Design and Evaluation of Virtual Reality-Based Therapy Games with Dual Focus on Therapeutic Relevance and User Experience for Children with Cerebral Palsy

Development of a virtual reality system usability questionnaire (VRSUQ)

Virtual reality (VR) has gained significant attention as a technology that provides immersive experiences similar to the real world. In order for a VR system to be accepted, usability needs to be guaranteed. Accordingly, VR-related researchers are continuing their efforts to improve VR systems by conducting usability evaluations. However, existing studies have limitations in that they cannot comprehensively evaluate the detailed properties of VR systems by using questionnaires developed for general product usability evaluation or focusing only on some usability aspects of VR systems. This suggests it may be difficult to fully capture usability issues in a VR system, and that it is necessary to develop a usability evaluation tool that reflects the specific characteristics of the VR system. Therefore, this study develops and proposes the Virtual Reality System Usability Questionnaire (VRSUQ). In the development of the questionnaire, items were structured based on a literature review and discussions with experts. To account for the diverse characteristics of VR systems, the validity of the questionnaire was verified through both exploratory and confirmatory factor analysis, utilizing data obtained from three distinct experimental studies that employed different VR systems. In addition, by comparing the results of VRSUQ with the results from the System Usability Scale, which is widely used for perceived usability evaluation, alternative possibilities for using VRSUQ are presented. Further testing on various VR platforms is needed to ensure the reliability and validity of VRSUQ, and as results from using VRSUQ are accumulated, it is expected to be widely used as a more powerful and robust VR-specific perceived usability evaluation tool.

The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review

Virtual reality (VR) technology has experienced a steady rise and has been widely applied in the field of rehabilitation. The integration of VR technology in rehabilitation has shown promising results in enhancing their motivation for treatment, thereby enabling patients to actively engage in rehab training. Despite the advancement, there is a dearth of comprehensive summary and analysis on the use of VR technology to enhance patient motivation in rehabilitation. Thus, this narrative review aims to evaluate the potential of VR technology in enhancing patient motivation during motor rehabilitation training. This review commences with an explanation of how enhancing motivation through the VR rehabilitation system could improve the efficiency and effectiveness of rehabilitation training. Then, the technology was analyzed to improve patient motivation in the present VR rehabilitation system in detail. Furthermore, these technologies are classified and summarized to provide a comprehensive overview of the state-of-the-art approaches for enhancing patient motivation in VR rehabilitation. Findings showed VR rehabilitation training utilizes game-like exercises to enhance the engagement and enjoyment of rehabilitation training. By immersing patients in a simulated environment with multisensory feedback, VR systems offer a unique approach to rehabilitation that can lead to improved patient motivation. Both ultimately lead to improved patient outcomes, which is not typically achievable with traditional rehabilitation methods. The review concludes that VR rehabilitation presents an opportunity to improve patient motivation and adherence to long-term rehabilitation training. However, to further enhance patient self-efficacy, VR rehabilitation should integrate psychology and incorporate methods. Moreover, it is necessary to build a game design theory for rehabilitation games, and the latest VR feedback technology should also be introduced.

Adaptation and Validation of a Serious Game for Motor Learning Training in Children with Cerebral Palsy

Objective: Children with cerebral palsy (CP) present motor learning disorders and somatosensory dysfunction. Although many protocols use videogames in children with CP, few apply or examine motor learning principles. This study aims at (1) implementing therapist-user-designer collaboration in adapting a videogame to the principles of motor learning and the characteristics of users with CP, and (2) piloting the effectiveness of these adaptations by analyzing the achievement of motor learning parameters (learning rate acquisition, retention, and transfer to motor and somatosensory function). Materials and Methods: Periodical interprofessional meetings conducted to the adaptation of a videogame, requiring the control of a joystick for traveling through a maze, to motor learning principles. In a pilot validation, effects in unilateral upper limb function, gross manual dexterity, and somatosensory thresholds were assessed before and after 10-week training in 13 children with CP. Results: After 10-week training with the adapted serious game, children showed learning rates above 90% and improvement in motor learning parameters along the sessions. Manual dexterity and pronation-supination of the dominant hand improved after training. No significant effects were found on somatosensory thresholds. Conclusion: Serious games are useful as motor learning tools for improving motor function in children with PC. Cooperative work among professionals and users is advisable for designing efficient videogames according to rehabilitation best practices.

Personalized Touch-Based Exergame System for Unilateral and Bilateral Rehabilitation Training

Background: Natural and intuitive interfaces that monitor and promote upper limb task-specific training need to be developed. This article presents the development and testing of a touch-based game system for training and assessment of unilateral (ULR) and bilateral (BLR) reaching movements. Interaction becomes intuitive and simple by introducing in-game touch and pressure onto virtual targets projected on a custom-made large touch panel. Materials and Methods: A custom-made App integrates exergames and a biomechanical model with advanced algorithms for movement analysis. It processes and manages data from a motion-tracking sensor and a large touch panel equipped with 1222 (26 × 47) piezoresistive sensors, including high-speed readout electronics and algorithms to measure touch points and contact forces during fingertip interaction. An experiment was conducted to evaluate the experience, motivation, and movements of healthy and stroke subjects when interacting with the proposed system. The panel height, dispersion of virtual targets, and required contact force were customized based on motor skills of each group of subjects. Results: Both groups of subjects showed high level of motivation and user experience when interacting with the virtual environments. Stroke subjects performed the task slower and traveled a similar path length than healthy subjects, but with shorter range of motion. The mechanical work and potential energy profiles of both groups are consistent with those achieved when reaching real objects. Conclusions: The proposed contact-based exergames are a feasible solution for performing natural and intuitive therapeutic ULR and BLR exercises. They elicit appropriate reaching movements and contact forces in healthy and stroke subjects. The spatial and temporal attributes of the proposed solution can be customized to influence the movement and energy expenditure of specific joints.

Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis

Health 4.0 aligns with Industry 4.0 and encourages the application of the latest technologies to healthcare. Virtual reality (VR) is a potentially significant component of the Health 4.0 vision. Though VR in health care is a popular topic, there is little knowledge of VR-aided therapy from a macro perspective. Therefore, this paper was aimed to explore the research of VR in aiding therapy, thus providing a potential guideline for futures application of therapeutic VR in healthcare towards Health 4.0. A mixed research method was adopted for this research, which comprised the use of a bibliometric analysis (a quantitative method) to conduct a macro overview of VR-aided therapy, the identification of significant research structures and topics, and a qualitative review of the literature to reveal deeper insights. Four major research areas of VR-aided therapy were identified and investigated, i.e., post-traumatic stress disorder (PTSD), anxiety and fear related disorder (A&F), diseases of the nervous system (DNS), and pain management, including related medical conditions, therapies, methods, and outcomes. This study is the first to use VOSviewer, a commonly used software tool for constructing and visualizing bibliometric networks and developed by Center for Science and Technology Studies, Leiden University, the Netherlands, to conduct bibliometric analyses on VR-aided therapy from the perspective of Web of Science core collection (WoSc), which objectively and visually shows research structures and topics, therefore offering instructive insights for health care stakeholders (particularly researchers and service providers) such as including integrating more innovative therapies, emphasizing psychological benefits, using game elements, and introducing design research. The results of this paper facilitate with achieving the vision of Health 4.0 and illustrating a two-decade (2000 to year 2020) map of pre-life of the Health Metaverse.

Towards a multi-user experience approach to exploring key requirements to design smart habilitation devices for children with cerebral palsy

Introduction

This paper takes a multi-stakeholder approach to generate key requirements to design smart habilitation devices for children with Cerebral Palsy. Four groups of different relevant stakeholders of smart-habilitation devices were approached to participate in this study, including children with Cerebral Palsy, their parents, occupational therapists, as well as technical specialists.

Methods

Profiles of children with Cerebral Palsy were generated to have a concrete idea of their needs and desires. Meanwhile, for the three stakeholders, focus groups were used to gather their insights and requirements on a prospective smart habilitation device for children. Successively, a thematic analysis was conducted to analyse the qualitative data obtained during the focus groups.

Results

Eight design requirements were developed to generate designs which stimulate high quality user experiences in children and other users of smart habilitation devices. In addition, an initial framework of the process that design engineers would follow to design such devices for children was proposed.

Conclusion

Adopting this framework, and the respective requirements, will help design engineers to implement a multi-user approach and amend the design according to stakeholders' goals and desires. The resulted design should ensure a high quality user experience for both the active and potential passive users of smart habilitation devices.

Effect of Virtual Reality Therapy on Balance and Walking in Children with Cerebral Palsy: A Systematic Review

Aim: To investigate the effect of Virtual Reality Therapy (VRT) on balance and walking in children with cerebral palsy (CP). Method: A systematic search in Pubmed and Embase was performed until the 9th of July 2019. Articles were included if the population consisted of children with CP and data on balance and/or walking were reported. Results were pooled in two meta-analyses. Results: 26 articles were included. For 'balance' 5 and for 'walking' 4 were used for the meta-analyses. The meta-analyses showed a significant result in favor of VRT for balance, SMD 0.89 [95% CI, SD 0.14, 1.63] and for walking, SMD 3.10 [95% Cl, SD 0.78, 5.35]. Interpretation: VRT seems a promising intervention for rehabilitation in children with CP. The meta-analysis confirmed this positive effect. These results must be interpreted with caution due to differences in the interventions used, the lack of randomized-controlled trials, and the relatively small groups.

Advantages and Limitations of Leap Motion from a Developers', Physical Therapists', and Patients' Perspective

BACKGROUND

Physical rehabilitation exergames (PREGs) are suitable for motivating patients toward completing treatments. Leap Motion (LM) is a motion sensor that may be useful for developing PREGs targeted at hands and fingers rehabilitation. Therefore, knowing the advantages and limitations of LM is relevant to understand under which conditions this sensor may be suitable.

OBJECTIVE

In this article, we present a qualitative study to identify the main advantages and limitations of LM for PREGs.

METHODS

We collect data using interviews with a group of PREGs developers, physical therapy experts, and patients. We employ the thematic analysis method to analyze the collected data.

RESULTS

We found that the advantages and limitations of LM are related to (1) the role as PREG development tool that enables hand movements detection, (2) the capability to be a mobile and easy-to-use capturing technology, and (3) the contribution to add value in rehabilitation therapy by motivating physical therapists and patients to use PREGs.

CONCLUSION

The analysis shows that LM is a suitable and cost-effective solution for developing usable PREGs for some hand and finger rehabilitation movements with a moderate development effort. However, the development maturity of LM poses limitations related to reliability and robustness, preventing the use of LM as a standalone physical rehabilitation tool. Our findings serve as guidelines for developers and physical therapists during the development and use of PREGs targeted at hands and fingers, guiding the decision-making process during feasibility analysis and design stages.

Challenges and Practical Considerations in Applying Virtual Reality in Medical Education and Treatment

Despite the benefits of using virtual reality (VR) in medical education and treatment, some challenges and limitations result in the uselessness or misuse of this technology. Therefore, recognizing potential challenges related to VR might be helpful in the strategic decision-making process to implement and develop this technology in the healthcare field. Accordingly, our review aimed to determine the challenges associated with the application of VR in the field of medical education and treatment. We searched Science Direct, Google Scholar, and PubMed databases for relevant papers using a defined search query. We restricted the search to articles in English or Persian language published by the end of 2018. The main challenges of developing and using VR with educational and therapeutic objectives are categorized as general and specific. General challenges include reduced face-to-face communications, education, cost challenges, users' attitudes, and specific challenges such as designing, safety considerations, VR side effects, evaluation, and validation of VR applications. Challenges related to VR will have different effects, thus identifying each of them helps to determine the solutions for each challenge. Also, it is suggested to develop and update laws, standards, and protocols, which play an important role in increasing the effective application of VR at the national level.

Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller

OBJECTIVE

To design and evaluate a low-cost gaming station that supports force resistance training in pediatric arm/hand grasp therapies through mainstream videogame play.

METHODS

The gaming station was developed through an iterative participatory design process and includes a force feedback game controller (Novint Falcon), custom grips, arm/wrist supports, and software to interface with mainstream games and manage difficulty settings in the controller. The station was tested for usability and feasibility with six therapists and six children with cerebral palsy, 7-16 years of age, attending weekly therapy sessions over 12 weeks. Pre- and post-assessments of perceived performance and satisfaction on self-identified goals were measured on the Canadian Occupational Performance Measure (COPM).

RESULTS

The gaming station was considered highly usable by therapists with a score of 76.7 (standard deviation [SD] = 6.1) on the System Usability Scale. Overall, children enjoyed the games, achieved high repetition rates for wrist extensions and arm movements, and all made clinically significant progress on therapy goals. Increases of 3.13 (SD = 1.69) on the performance scale and 2.97 (SD = 0.98) on the satisfaction scale were reported on the COPM. Conclusiion: In-clinic force resistance training for development of upper limb functional capacities is feasible using low-cost video game components adapted to therapy through a participatory design process.

"It's all about incentive": Social technology as a potential facilitator for self-determined physical activity participation for young people with physical disabilities

PURPOSE

To investigate the perceived role of social technologies in promoting physical activity participation for young people with physical disabilities and to identify design considerations that should be addressed when creating social technologies to promote physical activity.

METHOD

Interactive design workshops for young people with physical disabilities aged 12-18 (n = 8) were held. Data were analyzed using interpretive thematic analysis.

RESULTS

Young people perceived significant benefit for social technologies to promote physical activity as they have the potential to overcome many barriers to physical activity participation. Design features recommended by the participants included (1) options for diverse interests and preferences, (2) provision of informational support, (3) support through equitable technology design, (4) incentive through competition and play, and (5) opportunities to develop community.

CONCLUSIONS

Social technology has potential to provide tailored, equitable opportunities for social engagement and physical activity participation for young people with physical disabilities through needs- and preference-specific design.

Immersive Virtual Reality for Pediatric Pain

Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.

Clinical usefulness of augmented reality using infrared camera based real-time feedback on gait function in cerebral palsy: a case study

[Purpose] This study investigated the effects of real-time feedback using infrared camera recognition technology-based augmented reality in gait training for children with cerebral palsy. [Subjects] Two subjects with cerebral palsy were recruited. [Methods] In this study, augmented reality based real-time feedback training was conducted for the subjects in two 30-minute sessions per week for four weeks. Spatiotemporal gait parameters were used to measure the effect of augmented reality-based real-time feedback training. [Results] Velocity, cadence, bilateral step and stride length, and functional ambulation improved after the intervention in both cases. [Conclusion] Although additional follow-up studies of the augmented reality based real-time feedback training are required, the results of this study demonstrate that it improved the gait ability of two children with cerebral palsy. These findings suggest a variety of applications of conservative therapeutic methods which require future clinical trials.