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Chien SY, Wong AM, Wu CY, Beckman SL. Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study. JMIR Hum Factors 2024; 11:e56357. [PMID: 38904991 DOI: 10.2196/56357] [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] [Received: 01/14/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. OBJECTIVE This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. METHODS A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants' attention, executive functioning, and cognitive abilities. RESULTS The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. CONCLUSIONS Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients' cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care.
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Affiliation(s)
- Shih-Ying Chien
- Department of Industrial Design, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Alice Mk Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Medical Foundation, Taoyuan, Taiwan
| | - Ching-Yi Wu
- Department of Physical Medicine and Rehabilitation, Chang Gung Medical Foundation, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Sara L Beckman
- Haas School of Business, University of California, Berkeley, Berkeley, CA, United States
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Alashram AR. Effectiveness of combined robotics and virtual reality on lower limb functional ability in stroke survivors: A systematic review of randomized controlled trials. Neurol Sci 2024:10.1007/s10072-024-07618-1. [PMID: 38829579 DOI: 10.1007/s10072-024-07618-1] [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: 03/31/2024] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
Lower limb impairments are common consequences of stroke. Robotics and virtual reality (VR) play crucial roles in improving lower limb function post-stroke. This review aims to assess the effects of combined robot and VR interventions on lower limb functional ability poststroke and to provide recommendations for future studies in the rehabilitation field. PubMed, SCOPUS, CINAHL, MEDLINE, EMBASE, and Web of Science were searched from inception to March 1, 2024. Randomized controlled trials (RCTs) involving patients with a stroke, administering combined robot and VR compared with passive (i.e., rest) or active (any intervention), and including at least one outcome evaluating lower limb function (i.e., balance, gait, mobility, muscle tone, muscle strength, range of motion) or activities of daily living were selected. The Cochrane Collaboration tool was employed to evaluate the risk of bias in the included studies. Nine studies met the eligibility criteria. In total, 364 stroke survivors (Mean age 55.62 years) were involved in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," "moderate quality" (n=3), and "low quality" (n=1). There are mixed findings on the effects of combined robot and VR on lower limb functional ability in stroke survivors. The evidence for the effects of combined robot and VR on lower limb functional ability post-stroke is promising. Further trials with long-term follow-up are strongly warranted to understand the immediate and long-term effect of combined robot and VR intervention on various lower limb impairments and to define the optimal treatment protocols.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road 11831, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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3
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Alashram AR. Combined noninvasive brain stimulation virtual reality for upper limb rehabilitation poststroke: A systematic review of randomized controlled trials. Neurol Sci 2024; 45:2523-2537. [PMID: 38286919 DOI: 10.1007/s10072-024-07360-8] [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] [Received: 12/12/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
Upper limb impairments are common consequences of stroke. Noninvasive brain stimulation (NIBS) and virtual reality (VR) play crucial roles in improving upper limb function poststroke. This review aims to evaluate the effects of combined NIBS and VR interventions on upper limb function post-stroke and to provide recommendations for future studies in the rehabilitation field. PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. Randomized controlled trials (RCTs) encompassed patients with a confirmed stroke diagnosis, administrated combined NIBS and VR compared with passive (i.e., rest) or active (conventional therapy), and included at least one outcome assessing upper limb function (i.e., strength, spasticity, function) were selected. The quality of the included studies was assessed using the Cochrane Collaboration tool. Seven studies met the eligibility criteria. In total, 303 stroke survivors (Mean age: 61.74 years) were included in this review. According to the Cochrane Collaboration tool, five studies were classified as "high quality," while two were categorized as "moderate quality". There are mixed findings for the effects of combined NIBS and VR on upper limb function in stroke survivors. The evidence for the effects of combined transcranial direct current stimulation and VR on upper limb function post-stroke is promising. However, the evidence regarding the effects of combined repetitive transcranial magnetic stimulation and VR on upper limb function is limited. Further randomized controlled trials with long-term follow-up are strongly warranted.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Ceradini M, Losanno E, Micera S, Bandini A, Orlandi S. Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review. J Neuroeng Rehabil 2024; 21:75. [PMID: 38734690 PMCID: PMC11088157 DOI: 10.1186/s12984-024-01367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement. METHODS This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments. RESULTS Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs. CONCLUSION This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.
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Affiliation(s)
- Matteo Ceradini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Elena Losanno
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Andrea Bandini
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Orlandi
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Naqvi WM, Naqvi I, Mishra GV, Vardhan V. The Dual Importance of Virtual Reality Usability in Rehabilitation: A Focus on Therapists and Patients. Cureus 2024; 16:e56724. [PMID: 38646260 PMCID: PMC11032731 DOI: 10.7759/cureus.56724] [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: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Virtual reality (VR) has advanced in medical education and rehabilitation from basic graphical applications due to its ability to generate a virtual three-dimensional (3D) environment. This environment is mostly used to practice professional skills, plan surgery procedures, simulate surgeries, display 3D anatomy, and rehabilitate various disorders. VR has transformed the field of rehabilitation therapy by providing immersive and engaging experiences that go beyond traditional bounds, significantly improving patient care and therapeutic results. Considering the direct impact of VR on the efficacy of the treatment for both therapists and patients, its dual significance for usability and user experience cannot be overstated. The purpose of this article is to determine the synergistic association between VR accessibility and the rehabilitation process, highlighting the significance of VR technology in designing the future of rehabilitation therapy and demonstrating how advancing VR technology can improve therapeutic outcomes despite overcoming obstacles encountered during VR usage. In conclusion, VR offers a personalized, efficient, interesting, and engaging rehabilitative environment for patients, while also assisting therapists in cultivating empathy and efficiency and encouraging innovative approaches in treatment procedures.
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Affiliation(s)
- Waqar M Naqvi
- Interdisciplinary Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, ARE
| | - Ifat Naqvi
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Nagpur, IND
| | - Gaurav V Mishra
- Radiodiagnosis, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vishnu Vardhan
- Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Lim JY, Yu H, Kwon YE, Do JG, Hwang JH. Feasibility of digital technology-supported home exercise intervention for health promotion in community-dwelling older adults: A pilot randomized controlled trial. Heliyon 2024; 10:e24933. [PMID: 38333828 PMCID: PMC10850410 DOI: 10.1016/j.heliyon.2024.e24933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Ji Young Lim
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Heeju Yu
- Department of Physical Therapy, Graduate School, Sahmyook University, Republic of Korea
| | - Yeah Eun Kwon
- Research Institute for Future Medicine, Samsung Medical Center, Republic of Korea
| | - Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
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Bateni H, Carruthers J, Mohan R, Pishva S. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabil Res Pract 2024; 2024:1122286. [PMID: 38304610 PMCID: PMC10834096 DOI: 10.1155/2024/1122286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 02/03/2024] Open
Abstract
Within the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required.
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Affiliation(s)
- Hamid Bateni
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Jenna Carruthers
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Rebecca Mohan
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Seyedamirhossein Pishva
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO 64106, USA
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Li W, Shi P, Li S, Yu H. Current status and clinical perspectives of extended reality for myoelectric prostheses: review. Front Bioeng Biotechnol 2024; 11:1334771. [PMID: 38260728 PMCID: PMC10800532 DOI: 10.3389/fbioe.2023.1334771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024] Open
Abstract
Training with "Extended Reality" or X-Reality (XR) systems can undoubtedly enhance the control of the myoelectric prostheses. However, there is no consensus on which factors improve the efficiency of skill transfer from virtual training to actual prosthesis abilities. This review examines the current status and clinical applications of XR in the field of myoelectric prosthesis training and analyses possible influences on skill migration. We have conducted a thorough search on databases in the field of prostheses using keywords such as extended reality, virtual reality and serious gaming. Our scoping review encompassed relevant applications, control methods, performance evaluation and assessment metrics. Our findings indicate that the implementation of XR technology for myoelectric rehabilitative training on prostheses provides considerable benefits. Additionally, there are numerous standardised methods available for evaluating training effectiveness. Recently, there has been a surge in the number of XR-based training tools for myoelectric prostheses, with an emphasis on user engagement and virtual training evaluation. Insufficient attention has been paid to significant limitations in the behaviour, functionality, and usage patterns of XR and myoelectric prostheses, potentially obstructing the transfer of skills and prospects for clinical application. Improvements are recommended in four critical areas: activities of daily living, training strategies, feedback, and the alignment of the virtual environment with the physical devices.
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Affiliation(s)
- Wei Li
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Ping Shi
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Sujiao Li
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
| | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, Shanghai, China
- Key Laboratory of Neural-Functional Information and Rehabilitation Engineering of the Ministry of Civil Affairs, Shanghai, China
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Ghazavi Dozin SM, Mohammad Rahimi N, Aminzadeh R. Wii Fit-Based Biofeedback Rehabilitation Among Post-Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial. Biol Res Nurs 2024; 26:5-20. [PMID: 37247514 DOI: 10.1177/10998004231180316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Stroke is one of the most widespread reasons for acquired adult disability. Recent experimental studies have reported the beneficial influence of Wii Fit-based feedback on improving overall balance and gait for stroke survivors. METHODS We conducted a systematic review of the literature using the following keywords to retrieve the data: feedback, biofeedback, stroke, visual, auditory, tactile, virtual reality, videogame rehabilitation, Nintendo Wii stroke, videogame stroke, exergame stroke, Nintendo Wii rehabilitation, balance, and gait. A review and meta-analysis of RCTs regarding Wii Fit-based rehabilitation accompanied by conventional therapy effects on Berg Balance Scale (BBS), Timed Up and Go (TUG), functional reach test, and gait (speed) in stroke survivors was conducted. OBJECTIVE To determine the impacts of Wii Fit-based feedback combined with traditional therapy on balance and gait in stroke survivors. RESULTS 22 studies were included. The meta-analysis results revealed statistically significant improvements in functional ambulation measured using TUG (p < 0.0001), balance measured using BBS (p = 0.0001), and functional reach test (p = 0.01), but not in gait speed (p = 0.32) following Wii Fit-based feedback. Regarding the types of feedback, significant differences were found in BBS scores when mixed visual and auditory feedback was used. CONCLUSION Wii Fit-based feedback has desired effects on improving balance in stroke patients, making it a suitable adjunct to physical therapy.
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Affiliation(s)
| | | | - Reza Aminzadeh
- Department of Sports Sciences, Imam Reza International University, Mashhad, Iran
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Yalfani A, Abedi M, Raeisi Z, Asgarpour A. The effects of virtual reality training on postural sway and physical function performance on older women with chronic low back pain: A double-blind randomized clinical trial. J Back Musculoskelet Rehabil 2024; 37:761-770. [PMID: 38217579 DOI: 10.3233/bmr-230260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND Chronic low back pain (CLBP) is known as an important debilitating health condition among older women. OBJECTIVE This study aimed to evaluate the effects of eight-week virtual reality training (VRT) exercises on postural sway and physical function performance (PFP) among older women suffering from CLBP. METHODS Twenty-seven older women presenting with CLBP were randomized into experimental and control groups. The experimental group was instructed to perform 30-minute VRT exercises three times a week for eight weeks. Plantar pressure variables [sway velocity (SV) and anterior-posterior (AP) and medial-lateral (ML) fluctuations of the center of pressure (CoP)], 30-second chair stand test (30CST), and timed up and go (TUG) test were recorded. RESULTS The VRT group exhibited significant decreases in SV (p= 0.002), AP (p= 0.008), and ML (p= 0.02) fluctuations. Also, the performance of the VRT group in the 30CST and TUG tests significantly improved after the exercises (P< 0.001). CONCLUSION According to the results, VRT and the program used in this study should be used to enhance balance and PFP in older women with CLBP who mostly prefer activities that are accessible and feasible in low-risk environments.
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Affiliation(s)
- Ali Yalfani
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Mitra Abedi
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Zahra Raeisi
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Arak University, Arak, Iran
| | - Azadeh Asgarpour
- Department of Sports Rehabilitation, Faculty of Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
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Goel T, Sharma N, Gehlot A, Srivastav AK. Effectiveness of immersive virtual reality training to improve sitting balance control among individuals with acute and sub-acute paraplegia: A randomized clinical trial. J Spinal Cord Med 2023; 46:964-974. [PMID: 34935603 PMCID: PMC10653758 DOI: 10.1080/10790268.2021.2012053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Spinal cord injury (SCI) is a disabling condition with physical, psychological, and financial consequences. The study's goal is to compare the effectiveness of immersive virtual reality (VR) training in balance among individuals with incomplete paraplegia to that of functional electrical stimulation (FES). DESIGN Two groups, randomized clinical trial. SETTING Neurological Physiotherapy Out Patient Department, Tertiary Care Hospital. PARTICIPANTS Eighteen people aged 18-60 years with incomplete SCI. INTERVENTIONS VR training along with conventional physical therapy (CPT) and FES for Rectus Abdominis and Erector Spinae with CPT five times a week for 4 weeks. OUTCOME MEASURES The outcome measures were Modified Functional Reach Test (mFRT) and Function in Sitting Test (FIST) to assess sitting balance and Spinal Cord Independence Measure III (SCIM III) for the level of independence. Assessments were taken before initiating treatment and at the end of the 2 and 4 weeks after treatment. Within-group analyses for the mFRT values were performed using Repeated Measures ANOVA test, and between-group analyses were performed using the independent t-test test. Friedman and Mann-Whitney U-tests were used for analyzing FIST and SCIM III. RESULTS All variables (mFRT and FIST) improved significantly in both groups (P < 0.05), with the VR + CPT group showing a more significant result than the FES + CPT group (P value < 0.05), except for SCIM III. CONCLUSION VR as an adjunct to CPT demonstrated proved to be an effective treatment to improve balance among individuals with incomplete paraplegia.Trial registration: Clinical Trials Registry India identifier: CTRI/2020/03/024080.
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Affiliation(s)
- Tanya Goel
- Department of Neurological Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Nidhi Sharma
- Department of Neurological Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, India
| | - Ajay Gehlot
- Neurosurgery, Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana, India
- Neurosurgery Department, RD Gardi Medical College and attached Hospital, Ujjain, India
| | - Adarsh Kumar Srivastav
- Department of Physiotherapy School of Health Sciences, Chhatrapati Shahu Ji Maharaj University, Kanpur, India
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Hummel E, Cogne M, Lange M, Lecuyer A, Joly F, Gouranton V. VR for Vocational and Ecological Rehabilitation of Patients With Cognitive Impairment: A Survey. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4167-4178. [PMID: 37862281 DOI: 10.1109/tnsre.2023.3324131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Cognitive impairment arises from various brain injuries or diseases, such as traumatic brain injury, stroke, schizophrenia, or cancer-related cognitive impairment. Cognitive impairment can be an obstacle for patients to the return-to-work. Research suggests various interventions using technology for cognitive and vocational rehabilitation. The present work offers an overview of sixteen vocational or ecological VR-based clinical studies among patients with cognitive impairment. The objective is to analyze these studies from a VR perspective focusing on the VR apparatus and tasks, adaptivity, transferability, and immersion of the interventions. Our results highlight how a higher level of immersion could bring the participants to a deeper level of engagement and transferability, rarely assessed in current literature, and a lack of adaptivity in studies involving patients with cognitive impairments. From these considerations, we discuss the challenges of creating a standardized yet adaptive protocol and the perspectives of using immersive technologies to allow precise monitoring, personalized rehabilitation and increased commitment.
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Ferron A, Robert MT, Fortin W, Bau O, Cardinal MC, Desgagné J, Saussez G, Bleyenheuft Y, Levac D. Virtual Reality and Active Video Game Integration within an Intensive Bimanual Therapy Program for Children with Hemiplegia. Phys Occup Ther Pediatr 2023; 44:410-426. [PMID: 37846035 DOI: 10.1080/01942638.2023.2259462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
AIMS To describe the nature of custom and non-custom virtual reality and active video game (VR/AVG) implementation within a Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention program for children with hemiplegia. METHODS Six children aged 8-11 years participated in a 10-day HABIT-ILE intervention (65 h; 6.5 planned VR/AVG hours). VR/AVG implementation details were recorded daily and summarized with descriptive statistics; active motor engagement was quantified as minutes of active game participation. Post-intervention interviews with interventionists were analyzed with qualitative content analysis. RESULTS On average, participants received 79% of the planned VR/AVG dosage (314/400 planned minutes, range 214-400 min), of which the per-session active motor engagement average was 68% (27 min, SD 12 min). Participation involved equivalent amounts of custom (49%) and non-custom (51%) VR/AVG system use. Material and verbal adaptations facilitated alignment with HABIT-ILE principles. Interventionists identified type of task (gross versus fine motor), children's perceived motivation, and VR/AVG attributes as factors influencing active motor engagement and alignment with HABIT-ILE principles. CONCLUSIONS Describing individual and technological challenges of VR/AVG integration within HABIT-ILE can advance knowledge about VR/AVG use in intensive interventions and identify directions for subsequent research.
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Affiliation(s)
- Audrey Ferron
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | | | - William Fortin
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
| | - Odette Bau
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Marie-Claude Cardinal
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Julie Desgagné
- Centre Hospitalier Universitaire Sainte-Justine - Marie Enfant Rehabilitation Center, Montreal, Canada
| | - Geoffroy Saussez
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain, Belgium
| | - Danielle Levac
- Centre Hospitalier Universitaire Sainte-Justine - Research Center, Montreal, Canada
- Faculty of Medicine, University of Montreal, Montreal, Canada
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14
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Forero J, Vette AH, Hebert JS. Technology-based balance performance assessment can eliminate floor and ceiling effects. Sci Rep 2023; 13:14488. [PMID: 37660133 PMCID: PMC10475013 DOI: 10.1038/s41598-023-41671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023] Open
Abstract
Many clinical measurement tools for balance have ceiling effects. Technology-based assessments using virtual reality systems such as the Computer-Assisted Rehabilitation Environment (CAREN) may provide a way to develop objective, quantitative measures that scale from low to high levels of difficulty. Our objective was to: (1) develop a performance assessment tool (PAT) for the CAREN; (2) quantify the reliability of the tool; (3) validate the scores against clinical balance measures; and (4) compare the scores from a population with balance impairments to those from able-bodied individuals in a cross-sectional validation study. Three games were developed on the CAREN and tested on 49 participants (36 able-bodied and 13 with impaired mobility). For each module, the corresponding measures were transformed into scores using a series of functions such that ceiling and flooring effects would be minimized. The results showed an association between scores and age, an overlap in scores from impaired high-performance individuals and able-bodied low performance individuals, and a correlation of PAT scores with other clinical tests. Several of the limitations of current clinical tools, including floor and ceiling effects, were overcome by the PAT, suggesting that the PAT can be used to monitor the effect of rehabilitation and training.
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Affiliation(s)
- Juan Forero
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Albert H Vette
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Jacqueline S Hebert
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada.
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15
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Nardi F, Haar S, Faisal AA. Bill-EVR: An Embodied Virtual Reality Framework for Reward-and-Error-Based Motor Rehab-Learning. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941230 DOI: 10.1109/icorr58425.2023.10304742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
VR rehabilitation is an established field by now, however, it often refers to computer screen-based interactive rehabilitation activities. In recent years, there was an increased use of VR-headsets, which can provide an immersive virtual environment for real-world tasks, but they are lacking any physical interaction with the task objects and any proprioceptive feedback. Here, we focus on Embodied Virtual Reality (EVR), an emerging field where not only the visual input via VR-headset but also the haptic feedback is physically correct. This happens because subjects interact with physical objects that are veridically aligned in Virtual Reality. This technology lets us manipulate motor performance and motor learning through visual feedback perturbations. Bill-EVR is a framework that allows interventions in the performance of real-world tasks, such as playing pool billiard, engaging end-users in motivating life-like situations to trigger motor (re)learning - subjects see in VR and handle the real-world cue stick, the pool table and shoot physical balls. Specifically, we developed our platform to isolate and evaluate different mechanisms of motor learning to investigate its two main components, error-based and reward-based motor adaptation. This understanding can provide insights for improvements in neurorehabilitation: indeed, reward-based mechanisms are putatively impaired by degradation of the dopaminergic system, such as in Parkinson's disease, while error-based mechanisms are essential for recovering from stroke-induced movement errors. Due to its fully customisable features, our EVR framework can be used to facilitate the improvement of several conditions, providing a valid extension of VR-based implementations and constituting a motor learning tool that can be completely tailored to the individual needs of patients.
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16
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Tenforde AS, Alexander JJ, Alexander M, Annaswamy TM, Carr CJ, Chang P, Díaz M, Iaccarino MA, Lewis SB, Millett C, Pandit S, Ramirez CP, Rinaldi R, Roop M, Slocum CS, Tekmyster G, Venesy D, Verduzco-Gutierrez M, Zorowitz RD, Rowland TR. Telehealth in PM&R: Past, present, and future in clinical practice and opportunities for translational research. PM R 2023; 15:1156-1174. [PMID: 37354209 DOI: 10.1002/pmrj.13029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/26/2023]
Abstract
Telehealth refers to the use of telecommunication devices and other forms of technology to provide services outside of the traditional in-person health care delivery system. Growth in the use of telehealth creates new challenges and opportunities for implementation in clinical practice. The American Academy of Physical Medicine and Rehabilitation (AAPM&R) assembled an expert group to develop a white paper to examine telehealth innovation in Physical Medicine and Rehabilitation (PM&R). The resultant white paper summarizes how telehealth is best used in the field of PM&R while highlighting current knowledge deficits and technological limitations. The report identifies new and transformative opportunities for PM&R to advance translational research related to telehealth and enhance patient care.
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Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Joshua J Alexander
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Thiru M Annaswamy
- Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Conley J Carr
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philip Chang
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Stephen B Lewis
- Physiatry-Pharmacy Collaborative, NJ Institute for Successful Aging, Princeton, New Jersey, USA
| | - Carolyn Millett
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | | | | - Robert Rinaldi
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Megan Roop
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation, Charlestown, Massachusetts, USA
| | - Gene Tekmyster
- Department of Orthopedic Surgery, Keck Medicine of USC, Los Angeles, California, USA
| | | | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Richard D Zorowitz
- Department of Rehabilitation Medicine, MedStar National Rehabilitation Network, Georgetown University, Washington, District of Columbia, USA
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Choukou MA, He E, Moslenko K. Feasibility of a Virtual-Reality-Enabled At-Home Telerehabilitation Program for Stroke Survivors: A Case Study. J Pers Med 2023; 13:1230. [PMID: 37623481 PMCID: PMC10455082 DOI: 10.3390/jpm13081230] [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: 05/03/2023] [Revised: 07/12/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
Stroke rehabilitation is a lengthy procedure that is necessary for stroke recovery. However, stroke rehabilitation may not be readily available for patients who live rurally due to barriers such as transportation and expenses. This shortage in wearable technology, in turn, causes health disparity among the rural population, which was exacerbated by the COVID-19 pandemic restrictions. Telerehabilitation (TR) is a potential solution for stroke rehabilitation in rural areas. This one-case study aimed to examine the feasibility and safety of a technology-enabled at-home TR program for stroke survivors living in a rural area in Canada. A VR setup was installed successfully in the home of our participant. A tablet was also supplied for the TR program. Each program consisted of 24 sessions to be completed over a 12-week period. Our participant was assessed on day one using the Fugl-Meyer assessment, the Modified Ashworth Scale, the 10 m walk test, and the Mini-Mental State Exam. Three questionnaires were also completed, including the Motor Activity Log (MAL), the Stroke Index Scale (SIS), and the Treatment Self-Regulation Questionnaire. These assessments were completed thrice, on day 1, at week 6, and at week 12. The participant found the tablet and its accompanying exercises easy to use, with a few limitations. The participant found the VR system more challenging to manage independently as a lack of comfortability, the visual contrast during the first trials, and certain technical aspects of the technology created several functional barriers. Although some limitations with the technology were noted, this case study indicates that telerehabilitation is feasible under certain circumstances when used in conjunction with traditional rehabilitation services.
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Affiliation(s)
- Mohamed-Amine Choukou
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (E.H.); (K.M.)
- Centre on Aging, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Elizabeth He
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (E.H.); (K.M.)
| | - Kelly Moslenko
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T6, Canada; (E.H.); (K.M.)
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18
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Tresser S, Kuflik T, Levin I, Weiss PL. Personalisation of a virtual gaming system for children with motor impairments: performance and usability. Disabil Rehabil Assist Technol 2023; 18:876-882. [PMID: 34270909 DOI: 10.1080/17483107.2021.1936222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To demonstrate the potential role of virtual game personalisation for use as a therapeutic modality to improve upper extremity function in children with cerebral palsy (CP). METHODS The study tested a convenience sample of 60 typically developing children (TD) aged 6-10 years and 20 children with CP aged 7-11 years. Children participated in a single 30-min session when they played the game in accuracy mode (virtual targets are hit as they become progressively larger or smaller) or dwell mode (virtual targets are hit when the users remains on them for progressively shorter or longer durations). These two modes can be played in conventional (non-personalised), personalised and with and without arm weights conditions; weights were used for the TD group in order to ensure that game play would be sufficiently challenging as to require personalisation. We measured performance variables (frequency of changes in game level difficulty and accuracy as measured by percent success of hitting the virtual targets) in each condition and usability variables (self-reported perceived effort and enjoyment). RESULTS Comparisons between the usability of the conventional and personalised conditions among typically developing children showed that although children self-reported significantly more effort while playing the personalised game, the level of enjoyment remained high (no significant differences between conventional and personalised game play conditions). In addition, comparisons between playing the personalised game with and without weights by typically developing children, indicated that percent success was significantly higher for the game played without weights, suggesting that the system is sensitive to dynamic changes in performance. Comparisons between the TD and CP groups showed that when the game was played in personalised dwell mode (hovering over the target for several seconds) children with CP progressed significantly less quickly through different difficulty levels compared to typically developing children. In contrast, no significant differences were found in accuracy mode (immediate response on target hit), between the TD and CP groups in any of the experimental conditions. DISCUSSION The personalised game approach was shown to be enjoyable for both groups of users and able to change the level of difficulty in real time. The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment. CONCLUSION Personalised virtual therapy shows promise as a tool for upper extremity therapy for children with motor impairment.Implications for RehabiliationIn recent years, there has been an increase in the use of assistive technologies including virtual gaming in the general area of health care and clinical practice.Virtual gaming provides an interactive, real-time experiences that are flexible and ecologically valid ways to improve specific cognitive and motor abilities.Personalisation of virtual games entails dynamic adaptation of the parameters in real time according to the user's functional level).The results have demonstrated that personalised virtual gaming is enjoyable and feasible for typically developing children and children with cerebral palsy.The results suggest that this approach to gaming can provide motor challenges while preserving a high level of enjoyment.
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Affiliation(s)
- Sarit Tresser
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
| | - Tsvi Kuflik
- Department of Information Systems, University of Haifa, Haifa, Israel
| | - Irina Levin
- Department of Information Systems, University of Haifa, Haifa, Israel
| | - Patrice L Weiss
- Department of Occupational Therapy, University of Haifa, Haifa, Israel
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19
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Borresen A, Chakka K, Wu R, Lin CK, Wolfe C, Prabhakaran B, Annaswamy TM. Comparison of in-person and synchronous remote musculoskeletal exam using augmented reality and haptics: A pilot study. PM R 2023; 15:891-898. [PMID: 36197806 DOI: 10.1002/pmrj.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Utilization of telemedicine for health care delivery increased rapidly during the coronavirus disease 2019 (COVID-19) pandemic. However, physical examination during telehealth visits remains limited. A novel telerehabilitation system-The Augmented Reality-based Telerehabilitation System with Haptics (ARTESH)-shows promise for performing synchronous, remote musculoskeletal examination. OBJECTIVE To assess the potential of ARTESH in remotely examining upper extremity passive range of motion (PROM) and maximum isometric strength (MIS). DESIGN In this cross-sectional pilot study, we compared the in-person (reference standard) and remote evaluations (ARTESH) of participants' upper extremity PROM and MIS in 10 shoulder and arm movements. The evaluators were blinded to each other's results. SETTING Participants underwent in-person evaluations at a Veterans Affairs hospital's outpatient Physical Medicine and Rehabilitation (PM&R) clinic, and underwent remote examination using ARTESH with the evaluator located at a research lab 30 miles away, connected via a high-speed network. PATIENTS Fifteen participants with upper extremity pain and/or weakness. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Inter-rater agreement between in-person and remote evaluations on 10 PROM and MIS movements and presence/absence of pain with movement was calculated. RESULTS The highest inter-rater agreements were noted in shoulder abduction and protraction PROM (kappa (κ) = 0.44, confidence interval (CI): -0.1 to 1.0), and in elbow flexion, shoulder abduction, and shoulder protraction MIS (κ = 0.63, CI: 0 to 1.0). CONCLUSIONS This pilot study suggests that synchronous tele-physical examination using the ARTESH system with augmented reality and haptics has the potential to provide enhanced value to existing telemedicine platforms. With the additional technological and procedural improvements and with an adequately powered study, the accuracy of ARTESH-enabled remote tele-physical examinations can be better evaluated.
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Affiliation(s)
- Aleks Borresen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Richard Wu
- UT Southwestern Medical School, Dallas, Texas, USA
| | | | - Cody Wolfe
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Balakrishnan Prabhakaran
- Department of Computer Science, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, Texas, USA
| | - Thiru M Annaswamy
- PM&R Service, VA North Texas Health Care System, Department of PM&R, UT Southwestern Medical Center, Dallas, Texas, USA
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20
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Karunakaran KK, Pamula S, Ibironke O, Nolan KJ. Motor-Cognitive Virtual Reality Training to Improve Gait and Balance in Young Adults with TBI. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083726 DOI: 10.1109/embc40787.2023.10341060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Traumatic Brain Injury (TBI) is one of the leading causes of motor and cognitive deficits in adults, and often results in motor control and balance impairments. Motor deficits include gait dysfunction and decreased postural control & coordination; leading to compromised functional ambulation and reduced quality of life. Research has shown that cognitive (attention and executive) function contributes to motor deficits and recovery. Hence, targeting the motor and the cognitive domains simultaneously by increasing cognitive and motor effort to perform the task may lead to improved ambulation recovery. The objective of this investigation was to evaluate the efficacy of simultaneous motor & cognitive training (MCT) using virtual reality to improve ambulation; assessed using biomechanical, cognitive, and functional outcomes. Preliminary data is presented for three participants with chronic TBI who received MCT. The results show improved cognition, speed, endurance, step length, gait cycle time, static & reactive balance, dual-task performance, and progression towards healthy ambulation. These preliminary results suggest that integrated cognitive motor training has the potential to induce functional recovery in young adults with TBI.Clinical Relevance - Preliminary data provides initial evidence for MCT as a therapeutic intervention for gait and balance rehabilitation in young adults with TBI.
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21
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Patwardhan S, Gladhill KA, Joiner WM, Schofield JS, Sikdar S. Using Principles of Motor Control to Analyze Performance of Human Machine Interfaces. RESEARCH SQUARE 2023:rs.3.rs-2763325. [PMID: 37292730 PMCID: PMC10246101 DOI: 10.21203/rs.3.rs-2763325/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There have been significant advances in biosignal extraction techniques to drive external biomechatronic devices or to use as inputs to sophisticated human machine interfaces. The control signals are typically derived from biological signals such as myoelectric measurements made either from the surface of the skin or subcutaneously. Other biosignal sensing modalities are emerging. With improvements in sensing modalities and control algorithms, it is becoming possible to robustly control the target position of a end effector. It remains largely unknown to what extent these improvements can lead to naturalistic human-like movement. In this paper, we sought to answer this question. We utilized a sensing paradigm called sonomyography based on continuous ultrasound imaging of forearm muscles. Unlike myoelectric control strategies which measure electrical activation and use the extracted signals to determine the velocity of an end-effector; sonomyography measures muscle deformation directly with ultrasound and uses the extracted signals to proportionally control the position of an end-effector. Previously, we showed that users were able to accurately and precisely perform a virtual target acquisition task using sonomyography. In this work, we investigate the time course of the control trajectories derived from sonomyography. We show that the time course of the sonomyography-derived trajectories that users take to reach virtual targets reflect the trajectories shown to be typical for kinematic characteristics observed in biological limbs. Specifically, during a target acquisition task, the velocity profiles followed a minimum jerk trajectory shown for point-to-point arm reaching movements, with similar time to target. In addition, the trajectories based on ultrasound imaging result in a systematic delay and scaling of peak movement velocity as the movement distance increased. We believe this is the first evaluation of similarities in control policies in coordinated movements in jointed limbs, and those based on position control signals extracted at the individual muscle level. These results have strong implications for the future development of control paradigms for assistive technologies.
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Affiliation(s)
| | - Keri Anne Gladhill
- Department of Psychology, George Mason University, Fairfax, VA, 22030, USA
| | - Wilsaan M. Joiner
- Department of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, CA, 95616, USA
| | - Jonathon S. Schofield
- Mechanical and Aerospace Engineering Department, University of California, Davis, Davis, CA, 95616, USA
| | - Siddhartha Sikdar
- Department of Bioengineering, George Mason University, Fairfax VA, 22030, USA
- Center for Adaptive Systems of Brain-Body Interactions, Fairfax VA, 22030, USA
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22
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Banduni O, Saini M, Singh N, Nath D, Kumaran SS, Kumar N, Srivastava MVP, Mehndiratta A. Post-Stroke Rehabilitation of Distal Upper Limb with New Perspective Technologies: Virtual Reality and Repetitive Transcranial Magnetic Stimulation-A Mini Review. J Clin Med 2023; 12:jcm12082944. [PMID: 37109280 PMCID: PMC10142518 DOI: 10.3390/jcm12082944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Upper extremity motor impairment is the most common sequelae in patients with stroke. Moreover, its continual nature limits the optimal functioning of patients in the activities of daily living. Because of the intrinsic limitations in the conventional form of rehabilitation, the rehabilitation applications have been expanded to technology-driven solutions, such as Virtual Reality and Repetitive Transcranial Magnetic Stimulation (rTMS). The motor relearning processes are influenced by variables, such as task specificity, motivation, and feedback provision, and a VR environment in the form of interactive games could provide novel and motivating customized training solutions for better post-stroke upper limb motor improvement. rTMS being a precise non-invasive brain stimulation method with good control of stimulation parameters, has the potential to facilitate neuroplasticity and hence a good recovery. Although several studies have discussed these forms of approaches and their underlying mechanisms, only a few of them have specifically summarized the synergistic applications of these paradigms. To bridge the gaps, this mini review presents recent research and focuses precisely on the applications of VR and rTMS in distal upper limb rehabilitation. It is anticipated that this article will provide a better representation of the role of VR and rTMS in distal joint upper limb rehabilitation in patients with stroke.
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Affiliation(s)
- Onika Banduni
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - Debasish Nath
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
| | - S Senthil Kumaran
- Department of Nuclear Medicine and Resonance, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi 110016, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
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23
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Rodríguez-Hernández M, Polonio-López B, Corregidor-Sánchez AI, Martín-Conty JL, Mohedano-Moriano A, Criado-Álvarez JJ. Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial. J Neuroeng Rehabil 2023; 20:38. [PMID: 37016408 PMCID: PMC10071242 DOI: 10.1186/s12984-023-01170-3] [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: 02/24/2022] [Accepted: 03/30/2023] [Indexed: 04/06/2023] Open
Abstract
TRIAL OBJECTIVE To verify whether conventional rehabilitation combined with specific virtual reality is more effective than conventional therapy alone in restoring hand motor function and muscle tone after stroke. TRIAL DESIGN This prospective single-blind randomized controlled trial compared conventional rehabilitation based on physiotherapy and occupational therapy (control group) with the combination of conventional rehabilitation and specific virtual reality technology (experimental group). Participants were allocated to these groups in a ratio of 1:1. The conventional rehabilitation therapists were blinded to the study, but neither the participants nor the therapist who applied the virtual reality-based therapy could be blinded to the intervention. PARTICIPANTS Forty-six patients (43 of whom completed the intervention period and follow-up evaluation) were recruited from the Neurology and Rehabilitation units of the Hospital General Universitario of Talavera de la Reina, Spain. INTERVENTION Each participant completed 15 treatment sessions lasting 150 min/session; the sessions took place five consecutive days/week over the course of three weeks. The experimental group received conventional upper-limb strength and motor training (100 min/session) combined with specific virtual reality technology devices (50 min/session); the control group received only conventional training (150 min/session). RESULTS As measured by the Ashworth Scale, a decrease in wrist muscle tone was observed in both groups (control and experimental), with a notably larger decrease in the experimental group (baseline mean/postintervention mean: 1.22/0.39; difference between baseline and follow-up: 0.78; 95% confidence interval: 0.38-1.18; effect size = 0.206). Fugl-Meyer Assessment scores were observed to increase in both groups, with a notably larger increase in the experimental group (total motor function: effect size = 0.300; mean: - 35.5; 95% confidence interval: - 38.9 to - 32.0; wrist: effect size = 0.290; mean: - 5.6; 95% confidence interval: - 6.4 to - 4.8; hand: effect size = 0.299; mean: - -8.9; 95% confidence interval: - 10.1 to - 7.6). On the Action Research Arm Test, the experimental group quadrupled its score after the combined intervention (effect size = 0.321; mean: - 32.8; 95% confidence interval: - 40.1 to - 25.5). CONCLUSION The outcomes of the study suggest that conventional rehabilitation combined with a specific virtual reality technology system can be more effective than conventional programs alone in improving hand motor function and voluntary movement and in normalizing muscle tone in subacute stroke patients. With combined treatment, hand and wrist functionality and motion increase; resistance to movement (spasticity) decreases and remains at a reduced level. TRIALS REGISTRY International Clinical Trials Registry Platform: ISRCTN27760662 (15/06/2020; retrospectively registered).
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Affiliation(s)
- Marta Rodríguez-Hernández
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain.
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain.
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Juan-José Criado-Álvarez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Institute of Health Sciences, Talavera de la Reina, Spain
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Can Virtual Reality-Assisted Therapy Offer Additional Benefits to Patients With Vestibular Disorders Compared With Conventional Vestibular Physical Therapy? A Meta-analysis. Arch Phys Med Rehabil 2023; 104:490-501. [PMID: 36265531 DOI: 10.1016/j.apmr.2022.08.972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether virtual reality-assisted therapy (VRAT) significantly improves the treatment of peripheral or central vestibular disorders when compared with conventional vestibular physical therapy (CVPT) alone. Indicators of vestibular symptoms are used to determine this. DATA SOURCES Two reviewers independently searched PubMed, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Collaboration database from January 2010 to January 2022 for studies reporting on VRAT in vestibular disorders. STUDY SELECTION Randomized controlled trials (RCTs) were included that mainly focused on the following measures: the Dizziness Handicap Inventory (DHI), Simulator Sickness Questionnaire, visual analog scale, and balance measures such as the Activities-specific Balance Confidence Scale (ABC), timed Up and Go test, sensory organization test, and center of pressure. The primary outcome was assessment of symptomatic changes before and after VRAT. DATA EXTRACTION Two authors independently conducted the literature search and selection. After screening, meta-analysis was performed on the RCTs using RevMan 5.3 software. DATA SYNTHESIS The results showed that VRAT produced significantly greater improvement than CVPT alone in scores of DHI-Total (standardized mean difference [SMD]: -7.09, 95% confidence interval [CI]: [-12.17, -2.00], P=.006), DHI-Functional (SMD=-3.66, 95% CI: [-6.34, -0.98], P=.007), DHI-Physical (SMD=-3.14, 95% CI: [-5.46, -0.83], P=.008), and DHI-Emotional (SMD=-3.10, 95% CI: [-5.13, -1.08], P=.003). ABC scores did not show improvement (SMD: 0.58, 95% CI: [-3.69, 4.85], P=.79). Subgroup analysis showed that DHI-Total between-group differences were insignificant for central vestibular disorders (SMD=-1.47, 95% CI: [-8.71, -5.78], P=.69), although peripheral disorders showed significant improvements (SMD=-9.58, 95% CI: [-13.92, -5.25], P<.0001). However, the included studies showed high heterogeneity (I2>75%). CONCLUSIONS VRAT may offer additional benefits for rehabilitation from vestibular diseases, especially peripheral disorders, when compared with CVPT alone. However, because of high heterogeneity and limited data, additional studies with a larger sample size and more sensitive and specific measurements are required to conclusively determine the evidence-based utility of virtual reality.
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Benmahdjoub M, Thabit A, van Veelen MLC, Niessen WJ, Wolvius EB, Walsum TV. Evaluation of AR visualization approaches for catheter insertion into the ventricle cavity. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2023; PP:2434-2445. [PMID: 37027733 DOI: 10.1109/tvcg.2023.3247042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Augmented reality (AR) has shown potential in computer-aided surgery. It allows for the visualization of hidden anatomical structures as well as assists in navigating and locating surgical instruments at the surgical site. Various modalities (devices and/or visualizations) have been used in the literature, but few studies investigated the adequacy/superiority of one modality over the other. For instance, the use of optical see-through (OST) HMDs has not always been scientifically justified. Our goal is to compare various visualization modalities for catheter insertion in external ventricular drain and ventricular shunt procedures. We investigate two AR approaches: (1) 2D approaches consisting of a smartphone and a 2D window visualized through an OST (Microsoft HoloLens 2), and (2) 3D approaches consisting of a fully aligned patient model and a model that is adjacent to the patient and is rotationally aligned using an OST. 32 participants joined this study. For each visualization approach, participants were asked to perform five insertions after which they filled NASA-TLX and SUS forms. Moreover, the position and orientation of the needle with respect to the planning during the insertion task were collected. The results show that participants achieved a better insertion performance significantly under 3D visualizations, and the NASA-TLX and SUS forms reflected the preference of participants for these approaches compared to 2D approaches.
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X-reality for Phantom Limb Management for Amputees: A Systematic Review and Meta-Analysis. ENGINEERED REGENERATION 2023. [DOI: 10.1016/j.engreg.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Jicol C, Cheng HY, Petrini K, O’Neill E. A predictive model for understanding the role of emotion for the formation of presence in virtual reality. PLoS One 2023; 18:e0280390. [PMID: 36928040 PMCID: PMC10019638 DOI: 10.1371/journal.pone.0280390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/28/2022] [Indexed: 03/18/2023] Open
Abstract
Users' emotions may influence the formation of presence in virtual reality (VR). Users' expectations, state of arousal and personality may also moderate the relationship between emotions and presence. An interoceptive predictive coding model of conscious presence (IPCM) considers presence as a product of the match between predictions of interoceptive emotional states and the actual states evoked by an experience (Seth et al. 2012). The present paper aims to test this model's applicability to VR for both high-arousal and low-arousal emotions. The moderating effect of personality traits on the creation of presence is also investigated. Results show that user expectations about emotional states in VR have an impact on presence, however, expression of this relationship is moderated by the intensity of an emotion, with only high-arousal emotions showing an effect. Additionally, users' personality traits moderated the relationship between emotions and presence. A refined model is proposed that predicts presence in VR by weighting emotions according to their level of arousal and by considering the impact of personality traits.
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Barria P, Riquelme M, Reppich H, Cisnal A, Fraile JC, Pérez-Turiel J, Sierra D, Aguilar R, Andrade A, Nuñez-Espinosa C. Hand rehabilitation based on the RobHand exoskeleton in stroke patients: A case series study. Front Robot AI 2023; 10:1146018. [PMID: 37033674 PMCID: PMC10073561 DOI: 10.3389/frobt.2023.1146018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction: The RobHand (Robot for Hand Rehabilitation) is a robotic neuromotor rehabilitation exoskeleton that assists in performing flexion and extension movements of the fingers. The present case study assesses changes in manual function and hand muscle strength of four selected stroke patients after completion of an established training program. In addition, safety and user satisfaction are also evaluated. Methods: The training program consisted of 16 sessions; two 60-minute training sessions per week for eight consecutive weeks. During each session, patients moved through six consecutive rehabilitation stages using the RobHand. Manual function assessments were applied before and after the training program and safety tests were carried out after each session. A user evaluation questionnaire was filled out after each patient completed the program. Results: The safety test showed the absence of significant adverse events, such as skin lesions or fatigue. An average score of 4 out of 5 was obtained on the Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 Scale. Users were very satisfied with the weight, comfort, and quality of professional services. A Kruskal-Wallis test revealed that there were not statistically significant changes in the manual function tests between the beginning and the end of the training program. Discussion: It can be concluded that the RobHand is a safe rehabilitation technology and users were satisfied with the system. No statistically significant differences in manual function were found. This could be due to the high influence of the stroke stage on motor recovery since the study was performed with chronic patients. Hence, future studies should evaluate the rehabilitation effectiveness of the repetitive use of the RobHand exoskeleton on subacute patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05598892?id=NCT05598892&draw=2&rank=1, identifier NCT05598892.
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Affiliation(s)
- Patricio Barria
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
- *Correspondence: Patricio Barria,
| | - Matías Riquelme
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
| | - Hannah Reppich
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Ana Cisnal
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Juan-Carlos Fraile
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Javier Pérez-Turiel
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - David Sierra
- Instituto de las Tecnologías Avanzadas de la Producción (ITAP), University of Valladolid, Valladolid, Spain
| | - Rolando Aguilar
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Asterio Andrade
- Centro de Rehabilitación, Club de Leones Cruz del Sur, Punta Arenas, Chile
| | - Cristian Nuñez-Espinosa
- School of Medicine, University of Magallanes (UMAG), Punta Arenas, Chile
- Centro Asistencial Docente e Investigación (CADI), University of Magallanes (UMAG), Punta Arenas, Chile
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Juan MC, Elexpuru J, Dias P, Santos BS, Amorim P. Immersive virtual reality for upper limb rehabilitation: comparing hand and controller interaction. VIRTUAL REALITY 2022; 27:1157-1171. [PMID: 36475065 PMCID: PMC9715412 DOI: 10.1007/s10055-022-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/15/2022] [Indexed: 06/05/2023]
Abstract
Virtual reality shows great potential as an alternative to traditional therapies for motor rehabilitation given its ability to immerse the user in engaging scenarios that abstract them from medical facilities and tedious rehabilitation exercises. This paper presents a virtual reality application that includes three serious games and that was developed for motor rehabilitation. It uses a standalone headset and the user's hands without the need for any controller for interaction. Interacting with an immersive virtual reality environment using only natural hand gestures involves an interaction that is similar to that of real life, which would be especially desirable for patients with motor problems. A study involving 28 participants (4 with motor problems) was carried out to compare two types of interaction (hands vs. controllers). All of the participants completed the exercises. No significant differences were found in the number of attempts necessary to complete the games using the two types of interaction. The group that used controllers required less time to complete the exercise. The performance outcomes were independent of the gender and age of the participants. The subjective assessment of the participants with motor problems was not significantly different from the rest of the participants. With regard to the interaction type, the participants mostly preferred the interaction using their hands (78.5%). All four participants with motor problems preferred the hand interaction. These results suggest that the interaction with the user's hands together with standalone headsets could improve motivation, be well accepted by motor rehabilitation patients, and help to complete exercise therapy at home.
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Affiliation(s)
- M.-Carmen Juan
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camino de Vera, S/N, 46022 Valencia, Spain
| | - Julen Elexpuru
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camino de Vera, S/N, 46022 Valencia, Spain
| | - Paulo Dias
- Department of Electronics Telecommunications and Informatics (DETI), University of Aveiro, Aveiro, Portugal
| | - Beatriz Sousa Santos
- Department of Electronics Telecommunications and Informatics (DETI), University of Aveiro, Aveiro, Portugal
| | - Paula Amorim
- Centre Region Rehabilitation Medicine Centre Rovisco Pais (CMRRC-RP), Tocha, Portugal
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Başoğlu Y, Şerbetçioğlu MB, Çelik İ, Demirhan H. Effectiveness of virtual reality-based vestibular rehabilitation in patients with peripheral vestibular hypofunction. Turk J Med Sci 2022; 52:1970-1983. [PMID: 36945987 PMCID: PMC10390126 DOI: 10.55730/1300-0144.5545] [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: 05/23/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The rehabilitation of classical peripheral vestibular disorders is long and costly. Recently, interactive systems based on virtual reality (VR) technology have reduced the cost of vestibular rehabilitation therapy (VRT) and made the process more enjoyable. This study aims to investigate the effects of VR-based VRT in patients diagnosed with peripheral vestibular hypofunction (PVH). METHODS In this study, a VR-based VRT program that utilized Sony Playstation®4 VR Head Mounted Display was applied to 25 patients (between 18-60) diagnosed with PVH. PVH was diagnosed by evaluating the patients' clinical histories, the findings in the "Micromedical Technologies VisualEyes Spectrum" videonystagmography (VNG) and the "Micromedical Aqua Stim" model bithermal water caloric tests. VR-based VRT program was applied to the patients for 4 weeks, 2 sessions per week, 8 sessions in total. Each session lasted around 30 to 40 min. All patients underwent the Dizziness Handicap Inventory (DHI), Sensory Organization Test (SOT), Adaptation Test (ADT), Limits of Stability (LOS), and Rhythmic Weight Shift (RWS) before, after, and 8-week follow-up of the VRT program. In addition, the Cybersickness Survey was applied to the patients at the end of the VR-based VRT session every week. RESULTS The DHI mean scores of the patients were 54.60, 19.20, and 16.84, respectively, before, just after, and at the 8-week follow-up VRT (p < 0.001). The mean SOT composite score of the patients was obtained as 58.08 before VRT; 77.16 after VRT and 76.40 at 8-week after VRT (p < 0.000). On the other hand, the values in the 'movement velocity' and "direction control" parameters of the patients in LOS and RWS showed a significant improvement after VRT compared to before VRT (p < 0.000). From before VRT to 8 weeks after VRT, the patient's oscillation averages in the 'toes up' and 'toes down' positions in ADT reduced progressively (p < 0.000). DISCUSSION This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients with PVH. In addition, VR-based vestibular rehabilitation therapy has shown to be effective for PVH patients in the mid-term.
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Affiliation(s)
- Yuşa Başoğlu
- Department of Audiology, Faculty of Health Sciences, İstanbul Medipol University, İstanbul, Turkey
| | | | - İlayda Çelik
- Department of Speech and Language Therapy, Faculty of Health Sciences, İstanbul Medipol University, İstanbul, Turkey
| | - Hasan Demirhan
- Department of Otorhinolaryngology, Faculty of Medicine, İstanbul Medipol University, İstanbul, Turkey
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Active Video Games Performance and Heart Rate on the Wii or Kinect in Children with and without Developmental Coordination Disorder. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121823. [PMID: 36553267 PMCID: PMC9777480 DOI: 10.3390/children9121823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
Our objective was to compare changes in game performance and intensity of heart rate (HR) between two types of active video game (AVG) in children with and without Developmental Coordination Disorder (DCD). Additionally, we assessed the level of improvement per game as well as the perceived exertion and enjoyment during training. Seventy-six children, 36 with DCD and 40 without (TD) were randomly assigned to a 5-week program of Wii-Fit or Xbox-Kinect training 2× a week. The steepness of the performance curves was not different between consoles, nor between groups. Playing Kinect games resulted in higher HR in both groups. Wii and Kinect seem to be comparable AVG consoles that can be used for children with and without DCD, with the Kinect reaching a higher intensity of training.
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Maranesi E, Casoni E, Baldoni R, Barboni I, Rinaldi N, Tramontana B, Amabili G, Benadduci M, Barbarossa F, Luzi R, Di Donna V, Scendoni P, Pelliccioni G, Lattanzio F, Riccardi GR, Bevilacqua R. The Effect of Non-Immersive Virtual Reality Exergames versus Traditional Physiotherapy in Parkinson's Disease Older Patients: Preliminary Results from a Randomized-Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214818. [PMID: 36429537 PMCID: PMC9690935 DOI: 10.3390/ijerph192214818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 05/28/2023]
Abstract
(1) Background: Parkinson's disease (PD) is one of the most frequent causes of disability among older people. Recently, virtual reality and exergaming have been emerged as promising tools for gait and balance rehabilitation in PD patients. Our purpose is to evaluate an innovative treatment for older patients with PD, based on non-immersive virtual reality exergames, improving gait and balance and reducing falling risk. (2) Methods: Thirty PD patients were recruited and randomly divided into two groups, to receive a traditional rehabilitation (CG) or a technological rehabilitation (TG). (3) Results: A statistical improvement of balance at the end of treatments was observed in both groups (CG: 12.4 ± 0.7 vs. 13.5 ± 0.8, p = 0.017; TG: 13.8 ± 0.5 vs. 14.7 ± 0.4, p = 0.004), while the overall risk of falling was significantly reduced only in the TG (POMA Total: 24.6 ± 0.9 vs. 25.9 ± 0.7, p = 0.010). The results between groups shows that all POMA scores differ in a statistically significant manner in the TG, emphasizing improvement not only in balance but also in gait characteristics (9.7 ± 0.8 vs. 11.4 ± 0.2, p = 0.003). Moreover, TG also improves the psychological sphere, measured thorough MSC-(17.1 ± 0.4 vs. 16.5 ± 0.4, p = 0.034). Although an improvement in FES-I and Gait Speed can be observed, this increase does not turn out to be significant. (4) Conclusions: Results suggest how non-immersive virtual reality exergaming technology offers the opportunity to effectively train cognitive and physical domains at the same time.
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Affiliation(s)
| | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Ilaria Barboni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Barbara Tramontana
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | | | | | | | | | - Valentina Di Donna
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
| | - Pietro Scendoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy
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Moraes ÍAP, Lima JA, Silva NM, Simcsik AO, Silveira AC, Menezes LDC, Araújo LV, Crocetta TB, Voos MC, Tonks J, Silva TD, Dawes H, Monteiro CBM. Effect of Longitudinal Practice in Real and Virtual Environments on Motor Performance, Physical Activity and Enjoyment in People with Autism Spectrum Disorder: A Prospective Randomized Crossover Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14668. [PMID: 36429386 PMCID: PMC9690405 DOI: 10.3390/ijerph192214668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: People with ASD commonly present difficulty performing motor skills and a decline in physical activity (PA) level and low enjoyment of PA. We aimed to evaluate whether longitudinal practice of an activity in virtual and real environments improves motor performance and whether this improvement is transferred to a subsequent practice when changing the environment, promoting PA and providing enjoyment; (2) Methods: People with ASD, aged between 10 and 16 years, were included and distributed randomly into two opposite sequences. The participants performed a 10 session protocol, with five sessions practicing in each environment (virtual or real). Heart rate measurement was carried out and an enjoyment scale was applied; (3) Results: 22 participants concluded the protocol. Sequence A (virtual first) presented an improvement in accuracy and precision and transferred this when changing environment; they also had a greater change in heart rate reserve. The majority of participants reported "fun" and "great fun" levels for enjoyment; (4) Conclusions: The virtual reality activity presented a higher level of difficulty, with greater gains in terms of transference to the real environment. Considering PA, our task provided very light to light activity and the majority of participants enjoyed the task.
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Affiliation(s)
- Íbis A. P. Moraes
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- College of Medicine and Health, St Lukes Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Joyce A. Lima
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Nadja M. Silva
- Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Amanda O. Simcsik
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
| | - Ana C. Silveira
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Lilian D. C. Menezes
- Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Luciano V. Araújo
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Tânia B. Crocetta
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Mariana C. Voos
- Faculty of Humanities and Health Sciences, Pontifical Catholic University of São Paulo (PUC-SP), São Paulo 05014-901, Brazil
| | - James Tonks
- College of Medicine and Health, St Lukes Campus, University of Exeter, Exeter EX1 2LU, UK
| | - Talita D. Silva
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
- Faculty of Medicine, University City of São Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Helen Dawes
- College of Medicine and Health, St Lukes Campus, University of Exeter, Exeter EX1 2LU, UK
- Department of Paediatrics, University of Oxford, Oxford OX3 9DU, UK
| | - Carlos B. M. Monteiro
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
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Boomgaardt J, Dastan K, Chan T, Shilling A, Abd-Elsayed A, Kohan L. An Algorithm Approach to Phantom Limb Pain. J Pain Res 2022; 15:3349-3367. [PMID: 36320223 PMCID: PMC9618240 DOI: 10.2147/jpr.s355278] [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: 12/22/2021] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Phantom limb pain (PLP) is a common condition that occurs following both upper and lower limb amputation. First recognized and described in 1551 by Ambroise Pare, research into its underlying pathology and effective treatments remains a very active and growing field. To date, however, there is little consensus regarding the optimal management of phantom limb pain. With few large well-designed clinical trials of which to make treatment recommendations, as well as significant heterogeneity in clinical response to available treatments, the management of PLP remains challenging. Below we summarize the current state of knowledge in the field, as well as propose an algorithm for the approach to the treatment of PLP.
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Affiliation(s)
- Jacob Boomgaardt
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Kovosh Dastan
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA
| | - Tiffany Chan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Ashley Shilling
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA,Correspondence: Lynn Kohan, Department of Anesthesiology, University of Virginia, 545 Ray C Hunt Suite 3168, Charlottesville, VA, 22903, USA, Tel +1-434-243-5676, Fax +1-434-243-5689, Email
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Ramirez-Zamora JD, Dominguez-Ramirez OA, Ramos-Velasco LE, Sepulveda-Cervantes G, Parra-Vega V, Jarillo-Silva A, Escotto-Cordova EA. HRpI System Based on Wavenet Controller with Human Cooperative-in-the-Loop for Neurorehabilitation Purposes. SENSORS (BASEL, SWITZERLAND) 2022; 22:7729. [PMID: 36298088 PMCID: PMC9606880 DOI: 10.3390/s22207729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
There exist several methods aimed at human-robot physical interaction (HRpI) to provide physical therapy in patients. The use of haptics has become an option to display forces along a given path so as to it guides the physiotherapist protocol. Critical in this regard is the motion control for haptic guidance to convey the specifications of the clinical protocol. Given the inherent patient variability, a conclusive demand of these HRpI methods is the need to modify online its response with neither rejecting nor neglecting interaction forces but to process them as patient interaction. In this paper, considering the nonlinear dynamics of the robot interacting bilaterally with a patient, we propose a novel adaptive control to guarantee stable haptic guidance by processing the causality of patient interaction forces, despite unknown robot dynamics and uncertainties. The controller implements radial basis neural network with daughter RASP1 wavelets activation function to identify the coupled interaction dynamics. For an efficient online implementation, an output infinite impulse response filter prunes negligible signals and nodes to deal with overparametrization. This contributes to adapt online the feedback gains of a globally stable discrete PID regulator to yield stiffness control, so the user is guided within a perceptual force field. Effectiveness of the proposed method is verified in real-time bimanual human-in-the-loop experiments.
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Affiliation(s)
- Juan Daniel Ramirez-Zamora
- Basic Sciences and Engineering Institute, Autonomous University of the State of Hidalgo—UAEH, Mineral de la Reforma 42184, Hidalgo, Mexico
| | - Omar Arturo Dominguez-Ramirez
- Basic Sciences and Engineering Institute, Autonomous University of the State of Hidalgo—UAEH, Mineral de la Reforma 42184, Hidalgo, Mexico
| | - Luis Enrique Ramos-Velasco
- Aeronautical Engineering Department, Metropolitan Polytechnic University of Hidalgo—UPMH, Tolcayuca 43860, Hidalgo, Mexico
| | - Gabriel Sepulveda-Cervantes
- Center for Innovation and Technological Development in Computing, National Polytechnic Institute—CIDETEC-IPN, Mexico City 07700, Mexico
| | - Vicente Parra-Vega
- Robotics and Advanced Manufacturing Department, Research Center for Advanced Studies—CINVESTAV Saltillo, Ramos Arizpe 25900, Coahuila, Mexico
| | - Alejandro Jarillo-Silva
- Institute of Informatics, University of the South Sierra—UNSIS, Miahuatlán de Porfirio Díaz 70800, Oaxaca, Mexico
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Singh Y, Agrawal SK, Vashista V. Throwing Strategy in a Dual-Motor-Task of Aiming at the Bullseye While Walking in Virtual Reality. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3189820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yogesh Singh
- Human-Centered Robotics Lab, IIT Gandhinagar, Gandhinagar, Gujarat, India
| | - Sunil K. Agrawal
- Department of Rehabilitation and Regenerative Medicine and in the Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Vineet Vashista
- Human-Centered Robotics Lab, IIT Gandhinagar, Gandhinagar, Gujarat, India
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Porssut T, Hou Y, Blanke O, Herbelin B, Boulic R. Adapting Virtual Embodiment Through Reinforcement Learning. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:3193-3205. [PMID: 33556011 DOI: 10.1109/tvcg.2021.3057797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In Virtual Reality, having a virtual body opens a wide range of possibilities as the participant's avatar can appear to be quite different from oneself for the sake of the targeted application (e.g., for perspective-taking). In addition, the system can partially manipulate the displayed avatar movement through some distortion to make the overall experience more enjoyable and effective (e.g., training, exercising, rehabilitation). Despite its potential, an excessive distortion may become noticeable and break the feeling of being embodied into the avatar. Past researches have shown that individuals have a relatively high tolerance to movement distortions and a great variability of individual sensitivities to distortions. In this article, we propose a method taking advantage of Reinforcement Learning (RL) to efficiently identify the magnitude of the maximum distortion that does not get noticed by an individual (further noted the detection threshold). We show through a controlled experiment with subjects that the RL method finds a more robust detection threshold compared to the adaptive staircase method, i.e., it is more able to prevent subjects from detecting the distortion when its amplitude is equal or below the threshold. Finally, the associated majority voting system makes the RL method able to handle more noise within the forced choices input than adaptive staircase. This last feature is essential for future use with physiological signals as these latter are even more susceptible to noise. It would then allow to calibrate embodiment individually to increase the effectiveness of the proposed interactions.
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38
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Firwana YMS, Zolkefley MKI, Mohamed Hatta HZ, Rowbin C, Che Mohd Nassir CMN, Hanafi MH, Abdullah MS, Keserci B, Lannin NA, Mustapha M. Regional cerebral blood perfusion changes in chronic stroke survivors as potential brain correlates of the functional outcome following gamified home-based rehabilitation (IntelliRehab)-a pilot study. J Neuroeng Rehabil 2022; 19:94. [PMID: 36002827 PMCID: PMC9404656 DOI: 10.1186/s12984-022-01072-w] [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: 03/18/2021] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e., IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes. OBJECTIVE To explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function. METHODS Two-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n = 8) over 3-months intervention period. CBF alterations were mapped, and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively. RESULTS Regional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p = 0.044) and 3-months (p = 0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p = 0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function. CONCLUSIONS Participants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, within-participant improvements may have limited potential that suggests the need for a timely administration of IntelliRehab to get the maximum capacity of improvement.
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Affiliation(s)
- Younis M S Firwana
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Khairul Izamil Zolkefley
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Faculty of Industrial Sciences and Technology, Universiti Malaysia Pahang, Kuantan, Malaysia
| | - Hasnetty Zuria Mohamed Hatta
- Rehabilitation Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Christina Rowbin
- Rehabilitation Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Che Mohd Nasril Che Mohd Nassir
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Kulliyyah of Islamic Revealed Knowledge and Human Sciences, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Muhammad Hafiz Hanafi
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.,Rehabilitation Unit, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Mohd Shafie Abdullah
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Bilgin Keserci
- Department of Radiology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Muzaimi Mustapha
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.
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Chang WK, Lee JI, Hwang JH, Lim JY. Post-operative rehabilitation using a digital healthcare system in patients who had undergone rotator cuff repair: protocol for a single-center randomized controlled trial. Trials 2022; 23:667. [PMID: 35978437 PMCID: PMC9386934 DOI: 10.1186/s13063-022-06648-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background Operative repair of a rotator cuff tear requires up to 12 weeks of post-operative (post-op) home-based rehabilitation. Maintaining patients’ compliance in the post-op rehabilitation program is a pivotal component for generating successful outcomes. By developing a post-op rehabilitation-oriented digital healthcare system and applying it in patients who had undergone rotator cuff repair, we aim to increase the efficacy of the rehabilitation program and raise patients’ compliance levels. Here, we present a protocol developed for comparing the efficacy of rehabilitation using a newly developed augmented reality (AR)-based digital healthcare system with that of conventional rehabilitation for post-op rehabilitation of rotator cuff repair. Methods This study will recruit a total of 115 patients who had undergone rotator cuff repair within 3 days after surgery. Patients will be randomly allocated to rehabilitation using an AR-based digital healthcare system (digital group) or conventional rehabilitation (conventional group). Patients in both groups will perform brochure-based exercises from the immediate post-op period to post-op 6 weeks. From post-op 6 weeks to 12 weeks, patients in the digital group will use the AR-based system for post-op exercises, whereas patients in the conventional group will continue brochure-based rehabilitation exercises. The primary outcome will be scores on the Simple Shoulder Test at post-op 12 weeks. Secondary outcomes include numeric rating scale scores for pain, measures of range of motion and muscle strength of the affected shoulder, grip strength of the affected arm, scores on the Disabilities of the Arm, Shoulder and Hand test, the Shoulder Pain and Disability Index, and the EuroQoL-5D-5L quality-of-life measure. Analyses will be conducted using an intention-to-treat approach. Discussion This study will examine the effectiveness of an AR-based digital healthcare system for post-op rehabilitation in the patients after rotator cuff repair. The study will add evidence for the application of digital healthcare systems in post-op rehabilitation. Trial registration ClinicalTrials.gov NCT04511377. Registered on 10 August 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06648-4.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea. .,Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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40
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Ortet CP, Veloso AI, Vale Costa L. Cycling through 360° Virtual Reality Tourism for Senior Citizens: Empirical Analysis of an Assistive Technology. SENSORS (BASEL, SWITZERLAND) 2022; 22:6169. [PMID: 36015929 PMCID: PMC9413856 DOI: 10.3390/s22166169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
In recent years, there has been a renewed interest in using virtual reality (VR) to (re)create different scenarios and environments with interactive and immersive experiences. Although VR has been popular in the tourism sector to reconfigure tourists' relationships with places and overcome mobility restrictions, its usage in senior cyclotourism has been understudied. VR is suggested to positively impact tourism promotion, cycling simulation, and active and healthy ageing due to physical and mental rehabilitation. The purpose of this study is to assess the senior citizens' perceived experience and attitudes toward a designed 360° VR cyclotouristic experiment, using a head-mounted display (HMD) setting within a laboratory context. A total of 76 participants aged between 50 and 97 years old were involved in convergent parallel mixed-method research, and data were collected using a questionnaire based on the technology acceptance model, as well as the researchers' field notes. Findings suggest that 360° VR with HMD can be an effective assistive technology to foster senior cyclotourism by promoting tourism sites, simulating the cycling pedaling effect, and improving senior citizens' general wellbeing and independence with physical and mental rehabilitation.
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Lukacs MJ, Salim S, Katchabaw MJ, Yeung E, Walton DM. Virtual reality in physical rehabilitation: a narrative review and critical reflection. PHYSICAL THERAPY REVIEWS 2022. [DOI: 10.1080/10833196.2022.2105077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Michael J. Lukacs
- Health and Rehabilitation Sciences, Western University, Canada
- Bone and Joint Institute, Western University, Canada
| | - Shahan Salim
- Public Health and Health Systems, University of Waterloo, Canada
| | | | - Euson Yeung
- Physical Therapy, University of Toronto, Canada
| | - David M. Walton
- Bone and Joint Institute, Western University, Canada
- School of Physical Therapy, Western University, Canada
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42
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FarmDay: A Gamified Virtual Reality Neurorehabilitation Application for Upper Limb Based on Activities of Daily Living. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with upper limb disorders are limited in their activities of daily living and impose an important healthcare burden due to the repetitive rehabilitation they require. A way to reduce this burden is through home-based therapy using virtual reality solutions, since they are readily available, provide immersion, and enable accurate motion tracking, and custom applications can be developed for them. However, there is lack of guidelines for the design of effective VR rehabilitation applications in the literature, particularly for bimanual training. This work introduces a VR telerehabilitation system that uses off-the-shelf hardware, a real-time remote setup, and a bimanual training application that aims to improve upper extremity motor function. It is made of six activities and was evaluated by five physiotherapists specialised in (1) neuromotor disorders and (2) functional rehabilitation and (3) occupational therapy. A descriptive analysis of the results obtained from the System Usability Scale test of the application and a collection of qualitative assessments of each game have been carried out. The application obtained a mean score of 86.25 (±8.96 SD) in the System Usability Scale, and the experts concluded that it accurately reproduces activities of daily living movements except for wrist and finger movements. They also offer a set of design guidelines.
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Gaballa A, Cavalcante RS, Lamounier E, Soares A, Cabibihan JJ. Extended Reality "X-Reality" for Prosthesis Training of Upper-Limb Amputees: A Review on Current and Future Clinical Potential. IEEE Trans Neural Syst Rehabil Eng 2022; 30:1652-1663. [PMID: 35635835 DOI: 10.1109/tnsre.2022.3179327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The rejection rates of upper-limb prosthetic devices in adults are high, currently averaging 26% and 23% for body-powered and electric devices, respectively. While many factors influence acceptance, prosthesis training methods relying on novel virtual reality systems have been cited as a critical factor capable of increasing the likelihood of long-term, full-time use. Despite that, these implementations have not yet garnered widespread traction in the clinical setting, and their use remains immaterial. This review aims to explore the reasons behind this situation by identifying trends in existing research that seek to advance Extended Reality "X-Reality" systems for the sake of upper-limb prosthesis rehabilitation and, secondly, analyzing barriers and presenting potential pathways to deployment for successful adoption in the future. The search yielded 42 research papers that were divided into two categories. The first category included articles that focused on the technical aspect of virtual prosthesis training. Articles in the second category utilize user evaluation procedures to ensure applicability in a clinical environment. The review showed that 75% of articles that conducted whole system testing experimented with non-immersive virtual systems. Furthermore, there is a shortage of experiments performed with amputee subjects. From the large-scale studies analyzed, 71% of those recruited solely able-bodied participants. This paper shows that X-Reality technologies for prosthesis rehabilitation of upper-limb amputees carry significant benefits. Nevertheless, much still must be done so that the technology reaches widespread clinical use.
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Islam MS, Lim S. Vibrotactile feedback in virtual motor learning: A systematic review. APPLIED ERGONOMICS 2022; 101:103694. [PMID: 35086007 DOI: 10.1016/j.apergo.2022.103694] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
Vibrotactile feedback can be effectively applied to motor (physical) learning in virtual environments, as it can provide task-intrinsic and augmented feedback to users, assisting them in enhancing their motor performance. This review investigates current uses of vibrotactile feedback systems in motor learning applications built upon virtual environments by systematically synthesizing 24 peer-reviewed studies. We aim to understand: (1) the current state of the science of using real-time vibrotactile feedback in virtual environments for aiding the acquisition (or improvement) of motor skills, (2) the effectiveness of using vibrotactile feedback in such applications, and (3) research gaps and opportunities in current technology. We used the Sensing-Analysis-Assessment-Intervention framework to assess the scientific literature in our review. The review identifies several research gaps in current studies, as well as potential design considerations that can improve vibrotactile feedback systems in virtual motor learning applications, including the selection and placement of feedback devices and feedback designs.
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Affiliation(s)
- Md Shafiqul Islam
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Sol Lim
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, 24061, USA.
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Yalfani A, Abedi M, Raeisi Z. Effects of an 8-Week Virtual Reality Training Program on Pain, Fall Risk, and Quality of Life in Elderly Women with Chronic Low Back Pain: Double-Blind Randomized Clinical Trial. Games Health J 2022; 11:85-92. [PMID: 35290742 DOI: 10.1089/g4h.2021.0175] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Low back pain (LBP) and falls are among the major problems experienced by the elderly population. The present study investigated the effectiveness of an 8-week virtual reality training (VRT) program in helping relieve pain, minimize fall risk, and improve quality of life (QoL) in elderly women suffering from chronic LBP (CLBP). Materials and Methods: Twenty-five elderly women (VRT/intervention group = 13, control group = 12) with CLBP and aged 65 to 75 years were recruited. The VRT involved three 30-minute weekly sessions of exercises that were carried out using the Xbox Kinect headset. Pain intensity, fall risk, and QoL were assessed via the Visual Analog Scale, the Biodex Balance System, and the 36-Item Short Form Health Survey, respectively. Results: The outcomes of a one-way analysis of covariance indicated that the pain intensity score of the intervention group significantly decreased after participation in the VRT program (P = 0.001). The intervention group also showed reduced fall risk (P = 0.001) and elevated QoL (P = 0.001). Conclusion: The results confirmed that the VRT program can be regarded as a valid therapeutic intervention that helps reduce patients' symptoms and increase the effectiveness of exercises in the elderly by teaching pain-related insight as well as enhancing QoL and reduce fall risk through various movements.
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Affiliation(s)
- Ali Yalfani
- Department of Sports Rehabilitation, Faculty of Sport Science, Bu-Ali Sina University, Hamedan, Iran
| | - Mitra Abedi
- Department of Sports Rehabilitation, Faculty of Sport Science, Bu-Ali Sina University, Hamedan, Iran
| | - Zahra Raeisi
- Department of Sports Rehabilitation, Faculty of Sport Science, Arak University, Arak, Iran
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Maranesi E, Di Donna V, Pelliccioni G, Cameriere V, Casoni E, Baldoni R, Benadduci M, Rinaldi N, Fantechi L, Giammarchi C, Luzi R, Pelliccioni P, Di Rosa M, Scendoni P, Riccardi GR, Bevilacqua R. Acceptability and Preliminary Results of Technology-Assisted Balance Training in Parkinson's Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052655. [PMID: 35270348 PMCID: PMC8910202 DOI: 10.3390/ijerph19052655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/18/2022]
Abstract
(1) Background: Parkinson’s Disease (PD) is one of the most common causes of disability among older individuals. The advanced stages of PD are usually characterized by postural instability and, as a consequence, falls. Those are among the main factors that determine the quality of life, as well as the morbidity and mortality of a person with PD. In the field of PD rehabilitation, robotics is also rapidly gaining ground. As a primary aim, we evaluate the acceptability of the technology integrated intervention, using the Psychosocial Impact of Assistive Devices Scale (PIADS), in order to analyze the attitude of the participants towards the Tymo® system. As a secondary outcome, we assess the result of the rehabilitation treatment integrated with the Tymo® system on several patient’s features. (2) Methods: We studied a population of 16 patients with Parkinson’s Disease. Each recruited subject completed 10 treatment sessions, organized as two training sessions per week, for 5 weeks. The intervention included 30 min of traditional therapy and 20 min of technological treatment with a robotic system. PIADS is composed of three subscales (Competence subscale, Adaptability subscale, Self-esteem subscale) ranging from −3 to +3, reflecting, respectively, a negative or positive feeling towards the device. (3) Results: The Competence subscale, measuring feelings of competence and usefulness, obtained a score of 1.24 (SD = 0.78). The score of Adaptability subscale, indicating a willingness to try out new things and to take risks, was 1.83 (SD = 0.65). Finally, the Self-esteem subscale, indicating feelings of emotional health and happiness, reached a score of 1.31 (SD = 0.72). Moreover, statistical analysis reveals a significant effect on balance performance after intervention. (4) Conclusions: This feasibility study represents a starting point in the use of technology in the rehabilitation pathway of patients affected by Parkinson’s Disease. In fact, our results suggest that a standard therapy combined with an innovative treatment using Tymo® may be accepted by PD patients, which may benefit especially from preserving balance.
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Affiliation(s)
- Elvira Maranesi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (M.B.); (C.G.); (R.B.)
- Correspondence:
| | - Valentina Di Donna
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy; (V.D.D.); (N.R.); (P.S.)
| | | | | | - Elisa Casoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy; (E.C.); (R.B.); (G.R.R.)
| | - Renato Baldoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy; (E.C.); (R.B.); (G.R.R.)
| | - Marco Benadduci
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (M.B.); (C.G.); (R.B.)
| | - Nadia Rinaldi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy; (V.D.D.); (N.R.); (P.S.)
| | - Lorenzo Fantechi
- Clinical Unit of Nuclear Medicine, IRCCS INRCA, 60127 Ancona, Italy;
| | - Cinzia Giammarchi
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (M.B.); (C.G.); (R.B.)
| | - Riccardo Luzi
- Medical Direction, IRCCS INRCA, 60127 Ancona, Italy;
| | | | - Mirko Di Rosa
- Unit of Geriatric Pharmacoepidemiology, IRCCS INRCA, 60124 Ancona, Italy;
| | - Pietro Scendoni
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 63900 Fermo, Italy; (V.D.D.); (N.R.); (P.S.)
| | - Giovanni Renato Riccardi
- Clinical Unit of Physical Rehabilitation, IRCCS INRCA, 60127 Ancona, Italy; (E.C.); (R.B.); (G.R.R.)
| | - Roberta Bevilacqua
- Scientific Direction, IRCCS INRCA, 60124 Ancona, Italy; (M.B.); (C.G.); (R.B.)
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Vonstad EK, Bach K, Vereijken B, Su X, Nilsen JH. Performance of machine learning models in estimation of ground reaction forces during balance exergaming. J Neuroeng Rehabil 2022; 19:18. [PMID: 35152877 PMCID: PMC8842746 DOI: 10.1186/s12984-022-00998-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Balance training exercise games (exergames) are a promising tool for reducing fall risk in elderly. Exergames can be used for in-home guided exercise, which greatly increases availability and facilitates independence. Providing biofeedback on weight-shifting during in-home balance exercise improves exercise efficiency, but suitable equipment for measuring weight-shifting is lacking. Exergames often use kinematic data as input for game control. Being able to useg such data to estimate weight-shifting would be a great advantage. Machine learning (ML) models have been shown to perform well in weight-shifting estimation in other settings. Therefore, the aim of this study was to investigate the performance of ML models in estimation of weight-shifting during exergaming using kinematic data. Methods Twelve healthy older adults (mean age 72 (± 4.2), 10 F) played a custom exergame that required repeated weight-shifts. Full-body 3D motion capture (3DMoCap) data and standard 2D digital video (2D-DV) was recorded. Weight shifting was directly measured by 3D ground reaction forces (GRF) from force plates, and estimated using a linear regression model, a long-short term memory (LSTM) model and a decision tree model (XGBoost). Performance was evaluated using coefficient of determination (\documentclass[12pt]{minimal}
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\begin{document}$$R^2$$\end{document}R2) and root mean square error (RMSE). Results Results from estimation of GRF components using 3DMoCap data show a mean (± 1SD) RMSE (% total body weight, BW) of the vertical GRF component (\documentclass[12pt]{minimal}
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\begin{document}$$F_z$$\end{document}Fz) of 4.3 (2.5), 11.1 (4.5), and 11.0 (4.7) for LSTM, XGBoost and LinReg, respectively. Using 2D-DV data, LSTM and XGBoost achieve mean RMSE (± 1SD) in \documentclass[12pt]{minimal}
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\begin{document}$$F_z$$\end{document}Fz estimation of 10.7 (9.0) %BW and 19.8 (6.4) %BW, respectively. \documentclass[12pt]{minimal}
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\begin{document}$$R^2$$\end{document}R2 was \documentclass[12pt]{minimal}
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\begin{document}$$>.97$$\end{document}>.97 for the LSTM in the \documentclass[12pt]{minimal}
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\begin{document}$$F_z$$\end{document}Fz component using 3DMoCap data, and \documentclass[12pt]{minimal}
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\begin{document}$$>.77$$\end{document}>.77 using 2D-DV data. For XGBoost, \documentclass[12pt]{minimal}
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\begin{document}$$F_z$$\end{document}Fz\documentclass[12pt]{minimal}
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\begin{document}$$R^2$$\end{document}R2 was \documentclass[12pt]{minimal}
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\begin{document}$$>.86$$\end{document}>.86 using 3DMoCap data, and \documentclass[12pt]{minimal}
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\begin{document}$$>.56$$\end{document}>.56 using 2D-DV data. Conclusion This study demonstrates that an LSTM model can estimate 3-dimensional GRF components using 2D kinematic data extracted from standard 2D digital video cameras. The \documentclass[12pt]{minimal}
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\begin{document}$$F_z$$\end{document}Fz component is estimated more accurately than \documentclass[12pt]{minimal}
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\begin{document}$$F_y$$\end{document}Fy and \documentclass[12pt]{minimal}
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\begin{document}$$F_x$$\end{document}Fx components, especially when using 2D-DV data. Weight-shifting performance during exergaming can thus be extracted using kinematic data only, which can enable effective independent in-home balance exergaming.
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Ferrazzoli D, Ortelli P, Iansek R, Volpe D. Rehabilitation in movement disorders: From basic mechanisms to clinical strategies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:341-355. [PMID: 35034747 DOI: 10.1016/b978-0-12-819410-2.00019-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Movement disorders encompass a variety of conditions affecting the nervous system at multiple levels. The pathologic processes underlying movement disorders alter the normal neural functions and could lead to aberrant neuroplastic changes and to clinical phenomenology that is not expressed only through mere motor symptoms. Given this complexity, the responsiveness to pharmacologic and surgical therapies is often disappointing. Growing evidence supports the efficacy of neurorehabilitation for the treatment of movement disorders. Specific form of training involving both goal-based practice and aerobic training could drive and modulate neuroplasticity in order to restore the circuitries dysfunctions and to achieve behavioral gains. This chapter provides an overview of the alterations expressed in some movement disorders in terms of clinical signs and symptoms and plasticity, and suggests which ones and why tailored rehabilitation strategies should be adopted for the management of the different movement disorders.
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Affiliation(s)
- Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Paola Ortelli
- Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy; Department of Parkinson's Disease, Fresco Parkinson Center, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital-Gravedona ed Uniti, Como, Italy
| | - Robert Iansek
- Clinical Research Centre for Movement Disorders and Gait, National Parkinson Foundation Center of Excellence, Monash Health, Cheltenham, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Daniele Volpe
- Department of Rehabilitation, Fresco Parkinson Center, Villa Margherita, S. Stefano Riabilitazione, Vicenza, Italy
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Vinolo Gil MJ, Gonzalez-Medina G, Lucena-Anton D, Perez-Cabezas V, Ruiz-Molinero MDC, Martín-Valero R. Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis. JMIR Serious Games 2021; 9:e30985. [PMID: 34914611 PMCID: PMC8717132 DOI: 10.2196/30985] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/11/2021] [Accepted: 09/24/2021] [Indexed: 01/26/2023] Open
Abstract
Background Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36%) contributed information to the meta-analysis. Overall, 64% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95% CI −0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change −1.211, 95% CI −3.2005 to 0.7768; z=−1.194; P=.23). Conclusions AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=180766
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Affiliation(s)
- Maria Jesus Vinolo Gil
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Clinical Management Unit Rehabilitation Intercentre-Interlevel, University Hospitals of Puerto Real and Cadiz, Cadiz Bay-La Janda Health District, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
| | - Gloria Gonzalez-Medina
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
| | - David Lucena-Anton
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain
| | | | - María Del Carmen Ruiz-Molinero
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
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Janeh O, Steinicke F. A Review of the Potential of Virtual Walking Techniques for Gait Rehabilitation. Front Hum Neurosci 2021; 15:717291. [PMID: 34803632 PMCID: PMC8595292 DOI: 10.3389/fnhum.2021.717291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/06/2021] [Indexed: 12/04/2022] Open
Abstract
Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait disturbances in different cohorts of patients (such as Parkinson's disease, post-stroke, or other neurological disorders) as it allows patients to be engaged in an immersive and artificial environment, which can be designed to address the particular needs of each individual. This review demonstrates the state of the art in applications of virtual walking techniques and related technologies for gait therapy and rehabilitation of people with movement disorders makes recommendations for future research and discusses the use of VR in the clinic. However, the potential for using these techniques in gait rehabilitation is to provide a more personalized approach by simulate the experience of natural walking, while patients with neurological disorders are maintained localized in the real world. The goal of our work is to investigate how the human nervous system controls movement in health and neurodegenerative disease.
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Affiliation(s)
- Omar Janeh
- Department of Computer Engineering, University of Technology, Baghdad, Iraq
| | - Frank Steinicke
- Human-Computer Interaction, Department of Informatics, Universität Hamburg, Hamburg, Germany
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