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Everard G, Burton Q, Van de Sype V, Bibentyo TN, Auvinet E, Edwards MG, Batcho CS, Lejeune T. Extended reality to assess post-stroke manual dexterity: contrasts between the classic box and block test, immersive virtual reality with controllers, with hand-tracking, and mixed-reality tests. J Neuroeng Rehabil 2024; 21:36. [PMID: 38491540 PMCID: PMC10941416 DOI: 10.1186/s12984-024-01332-x] [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: 11/06/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Recent technological advancements present promising opportunities to enhance the frequency and objectivity of functional assessments, aligning with recent stroke rehabilitation guidelines. Within this framework, we designed and adapted different manual dexterity tests in extended reality (XR), using immersive virtual reality (VR) with controllers (BBT-VR-C), immersive VR with hand-tracking (BBT-VR-HT), and mixed-reality (MD-MR). OBJECTIVE This study primarily aimed to assess and compare the validity of the BBT-VR-C, BBT-VR-HT and MD-MR to assess post-stroke manual dexterity. Secondary objectives were to evaluate reliability, usability and to define arm kinematics measures. METHODS A sample of 21 healthy control participants (HCP) and 21 stroke individuals with hemiparesis (IHP) completed three trials of the traditional BBT, the BBT-VR-C, BBT-VR-HT and MD-MR. Content validity of the different tests were evaluated by asking five healthcare professionals to rate the difficulty of performing each test in comparison to the traditional BBT. Convergent validity was evaluated through correlations between the scores of the traditional BBT and the XR tests. Test-retest reliability was assessed through correlations between the second and third trial and usability was assessed using the System Usability Scale (SUS). Lastly, upper limb movement smoothness (SPARC) was compared between IHP and HCP for both BBT-VR test versions. RESULTS For content validity, healthcare professionals rated the BBT-VR-HT (0[0-1]) and BBT-MR (0[0-1]) as equally difficult to the traditional BBT, whereas they rated BBT-VR-C as more difficult than the traditional BBT (1[0-2]). For IHP convergent validity, the Pearson tests demonstrated larger correlations between the scores of BBT and BBT-VR-HT (r = 0.94;p < 0.001), and BBT and MD-MR (r = 0.95;p < 0.001) than BBT and BBT-VR-C (r = 0.65;p = 0.001). BBT-VR-HT and MD-MR usability were both rated as excellent, with median SUS scores of 83[57.5-91.3] and 83[53.8-92.5] respectively. Excellent reliability was found for the BBT-VR-C (ICC = 0.96;p < 0.001), BBT-VR-HT (ICC = 0.96;p < 0.001) and BBT-MR (ICC = 0.99;p < 0.001). The usability of the BBT-VR-C was rated as good with a median SUS of 70[43.8-83.8]. Upper limb movements of HCP were significantly smoother than for IHP when completing either the BBT-VR-C (t = 2.05;p = 0.043) and the BBT-VR-HT (t = 5.21;p < 0.001). CONCLUSION The different XR manual tests are valid, short-term reliable and usable tools to assess post-stroke manual dexterity. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT04694833 ; Unique identifier: NCT04694833, Date of registration: 11/24/2020.
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Affiliation(s)
- Gauthier Everard
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Quentin Burton
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Vincent Van de Sype
- Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | | | | | - Martin Gareth Edwards
- Psychological Sciences Research Institute (IPSY), Université Catholique de Louvain, Louvain‑la‑Neuve, Belgium
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Charles Sebiyo Batcho
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Québec, Canada
- Department of rehabilitation, Faculty of medicine, Laval University, Quebec, QC, Canada
| | - Thierry Lejeune
- Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
- Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium.
- Louvain Bionics, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Brock K, Vine SJ, Ross JM, Trevarthen M, Harris DJ. Movement kinematic and postural control differences when performing a visuomotor skill in real and virtual environments. Exp Brain Res 2023:10.1007/s00221-023-06639-0. [PMID: 37222777 DOI: 10.1007/s00221-023-06639-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023]
Abstract
Immersive technologies, like virtual and mixed reality, pose a novel challenge for our sensorimotor systems as they deliver simulated sensory inputs that may not match those of the natural environment. These include reduced fields of view, missing or inaccurate haptic information, and distortions of 3D space; differences that may impact the control of motor actions. For instance, reach-to-grasp movements without end-point haptic feedback are characterised by slower and more exaggerated movements. A general uncertainty about sensory input may also induce a more conscious form of movement control. We tested whether a more complex skill like golf putting was also characterized by more consciously controlled movement. In a repeated-measures design, kinematics of the putter swing and postural control were compared between (i) real-world putting, (ii) VR putting, and (iii) VR putting with haptic feedback from a real ball (i.e., mixed reality). Differences in putter swing were observed both between the real world and VR, and between VR conditions with and without haptic information. Further, clear differences in postural control emerged between real and virtual putting, with both VR conditions characterised by larger postural movements, which were more regular and less complex, suggesting a more conscious form of balance control. Conversely, participants actually reported less conscious awareness of their movements in VR. These findings highlight how fundamental movement differences may exist between virtual and natural environments, which may pose challenges for transfer of learning within applications to motor rehabilitation and sport.
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Affiliation(s)
- K Brock
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - S J Vine
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - J M Ross
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - M Trevarthen
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK
| | - D J Harris
- School of Public Health and Sport Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
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Wenk N, Buetler KA, Penalver-Andres J, Müri RM, Marchal-Crespo L. Naturalistic visualization of reaching movements using head-mounted displays improves movement quality compared to conventional computer screens and proves high usability. J Neuroeng Rehabil 2022; 19:137. [PMID: 36494668 PMCID: PMC9733395 DOI: 10.1186/s12984-022-01101-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar-with immersive VR (IVR)-or the user's real body-with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. METHODS We compared movement quality, cognitive load, motivation, and system usability in twenty elderly participants (>59 years old) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants' self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. RESULTS Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. CONCLUSIONS HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants' motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.*.
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Affiliation(s)
- Nicolas Wenk
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Karin A. Buetler
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - Joaquin Penalver-Andres
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
| | - René M. Müri
- grid.5734.50000 0001 0726 5157Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland ,grid.5734.50000 0001 0726 5157Department of Neurology, University Neurorehabilitation, University Hospital Bern (Inselspital), University of Bern, Bern, Switzerland
| | - Laura Marchal-Crespo
- grid.5734.50000 0001 0726 5157Motor Learning and Neurorehabilitation Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland ,grid.5292.c0000 0001 2097 4740Department of Cognitive Robotics, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands
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Ham Y, Yang DS, Choi Y, Shin JH. The feasibility of mixed reality-based upper extremity self-training for patients with stroke—A pilot study. Front Neurol 2022; 13:994586. [PMID: 36247775 PMCID: PMC9555565 DOI: 10.3389/fneur.2022.994586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Mixed reality (MR), which combines virtual reality and tangible objects, can be used for repetitive training by patients with stroke, allowing them to be immersed in a virtual environment while maintaining their perception of the real world. We developed an MR-based rehabilitation board (MR-board) for the upper limb, particularly for hand rehabilitation, and aimed to demonstrate the feasibility of the MR-board as a self-training rehabilitation tool for the upper extremity in stroke patients. The MR-board contains five gamified programs that train upper-extremity movements by using the affected hand and six differently shaped objects. We conducted five 30-min training sessions in stroke patients using the MR-board. The sensor measured hand movement and reflected the objects to the monitor so that the patients could check the process and results during the intervention. The primary outcomes were changes in the Box and Block Test (BBT) score, and the secondary outcomes were changes in the Fugl–Meyer assessment and Wolf Motor Function Test (WMFT) scores. Evaluations were conducted before and after the intervention. In addition, a usability test was performed to assess the patient satisfaction with the device. Ten patients with hemiplegic stroke were included in the analysis. The BBT scores and shoulder strength in the WMFT were significantly improved (p < 0.05), and other outcomes were also improved after the intervention. In addition, the usability test showed high satisfaction (4.58 out of 5 points), and patients were willing to undergo further treatment sessions. No safety issues were observed. The MR-board is a feasible intervention device for improving upper limb function. Moreover, this instrument could be an effective self-training tool that provides training routines for stroke patients without the assistance of a healthcare practitioner.Trial registrationThis study was registered with the Clinical Research Information Service (CRIS: KCT0004167).
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Affiliation(s)
- Yeajin Ham
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
| | - Dong-Seok Yang
- Business Growth Support Center, Neofect, Seongnam, South Korea
| | - Younggeun Choi
- Department of Computer Engineering, Dankook University, Yongin-si, South Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation Center, Ministry of Health and Welfare, Seoul, South Korea
- *Correspondence: Joon-Ho Shin
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How Cognitive Reserve should Influence Rehabilitation Choices using Virtual Reality in Parkinson’s Disease. PARKINSON'S DISEASE 2022; 2022:7389658. [PMID: 36160828 PMCID: PMC9507627 DOI: 10.1155/2022/7389658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/08/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
Virtual reality (VR) is used in the rehabilitation of patients with Parkinson's disease (PD) in several studies. In VR trials, the motor, physical characteristics, and the degree of the disease are often well defined, while PD cognitive reserve is not. This systematic review was performed to define a cognitive profile for patients with PD who could best benefit from using VR to enhance functional motor aspects during rehabilitation. PubMed, Cochrane Library, Scopus, and Web of Sciences databases were analysed to identify randomized clinical trials (RCT) and randomized pilot trials that addressed the rehabilitation of motor symptoms in subjects with PD using VR. The included studies used Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) to evaluate the cognitive aspect. Only articles written in English and with full texts were considered. The risk of bias from all included studies was assessed based on the Cochrane risk-of-bias tool and the PRISMA guideline was considered. Eighteen articles were eligible for review, including three randomized pilot trials. All studies aimed to evaluate the effect of VR on the motor aspects typically affected by PD (balance, postural control, risk of falls, walking, and reaching). The most widely adopted approach has been nonimmersive VR, except for one study that used immersive VR. Both the benefits of physical activity on the motor symptoms of patients with PD and the impact of cognitive reserve during the rehabilitation of these patients were highlighted. The analysis of the results allowed us to outline the ideal cognitive profile of patients with PD who can benefit from the effects of rehabilitation using VR.
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Lukashova-Sanz O, Agarwala R, Wahl S. Context matters during pick-and-place in VR: Impact on search and transport phases. Front Psychol 2022; 13:881269. [PMID: 36160516 PMCID: PMC9493493 DOI: 10.3389/fpsyg.2022.881269] [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: 02/22/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
When considering external assistive systems for people with motor impairments, gaze has been shown to be a powerful tool as it is anticipatory to motor actions and is promising for understanding intentions of an individual even before the action. Up until now, the vast majority of studies investigating the coordinated eye and hand movement in a grasping task focused on single objects manipulation without placing them in a meaningful scene. Very little is known about the impact of the scene context on how we manipulate objects in an interactive task. In the present study, it was investigated how the scene context affects human object manipulation in a pick-and-place task in a realistic scenario implemented in VR. During the experiment, participants were instructed to find the target object in a room, pick it up, and transport it to a predefined final location. Thereafter, the impact of the scene context on different stages of the task was examined using head and hand movement, as well as eye tracking. As the main result, the scene context had a significant effect on the search and transport phases, but not on the reach phase of the task. The present work provides insights into the development of potential supporting intention predicting systems, revealing the dynamics of the pick-and-place task behavior once it is realized in a realistic context-rich scenario.
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Affiliation(s)
- Olga Lukashova-Sanz
- Zeiss Vision Science Lab, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Carl Zeiss Vision International Gesellschaft mit beschränkter Haftung (GmbH), Aalen, Germany
- *Correspondence: Olga Lukashova-Sanz
| | - Rajat Agarwala
- Zeiss Vision Science Lab, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Siegfried Wahl
- Zeiss Vision Science Lab, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Carl Zeiss Vision International Gesellschaft mit beschränkter Haftung (GmbH), Aalen, Germany
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Alba-Rueda A, Moral-Munoz JA, De Miguel-Rubio A, Lucena-Anton D. Exergaming for Physical Therapy in Patients with Down Syndrome: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. Games Health J 2022; 11:67-78. [PMID: 35438549 DOI: 10.1089/g4h.2021.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this systematic review and meta-analysis of randomized-controlled trials was to analyze the effectiveness of exergaming on motor outcomes compared with control in patients with Down syndrome. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed up to July 2021 in the following scientific databases: PubMed, CENTRAL, CINAHL, Medline, Scopus, Web of Science, BioMed Central, and Physiotherapy Evidence Database (PEDro). The study eligibility criteria were previously established according to the PICOS model. The PEDro scale was used to assess the methodological quality of the studies, and the Cochrane Collaboration's tool was used to assess the risk of bias. A meta-analysis using standardized mean difference (SMD) and confidence interval (95% CI) was performed using the Review Manager 5.4 software. Eight articles were included in the systematic review and meta-analysis. Statistical analysis showed favorable results for exergaming on balance (SMD = 2.72; 95% CI = 1.68-3.76), functional mobility (SMD = 4.14; 95% CI = 3.69-4.59), and muscle strength (SMD = 6.40; 95% CI = 2.68-10.11). No conclusive results were found on aerobic endurance. In conclusion, the results show the potential benefits of exergaming to recover motor outcomes in patients with Down syndrome, specifically, in balance, functional mobility, and muscle strength. We encourage researchers and clinicians to integrate exergaming in clinical settings since it is an inexpensive and easily accessible therapy for different populations, and it could be a useful tool within the physical therapy interventions in patients with Down syndrome. PROSPERO registration number: CRD42021238335.
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Affiliation(s)
- Alvaro Alba-Rueda
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
| | - Jose A Moral-Munoz
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, Cadiz, Spain
| | | | - David Lucena-Anton
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
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Zeiaee A, Zarrin RS, Eib A, Langari R, Tafreshi R. CLEVERarm: A Lightweight and Compact Exoskeleton for Upper-Limb Rehabilitation. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2021.3138326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ossmy O, Mansano L, Frenkel-Toledo S, Kagan E, Koren S, Gilron R, Reznik D, Soroker N, Mukamel R. Motor learning in hemi-Parkinson using VR-manipulated sensory feedback. Disabil Rehabil Assist Technol 2022; 17:349-361. [PMID: 32657187 DOI: 10.1080/17483107.2020.1785561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/07/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023]
Abstract
AIMS Modalities for rehabilitation of the neurologically affected upper-limb (UL) are generally of limited benefit. The majority of patients seriously affected by UL paresis remain with severe motor disability, despite all rehabilitation efforts. Consequently, extensive clinical research is dedicated to develop novel strategies aimed to improve the functional outcome of the affected UL. We have developed a novel virtual-reality training tool that exploits the voluntary control of one hand and provides real-time movement-based manipulated sensory feedback as if the other hand is the one that moves. The aim of this study was to expand our previous results, obtained in healthy subjects, to examine the utility of this training setup in the context of neuro-rehabilitation. METHODS We tested the training setup in patient LA, a young man with significant unilateral UL dysfunction stemming from hemi-parkinsonism. LA underwent daily intervention in which he intensively trained the non-affected upper limb, while receiving online sensory feedback that created an illusory perception of control over the affected limb. Neural changes were assessed using functional magnetic resonance imaging (fMRI) scans before and after training. RESULTS Training-induced behavioral gains were accompanied by enhanced activation in the pre-frontal cortex and a widespread increase in resting-state functional connectivity. DISCUSSION Our combination of cutting edge technologies, insights gained from basic motor neuroscience in healthy subjects and well-known clinical treatments, hold promise for the pursuit of finding novel and more efficient rehabilitation schemes for patients suffering from hemiplegia.Implications for rehabilitationAssistive devices used in hospitals to support patients with hemiparesis require expensive equipment and trained personnel - constraining the amount of training that a given patient can receive. The setup we describe is simple and can be easily used at home with the assistance of an untrained caregiver/family member. Once installed at the patient's home, the setup is lightweight, mobile, and can be used with minimal maintenance . Building on advances in machine learning, our software can be adapted to personal use at homes. Our findings can be translated into practice with relatively few adjustments, and our experimental design may be used as an important adjuvant to standard clinical care for upper limb hemiparesis.
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Affiliation(s)
- Ori Ossmy
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Silvi Frenkel-Toledo
- Department of Physiotherapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Evgeny Kagan
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Shiri Koren
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Roee Gilron
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Reznik
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mukamel
- Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
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Ham Y, Shin JH. Efficiency and usability of a modified pegboard incorporating computerized technology for upper limb rehabilitation in patients with stroke. Top Stroke Rehabil 2022; 30:333-341. [PMID: 35348031 DOI: 10.1080/10749357.2022.2058293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Traditionally, a pegboard has been commonly used as a useful training and assessment tool for patients with stroke. However, training using pegboards could be monotonous and may discourage motivation in patients with stroke, as it requires only repetitive movements without feedback. OBJECTIVES We aimed to demonstrate the efficiency and usability of a novel rehabilitation instrument (Rapael Smart Pegboard; SP), which integrates computerized technology into a traditional pegboard. METHODS This single-center study with a single-group pre-post design included 19 patients with hemiplegic stroke (11 outpatients and 8 inpatients). The patients received 20 SP training sessions (30 minutes per session, 5 days per week, over 4 weeks) according to their ability and status without any therapist intervention. The primary outcome was changes in the Fugl-Meyer assessment of upper extremity (FMA), and the secondary outcomes were changes in the Box and Block test and Jebsen-Taylor Hand Function test (JHFT). Additionally, usability assessment was performed. RESULTS All outcome measurements except JHFT-gross score showed significant improvements with SP training. The significant improvements in these outcomes were consistently found in the outpatient group; however, the inpatient group failed to show improvement in the distal part of FMA, total JHFT score, and time. The usability test showed high satisfaction with 4.9 out of 5 points. CONCLUSIONS The SP is an effective and feasible instrument for upper limb rehabilitation. Moreover, the SP can be used as a self-training tool without the assistance of a health care practitioner.
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Affiliation(s)
- Yeajin Ham
- Department of Rehabilitation Medicine, National Rehabilitation center, Seoul, Republic of Korea
| | - Joon-Ho Shin
- Department of Rehabilitation Medicine, National Rehabilitation center, Seoul, Republic of Korea
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Rovini E, Galperti G, Manera V, Mancioppi G, Fiorini L, Gros A, Robert P, Cavallo F. A wearable ring-shaped inertial system to identify action planning impairments during reach-to-grasp sequences: a pilot study. J Neuroeng Rehabil 2021; 18:118. [PMID: 34315497 PMCID: PMC8314592 DOI: 10.1186/s12984-021-00913-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background The progressive ageing of the population is leading to an increasing number of people affected by cognitive decline, including disorders in executive functions (EFs), such as action planning. Current procedures to evaluate cognitive decline are based on neuropsychological tests, but novel methods and approaches start to be investigated. Reach-to-grasp (RG) protocols have shown that intentions can influence the EFs of action planning. In this work, we proposed a novel ring-shaped wearable inertial device, SensRing, to measure kinematic parameters during RG and after-grasp (AG) tasks with different end-goals. The aim is to evaluate whether SensRing can characterize the motor performances of people affected by Mild Neurocognitive Disorder (MND) with impairment in EFs. Methods Eight Individuals with dysexecutive MND, named d-MND, were compared to ten older healthy subjects (HC). They were asked to reach and grasp a can with three different intentions: to drink (DRINK), to place it on a target (PLACE), or to pass it to a partner (PASS). Twenty-one kinematic parameters were extracted from SensRing inertial data. Results Seven parameters resulted able to differentiate between HC and d-MND in the RG phase, and 8 features resulted significant in the AG phase. d-MND, indeed, had longer reaction times (in RG PLACE), slower peak velocities (in RG PLACE and PASS, in AG DRINK and PLACE), longer deceleration phases (in all RG and AG DRINK), and higher variability (in RG PLACE, in AG DRINK and PASS). Furthermore, d-MND showed no significant differences among conditions, suggesting that impairments in EFs influence their capabilities in modulating the action planning based on the end-goal. Conclusions Based on this explorative study, the system might have the potential for objectifying the clinical assessment of people affected by d-MND by administering an easy motor test. Although these preliminary results have to be investigated in-depth in a larger sample, the portability, wearability, accuracy, and ease-of use of the system make the SensRing potentially appliable for remote applications at home, including analysis of protocols for neuromotor rehabilitation in patients affected by MND.
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Affiliation(s)
- Erika Rovini
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Guenda Galperti
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Gianmaria Mancioppi
- The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Laura Fiorini
- Department of Industrial Engineering, University of Florence, Florence, Italy
| | - Auriane Gros
- CoBTeK Lab of the Université Cote D'Azur, Nice, France
| | | | - Filippo Cavallo
- Department of Industrial Engineering, University of Florence, Florence, Italy. .,The BioRobotics Institute of Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy. .,Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
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12
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Sakabe N, Altukhaim S, Hayashi Y, Sakurada T, Yano S, Kondo T. Enhanced Visual Feedback Using Immersive VR Affects Decision Making Regarding Hand Use With a Simulated Impaired Limb. Front Hum Neurosci 2021; 15:677578. [PMID: 34177496 PMCID: PMC8232051 DOI: 10.3389/fnhum.2021.677578] [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: 03/07/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
The long-term effects of impairment have a negative impact on the quality of life of stroke patients in terms of not using the affected limb even after some recovery (i.e., learned non-use). Immersive virtual reality (IVR) has been introduced as a new approach for the treatment of stroke rehabilitation. We propose an IVR-based therapeutic approach to incorporate positive reinforcement components in motor coordination as opposed to constraint-induced movement therapy (CIMT). This study aimed to investigate the effect of IVR-reinforced physical therapy that incorporates positive reinforcement components in motor coordination. To simulate affected upper limb function loss in patients, a wrist weight was attached to the dominant hand of participant. Participants were asked to choose their right or left hand to reach toward a randomly allocated target. The movement of the virtual image of the upper limb was reinforced by visual feedback to participants, that is, the participants perceived their motor coordination as if their upper limb was moving to a greater degree than what was occurring in everyday life. We found that the use of the simulated affected limb was increased after the visual feedback enhancement intervention, and importantly, the effect was maintained even after gradual withdrawal of the visual amplification. The results suggest that positive reinforcement within the IVR could induce an effect on decision making in hand usage.
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Affiliation(s)
- Naoko Sakabe
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Samirah Altukhaim
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom.,Physiotherapy Group in Stroke Unit, Alamiri Hospital, Kuwait City, Kuwait
| | - Yoshikatsu Hayashi
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Takeshi Sakurada
- College of Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Shiro Yano
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
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13
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Mangalam M, Yarossi M, Furmanek MP, Tunik E. Control of aperture closure during reach-to-grasp movements in immersive haptic-free virtual reality. Exp Brain Res 2021; 239:1651-1665. [PMID: 33774688 DOI: 10.1007/s00221-021-06079-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/08/2021] [Indexed: 12/27/2022]
Abstract
Virtual reality (VR) has garnered much interest as a training environment for motor skill acquisition, including for neurological rehabilitation of upper extremities. While the focus has been on gross upper limb motion, VR applications that involve reaching for, and interacting with, virtual objects are growing. The absence of true haptics in VR when it comes to hand-object interactions raises a fundamentally important question: can haptic-free immersive virtual environments (hf-VEs) support naturalistic coordination of reach-to-grasp movements? This issue has been grossly understudied, and yet is of significant importance in the development and application of VR across a number of sectors. In a previous study (Furmanek et al., J Neuroeng Rehabil 16:78, 2019), we reported that reach-to-grasp movements are similarly coordinated in both the physical environment (PE) and hf-VE. The most noteworthy difference was that the closure phase-which begins at maximum aperture and lasts through the end of the movement-was longer in hf-VE than in PE, suggesting that different control laws might govern the initiation of closure between the two environments. To do so, we reanalyzed data from Furmanek et al. (J Neuroeng Rehabil 16:78, 2019), in which the participants reached to grasp three differently sized physical objects, and matching 3D virtual object renderings, placed at three different locations. Our analysis revealed two key findings pertaining to the initiation of closure in PE and hf-VE. First, the respective control laws governing the initiation of aperture closure in PE and hf-VE both included state estimates of transport velocity and acceleration, supporting a general unified control policy for implementing reach-to-grasp across physical and virtual environments. Second, the aperture was less informative to the control law in hf-VE. We suggest that the latter was likely because transport velocity at closure onset and aperture at closure onset were less independent in hf-VE than in PE, ultimately resulting in an aperture at closure onset having a weaker influence on the initiation of closure. In this way, the excess time and muscular effort needed to actively bring the fingers to a stop at the interface of a virtual object was factored into the control law governing the initiation of closure in hf-VE. Critically, this control law remained applicable, albeit with different weights in hf-VE, despite the absence of terminal haptic feedback and potential perceptual differences.
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Affiliation(s)
- Madhur Mangalam
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, 02115, USA.
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, 02115, USA.,Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA
| | - Mariusz P Furmanek
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, 02115, USA.,Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education in Katowice, 40-065, Katowice, Poland
| | - Eugene Tunik
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA, 02115, USA.,Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, 02115, USA.,Department of Bioengineering, Northeastern University, Boston, MA, 02115, USA
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14
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Kravtsova EN, Meigal AY. [Virtual reality technologies in the rehabilitation of patients with peripheral vestibular dysfunction]. Vestn Otorinolaringol 2021; 86:103-107. [PMID: 33720661 DOI: 10.17116/otorino202186011103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Review of articles published in peer-reviewed international journals devoted to the issues of rehabilitation of patients with peripheral vestibular dysfunction using virtual reality conditions. IN the review provides a neurophysiological rationale for the use of virtual reality techniques for rehabilitation, the technical methods used to recreate the virtual environment, as well as the published results of their clinical application. It is concluded that the application of virtual reality methods in clinical vestibulology is promising. The search was carried out using the search engines Google Scholar, PubMed, PMC, CrossRef, Science Direct.
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Affiliation(s)
| | - A Yu Meigal
- Petrozavodsk State University, Petrozavodsk, Russia
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15
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Head-Mounted Display-Based Therapies for Adults Post-Stroke: A Systematic Review and Meta-Analysis. SENSORS 2021; 21:s21041111. [PMID: 33562657 PMCID: PMC7915338 DOI: 10.3390/s21041111] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Immersive virtual reality techniques have been applied to the rehabilitation of patients after stroke, but evidence of its clinical effectiveness is scarce. The present review aims to find studies that evaluate the effects of immersive virtual reality (VR) therapies intended for motor function rehabilitation compared to conventional rehabilitation in people after stroke and make recommendations for future studies. Data from different databases were searched from inception until October 2020. Studies that investigated the effects of immersive VR interventions on post-stroke adult subjects via a head-mounted display (HMD) were included. These studies included a control group that received conventional therapy or another non-immersive VR intervention. The studies reported statistical data for the groups involved in at least the posttest as well as relevant outcomes measuring functional or motor recovery of either lower or upper limbs. Most of the studies found significant improvements in some outcomes after the intervention in favor of the virtual rehabilitation group. Although evidence is limited, immersive VR therapies constitute an interesting tool to improve motor learning when used in conjunction with traditional rehabilitation therapies, providing a non-pharmacological therapeutic pathway for people after stroke.
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16
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Cai Q, Li J, Long J. Effect of Physical and Virtual Feedback on Reach-to-Grasp Movements in Virtual Environments. IEEE Trans Cogn Dev Syst 2021. [DOI: 10.1109/tcds.2021.3066618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Rovini E, Galperti G, Fiorini L, Mancioppi G, Manera V, Cavallo F. SensRing, a novel wearable ring-shaped device for objective analysis of reachto-grasp movements. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:4020-4023. [PMID: 33018881 DOI: 10.1109/embc44109.2020.9176116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reach-to-grasp actions have been recently studied to highlight how intentions influence action planning and shapes the movement kinematics. Reach-to-grasp (RG) kinematics can reveal important information on motor planning and control in several pathologies, including neurodegenerative diseases. Current methods are mainly based on optoelectronic analysis systems, which provide accurate movement tracking but are expensive, time-consuming, and limited to constrained research-oriented space. In this study, we proposed an innovative, non-invasive, and easy-to-use ringshaped wearable system, named SensRing, able to record inertial data during the movement. To ensure accurate and precise measures, which are mandatory for clinical practice, a preliminary technical validation of the SensRing with respect to the Vicon (i.e., gold standard for motion analysis) was performed on two finger tapping exercises. Preliminary results pointed out very low discrepancies in terms of absolute errors (AbsErr) between the values of repetitions (AbsErr≤0.8), frequency (AbsErr=0.04Hz) and amplitude (AbsErr≤2.7deg) measured by the two systems, as well as high correlation between the measures obtained with the inertial and optical system. Therefore, inertial data from the SensRing were used in a "reach-to-grasp and move" protocol to calculate the performance of a group of healthy young subjects during three RG and move sequences. Particularly, subjects were instructed to reach and grasp a bottle to drink (DRINK), to place it on the table (IND) or to pass it to another partner (SOC). Results showed that SensRing could identify that, in the RG phase, different intentions determine different kinematic parameters of grasping the same object. As concerns the phase of moving, if the movement is different (drink vs IND/SOC) it's easier to find differences between the tasks, but also when the action is the same but with different social intent (IND vs SOC) SensRing found a significant difference.
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18
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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence. J Clin Med 2020; 9:jcm9103369. [PMID: 33096678 PMCID: PMC7590210 DOI: 10.3390/jcm9103369] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
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19
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Faure C, Fortin-Cote A, Robitaille N, Cardou P, Gosselin C, Laurendeau D, Mercier C, Bouyer L, McFadyen BJ. Adding Haptic Feedback to Virtual Environments With a Cable-Driven Robot Improves Upper Limb Spatio-Temporal Parameters During a Manual Handling Task. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2246-2254. [PMID: 32877337 DOI: 10.1109/tnsre.2020.3021200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Physical interactions within virtual environments are often limited to visual information within a restricted workspace. A new system exploiting a cable-driven parallel robot to combine visual and haptic information related to environmental physical constraints (e.g. shelving, object weight) was developed. The aim of this study was to evaluate the impact on user movement patterns of adding haptic feedback in a virtual environment with this robot. Twelve healthy participants executed a manual handling task under three conditions: 1) in a virtual environment with haptic feedback; 2) in a virtual environment without haptic feedback; 3) in a real physical environment. Temporal parameters (movement time, peak velocity, movement smoothness, time to maximum flexion, time to peak wrist velocity) and spatial parameters of movement (maximum trunk flexion, range of motion of the trunk, length of the trajectory, index of curvature and maximum clearance from the shelf) were analysed during the reaching, lowering and lifting phases. Our results suggest that adding haptic feedback improves spatial parameters of movement to better respect the environmental constraints. However, the visual information presented in the virtual environment through the head mounted display appears to have an impact on temporal parameters of movement leading to greater movement time. Taken together, our results suggest that a cable-driven robot can be a promising device to provide a more ecological context during complex tasks in virtual reality.
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20
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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21
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Drew SA, Awad MF, Armendariz JA, Gabay B, Lachica IJ, Hinkel-Lipsker JW. The Trade-Off of Virtual Reality Training for Dart Throwing: A Facilitation of Perceptual-Motor Learning With a Detriment to Performance. Front Sports Act Living 2020; 2:59. [PMID: 33345050 PMCID: PMC7739782 DOI: 10.3389/fspor.2020.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/24/2020] [Indexed: 12/31/2022] Open
Abstract
Advancements in virtual reality (VR) technology now allow for the creation of highly immersive virtual environments and for systems to be commercially available at an affordable price. Despite increased availability, this access does not ensure that VR is appropriate for training for all motor skills. Before the implementation of VR for training sport-related skills takes place, it must first be established whether VR utilization is appropriate. To this end, it is crucial to better understand the mechanisms that drive learning in these new environments which will allow for optimization of VR to best facilitate transfer of learned skills to the real world. In this study we sought to examine how a skill acquired in VR compares to one acquired in the real world (RW), utilizing training to complete a dart-throwing task in either a virtual or real environment. We adopted a perceptual-motor approach in this study, employing measures of task performance (i.e., accuracy), as well as of perception (i.e., visual symptoms and oculomotor behavior) and motor behaviors (i.e., throwing kinematics and coordination). Critically, the VR-trained group performed significantly worse in terms of throwing accuracy compared to both the RW-trained group and their own baseline performance. In terms of perception, the VR-trained group reported greater acute visual symptoms compared to the RW-trained group, though oculomotor behaviors were largely the same across groups. In terms of motor behaviors, the VR-trained group exhibited different dart-throwing kinematics during training, but in the follow-up test adapted their throwing pattern to one similar to the RW-trained group. In total, VR training impaired real-world task performance, suggesting that virtual environments may offer different learning constraints compared to the real world. These results thus emphasize the need to better understand how some elements of virtual learning environments detract from transfer of an acquired sport skill to the real world. Additional work is warranted to further understand how perceptual-motor behaviors are acquired differently in virtual spaces.
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Affiliation(s)
- Stefanie A Drew
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Madeline F Awad
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Jazlyn A Armendariz
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Bar Gabay
- Visual Information Sciences and Neuroscience Laboratory, Department of Psychology, California State University, Northridge, CA, United States
| | - Isaiah J Lachica
- Move-Learn Laboratory, Department of Kinesiology, California State University, Northridge, CA, United States
| | - Jacob W Hinkel-Lipsker
- Move-Learn Laboratory, Department of Kinesiology, California State University, Northridge, CA, United States
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22
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Demers M, Levin MF. Kinematic Validity of Reaching in a 2D Virtual Environment for Arm Rehabilitation After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:679-686. [PMID: 32031942 DOI: 10.1109/tnsre.2020.2971862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Increasing evidence supports the use of virtual reality for stroke rehabilitation. However, movement performance and quality may be diminished by the attributes of the virtual environment (VE), which may be detrimental to motor relearning. Our aim was to determine whether reach-to-grasp movements made in a low-cost 2DVE were kinematically similar to those made in a comparable physical environment (PE) in healthy subjects and subjects with stroke. Subjects (healthy = 15, stroke = 22) made unilateral and bilateral reach-to-grasp movements in a 2DVE and a similar PE. Arm and trunk kinematics were recorded with an optoelectronic measurement system (23 markers; 120 Hz). Temporal and spatial characteristics of the endpoint trajectory, arm and trunk movement patterns were compared between environments and groups. In each group, hand positioning at object contact time and trunk displacement were unaffected by the environment. Compared to PE, in VE, unilateral movements were less smooth and time to peak velocity was prolonged. In healthy subjects, bilateral movements were simultaneous and symmetrical in both environments. In subjects with stroke, movements were less symmetrical in VE. Aside from differences in endpoint displacement between environments, movement quality variables were unaffected by the 2DVE. Thus, using a low-cost 2DVE may be a valid approach for sensorimotor rehabilitation following stroke.
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23
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Andreikanich A, Cardoso T, Dias P, Santos BS, Amorim P, Zagalo H, Marques B, Margalho P, Lains J, Faim F, Coelho M. An Exploratory Study on the use of Virtual Reality in Balance Rehabilitation .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3416-3419. [PMID: 31946613 DOI: 10.1109/embc.2019.8857469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Studies have shown the potential of Virtual Reality and motion tracking devices in physical rehabilitation. This paper addresses the topic of using non-immersive Virtual Reality therapeutic games with motion tracking in physical rehabilitation and describes an exploratory study performed in collaboration with a national public Rehabilitation Center about their use to motivate patients to perform exercises relevant for balance rehabilitation. The work involved developing and adapting mini-games to track patients posture; tests with patients recovering from Spinal Cord Injury suggest that this type of games can be helpful in the recovery process namely in patients' motivation for performing the therapeutic gestures.
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24
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Furmanek MP, Schettino LF, Yarossi M, Kirkman S, Adamovich SV, Tunik E. Coordination of reach-to-grasp in physical and haptic-free virtual environments. J Neuroeng Rehabil 2019; 16:78. [PMID: 31248426 PMCID: PMC6598288 DOI: 10.1186/s12984-019-0525-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Virtual reality (VR) offers unprecedented opportunity as a scientific tool to study visuomotor interactions, training, and rehabilitation applications. However, it remains unclear if haptic-free hand-object interactions in a virtual environment (VE) may differ from those performed in the physical environment (PE). We therefore sought to establish if the coordination structure between the transport and grasp components remain similar whether a reach-to-grasp movement is performed in PE and VE. Method Reach-to-grasp kinematics were examined in 13 healthy right-handed young adults. Subjects were instructed to reach-to-grasp-to-lift three differently sized rectangular objects located at three different distances from the starting position. Object size and location were matched between the two environments. Contact with the virtual objects was based on a custom collision detection algorithm. Differences between the environments were evaluated by comparing movement kinematics of the transport and grasp components. Results Correlation coefficients, and the slope of the regression lines, between the reach and grasp components were similar for the two environments. Likewise, the kinematic profiles of the transport velocity and grasp aperture were strongly correlated across the two environments. A rmANOVA further identified some similarities and differences in the movement kinematics between the two environments - most prominently that the closure phase of reach-to-grasp movement was prolonged when movements were performed in VE. Conclusions Reach-to-grasp movement patterns performed in a VE showed both similarities and specific differences compared to those performed in PE. Additionally, we demonstrate a novel approach for parsing the reach-to-grasp movement into three phases- initiation, shaping, closure- based on established kinematic variables, and demonstrate that the differences in performance between the environments are attributed to the closure phase. We discuss this in the context of how collision detection parameters may modify hand-object interactions in VE. Our study shows that haptic-free VE may be a useful platform to study reach-to-grasp movements, with potential implications for haptic-free VR in neurorehabilitation. Electronic supplementary material The online version of this article (10.1186/s12984-019-0525-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mariusz P Furmanek
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA. .,Department of Human Motor Behavior, the Jerzy Kukuczka Academy of Physical Education in Katowice, 72A Mikolowska St, 40-065, Katowice, Poland.
| | - Luis F Schettino
- Psychology Department, Lafayette College, Easton, PA, 18042, USA
| | - Mathew Yarossi
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA.,Department of Electrical and Computer Engineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA
| | - Sofia Kirkman
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA
| | - Sergei V Adamovich
- Department of Biomedical Engineering, NJIT, 323 Dr. Martin Luther King Jr. Boulevard, Newark, NJ, 07102, USA.,Department of Rehabilitation and Movement Science, Rutgers University, 65 Bergen St, Newark, NJ, 07107, USA
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA.,Department of Electrical and Computer Engineering, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA.,Department of Bioengineering, Northeastern University, 805 Columbus Ave., Boston, MA, 02120, USA
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Perturbed Point-to-Point Reaching Tasks in a 3D Environment Using a Portable Haptic Device. ELECTRONICS 2019. [DOI: 10.3390/electronics8010032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper, we propose a new protocol, integrating Virtual Reality with the Novint Falcon, to evaluate motion performance during perturbed 3D reaching tasks. The protocol consists of six 3D point-to-point reaching tasks, performed using Falcon with six opposing force fields. Twenty subjects were enrolled in the study. During each task, subjects reached 80 targets and the protocol was repeated over three different days. The trajectories of the end-effector were recorded to calculate: duration of movement, length ratio, lateral deviation, aiming angle, speed metric, and normalized jerk. The coefficient of variation was calculated to study the intra-subject variability and the intra-class correlation coefficient to assess the reliability of the indices. Two-way repeated measurement ANOVA tests were performed for all indices in order to ascertain the effects of force and direction on the trajectories. Duration of movement, length ratio and speed metric have proven to be the most repeatable and reliable indices. Considering the force fields, subjects were able to optimize the trajectory in terms of duration and accuracy but not in terms of smoothness. Considering the directions, the best motor performance occurred when the trajectories were performed in the upper quadrant compared to those performed in the lower quadrant.
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26
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Yang Z, Rafiei MH, Hall A, Thomas C, Midtlien HA, Hasselbach A, Adeli H, Gauthier LV. A Novel Methodology for Extracting and Evaluating Therapeutic Movements in Game-Based Motion Capture Rehabilitation Systems. J Med Syst 2018; 42:255. [PMID: 30406430 PMCID: PMC7183412 DOI: 10.1007/s10916-018-1113-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/26/2018] [Indexed: 10/27/2022]
Abstract
Virtual rehabilitation yields outcomes that are at least as good as traditional care for improving upper limb function and the capacity to carry out activities of daily living. Due to the advent of low-cost gaming systems and patient preference for game-based therapies, video game technology will likely be increasingly utilized in physical therapy practice in the coming years. Gaming systems that incorporate low-cost motion capture technology often generate large datasets of therapeutic movements performed over the course of rehabilitation. An infrastructure has yet to be established, however, to enable efficient processing of large quantities of movement data that are collected outside of a controlled laboratory setting. In this paper, a methodology is presented for extracting and evaluating therapeutic movements from game-based rehabilitation that occurs in uncontrolled and unmonitored settings. By overcoming these challenges, meaningful kinematic analysis of rehabilitation trajectory within an individual becomes feasible. Moreover, this methodological approach provides a vehicle for analyzing large datasets generated in uncontrolled clinical settings to enable better predictions of rehabilitation potential and dose-response relationships for personalized medicine.
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Affiliation(s)
- Zhichao Yang
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, 01003, USA
| | - Mohammad H Rafiei
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
- Departments of Biomedical Informatics, Neurology, Neuroscience, The Ohio State University, Columbus, OH, 43210, USA
- Department of Physical Therapy, University of Massachusetts, Lowell, Lowell, MA, 01854, USA
| | - Alexis Hall
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Caroline Thomas
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Hali A Midtlien
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Alexander Hasselbach
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
| | - Hojjat Adeli
- Departments of Biomedical Informatics, Neurology, Neuroscience, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lynne V Gauthier
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH, 43210, USA
- Department of Physical Therapy, University of Massachusetts, Lowell, Lowell, MA, 01854, USA
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Hussain N, Alt Murphy M, Sunnerhagen KS. Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality. Front Neurol 2018; 9:300. [PMID: 29867717 PMCID: PMC5954035 DOI: 10.3389/fneur.2018.00300] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation. Objective To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls. Methods Sixty-seven participants with moderate (32–57 points) or mild (58–65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg—SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement. Results The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider’s web) close to the target indicating deficits in movement precision. Conclusion The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale. Trial registration details The trial was registered with register number NCT01115348 at clinicaltrials.gov, on May 4, 2010. URL: https://clinicaltrials.gov/ct2/show/NCT01115348.
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Affiliation(s)
- Netha Hussain
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margit Alt Murphy
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Robert MT, Levin MF. Validation of reaching in a virtual environment in typically developing children and children with mild unilateral cerebral palsy. Dev Med Child Neurol 2018; 60:382-390. [PMID: 29427357 DOI: 10.1111/dmcn.13688] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/01/2022]
Abstract
AIM To compare three reaching movements made in two planes between a low-cost, game-based virtual reality and a matched physical environment in typically developing children and children with cerebral palsy (CP). To determine if differences in kinematics are related to sensory deficits. METHOD An observational study in which 27 children (typically developing, n=17, mean age 13y, [SD] 2y 2mo, range 9y 3mo-17y 2mo; CP, n=10, mean age 13y 8mo, [SD] 1y 8mo, range 11y 1mo-17y 1mo, Manual Ability Classification System levels I-II) performed 15 trials of three gestures in each of a virtual reality and a matched physical environment. Upper-limb and trunk kinematics were recorded using an electromagnetic system (G4, Polhemus, six markers, 120Hz). RESULTS Compared to the physical environment, movements in virtual reality made by typically developing children were slower (p=0.002), and involved less trunk flexion (p=0.002) and rotation (p=0.026). Children with CP had more curved trajectories (p=0.005) and used less trunk flexion (p=0.003) and rotation (p=0.005). Elbow and shoulder kinematics differed from 2.8% to 155.4% between environments in both groups. Between groups, there were small, clinically insignificant differences with only the vertical gesture being longer in typically developing children. Children with CP who had greater tactile impairment used more trunk displacement. INTERPRETATION Clinicians and researchers need to be aware of differences in movement variables when setting goals or designing protocols for improving reaching in children with CP using low-cost, game-based virtual reality systems. WHAT THIS PAPER ADDS Upper-limb kinematics differed in each group when reaching in physical versus virtual environments. There were small differences in movements made by children with mild unilateral cerebral palsy (CP) compared to typically developing children. Differences in reaching kinematics should be considered when goal setting using virtual reality interventions for children with mild unilateral CP.
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Affiliation(s)
- Maxime T Robert
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada
| | - Mindy F Levin
- Integrated Program of Neuroscience, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation, Montreal, QC, Canada.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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Sequence-specific implicit motor learning using whole-arm three-dimensional reach movements. Exp Brain Res 2017; 236:59-67. [PMID: 29075834 PMCID: PMC6530897 DOI: 10.1007/s00221-017-5107-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
Implicit motor learning is essential to the acquisition of motor skills. Examination of implicit motor learning, however, has largely involved single-finger button presses or two-dimensional movements of a computer mouse or joystick. The purpose of this study was to examine sequence-specific implicit motor learning during practice of a three-dimensional (3D) whole-arm reach task. Fifteen young, non-disabled individuals completed two consecutive days of practice of a 3D target task presented in a virtual environment with the dominant, right arm. Stimuli were displayed one at a time and alternated between an eight-target random sequence and an eight-target repeated sequence. Movement of the shoulder and elbow was required to successfully capture a target. Performance was indicated by time to complete a sequence (response time) and analyzed by sequence type (random, repeated). Kinematic data (total distance to complete a sequence, peak velocity, and time to peak velocity) were used to determine how movement changed over time. Results showed significant improvements in performance early in practice, regardless of sequence type. However, individuals completed the repeated sequence faster than the random sequence, indicating sequence-specific implicit motor learning. The difference in response time between the sequence types was driven by the total distance of the hand path; the distance traveled for the repeated sequence was shorter than the distance of the random sequence. Examination of implicit motor learning using 3D reach movements provides the opportunity to study learning using whole-arm movements, an important component of many real-world, functional tasks.
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30
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Combining Upper Limb Robotic Rehabilitation with Other Therapeutic Approaches after Stroke: Current Status, Rationale, and Challenges. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8905637. [PMID: 29057269 PMCID: PMC5615953 DOI: 10.1155/2017/8905637] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 07/12/2017] [Accepted: 08/10/2017] [Indexed: 01/19/2023]
Abstract
A better understanding of the neural substrates that underlie motor recovery after stroke has led to the development of innovative rehabilitation strategies and tools that incorporate key elements of motor skill relearning, that is, intensive motor training involving goal-oriented repeated movements. Robotic devices for the upper limb are increasingly used in rehabilitation. Studies have demonstrated the effectiveness of these devices in reducing motor impairments, but less so for the improvement of upper limb function. Other studies have begun to investigate the benefits of combined approaches that target muscle function (functional electrical stimulation and botulinum toxin injections), modulate neural activity (noninvasive brain stimulation), and enhance motivation (virtual reality) in an attempt to potentialize the benefits of robot-mediated training. The aim of this paper is to overview the current status of such combined treatments and to analyze the rationale behind them.
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31
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Broeren J, Rydmark M, Björkdahl A, Sunnerhagen KS. Assessment and Training in a 3-Dimensional Virtual Environment With Haptics: A Report on 5 Cases of Motor Rehabilitation in the Chronic Stage After Stroke. Neurorehabil Neural Repair 2016; 21:180-9. [PMID: 17312093 DOI: 10.1177/1545968306290774] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. This exploratory study assessed the possible effectiveness of hemiparetic upper extremity training in subjects with chronic stroke with computer instrumentation (haptic force feedback) and 3-dimensional visualization applied to computer games, as well as to evaluate concurrent computer-assisted assessment of the kinematics of movements and test whether any improvement detected in the computer environment was reflected in activities of daily living (ADLs). Methods. A single-subject repeated-measures experimental design (AB) was used. After baseline testing, 5 patients were assigned to the therapy 3 times a week for 45 min for 5 weeks. Velocity, time needed to reach, and hand path ratio (reflecting superfluous movements) were the outcome measures, along with the Assessment of Motor and Process Skills and the Box and Block test. The follow-up phase (C) occurred 12 weeks later. Results. Improvements were noted in velocity, time, and hand path ratio. One patient showed improvement in occupational performance in ADLs. Conclusions.The application of this strategy of using virtual reality (VR) technologies may be useful in assessing and training stroke patients. The results of this study must be reproduced in further studies. The VR systems can be placed in homes or other nonclinical settings.
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Affiliation(s)
- Jurgen Broeren
- Rehabilitation Medicine Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
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Kiper P, Szczudlik A, Venneri A, Stozek J, Luque-Moreno C, Opara J, Baba A, Agostini M, Turolla A. Computational models and motor learning paradigms: Could they provide insights for neuroplasticity after stroke? An overview. J Neurol Sci 2016; 369:141-148. [PMID: 27653881 DOI: 10.1016/j.jns.2016.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 08/08/2016] [Accepted: 08/09/2016] [Indexed: 01/08/2023]
Abstract
Computational approaches for modelling the central nervous system (CNS) aim to develop theories on processes occurring in the brain that allow the transformation of all information needed for the execution of motor acts. Computational models have been proposed in several fields, to interpret not only the CNS functioning, but also its efferent behaviour. Computational model theories can provide insights into neuromuscular and brain function allowing us to reach a deeper understanding of neuroplasticity. Neuroplasticity is the process occurring in the CNS that is able to permanently change both structure and function due to interaction with the external environment. To understand such a complex process several paradigms related to motor learning and computational modeling have been put forward. These paradigms have been explained through several internal model concepts, and supported by neurophysiological and neuroimaging studies. Therefore, it has been possible to make theories about the basis of different learning paradigms according to known computational models. Here we review the computational models and motor learning paradigms used to describe the CNS and neuromuscular functions, as well as their role in the recovery process. These theories have the potential to provide a way to rigorously explain all the potential of CNS learning, providing a basis for future clinical studies.
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Affiliation(s)
- Pawel Kiper
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy.
| | - Andrzej Szczudlik
- Jagiellonian University Medical College, ul. Sw. Anny 12, 31-008 Krakow, Poland
| | - Annalena Venneri
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
| | - Joanna Stozek
- The University of Physical Education, Al. Jana Pawla II 78, 31-571 Krakow, Poland
| | - Carlos Luque-Moreno
- Department of Physical Therapy, The University of Seville, C/Avicena S/N, 41009 Seville, Spain; Motion Analysis Laboratory, Virgen del Rocio Hospital, Avda. Manuel Siurot S/N, 41013 Seville, Spain
| | - Jozef Opara
- Academy of Physical Education, ul. Mikolowska 72a, 40-065 Katowice, Poland
| | - Alfonc Baba
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Michela Agostini
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy
| | - Andrea Turolla
- Laboratory of Kinematics and Robotics, IRCCS San Camillo Hospital Foundation, via Alberoni 70, 30126 Venice, Italy; Department of Neuroscience, The University of Sheffield, 385a Glossop Road, S10 2HQ Sheffield, UK
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Borrego A, Latorre J, Llorens R, Alcañiz M, Noé E. Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters. J Neuroeng Rehabil 2016; 13:68. [PMID: 27503112 PMCID: PMC4977644 DOI: 10.1186/s12984-016-0174-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 07/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though virtual reality (VR) is increasingly used in rehabilitation, the implementation of walking navigation in VR still poses a technological challenge for current motion tracking systems. Different metaphors simulate locomotion without involving real gait kinematics, which can affect presence, orientation, spatial memory and cognition, and even performance. All these factors can dissuade their use in rehabilitation. We hypothesize that a marker-based head tracking solution would allow walking in VR with high sense of presence and without causing sickness. The objectives of this study were to determine the accuracy, the jitter, and the lag of the tracking system and its elicited sickness and presence in comparison of a CAVE system. METHODS The accuracy and the jitter around the working area at three different heights and the lag of the head tracking system were analyzed. In addition, 47 healthy subjects completed a search task that involved navigation in the walking VR system and in the CAVE system. Navigation was enabled by natural locomotion in the walking VR system and through a specific device in the CAVE system. An HMD was used as display in the walking VR system. After interacting with each system, subjects rated their sickness in a seven-point scale and their presence in the Slater-Usoh-Steed Questionnaire and a modified version of the Presence Questionnaire. RESULTS Better performance was registered at higher heights, where accuracy was less than 0.6 cm and the jitter was about 6 mm. The lag of the system was 120 ms. Participants reported that both systems caused similar low levels of sickness (about 2.4 over 7). However, ratings showed that the walking VR system elicited higher sense of presence than the CAVE system in both the Slater-Usoh-Steed Questionnaire (17.6 ± 0.3 vs 14.6 ± 0.6 over 21, respectively) and the modified Presence Questionnaire (107.4 ± 2.0 vs 93.5 ± 3.2 over 147, respectively). CONCLUSIONS The marker-based solution provided accurate, robust, and fast head tracking to allow navigation in the VR system by walking without causing relevant sickness and promoting higher sense of presence than CAVE systems, thus enabling natural walking in full-scale environments, which can enhance the ecological validity of VR-based rehabilitation applications.
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Affiliation(s)
- Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain. .,Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain.
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA, Fundación Hospitales NISA, Río Tajo 1, 46011, Valencia, Spain
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Colomer C, Llorens R, Noé E, Alcañiz M. Effect of a mixed reality-based intervention on arm, hand, and finger function on chronic stroke. J Neuroeng Rehabil 2016; 13:45. [PMID: 27169462 PMCID: PMC4864937 DOI: 10.1186/s12984-016-0153-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Virtual and mixed reality systems have been suggested to promote motor recovery after stroke. Basing on the existing evidence on motor learning, we have developed a portable and low-cost mixed reality tabletop system that transforms a conventional table in a virtual environment for upper limb rehabilitation. The system allows intensive and customized training of a wide range of arm, hand, and finger movements and enables interaction with tangible objects, while providing audiovisual feedback of the participants’ performance in gamified tasks. This study evaluates the clinical effectiveness and the acceptance of an experimental intervention with the system in chronic stroke survivors. Methods Thirty individuals with stroke were included in a reversal (A-B-A) study. Phase A consisted of 30 sessions of conventional physical therapy. Phase B consisted of 30 training sessions with the experimental system. Both interventions involved flexion and extension of the elbow, wrist, and fingers, and grasping of different objects. Sessions were 45-min long and were administered three to five days a week. The body structures (Modified Ashworth Scale), functions (Motricity Index, Fugl-Meyer Assessment Scale), activities (Manual Function Test, Wolf Motor Function Test, Box and Blocks Test, Nine Hole Peg Test), and participation (Motor Activity Log) were assessed before and after each phase. Acceptance of the system was also assessed after phase B (System Usability Scale, Intrinsic Motivation Inventory). Results Significant improvement was detected after the intervention with the system in the activity, both in arm function measured by the Wolf Motor Function Test (p < 0.01) and finger dexterity measured by the Box and Blocks Test (p < 0.01) and the Nine Hole Peg Test (p < 0.01); and participation (p < 0.01), which was maintained to the end of the study. The experimental system was reported as highly usable, enjoyable, and motivating. Conclusions Our results support the clinical effectiveness of mixed reality interventions that satisfy the motor learning principles for upper limb rehabilitation in chronic stroke survivors. This characteristic, together with the low cost of the system, its portability, and its acceptance could promote the integration of these systems in the clinical practice as an alternative to more expensive systems, such as robotic instruments. Electronic supplementary material The online version of this article (doi:10.1186/s12984-016-0153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolina Colomer
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Roberto Llorens
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain. .,Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.
| | - Enrique Noé
- Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
| | - Mariano Alcañiz
- Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain.,Ciber, Fisiopatología Obesidad y Nutrición, CB06/03 Instituto de Salud Carlos III, Av. Sos Baynat s/n, Univesity of Jaume I, Castellón, 12071, Spain
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Kato N, Tanaka T, Sugihara S, Shimizu K, Kudo N. A study of the effect of visual depth information on upper limb movement by use of measurement of smoothness. J Phys Ther Sci 2016; 28:1134-41. [PMID: 27190441 PMCID: PMC4868201 DOI: 10.1589/jpts.28.1134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study verified that the smoothness of reaching movements is able to quantitatively evaluate the effects of two- and three-dimensional images on movement in healthy people. In addition, clinical data of cerebrovascular accident patients were also analyzed by the same method. [Subjects] Ten healthy adult volunteers and two male patients with previous cerebrovascular accidents participated. [Methods] The subjects were tasked with reaching for objects shown on a display. The target and virtual limb, rendered with computer graphics, were shown on the display. Movements of the virtual limb were synchronized with those of the subject. Healthy subjects reached for targets with their dominant arm, and cerebrovascular accident patients used their paretic arm. A polarized display and polarized glasses were used when the subjects were shown three-dimensional images. In the present study, jerk cost was used to quantify the smoothness of movement. [Results] Six of the 10 healthy subjects had significantly smoother reaching movements when viewing the three-dimensional images. The two cerebrovascular accident patients tended to have smoother movements in response to the three-dimensional images. [Conclusion] Analysis of the smoothness of movement was able to detect the influence of the depth cue in vision on movement quantitatively for the healthy subjects and cerebrovascular accident patients.
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Affiliation(s)
- Norio Kato
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Toshiaki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences,
Hokkaido University of Scienc,
Japan
- Graduate School of Information Science and Technology,
Hokkaido University, Japan
| | - Syunichi Sugihara
- Institute of Gerontology, The University of Tokyo,
Japan
- Sapporo Syuyukai Hospital, Japan
| | - Koichi Shimizu
- Institute of Gerontology, The University of Tokyo,
Japan
| | - Nobuki Kudo
- Institute of Gerontology, The University of Tokyo,
Japan
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Tao G, Archambault PS. Powered wheelchair simulator development: implementing combined navigation-reaching tasks with a 3D hand motion controller. J Neuroeng Rehabil 2016; 13:3. [PMID: 26786110 PMCID: PMC4717555 DOI: 10.1186/s12984-016-0112-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Powered wheelchair (PW) training involving combined navigation and reaching is often limited or unfeasible. Virtual reality (VR) simulators offer a feasible alternative for rehabilitation training either at home or in a clinical setting. This study evaluated a low-cost magnetic-based hand motion controller as an interface for reaching tasks within the McGill Immersive Wheelchair (miWe) simulator. Methods Twelve experienced PW users performed three navigation-reaching tasks in the real world (RW) and in VR: working at a desk, using an elevator, and opening a door. The sense of presence in VR was assessed using the iGroup Presence Questionnaire (IPQ). We determined concordance of task performance in VR with that in the RW. A video task analysis was performed to analyse task behaviours. Results Compared to previous miWe data, IPQ scores were greater in the involvement domain (p < 0.05). Task analysis showed most of navigation and reaching behaviours as having moderate to excellent (K > 0.4, Cohen’s Kappa) agreement between the two environments, but greater (p < 0.05) risk of collisions and reaching errors in VR. VR performance demonstrated longer (p < 0.05) task times and more discreet movements for the elevator and desk tasks but not the door task. Conclusions Task performance showed poorer kinematic performance in VR than RW but similar strategies. Therefore, the reaching component represents a promising addition to the miWe training simulator, though some limitations must be addressed in future development.
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Affiliation(s)
- Gordon Tao
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. .,Interdisciplinary Research Center in Rehabilitation (CRIR), Hôpital Juif de Réadaptation, 3205 Place Alton Goldbloom, Laval, QC, H7V 1R2, Canada.
| | - Philippe S Archambault
- School of Physical and Occupational Therapy, McGill University, 3654 prom Sir-William-Osler, Montréal, QC, H3G 1Y5, Canada. .,Interdisciplinary Research Center in Rehabilitation (CRIR), Hôpital Juif de Réadaptation, 3205 Place Alton Goldbloom, Laval, QC, H7V 1R2, Canada.
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Sonar HA, Paik J. Soft Pneumatic Actuator Skin with Piezoelectric Sensors for Vibrotactile Feedback. Front Robot AI 2016. [DOI: 10.3389/frobt.2015.00038] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hosang S, Chan J, Davarpanah Jazi S, Heath M. Grasping a 2D object: terminal haptic feedback supports an absolute visuo-haptic calibration. Exp Brain Res 2015; 234:945-54. [DOI: 10.1007/s00221-015-4521-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
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Levin MF, Magdalon EC, Michaelsen SM, Quevedo AAF. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in Individuals With Stroke. IEEE Trans Neural Syst Rehabil Eng 2015; 23:1047-55. [PMID: 25594971 DOI: 10.1109/tnsre.2014.2387412] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reaching and grasping parameters with and without haptic feedback were characterized in people with chronic post-stroke behaviors. Twelve (67 ± 10 years) individuals with chronic stroke and arm/hand paresis (Fugl-Meyer Assessment-Arm: ≥ 46/66 pts) participated. Three dimensional (3-D) temporal and spatial kinematics of reaching and grasping movements to three objects (can: cylindrical grasp; screwdriver: power grasp; pen: precision grasp) in a physical environment (PE) with and without additional haptic feedback and a 3-D virtual environment (VE) with haptic feedback were recorded. Participants reached, grasped and transported physical and virtual objects using similar movement strategies in all conditions. Reaches made in VE were less smooth and slower compared to the PE. Arm and trunk kinematics were similar in both environments and glove conditions. For grasping, stroke subjects preserved aperture scaling to object size but used wider hand apertures with longer delays between times to maximal reaching velocity and maximal grasping aperture. Wearing the glove decreased reaching velocity. Our results in a small group of subjects suggest that providing haptic information in the VE did not affect the validity of reaching and grasping movement. Small disparities in movement parameters between environments may be due to differences in perception of object distance in VE. Reach-to-grasp kinematics to smaller objects may be improved by better 3-D rendering. Comparable kinematics between environments and conditions is encouraging for the incorporation of high quality VEs in rehabilitation programs aimed at improving upper limb recovery.
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Mao Y, Chen P, Li L, Huang D. Virtual reality training improves balance function. Neural Regen Res 2014; 9:1628-34. [PMID: 25368651 PMCID: PMC4211206 DOI: 10.4103/1673-5374.141795] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/23/2022] Open
Abstract
Virtual reality is a new technology that simulates a three-dimensional virtual world on a computer and enables the generation of visual, audio, and haptic feedback for the full immersion of users. Users can interact with and observe objects in three-dimensional visual space without limitation. At present, virtual reality training has been widely used in rehabilitation therapy for balance dysfunction. This paper summarizes related articles and other articles suggesting that virtual reality training can improve balance dysfunction in patients after neurological diseases. When patients perform virtual reality training, the prefrontal, parietal cortical areas and other motor cortical networks are activated. These activations may be involved in the reconstruction of neurons in the cerebral cortex. Growing evidence from clinical studies reveals that virtual reality training improves the neurological function of patients with spinal cord injury, cerebral palsy and other neurological impairments. These findings suggest that virtual reality training can activate the cerebral cortex and improve the spatial orientation capacity of patients, thus facilitating the cortex to control balance and increase motion function.
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Affiliation(s)
- Yurong Mao
- Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Peiming Chen
- Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Le Li
- Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Dongfeng Huang
- Department of Rehabilitation Medicine, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Sandlund M, Domellöf E, Grip H, Rönnqvist L, Häger CK. Training of goal directed arm movements with motion interactive video games in children with cerebral palsy - a kinematic evaluation. Dev Neurorehabil 2014; 17:318-26. [PMID: 23863100 DOI: 10.3109/17518423.2013.776124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context. METHOD Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets. RESULTS The children's movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness. CONCLUSION Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.
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Affiliation(s)
- Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Umeå University , Umeå , Sweden and
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Kottink AI, Prange GB, Krabben T, Rietman JS, Buurke JH. Gaming and Conventional Exercises for Improvement of Arm Function After Stroke: A Randomized Controlled Pilot Study. Games Health J 2014. [DOI: 10.1089/g4h.2014.0026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anke I.R. Kottink
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Gerdienke B. Prange
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Mechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Thijs Krabben
- Roessingh Research and Development, Enschede, The Netherlands
| | - Johan S. Rietman
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Mechanical Engineering, University of Twente, Enschede, The Netherlands
- Department of Rehabilitation, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jaap H. Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
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Weiss PL, Keshner EA, Levin MF. Current and Future Trends for VR and Motor Rehabilitation. VIRTUAL REALITY FOR PHYSICAL AND MOTOR REHABILITATION 2014. [DOI: 10.1007/978-1-4939-0968-1_11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Haptic-based neurorehabilitation in poststroke patients: a feasibility prospective multicentre trial for robotics hand rehabilitation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:895492. [PMID: 24319496 PMCID: PMC3844272 DOI: 10.1155/2013/895492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/11/2013] [Indexed: 11/18/2022]
Abstract
Background. Haptic
robots allow the exploitation of known motor
learning mechanisms, representing a valuable
option for motor treatment after stroke. The aim
of this feasibility multicentre study was to
test the clinical efficacy of a haptic
prototype, for the recovery of hand function
after stroke. Methods. A
prospective pilot clinical trial was planned on
15 consecutive patients enrolled in 3
rehabilitation centre in Italy. All the
framework features of the haptic robot (e.g.,
control loop, external communication, and graphic
rendering for virtual reality) were implemented
into a real-time MATLAB/Simulink environment,
controlling a five-bar linkage able to provide
forces up to 20 [N] at the end effector, used
for finger and hand rehabilitation therapies.
Clinical (i.e., Fugl-Meyer upper extremity
scale; nine hold pegboard test) and kinematics
(i.e., time; velocity; jerk metric;
normalized jerk of standard movements) outcomes
were assessed before and after treatment to
detect changes in patients' motor performance.
Reorganization of cortical activation was
detected in one patient by fMRI. Results
and Conclusions. All patients showed
significant improvements in both clinical and
kinematic outcomes. Additionally, fMRI results
suggest that the proposed approach may promote a
better cortical activation in the
brain.
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Edwards J, Vess J, Reger G, Cernich A. The use of virtual reality in the military's assessment of service members with traumatic brain injury: recent developments and emerging opportunities. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:220-30. [PMID: 25084846 DOI: 10.1080/09084282.2013.796554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Traumatic brain injury (TBI) is a common event in the current extended conflicts by American service members, with estimates that as many as 300,000 have sustained combat-related concussions during Operation Iraqi Freedom and Operation Enduring Freedom. The limited ecological validity of traditional neuropsychological assessment measures presents a challenge to effective postconcussion evaluation of service members in relation to fitness-for-duty decisions or rehabilitation needs. Virtual reality (VR) technology offers a promising opportunity to advance the field of functional assessment for TBI. This article reviews the current professional literature on VR applications for TBI assessment, with special emphasis on those that are particularly relevant to U.S. service members. VR affords several advantages for clinical use. These include assessment of complex sets of cognitive and behavioral functions rather than the isolated components assessed by traditional measures; more precise control over the standardized presentation of task stimuli and the recording of response data; and enhanced ecological validity that can lead to more useful assessment data in the applied contexts faced by the U.S. military.
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Affiliation(s)
- Joe Edwards
- a Department of Behavioral Health , TBI Clinic , Ft. Wainwright , Alaska
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Broeren J, Sunnerhagen KS, Rydmark M. Haptic virtual rehabilitation in stroke: transferring research into clinical practice. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331909x12488667117212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Crosbie JH, McNeill MDJ, Burke J, McDonough S. Utilising technology for rehabilitation of the upper limb following stroke: the Ulster experience. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331909x12540993897892] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Schafer AY, Ustinova KI. Does use of a virtual environment change reaching while standing in patients with traumatic brain injury? J Neuroeng Rehabil 2013; 10:76. [PMID: 23866962 PMCID: PMC3733631 DOI: 10.1186/1743-0003-10-76] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 06/14/2013] [Indexed: 12/01/2023] Open
Abstract
Background Although numerous virtual reality applications have been developed for sensorimotor retraining in neurologically impaired individuals, it is unclear whether the virtual environment (VE) changes motor performance, especially in patients with brain injuries. To address this question, the movement characteristics of forward arm reaches during standing were compared in physical and virtual environments, presented at different viewing angles. Methods Fifteen patients with traumatic brain injuries (TBI) and 15 sex- and age-matched healthy individuals performed virtual reaches in a computer-generated courtyard with a flower-topped hedge. The hedge was projected on a flat screen and viewed in 3D format in 1 of 3 angles: 10° above horizon (resembling a real-world viewing angle), 50° above horizon, or 90° above horizon (directly overhead). Participants were instructed to reach with their dominant hand avatar and to touch the farthest flower possible without losing their balance or stepping. Virtual reaches were compared with reaches-to-point to a target in an equivalent physical environment. A set of kinematic parameters was used. Results Reaches by patients with TBI were characterized by shorter distances, lower peak velocities, and smaller postural displacements than reaches by control individuals. All participants reached ~9% farther in the VE presented at a 50° angle than they did in the physical environment. Arm displacement in the more natural 10° angle VE was reduced by the same 9-10% compared to physical reaches. Virtual reaches had smaller velocity peaks and took longer than physical reaches. Conclusion The results suggest that visual perception in the VE differs from real-world perception and the performance of functional tasks (e.g., reaching while standing) can be changed in TBI patients, depending on the viewing angle. Accordingly, the viewing angle is a critical parameter that should be adjusted carefully to achieve maximal therapeutic effect during practice in the VE.
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Affiliation(s)
- Amanda Y Schafer
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, MI, USA
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Tanaka T, Kudo A, Sugihara S, Izumi T, Maeda Y, Kato N, Miyasaka T, Holden MK. A study of upper extremity training for patients with stroke using a virtual environment system. J Phys Ther Sci 2013; 25:575-80. [PMID: 24259805 PMCID: PMC3804986 DOI: 10.1589/jpts.25.575] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022] Open
Abstract
[Purpose] A virtual environment (VE) system was designed to facilitate the retraining of
motor control by feedback of movement trajectory to patients with neurological
impairments, such as stroke victims or those with an acquired brain injury. In this study,
we quantitatively assessed motion trajectory of the upper extremity during VE in order to
further understand the effect of paralyzed upper extremity movement in VE for each patient
as well as the functional clinical evaluations. [Subjects and Methods] Six patients with
stroke were participated in this study. The VE system consisted of a computer, an
electromagnetic motion tracking device, which monitored and displayed patient movement on
the computer, and the VE software, which provided the tools for creating training scenes.
This system was used to facilitate motor relearning of the upper extremity for six
patients with stroke. [Results] The results showed there were improvements in variability
and accuracy of the arm movement in motion trajectory. In addition, the scores of clinical
evaluations improved, and VE did not hinder motor relearning of the upper extremity, which
is necessary for activities of daily living. [Conclusion] This VE system might be
effective at facilitating motor relearning of the upper extremity for stroke patients.
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Affiliation(s)
- Toshiaki Tanaka
- Research Center for Advanced Science and Technology, The University of Tokyo
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Schütz C, Schack T. Motor primitives of pointing movements in a three-dimensional workspace. Exp Brain Res 2013; 227:355-65. [PMID: 23604576 DOI: 10.1007/s00221-013-3516-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Christoph Schütz
- Faculty of Psychology and Sports Science, Bielefeld University, Universitätsstrasse 25, P.O. Box 100 131, 33615 Bielefeld, Germany.
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