ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience

Virtual reality exergames for enhancing engagement in stroke rehabilitation: A narrative review

This narrative review focuses on upper-limb stroke rehabilitation and virtual reality (VR) exergaming interventions that seek to facilitate the rehabilitation process. We examine exergaming interventions from the perspective of diegesis ("narration"), an aspect often overlooked despite its significance in neuronal rehabilitation. The importance of diegesis and narrative engagement in rehabilitation exergames started becoming clear only recently, with findings in the field of neurology underscoring the impact of purpose-driven task engagement on neuroplasticity. We begin this review by examining various frameworks for stroke rehabilitation exergames and identifying the gaps in the existing literature. We continue with summarizing the literature on exergames in upper-limb stroke rehabilitation, emphasizing the contribution of diegesis on exercise motivation and engagement. Finally, we conclude this review by offering insights into the current state of research, along with future perspectives on the topic.

Safety and Potential Usability of Immersive Virtual Reality for Brain Rehabilitation: A Pilot Study

Objective: This study was conducted to demonstrate the safety and usability of an immersive virtual reality (VR) game as a rehabilitative training by assessing adverse events (AEs), adherence, and satisfaction in patients with brain injury who had free optional opportunities. Materials and Methods: The results were analyzed retrospectively. Seventy-eight patients with brain injury, undergoing rehabilitation treatment for motor impairment, were recruited. Among them, 51 were available for postintervention survey. The immersive type of VR training was programmed to facilitate use of the paralyzed upper extremity through a fishing simulation game. The Oculus Rift was used as head-mounted display device. Patients were observed for any AEs as defined in the Common Terminology Criteria for AEs during and after each VR training session. A postintervention telephone survey was done to investigate adherence-related factors and safety. Results: The results were analyzed after dividing the patients into nonadherence (patients participated <3 times) and high-adherence (≥3 times) groups. No serious AEs were reported during and after the VR training, and several patients reported other AEs, predominantly dizziness, with one case requiring cessation of VR training. Overall, the satisfaction rate was 54%. Compared with the nonadherence group, the high-adherence group expressed higher satisfaction with VR training, regarded it as effective for recovery from upper limb paralysis, accepted VR as comprehensible, and considered the level of difficulty to be appropriate (P < 0.05). Conclusion: Immersive VR training appeared to be safe for patients with brain injury.

A New Architecture for Customizable Exergames: User Evaluation for Different Neuromuscular Disorders

This paper presents a modular approach to generic exergame design that combines custom physical exercises in a meaningful and motivating story. This aims to provide a tool that can be individually tailored and adapted to people with different needs, making it applicable to different diseases and states of disease. The game is based on motion capturing and integrates four example exercises that can be configured via our therapeutic web platform “Blexer-med”. To prove the feasibility for a wide range of different users, evaluation tests were performed on 14 patients with various types and degrees of neuromuscular disorders, classified into three groups based on strength and autonomy. The users were free to choose their schedule and frequency. The game scores and three surveys (before, during, and after the intervention) showed similar experiences for all groups, with the most vulnerable having the most fun and satisfaction. The players were motivated by the story and by achieving high scores. The average usage time was 2.5 times per week, 20 min per session. The pure exercise time was about half of the game time. The concept has proven feasible and forms a reasonable basis for further developments. The full 3D exercise needs further fine-tuning to enhance the fun and motivation.

An sEMG-Controlled Forearm Bracelet for Assessing and Training Manual Dexterity in Rehabilitation: A Systematic Review

Background: The ability to perform activities of daily living (ADL) is essential to preserving functional independence and quality of life. In recent years, rehabilitation strategies based on new technologies, such as MYO Armband^®, have been implemented to improve dexterity in people with upper limb impairment. Over the last few years, many studies have been published focusing on the accuracy of the MYO Armband^® to capture electromyographic and inertial data, as well as the clinical effects of using it as a rehabilitation tool in people with loss of upper limb function. Nevertheless, to our knowledge, there has been no systematic review of this subject. Methods: A systematically comprehensive literature search was conducted in order to identify original studies that answered the PICO question (patient/population, intervention, comparison, and outcome): What is the accuracy level and the clinical effects of the MYO Armband^® in people with motor impairment of the upper limb compared with other assessment techniques or interventions or no intervention whatsoever? The following data sources were used: Pubmed, Scopus, Web of Science, ScienceDirect, Physiotherapy Evidence Database, and the Cochrane Library. After identifying the eligible articles, a cross-search of their references was also completed for additional studies. The following data were extracted from the papers: study design, disease or condition, intervention, sample, dosage, outcome measures or data collection procedure and data analysis and results. The authors independently collected these data following the CONSORT 2010 statement when possible, and eventually reached a consensus on the extracted data, resolving disagreements through discussion. To assess the methodological quality of papers included, the tool for the critical appraisal of epidemiological cross-sectional studies was used, since only case series studies were identified after the search. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, The Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed to carry out this review. Results: 10 articles with a total 180 participants were included in the review. The characteristics of included studies, sample and intervention characteristics, outcome measures, the accuracy of the system and effects of the interventions and the assessment of methodological quality of the studies and risk of bias are shown. Conclusions: Therapy with the MYO Armband^® has shown clinical changes in range of motion, dexterity, performance, functionality and satisfaction. It has also proven to be an accurate system to capture signals from the forearm muscles in people with motor impairment of the upper limb. However, further research should be conducted using bigger samples, well-defined protocols, comparing with control groups or comparing with other assessment or therapeutic tools, since the studies published so far present a high risk of bias and low level of evidence and grade of recommendation.

Improving Haptic Response for Contextual Human Robot Interaction

For haptic interaction, a user in a virtual environment needs to interact with proxies attached to a robot. The device must be at the exact location defined in the virtual environment in time. However, due to device limitations, delays are always unavoidable. One of the solutions to improve the device response is to infer human intended motion and move the robot at the earliest time possible to the desired goal. This paper presents an experimental study to improve the prediction time and reduce the robot time taken to reach the desired position. We developed motion strategies based on the hand motion and eye-gaze direction to determine the point of user interaction in a virtual environment. To assess the performance of the strategies, we conducted a subject-based experiment using an exergame for reach and grab tasks designed for upper limb rehabilitation training. The experimental results in this study revealed that eye-gaze-based prediction significantly improved the detection time by 37% and the robot time taken to reach the target by 27%. Further analysis provided more insight on the effect of the eye-gaze window and the hand threshold on the device response for the experimental task.

Getting into a "Flow" state: a systematic review of flow experience in neurological diseases

BACKGROUND

Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting.

DESIGN

A systematic review using PRISMA and COSMIN guidelines.

METHODS

MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson's disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires.

RESULTS

Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population.

CONCLUSION

The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

Virtual Reality Customized 360-Degree Experiences for Stress Relief

The latest studies in virtual reality (VR) have evidenced the potential of this technology to reproduce environments from multiple domains in an immersive way. For instance, in stress relief research, VR has been presented as a portable and inexpensive alternative to chromotherapy rooms, which require an adapted space and are expensive. In this work, we propose a portable and versatile alternative to the traditional chromotherapy color-loop treatment through four different 360-degree virtual experiences. A group of 23 healthy participants (mean age 22.65 ± 5.48) were conducted through a single-session experience divided into four phases while their electroencephalography (EEG) was recorded. First, they were stressed via the Montreal imaging stress task (MIST), and then relaxed using our VR proposal. We applied the Wilcoxon test to evaluate the relaxation effect in terms of the EEG relative gamma and self-perceived stress surveys. The results that we obtained validate the effectiveness of our 360-degree proposal to significantly reduce stress (p-value = 0.0001). Furthermore, the participants deemed our proposal comfortable and immersive (score above 3.5 out of 5). These results suggest that 360-degree VR experiences can mitigate stress, reduce costs, and bring stress relief assistance closer to the general public, like in workplaces or homes.

Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system's accuracy and investigate a wireless alternative based on neural networks.