and to assess participants' perceived exertion and knee pain during exergaming and exercising. Materials and methods Patients up to 4 months after the TKR surgery were invited in a single-visit exercise laboratory session. A 2D motion analysis and force plates were employed to evaluate movement characteristics as the volume, range, and intensity of movement performed during custom-designed knee extension-flexion and weight shifting exergames and conventional therapeutic exercises post TKR. The perceived exertion and knee pain were assessed using the Borg Rating of Perceived Exertion and Visual Analog Scale, respectively. Results Evaluation of seven patients with TKR [age median (IQR), 65 (10) years] revealed that the volume and intensity of movement were mostly higher during exergames. Individual goniometer-measured knee range of motion were achieved either with exergames and conventional therapeutic exercises, especially in knee extension exercises. The perceived exertion and knee pain were similar after exergames and conventional therapeutic exercises. Conclusions During custom-designed exergaming the patients with TKR achieve the movement characteristics appropriate for post-TKR rehabilitation without increasing the stress and pain experienced even though the movement characteristics might be partly different from conventional therapeutic exercises by the volume and intensity of movement. Physical therapists could consider implementing such exergames in rehabilitation practice for patients with TKR once effectiveness have been approved and they are widely available.
Collapse
Affiliation(s)
- Maarit Janhunen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Maarit Janhunen
| | - Antti Löppönen
- Faculty of Sport and Health Sciences, Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
- Department of Movement Sciences, Physical Activity, Sports and Health Research Group, Katholieke Universiteit Leuven, Leuven, Belgium
- Antti Löppönen
| | - Simon Walker
- Faculty of Sport and Health Sciences, NeuroMuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Taavi Punsár
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Niina Katajapuu
- Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Sulin Cheng
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Exercise Translational Medicine Center, Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juha Paloneva
- Department of Orthopedics and Traumatology, Hospital Nova of Central Finland, Jyväskylä, Finland
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Konsta Pamilo
- Department of Orthopedics, Coxa Hospital for Joint Replacement, Tampere, Finland
| | - Mika Luimula
- Faculty of Business and Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Raija Korpelainen
- Department of Sports and Exercise Medicine, Oulu Deaconess Institute Foundation sr., Oulu, Finland
- Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Timo Jämsä
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Ari Heinonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Eeva Aartolahti
- Institute of Rehabilitation, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
| |
Collapse
|
8
|
Retention Effects of Long-Term Balance Training with Vibrotactile Sensory Augmentation in Healthy Older Adults. SENSORS 2022; 22:s22083014. [PMID: 35459000 PMCID: PMC9027305 DOI: 10.3390/s22083014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/25/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023]
Abstract
Vibrotactile sensory augmentation (SA) decreases postural sway during real-time use; however, limited studies have investigated the long-term effects of training with SA. This study assessed the retention effects of long-term balance training with and without vibrotactile SA among community-dwelling healthy older adults, and explored brain-related changes due to training with SA. Sixteen participants were randomly assigned to the experimental group (EG) or control group (CG), and trained in their homes for eight weeks using smart-phone balance trainers. The EG received vibrotactile SA. Balance performance was assessed before, and one week, one month, and six months after training. Functional MRI (fMRI) was recorded before and one week after training for four participants who received vestibular stimulation. Both groups demonstrated significant improvement of SOT composite and MiniBESTest scores, and increased vestibular reliance. Only the EG maintained a minimal detectable change of 8 points in SOT scores six months post-training and greater improvements than the CG in MiniBESTest scores one month post-training. The fMRI results revealed a shift from activation in the vestibular cortex pre-training to increased activity in the brainstem and cerebellum post-training. These findings showed that additional balance improvements were maintained for up to six months post-training with vibrotactile SA for community-dwelling healthy older adults.
Collapse
|
9
|
Slackline training and postural control in older adults: A systematic review and meta-analysis. J Bodyw Mov Ther 2022; 30:10-16. [DOI: 10.1016/j.jbmt.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/03/2021] [Accepted: 10/17/2021] [Indexed: 11/18/2022]
|
10
|
Wiskerke E, Kool J, Hilfiker R, Sattelmayer KM, Verheyden G. Determining the Optimal Virtual Reality Exergame Approach for Balance Therapy in Persons With Neurological Disorders Using a Rasch Analysis: Longitudinal Observational Study. JMIR Serious Games 2022; 10:e30366. [PMID: 35315785 PMCID: PMC8984820 DOI: 10.2196/30366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 11/15/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Virtual reality (VR) exergames have gained popularity in the rehabilitation of persons with neurological disorders as an add-on therapy to increase intensity of training. Intensity is strongly dependent on the motivation of the patient. Motivation can be increased by delivering variation within training and challenging exercises. However, patients are often underchallenged, as exergame difficulty often does not match the patient’s ability. A Rasch analysis can establish hierarchy of exergame items in order to assist the delivery of patient-centered therapy. Objective The aim of this study was to apply the Rasch model to create a hierarchical order of existing VR balance exergames and to relate these exergames to the abilities of persons with neurological disorders, in order to deliver challenge and variation. Methods A total of 30 persons with stroke and 51 persons with multiple sclerosis (MS) were included in the study. All participants performed a training program, lasting 3 weeks for persons with MS and 4 weeks for persons with stroke, in which they performed VR balance exergames with a movement recognition–based system (MindMotion GO; MindMaze SA). VR exercise scores, Berg Balance Scale scores, and clinical descriptive data were collected. Berg Balance Scale and device scores were analyzed with the Rasch model using a repeated-measures approach to examine whether the distribution of exercise scores fitted the Rasch model. Secondly, a person-item map was created to show the hierarchy of exercise difficulty and person ability. Results Participants completed a selection of 56 balance exercises (ie, items), which consisted of a combination of various balance tasks and levels (ie, exercises). Using repeated measures, this resulted in a count of 785 observations. Analysis showed strong evidence for unidimensionality of the data. A total of 47 exercises (ie, items) had a sufficiently good fit to the Rasch model. Six items showed underfit, with outfit mean square values above 1.5. One item showed underfit but was kept in the analysis. Three items had negative point-biserial correlations. The final model consisted of 47 exercises, which were provided for persons with low to moderate balance ability. Conclusions The VR exercises sufficiently fitted the Rasch model and resulted in a hierarchical order of VR balance exercises for persons with stroke and MS with low to moderate balance ability. In combination with the Berg Balance Scale, the results can guide clinical decision-making in the selection of patient-focused VR balance exercises. Trial Registration ClinicalTrials.gov NCT03993275; https://clinicaltrials.gov/ct2/show/NCT03993275
Collapse
Affiliation(s)
- Evelyne Wiskerke
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium.,Rehazentrum Valens, Kliniken Valens, Valens, Switzerland
| | - Jan Kool
- Rehazentrum Valens, Kliniken Valens, Valens, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland
| | | | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| |
Collapse
|
11
|
Pastel S, Petri K, Bürger D, Marschal H, Chen CH, Witte K. Influence of body visualization in VR during the execution of motoric tasks in different age groups. PLoS One 2022; 17:e0263112. [PMID: 35077512 PMCID: PMC8789136 DOI: 10.1371/journal.pone.0263112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Stefan Pastel
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katharina Petri
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Dan Bürger
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Hendrik Marschal
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Chien-Hsi Chen
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| | - Kerstin Witte
- Department of Sports Engineering and Movement Science, Institute III: Sports Science, Otto-von-Guericke-University, Magdeburg, Germany
| |
Collapse
|
12
|
Moreira GM, Tesser IM, Scrok ND, Boumer TC, Manffra EF. Estabilidade dinâmica de pessoas com AVE durante o movimento de cabeceio simulado em um jogo digital. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/19027628042021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO A estabilidade postural é um objetivo de tratamento na fisioterapia que pode ser alcançado por meio de exercícios de transferência de peso bilateral. Os jogos digitais surgem como alternativa para execução desses exercícios, mas sua avaliação ainda necessita de aprimoramento. Propõe-se aqui o uso de variáveis biomecânicas para verificar o comportamento da estabilidade postural dinâmica durante um movimento de cabeceio, simulado por um jogo digital com diferentes exigências de velocidades. Para isso, 16 voluntários pós-acidente vascular encefálico (AVE) - 12 homens e 4 mulheres, com idade média de 56 anos - e 16 hígidos pareados por sexo e idade participaram da coleta experimental, na qual eles foram submetidos ao jogo digital “cabeceio”, que tem cinco níveis de velocidade, do mais lento ao mais rápido, com duração de 30 segundos cada. A partir dos sinais cinemáticos foi possível calcular os indicadores de interesse, a área da base de suporte e a margem de estabilidade, definida como a menor distância entre as bordas da base de suporte e a projeção vertical do centro de massa (CM) extrapolado, que considera a velocidade do CM. Os valores da base de suporte não apresentaram diferenças entre os níveis de velocidade do jogo, mas sim entre grupos. A margem de estabilidade não diferiu entre níveis e grupos. Os níveis de velocidade do jogo, possivelmente, não estimularam os voluntários a buscar estratégias diferentes para manter a estabilidade, como dar um passo, mas os fizeram adotar bases de suporte diferentes, sendo que indivíduos com AVE adotaram uma base de suporte menor do que a dos hígidos.
Collapse
|
13
|
Yousefi Babadi S, Daneshmandi H. Effects of virtual reality versus conventional balance training on balance of the elderly. Exp Gerontol 2021; 153:111498. [PMID: 34311059 DOI: 10.1016/j.exger.2021.111498] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aging population is growing in the world, and the reduction in physical function caused by this is an important issue that, particularly, causes a disorder of balance and an increased risk of falling. This study aimed at the comparison between the effects of virtual reality training (VRT) and Conventional balance training (CBT) on the balance of the elderly. METHODS The present study was conducted on 36 elderly (men and women) who are living in nursing homes. Participants were randomly divided into three groups: virtual reality training (6 males, 6 females; age = 66.5 ± 3.8 years), Conventional balance training (6 males, 6 females; age = 67.5 ± 3.1 years), and control (5 males, 7 females; age = 66.7 ± 3.2 years). Each group participated in a 60-min session, 3 times per week, for 9 weeks. To assess the participants' balance, the balance tests were used on single-leg stance (SLS) with open and closed eyes, Functional reach test (FRT), Timed up and Go Test (TUG), and Fullerton Advance Balance Scale (FABS). Data analysis was done using paired t-test and analysis of covariance by SPSS software version 24 at the significant level (P = 0.05). RESULTS In both groups (VRT, CBT), SLS with open and closed eyes, FRT, TUG, and FABS were significantly improved (P˂0.05). After the intervention, changes in both groups were similar (P > 0.05), which indicates that neither VRT and CBT training methods were superior to the other. CONCLUSION According to the results of this study, it seems that a virtual reality training program can be used as a new training method to improve the elderly's balance in daily programs of nursing homes.
Collapse
Affiliation(s)
- Saeed Yousefi Babadi
- Faculty of Physical Education and Sport Sciences, Department of Sport Injuries & Corrective Exercises, University of Guilan, Rasht, Iran.
| | - Hassan Daneshmandi
- Faculty of Physical Education and Sport Sciences, Department of Sport Injuries & Corrective Exercises, University of Guilan, Rasht, Iran
| |
Collapse
|
14
|
de Rond V, Orcioli-Silva D, Dijkstra BW, Orban de Xivry JJ, Pantall A, Nieuwboer A. Compromised Brain Activity With Age During a Game-Like Dynamic Balance Task: Single- vs. Dual-Task Performance. Front Aging Neurosci 2021; 13:657308. [PMID: 34290599 PMCID: PMC8287632 DOI: 10.3389/fnagi.2021.657308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/31/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Postural control and cognition are affected by aging. We investigated whether cognitive distraction influenced neural activity differently in young and older adults during a game-like mediolateral weight-shifting task with a personalized task load. Methods: Seventeen healthy young and 17 older adults performed a balance game, involving hitting virtual wasps, serial subtractions and a combination of both (dual-task). A motion analysis system estimated each subject's center of mass position. Cortical activity in five regions was assessed by measuring oxygenated hemoglobin (HbO2) with a functional Near-Infrared Spectroscopy system. Results: When adding cognitive load to the game, weight-shifting speed decreased irrespective of age, but older adults reduced the wasp-hits more than young adults. Accompanying these changes, older adults decreased HbO2 in the left pre-frontal cortex (PFC) and frontal eye fields (FEF) compared to single-tasking, a finding not seen in young adults. Additionally, lower HbO2 levels were found during dual-tasking compared to the summed activation of the two single tasks in all regions except for the right PFC. These relative reductions were specific for the older age group in the left premotor cortex (PMC), the right supplementary motor area (SMA), and the left FEF. Conclusion: Older adults showed more compromised neural activity than young adults when adding a distraction to a challenging balance game. We interpret these changes as competitive downgrading of neural activity underpinning the age-related deterioration of game performance during dual-tasking. Future work needs to ascertain if older adults can train their neural flexibility to withstand balance challenges during daily life activities.
Collapse
Affiliation(s)
- Veerle de Rond
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Diego Orcioli-Silva
- Posture and Gait Studies Laboratory (LEPLO), Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Bauke Wybren Dijkstra
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jean-Jacques Orban de Xivry
- Motor Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| | - Annette Pantall
- Clinical Ageing Research Unit, Institute of Neuroscience, Newcastle University Institute of Ageing, Newcastle upon Tyne, United Kingdom
| | - Alice Nieuwboer
- Neuromotor Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, Leuven, Belgium
| |
Collapse
|
15
|
Lima Rebêlo F, de Souza Silva LF, Doná F, Sales Barreto A, de Souza Siqueira Quintans J. Immersive virtual reality is effective in the rehabilitation of older adults with balance disorders: A randomized clinical trial. Exp Gerontol 2021; 149:111308. [PMID: 33744393 DOI: 10.1016/j.exger.2021.111308] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
QUESTION What are the effects of immersive virtual reality (IVR) training compared to conventional physiotherapy on body balance and risk of falls in older adults with balance disorders? DESIGN A randomized controlled trial with two intervention arms, concealed allocation, per-protocol analysis, and blinded assessment. PARTICIPANTS Thirty-seven older adults with balance disorders and risk of falling. INTERVENTION Participants were randomized into two groups: a control group, which received balance training with conventional physiotherapy using multimodal circuit exercises, and an experimental group, which received balance training using immersive virtual reality. Both groups received 16 individual sessions, twice a week. OUTCOME MEASURES The primary outcome was functional balance. Secondary outcomes were static balance, gait speed, functional range, dizziness symptoms, and fear of falling. Safety was ensured by assessing any adverse events during the intervention. RESULTS After 16 sessions, in the intragroup analysis, the functional balance score in the experimental group increased by 3.00 (95% CI 1.42 to 4.57) and in the control group by 3.88 (95% CI 2.16 to 5.59). Both groups improved in assessments of sensory interaction and anterior reach. Only the experimental group presented increased mobility and reduced dizziness. After two months, there was a maintenance of gains in functional balance and a reduction of the gains in functional reach for both groups. In the intergroup comparison, there was no significant difference. CONCLUSION Immersive Virtual Reality training proved to be effective for balance-related outcomes, although it was not superior to conventional therapy. TRIAL REGISTRATION RBR-3tk7fw.
Collapse
Affiliation(s)
- Felipe Lima Rebêlo
- Health Sciences from the Federal University of Alagoas, Physiotherapy Department, State University of Health Sciences of Alagoas and Cesmac University Center, Maceió, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; State University of Health Sciences of Alagoas, Maceió, Brazil; Department of Physiotherapy, Cesmac University Center, Maceió, Brazil.
| | | | - Flávia Doná
- Health Sciences, Ibirapuera University, Physiotherapy Department, São Paulo, Brazil
| | - André Sales Barreto
- Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; Health Sciences, Federal University of Sergipe, Health Education Department, Aracaju, Brazil
| | | |
Collapse
|
16
|
de Vries AW, Willaert J, Jonkers I, van Dieën JH, Verschueren SMP. Virtual Reality Balance Games Provide Little Muscular Challenge to Prevent Muscle Weakness in Healthy Older Adults. Games Health J 2020; 9:227-236. [PMID: 32520612 DOI: 10.1089/g4h.2019.0036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: Muscle weakness is an important risk factor for falls in older adults. Intensity and duration of muscle activity are important determinants of exercise effectiveness in combating muscle weakness. The aim of this article was to assess the intensity and duration of muscle activity in virtual reality (VR) balance games. Materials and Methods: Thirty young and 30 healthy older adults played seven different VR balance games. Muscle activity of the vastus lateralis, vastus medialis, soleus, and gluteus medius was obtained using surface electromyography (EMG). The processed EMG signals were divided into 200-ms blocks, after which each block was categorized by its average normalized EMG activity, that is, >80%, 60%-80%, 40%-60%, or <40% of maximum voluntary contraction (MVC). We calculated the total number of blocks in each category to score intensity, as well as the maximal number of consecutive 200-ms blocks (MCBs) >40% MVC, to identify prolonged muscle activity. Results: Muscle activity during game play was mostly <40% MVC and prolonged activation was lacking. Only the games that included more dynamic movements showed activation blocks of higher intensity and resulted in more MCBs. Conclusion: Our method allowed us to analyze the overall muscle activity and the distribution of activity over a trial. Although the activation levels during these VR games were low in general, we identified game elements that could potentially provide a strength training stimulus. Future research should aim to implement these elements, such that the intensity, prolonged activity, and rest are optimized to sufficiently challenge lower limb muscles in VR training.
Collapse
Affiliation(s)
- Aijse W de Vries
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jente Willaert
- Human Movement Biomechanics Research Group, Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jaap H van Dieën
- Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sabine M P Verschueren
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| |
Collapse
|
17
|
Davoodeh S, Sheikh M, Houminiyan Sharifabadi D, Bagherzadeh F. The effect of Wii Fit exergames on static balance and motor competence in obese and non-obese college women. ACTA GYMNICA 2020. [DOI: 10.5507/ag.2020.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
18
|
Dickson TJ, Witchalls J, Terwiel FA, Jaros R, Waddington G, McGrath B. Proprioceptive abilities improve in expert skiers and snowboarders from early-season to mid-season. J Sci Med Sport 2020; 24:1021-1025. [PMID: 32471786 DOI: 10.1016/j.jsams.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/31/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine whether the proprioceptive ability of advanced and expert snowsport participants increased with time on-snow, and whether gender, age, snowsport discipline and/or previous ankle injury were factors in proprioceptive ability at the start of the winter snow season (T1, n=80) compared to mid- season (T2, n=39). DESIGN Observational study METHOD: Participants completed a questionnaire at T1, and proprioception was measured at T1 and T2 by the Active Movement Extent Discrimination Apparatus (AMEDA), which tests lower limb proprioception. RESULTS At T1 there was no significant difference between the proprioception scores of the two cohorts of advanced and expert snowsport participants, between females and males, younger and older age groups, nor between alpine skiers and snowboarders. At T2, after a minimum of 5 weeks on-snow, the whole group had improved their proprioception by 0.04 (p<.0001) as measured by the AMEDA. Groups undertaking different snowsport disciplines achieved different gains across the season, with minimal change of 0.02 in skiers (p=.056), while snowboarders and mixed ski/snowboard participants gained 0.05 (p=.034) and 0.06 (p=.005) (η2 0.63 and 0.47 respectively). Males, females, instructors and elite youth participants all improved their proprioception by mid-season (η2 0.29-0.46). CONCLUSIONS Amongst an established group of snowsports participants, lower limb proprioception is a consistent skill that is equally well developed in all cohorts. Several weeks of regular snowsport exposure improves this proprioceptive acuity amongst snowboarders, and those who mix snowboarding with skiing. Exposure to a prolonged period of snowsport improves proprioception, with benefits to neuromuscular control mechanisms.
Collapse
Affiliation(s)
- Tracey J Dickson
- University of Canberra Research Institute for Sport and Exercise, University Avenue, University of Canberra, Australia.
| | - Jeremy Witchalls
- University of Canberra Research Institute for Sport and Exercise, University Avenue, University of Canberra, Australia
| | - F Anne Terwiel
- Faculty of Adventure, Culinary Arts and Tourism, Thompson Rivers University, Canada
| | - Rachel Jaros
- Cann Pharmaceutical Australia Ltd., Canberra, Australia
| | - Gordon Waddington
- University of Canberra Research Institute for Sport and Exercise, University Avenue, University of Canberra, Australia
| | - Braden McGrath
- Human Factors and Behavioral Neurobiology, Embry-Riddle Aeronautical University, US
| |
Collapse
|
19
|
Training With Wii Balance Board for Dynamic Balance in Older Adults. TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
20
|
Willaert J, De Vries AW, Tavernier J, Van Dieen JH, Jonkers I, Verschueren S. Does a novel exergame challenge balance and activate muscles more than existing off-the-shelf exergames? J Neuroeng Rehabil 2020; 17:6. [PMID: 31941518 PMCID: PMC6961365 DOI: 10.1186/s12984-019-0628-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 11/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Novel balance-targeting exergames controlled with off-the-shelf hardware, were developed based on current recommendations for balance training in healthy older adults and documented shortcomings of existing games. The aim of this study was to explore the feasibility of these novel exergames as training tool for elderly and, more specifically whether these games can elicit more challenging weight shifts and higher levels of muscle activity compared to existing off-the-shelf exergames. Furthermore, the motivational pull in these new games was studied. METHODS Sixteen healthy older adults were recruited to play the novel games and two reference games that were found to be the most challenging ones in terms of weight shifts or muscle activity in previous studies. Weight shifts were expressed relative to participants' Functional Limits of Stability (FLOS). Muscular challenge of the games was quantified by dividing the signal into 200 ms blocks and determining the average muscle activity within these blocks. The muscle activity was normalized to maximal voluntary contractions (MVC) to categorize the blocks in zones of < 40, 40-60, 60-80 and > 80% MVC. Subsequently, the number of blocks per intensity level and the number of consecutive blocks above 40% were determined. Motivation to play the games was assessed using the Intrinsic Motivation Inventory (IMI) and scores between the games were analyzed using Generalized Estimated Equations (GEE). RESULTS The novel exergames successfully elicited center of mass (COM) displacements with medians of around 80% of FLOS or higher for all directions. Furthermore, the COM displacements in the novel games were larger for each direction than in the reference games, although for one game the sideward left direction reached significance only at the third trial. Compared to the existing games, longer blocks of muscle activation above 40% MVC were found, but overall intensity remained low. IMI scores were high on all subscales, indicating that older adults experienced the games as motivating. CONCLUSION We conclude that affordable hardware can be used to create challenging and enjoyable balance training programs using exergames. The exergames that were successful in eliciting challenging weight shifts and muscle activity should now be further studied in longitudinal randomized controlled interventions, to assess effects on balance, muscle strength and eventually fall risk in healthy older adults.
Collapse
Affiliation(s)
- Jente Willaert
- KU Leuven (Faculteit bewegings- en revalidatiewetenschappen), Leuven, Belgium
| | | | - Julie Tavernier
- KU Leuven (Faculteit bewegings- en revalidatiewetenschappen), Leuven, Belgium
| | - Jaap H. Van Dieen
- Vrije Universiteit Amsterdam (Faculteit gedrags- en bewegingswetenschappen), Amsterdam, The Netherlands
| | - Ilse Jonkers
- KU Leuven (Faculteit bewegings- en revalidatiewetenschappen), Leuven, Belgium
| | - Sabine Verschueren
- KU Leuven (Faculteit bewegings- en revalidatiewetenschappen), Leuven, Belgium
| |
Collapse
|
21
|
Freitas L, de Araújo Val S, Magalhães F, Marinho V, Ayres C, Teixeira S, Bastos VH. Virtual reality exposure therapy for neuro-psychomotor recovery in adults: a systematic review. Disabil Rehabil Assist Technol 2019; 16:646-652. [PMID: 31746256 DOI: 10.1080/17483107.2019.1688400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyse the virtual reality applications in the subjects' neuro-psychomotor functions rehabilitation with motor and/or neuropsychiatric impairment. METHODS The search was carried out in nine databases (Scopus, PubMed, Web of Science, ScienceDirect, Cochrane Library, CINAHL, PsycINFO, LILACS, and SciELO), from December 2017 to March 2019. An additional manual search was performed, taking into consideration references of the included papers, through the same eligibility criteria. The methodological quality of the included papers was evaluated using the Physiotherapy Evidence Database (PEDro). RESULTS One hundred and twenty-two papers were selected by the initial screening, but only 33 studies participated in the final inclusion in the study (11 clinical trials and 14 experimental studies). The data extracted were: the proposed objective, the sample population, the neurological condition treated, the VR modality used in the procedures and the study intervention period. CONCLUSIONS Virtual reality supports the rehabilitation process of neuro-psychomotor functions, allowing potential gains in the patients' recovery. Therefore, its development facilitates its availability and access in the future.Implications for rehabilitationIt has minimal adverse effects during the virtual therapies performance, such as the presence of vertigo related to cybersickness conditions, suggesting virtual reality as a safe rehabilitation tool, compared to other therapies.Virtual reality use is useful and effective in helping the rehabilitation process of motor, cognitive and psychosocial functions.It plays a role as an adjunctive and complementary therapy in the neuro-psychomotor rehabilitation process to obtain a clinically significant result.
Collapse
Affiliation(s)
- Luan Freitas
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Sabrina de Araújo Val
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Francisco Magalhães
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Victor Marinho
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Carla Ayres
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil
| | - Silmar Teixeira
- Neuro-Innovation Technology and Brain Mapping Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| | - Victor Hugo Bastos
- Brain Mapping and Functionality Laboratory, Federal University of Piauí, Parnaíba, Brazil.,The Northeast Biotechnology Network, Federal University of Piauí, Teresina, Brazil
| |
Collapse
|
22
|
Dunsky A. The Effect of Balance and Coordination Exercises on Quality of Life in Older Adults: A Mini-Review. Front Aging Neurosci 2019; 11:318. [PMID: 31803048 PMCID: PMC6873344 DOI: 10.3389/fnagi.2019.00318] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022] Open
Abstract
The ability to control balance during activities of daily living (ADL) is impaired in older adults as a result of deterioration in the sensory systems (i.e., vestibular, visual, somatosensory), the cognitive system (central nervous system), and the musculoskeletal system. Consequently, many older adults face a risk of falling during their ADL. In most cases, falls and related injuries impair the quality of life and result in physical limitations, anxiety, loss of confidence, and fear of falling. Among a variety of fall prevention interventions, adapted physical activity programs have been suggested for improving balance control during ADL. These programs challenge the sensory, cognitive, and musculoskeletal systems while addressing balance constraints such as orientation in space, changes in direction, and the speed or height of the center of mass during static and dynamic situations resembling ADL. The above-mentioned elements can be dealt with through a combination of balance and coordination exercises that challenge the postural control systems in multiple dimensions—including vertical and horizontal changes of the center of mass, standing on unstable surfaces with a reduced base of support, and changing body directions. Consequently, such exercises require environmental information-processing. The combination of dual-task, function-oriented challenges while controlling balance stimulates the sensory and neuromuscular control mechanisms. Among older adults, these programs have been found to improve static and dynamic stability, as well as a number of aspects in the quality of life. Recently, they have also been found to improve cognitive functions such as memory and spatial cognition.
Collapse
Affiliation(s)
- Ayelet Dunsky
- School of Human Movement and Sport Sciences, The Academic College at Wingate, Wingate Institute, Netanya, Israel
| |
Collapse
|
23
|
Kouris I, Sarafidis M, Androutsou T, Koutsouris D. HOLOBALANCE: An Augmented Reality virtual trainer solution forbalance training and fall prevention. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4233-4236. [PMID: 30441288 DOI: 10.1109/embc.2018.8513357] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Balance disorders affect a large number of older people, leading to falls. To promote independence, self-care and the quality of living of the long-lived population, an innovative solution is devoped to act as a virtual trainer for people that suffer from vestibular dysfunction related balance disorders. Our solution offers a virtual balance therapy, supported by Information and Communication Technology devices, to monitor user's activity during the day and provide real time feedback for the correct execution of physiotherapy exercises. Wearable sensors are utilized to monitor user activity, while during the execution of exercises, cameras are used to track the body of the user. An Augmented Reality headset is used to project the virtual trainer's 3D avatar in front of the user, providing real time guidance for the correct execution of the exercises.
Collapse
|
24
|
Katharina Petri, Peter Emmermacher, Steffen Masik, Kerstin Witte. Comparison of response quality and attack recognition in karate kumite between reality and virtual reality – a pilot study. ACTA ACUST UNITED AC 2019. [DOI: 10.26524/ijpefs1946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Virtual reality (VR) is an often-used instrument in sports science research and practical training. However, VR studies with experienced athletes and sports specific tasks are rare. Furthermore, the transfer from interventions in VR into reality is even less investigated. It is possible to analyze benefits of VR using in-situ studies comparing human behavior in VR with reality. If no differences occur in the human behavior, then VR would be appropriate for interventions to improve athletes’ performance. Therefore, we let seven karate athletes respond each to ten attacks of a real attacker (reality) and a virtual attacker (VR using a Head Mounted Display) and compared the parameters “response quality” and “attack recognition” under both conditions. As attacks we chose Gyaku-Zuki (reverse punch, GZ) and Kizami-Zuki (attack with the front arm, KZ). ANOVAs and sign tests showed isolated cases of significant differences between both conditions: response quality in KZ, and attack recognition for 150ms in GZ, all p0.05). The remaining comparisons showed no significant differences (p>0.05). We conclude that further research is needed but the results of the present pilot study are promising to assume that VR is suitable for applications because similar performance outcome in reality and VR were obtained.
Collapse
|
25
|
Liu Q, Cheng Z, Chen M. Effects of environmental education on environmental ethics and literacy based on virtual reality technology. ELECTRONIC LIBRARY 2019. [DOI: 10.1108/el-12-2018-0250] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This study aims to propose the corresponding ways and methods to strengthen the environmental moral education based on scientific research methods, rigorous scientific theory and the specific content of environmental moral education.
Design/methodology/approach
In this study, taking 360 volunteers of Yangtze University, Hubei, as the research samples, the 32-week (3 h per week) experimental research was preceded in this study. Among the 360 distributed copies of questionnaires, 289 copies are valid, with the retrieval rate 80 per cent.
Findings
The research results show significant correlations between environmental education and environmental ethics; environmental ethics and environmental literacy; and environmental education and environmental literacy.
Research limitations/implications
The research on the environmental moral education in China was still in the primary stage, and there were few results that can be used for reference. As a result, there was a lack of empirical research in this paper, which needed to be further expanded and improved.
Practical implications
This study put forward a series of new judgments and new views to solve the problems, which provided a good theoretical basis for the current education and teaching work of the majority of educators and valuable reference for future research on related topics. This study was helpful to further enhance the environmental moral awareness and environmental moral level. Aiming at the problems existing in environmental moral education, this study proposed a series of solutions to make the whole society, schools and families work together for the improvement and development of environmental moral education.
Originality/value
This study was helpful to promote environmental moral quality and level, promote the harmony between man and nature and form a good habit of environmental protection in the whole society.
Collapse
|
26
|
Sielużycki C, Maśliński J, Kaczmarczyk P, Kubacki R, Cieśliński WB, Witkowski K. Can Kinect aid motor learning in sportsmen? A study for three standing techniques in judo. PLoS One 2019; 14:e0210260. [PMID: 30726211 PMCID: PMC6364886 DOI: 10.1371/journal.pone.0210260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 12/19/2018] [Indexed: 11/18/2022] Open
Abstract
Our objective was to examine how exercises with the second generation of the Microsoft Kinect sensor may aid in the process of motor learning in young judo practitioners. We addressed improvements in spatio-temporal accuracy during execution of three standing techniques in judo, in a simple paradigm designed to study short-term practice effects. Two groups of judokas, 12 athletes each—one aided with Kinect and our dedicated software vs a group of controls—were asked to mimic previously recorded master-level performances of the three techniques, established as benchmarks by a two times world champion in judo. In five training sessions, athletes of the aided group used a virtual-reality setup in which they trained with a virtual representation of the master displayed on a large screen with a simultaneous real-time visualisation of their own movements in the form of an avatar based on body joint localisation, as determined by Kinect, which also measured their performance. The control group used Kinect in the 1st and 5th session, which was necessary for the measurements that constituted the basis for subsequent statistical comparisons, whereas the 2nd, 3rd, and 4th session in this group was guided by a coach, without the use of the Kinect setup. In addition, athletes of the two groups had unrestricted access to a video recording of the master performing the three throws. We found statistically significant improvements (p < 0.05) in the accuracy of executing the three techniques between the 1st and the 5th training session for the aided group but not for the control group. We conclude that incorporating Kinect based exercises into a judo training programme may be a useful means to supporting motor learning, therefore enhancing training efficiency, and thus improving performance.
Collapse
Affiliation(s)
- Cezary Sielużycki
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wrocław University of Science and Technology, Wrocław, Poland.,Faculty of Computer Science and Management, Wrocław University of Science and Technology, Wrocław, Poland
| | - Jarosław Maśliński
- Faculty of Sport Sciences, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Patryk Kaczmarczyk
- Faculty of Computer Science and Management, Wrocław University of Science and Technology, Wrocław, Poland
| | - Rafał Kubacki
- Faculty of Sport Sciences, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Wojciech B Cieśliński
- Faculty of Sport Sciences, University School of Physical Education in Wrocław, Wrocław, Poland
| | - Kazimierz Witkowski
- Faculty of Sport Sciences, University School of Physical Education in Wrocław, Wrocław, Poland
| |
Collapse
|
27
|
Wiederhold BK. Virtual Reality Enhances Seniors' Health and Well-Being. CYBERPSYCHOLOGY, BEHAVIOR, AND SOCIAL NETWORKING 2018. [DOI: 10.1089/cyber.2018.29132.bkw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
28
|
de Vries AW, van Dieën JH, van den Abeele V, Verschueren SMP. Understanding Motivations and Player Experiences of Older Adults in Virtual Reality Training. Games Health J 2018; 7:369-376. [PMID: 30285493 DOI: 10.1089/g4h.2018.0008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We studied which games and underlying game mechanics are considered motivating by older adults, so that designers and therapists make informed choices when designing or selecting virtual reality (VR)-training interventions. MATERIALS AND METHODS We conducted a repeated measures design with 30 older participants, who played eight different VR-training games and afterward filled out the intrinsic motivation inventory (IMI). Differences in intrinsic motivation between games were analyzed using Friedman's tests. In addition, in-depth interviews were conducted according to the laddering technique, to unveil the underlying game mechanics that lead to the players preferences. RESULTS IMI scores were relatively high for all games, indicating that these VR games seem effective for inducing a high intrinsic motivation. Wii yoga and Kinect Adventures were the highest scoring games on all but the negative subscale tension. Both games provided regular positive feedback. An important game mechanic was Variation, which showed a strong link to important values such as: to Stay Focused, Improve Fitness, and Health and Independency. Furthermore, the game mechanics Visual Feedback and Positive Feedback, which lead to an increased Drive to Perform, were perceived valuable. Seemingly contradicting, but both important attributes such as Speed versus Slow Movements emphasize the importance of designing VR training that adapts to the skill level of the player. CONCLUSION We have shown that games with different game mechanics can induce high intrinsic motivation. When designing or selecting VR balance training games for older adults, these game mechanics should be incorporated to optimize a positive user experience and increase intrinsic motivation.
Collapse
Affiliation(s)
- Aijse W de Vries
- 1 Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven, Belgium
| | - Jaap H van Dieën
- 2 MOVE Research Institute Amsterdam, Faculty of Human Movement Sciences, VU University Amsterdam , Amsterdam, The Netherlands
| | - Vero van den Abeele
- 3 Computer Science Technology TC, Group T, Faculty of Engineering Technology, Katholieke Universiteit Leuven , Leuven, Belgium
| | - Sabine M P Verschueren
- 1 Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven , Leuven, Belgium
| |
Collapse
|
29
|
Juras G, Brachman A, Michalska J, Kamieniarz A, Pawłowski M, Hadamus A, Białoszewski D, Błaszczyk J, Słomka KJ. Standards of Virtual Reality Application in Balance Training Programs in Clinical Practice: A Systematic Review. Games Health J 2018; 8:101-111. [PMID: 30239217 DOI: 10.1089/g4h.2018.0034] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the effect of virtual reality (VR) games on improving balance in different groups of neurological patients with a particular focus on the study quality and to determine the gold standard in VR training in these groups. MATERIALS AND METHODS A systematic review of controlled trials published between January 2009 and December 2017 was conducted. The PubMed, SCOPUS, SPORTDiscus, and Medline databases were searched. Studies involved patients with stroke or Parkinson's disease or children with cerebral palsy. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS A total of 20 studies met the inclusion criteria. The PEDro scores ranged from 4 to 8 points. Analysis of the rehabilitation programs revealed a very large discrepancy in the planned volume of exercises in different subgroups of patients. CONCLUSIONS Overall, the comparison of VR interventions between conventional rehabilitation and no intervention exhibited significantly better results. However, these results should be interpreted with great caution due to the large diversity of the systems, games, and training volume used in the VR therapy. In all included studies, only several articles included objective methods to assess the effect of VR. In addition, most of the articles showed a high risk of bias, such as a lack of randomization and blinding or a small sample size. That is why further well-designed randomized control trials are required to evaluate the influence of VR on balance in different groups of neurological patients.
Collapse
Affiliation(s)
- Grzegorz Juras
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Brachman
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Justyna Michalska
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Kamieniarz
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Michał Pawłowski
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Anna Hadamus
- 2 Department of Rehabilitation, Division of Physiotherapy of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Białoszewski
- 2 Department of Rehabilitation, Division of Physiotherapy of the 2nd Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Błaszczyk
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| | - Kajetan J Słomka
- 1 Department of Human Motor Behavior, The Jerzy Kukuczka Academy of Physical Education in Katowice, Katowice, Poland
| |
Collapse
|
30
|
Wu J, Han RP, Liu YL. Using a Somatosensory Controller to Assess Body Size for Size-Specific Dose Estimates in Computed Tomography. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2734297. [PMID: 29955599 PMCID: PMC6000849 DOI: 10.1155/2018/2734297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/03/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
Abstract
Computed tomography (CT) has been widely used in the healthcare environment. Presently, the radiation dose in CT is determined using the size-specific dose estimate (SSDE). Accurate assessment of individual's body size is essential for dose estimation. In this study, we integrated a somatosensory controller with a CT scanner to measure patient's anterior-posterior diameter (APD) and lateral diameter (LATD) and calculate the corresponding effective diameter (ED). A total of 108 individuals with an average age of 38.6 years were enrolled in this study. Microsoft Kinect was used to acquire the depth image of subjects. A grayscale-to-surface height conversion curve was created using acrylic sheets for APD estimation. The APD, LATD, and ED were measured and compared with the results obtained using F ruler and CT images. The mean absolute differences for APD, LATD, and ED between Kinect and F ruler measurements were 5.2%, 1.3%, and 2.5%, respectively, while those between Kinect and CT measurements were 8.8%, 2.6%, and 5.0%, respectively. Kinect can replace CT or F ruler for real-time body size measurements. The use of the somatosensory controller has the advantages of simple, low cost, no radiation, and automatic calculation. It can accurately estimate patient's APD, LATD, and ED for SSDE.
Collapse
Affiliation(s)
- Jay Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Ruo-Ping Han
- Department of Management Information Systems, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Yan-Lin Liu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
- Institute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu, Taiwan
| |
Collapse
|