The impact of positive, negative and neutral stimuli in a virtual reality cognitive-motor rehabilitation task: a pilot study with stroke patients

Cognitive-motor interventions based on virtual reality and instrumental activities of daily living (iADL): an overview

Non-invasive, non-pharmacological interventions utilizing virtual reality (VR) represent a promising approach to enhancing cognitive function in patients with degenerative cognitive disorders. Traditional "pen and paper" therapies often lack the practical engagement in everyday activities that older individuals encounter in their environment. These activities pose both cognitive and motor challenges, underscoring the necessity of understanding the outcomes of such combined interventions. This review aimed to assess the advantages of VR applications that integrate cognitive-motor tasks, simulating instrumental activities of daily living (iADLs). We systematically searched five databases-Scopus, Web of Science, Springer Link, IEEE Xplore, and PubMed, from their inception until January 31, 2023. Our review revealed that motor movements, coupled with VR-based cognitive-motor interventions, activate specific brain areas and foster improvements in general cognition, executive function, attention, and memory. VR applications that meld cognitive-motor tasks and simulate iADLs can offer significant benefits to older adults. Enhanced cognitive and motor performance can promote increased independence in daily activities, thereby contributing to improved quality of life.

Extended reality for biomedicine

Extended reality (XR) refers to an umbrella of methods that allows users to be immersed in a three-dimensional (3D) or a 4D (spatial + temporal) virtual environment to different extents, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). While VR allows a user to be fully immersed in a virtual environment, AR and MR overlay virtual objects over the real physical world. The immersion and interaction of XR provide unparalleled opportunities to extend our world beyond conventional lifestyles. While XR has extensive applications in fields such as entertainment and education, its numerous applications in biomedicine create transformative opportunities in both fundamental research and healthcare. This Primer outlines XR technology from instrumentation to software computation methods, delineating the biomedical applications that have been advanced by state-of-the-art techniques. We further describe the technical advances overcoming current limitations in XR and its applications, providing an entry point for professionals and trainees to thrive in this emerging field.

Work Emotion Intervention and Guidance Training Method for Enterprise Employees Based on Virtual Reality

Objective

Improper management of employees' emotions has a great impact on work status and work efficiency, and emotional management has increasingly become a very important part of corporate human resource management. How to adjust the various emotions of employees, so that employees can work in a fuller and more passionate attitude, is a problem that enterprise managers need to consider. From the perspective of employees themselves, a good mood will also bring happiness and satisfaction to life and work. Only in this way can the company and the employees be satisfied with each other and continue to maintain the good development momentum of the company.

Method

This paper proposes a new method of using virtual reality scenes to induce human emotions. Based on computer science and psychological cognitive science, a scene library of "virtual reality emotion induction system" is constructed. Emotion induction based on virtual reality scenes has better interactivity and generalization, as well as stronger immersion and user operability. Its emotional arousal is high, the data is reliable, and the interference of environmental factors in the induction process is weakened, and relatively objective emotional data can be obtained. The factors affecting the emotional management of the enterprise are investigated by means of a questionnaire survey, statistics and problems are found, and the objective problems existing in the emotional management work of the company are determined. According to the analysis, the problems are summarized, and it is believed that the company still has certain room for improvement and improvement potential in terms of corporate culture construction, emotional counseling system construction, and human resource career planning. In the research of this paper, through the combination of theory and practice, the enterprise's emotional management work has been comprehensively analyzed, and the practical problems existing in its emotional management work have been found through questionnaires. Results/Discussion. In the field of enterprise human resource management, emotion management is always an eternal topic worthy of our attention. But unfortunately, emotional management has not been given enough attention by managers. Most companies often think that emotions are their own business. Employees should self-regulate, control, and tolerate themselves. They should not bring personal emotions to work and even think that emotional work is unprofessional. This kind of misunderstanding has led to the fact that emotional management has not received due attention and affirmation in many enterprises.

Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects

Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.

What can virtual reality offer to stroke patients? A narrative review of the literature

BACKGROUND

Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients.

OBJECTIVES

To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions.

METHODS

An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included.

RESULTS

In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included.

CONCLUSION

The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.

Benefits of emotion-based training for the rehabilitation of stroke patients: A scoping review

BACKGROUND

The application of emotional stimuli is beneficial when practicing tasks that must be learned.

OBJECTIVE

This scoping review examined related literature to identify the applicability of emotion-based training for therapeutic activities.

METHOD

All relevant literature published as of April 1, 2020 in four prominent databases was searched (CINAHL, Embase, PubMed, and PsycINFO) using the five-stage review framework proposed by Arksey and O'Malley.

RESULTS

After sophisticated searches and exclusions, ten publications were included for further review. Our results revealed three types of emotion-based stimulation methods that can influence therapeutic effects on stroke patients. However, the research did not compare the difference between the pros, cons, and effectiveness of each type of sensory stimulation.

CONCLUSION

Rehabilitation specialists are encouraged to obtain a broad understanding of therapeutic situations and their possible impacts on a given environment.

Effects of Presence and Challenge Variations on Emotional Engagement in Immersive Virtual Environments

Serious games and immersive virtual reality promote emotional engagement during learning tasks, mostly by providing (1) skill-adapted challenges with performance feedback (for trial and error learning) and (2) enhanced presence (further reactions to multimodal stimuli), respectively. However, it is still unclear how each of these two strategies independently influence emotional states to engage subjects to a task. This study assessed the dimensions of emotion (valence-arousal-dominance) of 87 healthy subjects in a virtual game, assigned to 2 groups that were exposed to a different set of 5 trials: Group A experienced game variations by virtual factors affecting user's presence, whereas group B experienced levels of difficulty, affecting challenge. Emotional reports and 26 features extracted from physiological signals were statistically analyzed. Results showed that presence-based experimental conditions were able to modify the sense of arousal, whereas valence and dominance responded to challenge variation, i.e. were positively correlated with game score. Arousal is likely to increase with low sense of coexistence (social presence) and decrease with low scenario realism (physical presence). Faster breathing and higher skin conductance (SC) were detected at high challenge, whereas heart rate variability and SC increased with higher arousal. The evidence from this study suggests that both strategies can be used to separately influence dimensions of emotion, pointing out the customization of presence-based factors as a promising method to adjust emotional engagement by impacting arousal. Further research should be undertaken to identify the independent effect of single presence factors on emotional states.

Virtual reality exposure therapy for neuro-psychomotor recovery in adults: a systematic review

OBJECTIVE

To analyse the virtual reality applications in the subjects' neuro-psychomotor functions rehabilitation with motor and/or neuropsychiatric impairment.

METHODS

The search was carried out in nine databases (Scopus, PubMed, Web of Science, ScienceDirect, Cochrane Library, CINAHL, PsycINFO, LILACS, and SciELO), from December 2017 to March 2019. An additional manual search was performed, taking into consideration references of the included papers, through the same eligibility criteria. The methodological quality of the included papers was evaluated using the Physiotherapy Evidence Database (PEDro).

RESULTS

One hundred and twenty-two papers were selected by the initial screening, but only 33 studies participated in the final inclusion in the study (11 clinical trials and 14 experimental studies). The data extracted were: the proposed objective, the sample population, the neurological condition treated, the VR modality used in the procedures and the study intervention period.

CONCLUSIONS

Virtual reality supports the rehabilitation process of neuro-psychomotor functions, allowing potential gains in the patients' recovery. Therefore, its development facilitates its availability and access in the future.Implications for rehabilitationIt has minimal adverse effects during the virtual therapies performance, such as the presence of vertigo related to cybersickness conditions, suggesting virtual reality as a safe rehabilitation tool, compared to other therapies.Virtual reality use is useful and effective in helping the rehabilitation process of motor, cognitive and psychosocial functions.It plays a role as an adjunctive and complementary therapy in the neuro-psychomotor rehabilitation process to obtain a clinically significant result.

Development of a robotic upper limb assessment to configure a serious game

BACKGROUNDROBiGAME project aims to implement serious games on robots to rehabilitate upper limb (UL) in stroke patients. The serious game characteristics (target position, level of assistance/resistance, level of force) are adapted based on the patient's assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength).OBJECTIVETo develop an UL robotic motor assessment protocol to configure the serious game.METHODS32 healthy subjects and 20 stroke patients participated in the study. Subjects were clinically assessed (UL length and isometric force) and using a robot. The robot assessment consisted of the patient's UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances.RESULTSThe WA and the UL isometric force were moderately to highly correlated with clinical measures (respectively ρ= 0.52; p = 0.003, ρ= 0.68-0.73; p < 0.001). Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all subjects increased when subjects had to reach to targets placed more distantly (r= 0.82-0.90; ρ= 0.86-0.90 respectively; p < 0.001).CONCLUSIONSThis protocol can be integrated into a serious game in order to continuously configure the game characteristics to patient's performance.

Closing the Loop: From Motor Neuroscience to Neurorehabilitation

The fields of human motor control, motor learning, and neurorehabilitation have long been linked by the intuition that understanding how we move (and learn to move) leads to better rehabilitation. In reality, these fields have remained largely separate. Our knowledge of the neural control of movement has expanded, but principles that can directly impact rehabilitation efficacy remain somewhat sparse. This raises two important questions: What can basic studies of motor learning really tell us about rehabilitation, and are we asking the right questions to improve the lives of patients? This review aims to contextualize recent advances in computational and behavioral studies of human motor learning within the framework of neurorehabilitation. We also discuss our views of the current challenges facing rehabilitation and outline potential clinical applications from recent theoretical and basic studies of motor learning and control.