Learning in a virtual environment using haptic systems for movement re-education: can this medium be used for remodeling other behaviors and actions?

Augmented Reality Interface for Complex Anatomy Learning in the Central Nervous System: A Systematic Review

The medical system is facing the transformations with augmentation in the use of medical information systems, electronic records, smart, wearable devices, and handheld. The central nervous system function is to control the activities of the mind and the human body. Modern speedy development in medical and computational growth in the field of the central nervous system enables practitioners and researchers to extract and visualize insight from these systems. The function of augmented reality is to incorporate virtual and real objects, interactively running in a real-time and real environment. The role of augmented reality in the central nervous system becomes a thought-provoking task. Gesture interaction approach-based augmented reality in the central nervous system has enormous impending for reducing the care cost, quality refining of care, and waste and error reducing. To make this process smooth, it would be effective to present a comprehensive study report of the available state-of-the-art-work for enabling doctors and practitioners to easily use it in the decision making process. This comprehensive study will finally summarise the outputs of the published materials associate to gesture interaction-based augmented reality approach in the central nervous system. This research uses the protocol of systematic literature which systematically collects, analyses, and derives facts from the collected papers. The data collected range from the published materials for 10 years. 78 papers were selected and included papers based on the predefined inclusion, exclusion, and quality criteria. The study supports to identify the studies related to augmented reality in the nervous system, application of augmented reality in the nervous system, technique of augmented reality in the nervous system, and the gesture interaction approaches in the nervous system. The derivations from the studies show that there is certain amount of rise-up in yearly wise articles, and numerous studies exist, related to augmented reality and gestures interaction approaches to different systems of the human body, specifically to the nervous system. This research organises and summarises the existing associated work, which is in the form of published materials, and are related to augmented reality. This research will help the practitioners and researchers to sight most of the existing studies subjected to augmented reality-based gestures interaction approaches for the nervous system and then can eventually be followed as support in future for complex anatomy learning.

Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol

INTRODUCTION

In the recent past, training systems using an interactive virtual environment have been introduced to neurorehabilitation. Such systems can be applied to encourage purposeful limb movements and will increasingly be used at home by the individual patient. Therefore, an integrated valid and reliable assessment tool on the basis of such a system to monitor the recovery process would be an essential asset.

OBJECTIVES

The aim of the study is to evaluate usability, feasibility and validity of the digital version of the Action Research Arm Test using the Bi-Manu-Trainer system as a platform. Additionally, the feasibility and usability of the implementation of action observation and motor imagery tasks into the Bi-Manu-Trainer software will be evaluated.

PATIENTS AND METHODS

This observational study is planned as a single-arm trial for testing the new assessment and the action observation and motor imagery training module. Therefore, 75 patients with Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury or Guillain-Barré syndrome will be included. 30 out of the 75 patients will additionally take part in a 4-week training on the enhanced Bi-Manu-Trainer system. Primary outcomes will be the score on the System Usability Scale and the correlation between the conventional and digital Action Research Arm Test scores. Secondary outcomes will be hand dexterity, upper limb activities of daily living and quality of life.

HYPOTHESIS

We hypothesise that the digital Action Research Arm Test assessment is a valid and essential tool and that it is feasible to incorporate action observation and motor imagery into Bi-Manu-Trainer practice. The results are expected to give recommendations for necessary modifications and might also contribute knowledge concerning the application of action observation and motor imagery tasks using a training system such as the Bi-Manu-Trainer.

TRIAL REGISTRATION NUMBER

NCT03268304; Pre-results.

Auditory and visual cueing modulate cycling speed of older adults and persons with Parkinson's disease in a Virtual Cycling (V-Cycle) system

BACKGROUND

Evidence based virtual environments (VEs) that incorporate compensatory strategies such as cueing may change motor behavior and increase exercise intensity while also being engaging and motivating. The purpose of this study was to determine if persons with Parkinson's disease and aged matched healthy adults responded to auditory and visual cueing embedded in a bicycling VE as a method to increase exercise intensity.

METHODS

We tested two groups of participants, persons with Parkinson's disease (PD) (n = 15) and age-matched healthy adults (n = 13) as they cycled on a stationary bicycle while interacting with a VE. Participants cycled under two conditions: auditory cueing (provided by a metronome) and visual cueing (represented as central road markers in the VE). The auditory condition had four trials in which auditory cues or the VE were presented alone or in combination. The visual condition had five trials in which the VE and visual cue rate presentation was manipulated. Data were analyzed by condition using factorial RMANOVAs with planned t-tests corrected for multiple comparisons.

RESULTS

There were no differences in pedaling rates between groups for both the auditory and visual cueing conditions. Persons with PD increased their pedaling rate in the auditory (F 4.78, p = 0.029) and visual cueing (F 26.48, p < 0.000) conditions. Age-matched healthy adults also increased their pedaling rate in the auditory (F = 24.72, p < 0.000) and visual cueing (F = 40.69, p < 0.000) conditions. Trial-to-trial comparisons in the visual condition in age-matched healthy adults showed a step-wise increase in pedaling rate (p = 0.003 to p < 0.000). In contrast, persons with PD increased their pedaling rate only when explicitly instructed to attend to the visual cues (p < 0.000).

CONCLUSIONS

An evidenced based cycling VE can modify pedaling rate in persons with PD and age-matched healthy adults. Persons with PD required attention directed to the visual cues in order to obtain an increase in cycling intensity. The combination of the VE and auditory cues was neither additive nor interfering. These data serve as preliminary evidence that embedding auditory and visual cues to alter cycling speed in a VE as method to increase exercise intensity that may promote fitness.

Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke

Reaching and grasping parameters with and without haptic feedback were characterized in people with chronic post-stroke behaviors. Twelve (67 ± 10 years) individuals with chronic stroke and arm/hand paresis (Fugl-Meyer Assessment-Arm: ≥ 46/66 pts) participated. Three dimensional (3-D) temporal and spatial kinematics of reaching and grasping movements to three objects (can: cylindrical grasp; screwdriver: power grasp; pen: precision grasp) in a physical environment (PE) with and without additional haptic feedback and a 3-D virtual environment (VE) with haptic feedback were recorded. Participants reached, grasped and transported physical and virtual objects using similar movement strategies in all conditions. Reaches made in VE were less smooth and slower compared to the PE. Arm and trunk kinematics were similar in both environments and glove conditions. For grasping, stroke subjects preserved aperture scaling to object size but used wider hand apertures with longer delays between times to maximal reaching velocity and maximal grasping aperture. Wearing the glove decreased reaching velocity. Our results in a small group of subjects suggest that providing haptic information in the VE did not affect the validity of reaching and grasping movement. Small disparities in movement parameters between environments may be due to differences in perception of object distance in VE. Reach-to-grasp kinematics to smaller objects may be improved by better 3-D rendering. Comparable kinematics between environments and conditions is encouraging for the incorporation of high quality VEs in rehabilitation programs aimed at improving upper limb recovery.

Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial

Objectives. To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic). Design. Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N = 23) and TR (N = 21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak). Results. The F-M UE (P = 0.030), FIM (P = 0.021), time (P = 0.008), and peak (P = 0.018), were significantly higher in the RFVE group after treatment, but not speed (P = 0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P = 0.031), time (P = 0.011), and peak (P = 0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P = 0.005) when treated by RFVE. Conclusion. These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291.

Visuomotor discordance during visually-guided hand movement in virtual reality modulates sensorimotor cortical activity in healthy and hemiparetic subjects

We investigated neural effects of visuomotor discordances during visually-guided finger movements. A functional magnetic resonance imaging (fMRI)-compatible data glove was used to actuate (in real-time) virtual hand models shown on a display in first person perspective. In Experiment 1, we manipulated virtual hand motion to simulate either hypometric or unintentional (actuation of a mismatched finger) feedback of sequential finger flexion in healthy subjects. Analysis of finger motion revealed no significant differences in movement behavior across conditions, suggesting that between-condition differences in brain activity could only be attributed to varying modes of visual feedback rather than motor output. Hypometric feedback and mismatched finger feedback (relative to veridical) were associated with distinct activation. Hypometric feedback was associated with activation in the contralateral motor cortex. Mismatched feedback was associated with activation in bilateral ventral premotor, left dorsal premotor, and left occipitotemporal cortex. The time it took the subject to evaluate visuomotor discordance was positively correlated with activation in bilateral supplementary motor area, bilateral insula, right postcentral gyrus, bilateral dorsal premotor areas, and bilateral posterior parietal lobe. In Experiment 2, we investigated the effects of hypo- and hypermetric visual feedback in three stroke subjects. We observed increased activation of ipsilesional motor cortex in both hypometric and hypermetric feedback conditions. Our data indicate that manipulation of visual feedback of one's own hand movement may be used to facilitate activity in select brain networks. We suggest that these effects can be exploited in neurorehabilition to enhance the processes of brain reorganization after injury and, specifically, might be useful in aiding recovery of hand function in patients during virtual reality-based training.

Integrative rehabilitation of elderly stroke survivors: the design and evaluation of the BrightArm™

PURPOSE

To describe the development of the BrightArm upper extremity rehabilitation system, and to determine its clinical feasibility with older hemiplegic patients.

METHOD

The BrightArm adjusted arm gravity loading through table tilting. Patients wore an arm support that sensed grasp strength and communicated wirelessly with a personal computer. Games were written to improve cognitive, psychosocial and the upper extremity motor function and adapted automatically to each patient. The system underwent feasibility trials spanning 6 weeks. Participants were evaluated pre-therapy, post-therapy, and at 6 weeks follow-up using standardized clinical measures. Computerized measures of supported arm reach and game performance were stored on a remote server.

RESULTS

Five participants had clinically significant improvements in their active range of shoulder movement, shoulder strength, grasp strength, and their ability to focus. Several participants demonstrated substantially higher arm function (measured with the Fugl-Meyer test) and two were less-depressed (measured with the Becks Depression Inventory, Second Edition). The BrightArm technology was well-accepted by the participants, who gave it an overall subjective rating of 4.1 on a 5 point Likert scale.

CONCLUSIONS

Given these preliminary findings, it will be beneficial to evaluate the BrightArm through controlled clinical trials and to investigate its application to other clinical populations.

Virtual reality technologies for research and education in obesity and diabetes: research needs and opportunities

The rising rates, high prevalence, and adverse consequences of obesity and diabetes call for new approaches to the complex behaviors needed to prevent and manage these conditions. Virtual reality (VR) technologies, which provide controllable, multisensory, interactive three-dimensional (3D) stimulus environments, are a potentially valuable means of engaging patients in interventions that foster more healthful eating and physical activity patterns. Furthermore, the capacity of VR technologies to motivate, record, and measure human performance represents a novel and useful modality for conducting research. This article summarizes background information and discussions for a joint July 2010 National Institutes of Health - Department of Defense workshop entitled Virtual Reality Technologies for Research and Education in Obesity and Diabetes. The workshop explored the research potential of VR technologies as tools for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR in fostering more effective utilization of diabetes- and obesity-related nutrition and lifestyle information. Virtual reality technologies were considered especially relevant for fostering desirable health-related behaviors through motivational reinforcement, personalized teaching approaches, and social networking. Virtual reality might also be a means of extending the availability and capacity of health care providers. Progress in the field will be enhanced by further developing available platforms and taking advantage of VR's capabilities as a research tool for well-designed hypothesis-testing behavioral science. Multidisciplinary collaborations are needed between the technology industry and academia, and among researchers in biomedical, behavioral, pedagogical, and computer science disciplines. Research priorities and funding opportunities for use of VR to improve prevention and management of obesity and diabetes can be found at agency websites (National Institutes of Health: http://grants.nih.gov/grants/guide/index.html; Department of Defense: www.tatrc.org).