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Matys-Popielska K, Popielski K, Sibilska-Mroziewicz A. Study of the Possibility of Using Virtual Reality Application in Rehabilitation among Elderly Post-Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2024; 24:2745. [PMID: 38732851 PMCID: PMC11086137 DOI: 10.3390/s24092745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024]
Abstract
Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact (p = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.
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Affiliation(s)
- Katarzyna Matys-Popielska
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, Poland;
| | - Krzysztof Popielski
- Institute of Metrology and Biomedical Engineering, Warsaw University of Technology, 02-525 Warsaw, Poland;
| | - Anna Sibilska-Mroziewicz
- Institute of Micromechanics and Photonics, Warsaw University of Technology, 02-525 Warsaw, Poland;
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Maggio MG, Baglio F, Arcuri F, Borgnis F, Contrada M, Diaz MDM, Leochico CF, Neira NJ, Laratta S, Suchan B, Tonin P, Calabrò RS. Cognitive telerehabilitation: an expert consensus paper on current evidence and future perspective. Front Neurol 2024; 15:1338873. [PMID: 38426164 PMCID: PMC10902044 DOI: 10.3389/fneur.2024.1338873] [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: 11/15/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
The progressive improvement of the living conditions and medical care of the population in industrialized countries has led to improvement in healthcare interventions, including rehabilitation. From this perspective, Telerehabilitation (TR) plays an important role. TR consists of the application of telemedicine to rehabilitation to offer remote rehabilitation services to the population unable to reach healthcare. TR integrates therapy-recovery-assistance, with continuity of treatments, aimed at neurological and psychological recovery, involving the patient in a family environment, with an active role also of the caregivers. This leads to reduced healthcare costs and improves the continuity of specialist care, as well as showing efficacy for the treatment of cognitive disorders, and leading to advantages for patients and their families, such as avoiding travel, reducing associated costs, improving the frequency, continuity, and comfort of performing the rehabilitation in its own spaces, times and arrangements. The aim of this consensus paper is to investigate the current evidence on the use and effectiveness of TR in the cognitive field, trying to also suggest some recommendations and future perspectives. To the best of our knowledge, this is the first consensus paper among multiple expert researchers that comprehensively examines TR in different neurological diseases. Our results supported the efficacy and feasibility of TR with good adherence and no adverse events among patients. Our consensus summarizes the current evidence for the application of cognitive TR in neurological populations, highlighting the potential of this tool, but also the limitations that need to be explored further.
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Affiliation(s)
| | | | - Francesco Arcuri
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Marianna Contrada
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | | | - Carl Froilan Leochico
- University of the Philippines Manila, Manila, Philippines
- St. Luke’s Medical Center, Quezon City, Philippines
| | | | - Stefania Laratta
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
| | - Boris Suchan
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation, Crotone, Italy
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Ouédraogo F, Auger LP, Moreau E, Côté O, Guerrera R, Rochette A, Kairy D. Acceptability of Telerehabilitation: Experiences and Perceptions by Individuals with Stroke and Caregivers in an Early Supported Discharge Program. Healthcare (Basel) 2024; 12:365. [PMID: 38338250 PMCID: PMC10855122 DOI: 10.3390/healthcare12030365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Telerehabilitation (TR) is a promising method for facilitating the delivery and access to post-stroke rehabilitation services. OBJECTIVE The aim of this study was to explore the acceptability of TR and factors influencing its adoption by individuals with stroke and caregivers. METHODS A qualitative descriptive approach was used. Six individuals with stroke and three caregivers participated in individual online interviews. An abductive thematic analysis was employed to analyze the qualitative data, using the Unified Theory of Acceptance and Use of Technology 2 (UTAUT-2) model. RESULTS Participants reported positive experiences with TR, resulting in improvements in functional abilities, such as manual dexterity, balance, and positive interactions with therapists. They found the technology easy to learn and use, facilitating engagement in TR. Participants' prior experiences with technology, along with support from caregivers and therapists, facilitated acceptance and the use of TR. The COVID-19 pandemic also motivated participants to accept TR. However, technical issues, unstable internet connections, and lack of feedback were barriers to the use of TR. CONCLUSION Despite existing obstacles, TR can be used to provide rehabilitation services for individuals with stroke. Addressing these barriers is necessary to promote the widespread and effective use of TR in the context of stroke recovery.
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Affiliation(s)
- Fatimata Ouédraogo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
| | - Louis-Pierre Auger
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montréal, QC H3G 1A1, Canada
| | - Emmanuelle Moreau
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Odile Côté
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Rosalba Guerrera
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC H3N 1X7, Canada; (A.R.); (D.K.)
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, QC H3S 1M9, Canada;
- Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Centre Intégré Universitaire de Santé et Services Sociaux (CIUSSS) du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H3S 2J4, Canada; (E.M.); (O.C.); (R.G.)
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Norwood MF, Painter DR, Marsh CH, Reid C, Hine T, Harvie DS, Jones S, Dungey K, Chen B, Libera M, Gan L, Bernhardt J, Kendall E, Zeeman H. The attention atlas virtual reality platform maps three-dimensional (3D) attention in unilateral spatial neglect patients: a protocol. BRAIN IMPAIR 2023; 24:548-567. [PMID: 38167362 DOI: 10.1017/brimp.2022.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Deficits in visuospatial attention, known as neglect, are common following brain injury, but underdiagnosed and poorly treated, resulting in long-term cognitive disability. In clinical settings, neglect is often assessed using simple pen-and-paper tests. While convenient, these cannot characterise the full spectrum of neglect. This protocol reports a research programme that compares traditional neglect assessments with a novel virtual reality attention assessment platform: The Attention Atlas (AA). METHODS/DESIGN The AA was codesigned by researchers and clinicians to meet the clinical need for improved neglect assessment. The AA uses a visual search paradigm to map the attended space in three dimensions and seeks to identify the optimal parameters that best distinguish neglect from non-neglect, and the spectrum of neglect, by providing near-time feedback to clinicians on system-level behavioural performance. A series of experiments will address procedural, scientific, patient, and clinical feasibility domains. RESULTS Analyses focuses on descriptive measures of reaction time, accuracy data for target localisation, and histogram-based raycast attentional mapping analysis; which measures the individual's orientation in space, and inter- and intra-individual variation of visuospatial attention. We will compare neglect and control data using parametric between-subjects analyses. We present example individual-level results produced in near-time during visual search. CONCLUSIONS The development and validation of the AA is part of a new generation of translational neuroscience that exploits the latest advances in technology and brain science, including technology repurposed from the consumer gaming market. This approach to rehabilitation has the potential for highly accurate, highly engaging, personalised care.
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Affiliation(s)
- Michael Francis Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - David Ross Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Chelsea Hannah Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Connor Reid
- Technical Partners Health (TPH), Griffith University, Nathan, QLD, Australia
| | - Trevor Hine
- School of Applied Psychology, Griffith University, Mt Gravatt, QLD, Australia
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
- Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Susan Jones
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Kelly Dungey
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, QLD, Australia
| | - Ben Chen
- Allied Health and Rehabilitation, Emergency and Specialty Services, Gold Coast Health, Gold Coast, QLD, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Meadowbrook, QLD, Australia
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Jang WH, Seo SM. Digital Therapeutics for the Egocentric and Allocentric Neglects in Patients with Brain Injury: A Mini Review. Brain Sci 2023; 13:1170. [PMID: 37626526 PMCID: PMC10452466 DOI: 10.3390/brainsci13081170] [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: 05/26/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Various therapeutic approaches have been developed for neglect. Many studies have demonstrated the effect of digital therapeutics (DTx) on neglect. However, few studies have reported the effects of DTx on egocentric and allocentric neglect. The differentiation of types of neglect and separate interventions is crucial in the rehabilitation process. In this article, seven studies on DTx on egocentric and allocentric neglect were reviewed. DTx, which was employed in these studies, could be classified as follows: (1) software adaptation in traditional treatment, (2) VR game using the head-mount display as treatment, and (3) the development of a new digital program like ReMoVES. In addition, more studies and more effective results were reported for egocentric neglect than for allocentric neglect. In future studies, each effect on egocentric and allocentric neglect should be identified in detail with the appropriate use of differential evaluation and long-term application of independent DTx.
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Affiliation(s)
- Woo-Hyuk Jang
- Department of Occupational Therapy, Kangwon National University, Samcheok 25949, Republic of Korea;
| | - Sang-Min Seo
- Department of Occupational Therapy, Semyung University, Jecheon 27136, Republic of Korea
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Pol M, Qadeer A, van Hartingsveldt M, Choukou MA. Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study. JMIR Rehabil Assist Technol 2023; 10:e44498. [PMID: 37463040 PMCID: PMC10394599 DOI: 10.2196/44498] [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: 11/21/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identified as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. OBJECTIVE The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. METHODS We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. RESULTS The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. CONCLUSIONS Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals.
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Affiliation(s)
- Margriet Pol
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
- Amsterdam University Medical center, location Vrije Universiteit Amsterdam, Department of Medicine for Older People, Amsterdam, Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, Netherlands
| | - Amarzish Qadeer
- Bimedical Engineering graduate program, University of Manitoba, Winnipeg, MB, Canada
| | - Margo van Hartingsveldt
- Amsterdam University of Applied Sciences, Research Group Occupational Therapy - Participation and Environment, Faculty of Health, Center of Expertise Urban Vitality, Amsterdam, Netherlands
| | - Mohamed-Amine Choukou
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
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7
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Torres-Castaño A, Abt-Sacks A, Toledo-Chávarri A, Suarez-Herrera JC, Delgado-Rodríguez J, León-Salas B, González-Hernández Y, Carmona-Rodríguez M, Serrano-Aguilar P. Ethical, Legal, Organisational and Social Issues of Teleneurology: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3694. [PMID: 36834388 PMCID: PMC9962592 DOI: 10.3390/ijerph20043694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. METHODS A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. RESULTS 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. CONCLUSIONS This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.
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Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Analía Abt-Sacks
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - José Carlos Suarez-Herrera
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- UNITWIN/UNESCO Chair, Research, Planning and Development of Local Health Systems, Department of Clinical Sciences, University of Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain
| | - Janet Delgado-Rodríguez
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Department of Philosophy I, University of Granada, 18071 Granada, Spain
| | - Beatriz León-Salas
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Yadira González-Hernández
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Evaluation Unit of the Canary Islands Health Service (SESCS), 38109 Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
| | - Montserrat Carmona-Rodríguez
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 28029 Madrid, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), 28071 Madrid, Spain
- Health Technology Assessment Agency, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pedro Serrano-Aguilar
- Canary Islands Health Research Institute Foundation (FIISC), 38320 Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, 38200 Tenerife, Spain
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8
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Khan A, Podlasek A, Somaa F. Virtual reality in post-stroke neurorehabilitation - a systematic review and meta-analysis. Top Stroke Rehabil 2023; 30:53-72. [PMID: 34747351 DOI: 10.1080/10749357.2021.1990468] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stroke is a neurological disorder and one of the leading causes of disability worldwide. The patient may lose the ability to adequately move the extremities, perceive sensations, or ambulate independently. Recent experimental studies have reported the beneficial influence of virtual reality training strategies on improving overall functional abilities for stroke survivors. METHODS Conducted a systematic review of the literature using the following keywords to retrieve the data: stroke, virtual reality, motor deficits, neurorehabilitation, cognitive impairments, and sensory deficits. A random-effect meta-analysis was performed for seven scales - one cognitive (MMSE) and six motor (Fugl-Meyer, Berg Balance Scale, Time up and go, Wolf motor function, 10 m walk, Brunnstrom score). OBJECTIVE To organize and compare all the available data regarding the effectiveness of virtual reality for stroke rehabilitation. RESULTS This literature reviewed 150 studies and included 46 for qualitative and 27 for quantitative analysis. There was no statistically significant difference between groups in MMSE score (MD = 0.24, 95%CI = ((-0.42) -(0.9)), p = .47, I2 = 0%) and Fugl-Meyer score (MD = (-0.38), 95%CI = ((-12.88)-(12.11)), p = .95, I2 = 98%) . The statistical significance was not reached in any of the other outcomes. CONCLUSIONS This review supports that stroke rehabilitation programs incorporating virtual reality are associated with improved functional outcomes, but there is no statistically significant difference compared to standard therapy.
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Affiliation(s)
- Azka Khan
- Faculty of Rehabilitation and Allied Health Sciences Islamabad, Riphah International University, Rawalpindi, Pakistan
| | - Anna Podlasek
- Neuroscience and Vascular Simulation, School of Medicine, Anglia Ruskin University, Chelmsford, Essex, UK.,Nihr Nottingham Brc, University of Nottingham, Nottingham, UK.,Clinical Radiology,Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Fahad Somaa
- King Abdulaziz University,Occupational Therapy Department, Faculty of Medical Rehabilitation Sciences, King AbdulAziz University Jeddah, Saudi, Arabia
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Buckingham SA, Sein K, Anil K, Demain S, Gunn H, Jones RB, Kent B, Logan A, Marsden J, Playford ED, Freeman J. Telerehabilitation for physical disabilities and movement impairment: A service evaluation in South West England. J Eval Clin Pract 2022; 28:1084-1095. [PMID: 35437833 PMCID: PMC9790516 DOI: 10.1111/jep.13689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES: Telerehabilitation was used to ensure continued provision of care during the COVID-19 pandemic, but there was a lack of guidance on how to use it safely and effectively for people with physical disabilities and movement impairment. In this service evaluation, we aimed to collate information on practitioner and patient experiences, challenges and facilitators, and examples of best practice to inform the development of an online toolkit and training package. METHODS Guided discussions were carried out with 44 practitioners, 7 patients and 2 carers from five health and social care organisations in South West England, and analysed thematically. RESULTS Practitioners and patients had positive experiences of telerehabilitation and were optimistic about its future use. Recognized benefits for people with physical disabilities included greater flexibility, reduced travel and fatigue, having appointments in a familiar environment and ease of involving family members. Challenges encountered were: technological (usability issues, access to technology and digital skills); difficulties seeing or hearing patients; the lack of 'hands-on' care; and safety concerns. Facilitators were supported by colleagues or digital champions, and family members or carers who could assist patients during their appointments. Key themes in best practice were: person-centred and tailored care; clear and open communication and observation and preparation and planning. Practitioners shared tips for remote physical assessments; for example, making use of patient-reported outcomes, and asking patients to wear bright and contrasting coloured clothing to make it easier to see movement. CONCLUSION Telerehabilitation holds promise in health and social care, but it is necessary to share good practice to ensure it is safe, effective and accessible. We collated information and recommendations that informed the content of the Telerehab Toolkit (https://www.plymouth.ac.uk/research/telerehab), a practical resource for practitioners, patients and carers, with a focus on remote assessment and management of physical disabilities and movement impairment.
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Affiliation(s)
- Sarah A. Buckingham
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
| | - Kim Sein
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
| | - Krithika Anil
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
| | - Sara Demain
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Hilary Gunn
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
| | - Ray B. Jones
- Centre for Health Technology, School of Nursing and MidwiferyUniversity of PlymouthPlymouthUK
| | - Bridie Kent
- School of Nursing and MidwiferyUniversity of PlymouthPlymouthUK
| | - Angela Logan
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
- Stroke Rehabilitation, Royal Devon University Healthcare NHS Foundation Trust, William Wright House, Wonford HospitalExeterUK
| | - Jonathan Marsden
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
| | - E D. Playford
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Jenny Freeman
- Peninsula Allied Health Centre, School of Health ProfessionsUniversity of PlymouthPlymouthUK
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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From Patient to Musician: A Multi-Sensory Virtual Reality Rehabilitation Tool for Spatial Neglect. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Unilateral Spatial Neglect (USN) commonly results from a stroke or acquired brain injury. USN affects multiple modalities and results in failure to respond to stimuli on the contralesional side of space. Although USN is a heterogeneous syndrome, present-day therapy methods often fail to consider multiple modalities. Musical Neglect Therapy (MNT) is a therapy method that succeeds in incorporating multiple modalities by asking patients to make music. This research aimed to exploit the immersive and modifiable aspect of VR to translate MNT to a VR therapy tool. The tool was evaluated in a 2-week pilot study with four clinical users. These results are compared to a control group of four non-clinical users. Results indicated that patients responded to triggers in their entire environment and performance results could be clearly differentiated between clinical and non-clinical users. Moreover, patients increasingly corrected their head direction towards their neglected side. Patients stated that the use of VR increased their enjoyment of the therapy. This study contributes to the current research on rehabilitation for USN by proposing the first system to apply MNT in a VR environment. The tool shows promise as an addition to currently used rehabilitation methods. However, results are limited to a small sample size and performance metrics. Future work will focus on validating these results with a larger sample over a longer period. Moreover, future efforts should explore personalisation and gamification to tailor to the heterogeneity of the condition.
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