Attentional Demand of a Virtual Reality-Based Reaching Task in Nondisabled Older Adults

Virtual Rehabilitation in Parkinson Disease: A Dopamine Transporter Imaging Study

OBJECTIVE

The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life.

DESIGN

Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance.

RESULTS

Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015).

CONCLUSIONS

In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.

Multipurpose Virtual Reality Environment for Biomedical and Health Applications

Virtual reality is a trending, widely accessible, and contemporary technology of increasing utility to biomedical and health applications. However, most implementations of virtual reality environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. This environment can be interfaced with different hardware and data sources, ranging from gyroscopes to fMRI scanners. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific brain regions of interest. Both applications were tested by pilot subjects that unanimously provided very positive feedback, suggesting that appropriately designed VR environments can indeed be robustly and efficiently used for multiple biomedical purposes. We attribute the versatility of our approach on three principles implicit in the design: selectivity, immersiveness, and adaptability. The software, including both applications, is publicly available free of charge, via a GitHub repository, in support of the Open Science Initiative. Although using this software requires specialized hardware and engineering know-how, we anticipate our contribution to catalyze further progress, interdisciplinary collaborations and replicability, with regards to the usage of virtual reality in biomedical and health applications.

Ecological assessment of divided attention: What about the current tools and the relevancy of virtual reality

The ability to perform two tasks simultaneously has become increasingly important as attention-demanding technologies have become more common in daily life. This type of attentional resources allocation is commonly called "divided attention". Because of the importance of divided attention in natural world settings, substantial efforts have been made recently so as to promote an integrated, realistic assessment of functional abilities in dual-task paradigms. In this context, virtual reality methods appear to be a good solution. However to date, there has been little discussion on validity of such methods. Here, we offer a comparative review of conventional tools used to assess divided attention and of the first virtual reality studies (mostly from the field of road and pedestrian safety). The ecological character of virtual environments leads to a better understanding of the influence of dual-task settings and also makes it possible to clarify issues such as the utility of hands-free phones. After discussing the theoretical and clinical contributions of these studies, we discuss the limits of virtual reality assessment, focusing in particular: (i) on the challenges associated with lack of familiarity with new technological devices; (ii) on the validity of the ecological character of virtual environments; and (iii) on the question of whether the results obtained in a specific context can be generalized to all dual-task situations typical of daily life. To overcome the limitations associated with virtual reality, we propose: (i) to include a standardized familiarization phase in assessment protocols so as to limit the interference caused by the use of new technologies; (ii) to systematically compare virtual reality performance with conventional tests or real-life tests; and (iii) to design dual-task scenarios that are independent from the patient's expertise on one of the two tasks. We conclude that virtual reality appears to constitute a useful tool when used in combination with more conventional tests.