Immersive Virtual Environments and Wearable Haptic Devices in rehabilitation of children with neuromotor impairments: a single-blind randomized controlled crossover pilot study

A Glove-Based Virtual Hand Rehabilitation System for Patients With Post-Traumatic Hand Injuries

Recent studies have shown that virtual gamified therapy can be a potential adjunct to conventional orthopedic rehabilitation. However, the off-the-shelf gaming consoles used for virtual rehabilitation pose several practical challenges in deploying them in clinical settings. In this article, we present the design of a portable glove-based virtual hand rehabilitation system (RehabRelive Glove) that can be used at both clinics and homes for physiotherapy. We also evaluate the system's efficacy on patients with post-traumatic hand injuries. Thirty patients were randomly categorized into groups A (virtual rehabilitation) and B (conventional physiotherapy). Both groups received fifteen 25-minute sessions of respective therapy over three weeks. The wrist and finger joints' range of motion (ROM) and grip strength were measured every seven sessions to compare the efficacy. Group A showed about 1.5 times greater improvement in flexion/extension ROM of the wrist compared to Group B. While both groups improved finger ROM and grip strength with time, no significant difference was observed between the groups. The results suggest that the proposed virtual rehabilitation system effectively enables patients with hand injuries to recover ROM faster.

Evaluating the impact of virtual reality game training on upper limb motor performance in children and adolescents with developmental coordination disorder: a scoping review using the ICF framework

OBJECTIVE

This scoping review aims to explore published literature testing Virtual Reality (VR) interventions for improving upper limb motor performance in children and adolescents with Developmental Coordination Disorder (DCD). Our primary focus was on the types of VR systems used and the measurement tools employed within the International Classification of Functioning, Disability and Health Children and Youth Version (ICF-CY) domains in these studies.

METHODS

A comprehensive search of six electronic databases up to 11th January 2024 was conducted using predefined terms. Inclusion and exclusion criteria were applied to determine study eligibility, with two authors independently assessing titles, abstracts, and full-text articles.

RESULTS

Out of 788 potential studies, 14 met the eligibility criteria. Studies predominantly utilized non-immersive VR (nVR) systems, for example, commercial platforms such as Nintendo Wii. Most interventions targeted general motor coordination or balance, with only four studies specifically focusing on upper limb motor performance. The Movement Assessment Battery for Children-2 was the predominant assessment tool. However, the use of game scores and trial durations raised concerns about the accuracy of assessments. The majority of studies reported no significant improvement in upper limb motor performance following VR interventions, though some noted improvements in specific tasks or overall outcomes.

CONCLUSION

The findings suggest that, while nVR interventions are being explored for paediatric motor rehabilitation, their impact on enhancing upper limb motor performance in children with DCD is unclear. The variability in intervention designs, outcome measures, and the predominant focus on general motor skills rather than specific upper limb improvements highlight the need for more targeted research in this area.

IMPACT

This review underscores the importance of developing precise and clinically relevant measurement tools in a broader range of VR technologies to optimize the use of VR in therapy for children with DCD. Future research should aim for more rigorous study designs and emerging immersive technologies to maximize therapeutic benefits.

The Role of Immersive Virtual Reality Interventions in Pediatric Cerebral Palsy: A Systematic Review across Motor and Cognitive Domains

Background: In recent years, new technologies have been applied in cerebral palsy. Among these, immersive virtual reality is one with promising motor and cognitive effects along with the reduced costs of its application. The level of immersion of the subject in the illusional world gives the feeling of being a real part of the virtual environment. This study aims to investigate the safety and the efficacy of immersive virtual reality in children affected by cerebral palsy. Methods: PubMed, Embase, Cochrane Database of Systematic Reviews, RehabData, and Web of Science were screened up to February 2023 to identify eligible clinical studies. Results: Out of 788, we included 15 studies involving CP patients. There was high heterogeneity in the outcomes considered, and the results showed non-inferiority to conventional therapy and initial additional benefits in comparison with conventional rehabilitation. Conclusions: Immersive virtual reality emerges as a pivotal technological tool in rehabilitation, seamlessly integrating with conventional therapy within CP rehabilitation programs. Indeed, it not only enhances motivation but significantly increases children's functional capacity and abilities.

Role of telerehabilitation in the rehabilitation of children with cerebral palsy during COVID-19: A review

Individuals with cerebral palsy (CP) have limited mobility and are unable to actively participate in tasks that are part of their daily living. Thus, continuous therapeutic sessions are required to keep such individuals active and engaged in the environment. Due to the coronavirus disease of 2019 (COVID-19) lockdowns, rehabilitation for children with CP was inhibited which consequently put them at risk of losing their functional gains which were obtained through previous in-person therapies. In order to avoid this, an alternate to conventional therapy was required and this rendered it necessary to review the role of telerehabilitation (TR) and its various modes for the rehabilitation of children with CP. This study aimed to explore the effectiveness of TR for children with CP during COVID-19 through the present literature and to determine if TR is an alternate to conventional physical therapy in children with CP during the coronavirus outbreak. This scoping review was conducted by searching different databases such as PubMed, Cochrane Collaboration, Medline, and Google Scholar on the basis of inclusion criteria. Screening was performed from January 2019 to June 2022 and the initial screening attempt returned 469 studies. After applying the aforementioned criteria, all impertinent studies were excluded which resulted in 28 studies being included for this review as they contained information about the effectiveness of TR on children with CP during COVID-19. These 28 articles included randomised controlled trials, surveys, reviews, clinical trials, case reports, prospective studies, editorials, and longitudinal studies. Three out of the 7 randomised controlled trial studies revealed that action observation treatment can be a useful approach for TR in child with CP during similar pandemics. The other 3 studies supported the use of computer-based games, robots, nonimmersive virtual reality, and wearable haptic devices as a significant means of TR in child with CP as an alternate to routine therapy during COVID-19. TR is an affable mode of rehabilitation specifically for the pediatric population. In the future, it can be an alternate to routine therapy for those who are unlikely to get daily access to in-person therapeutic sessions due to various reasons or circumstances.

Playfulness and New Technologies in Hand Therapy for Children With Cerebral Palsy: Scoping Review

BACKGROUND

Innovative technologies such as game consoles and smart toys used with games or playful approaches have proven to be successful and attractive in providing effective and motivating hand therapy for children with cerebral palsy (CP). Thus, there is an increased interest in designing and implementing interventions that can improve the well-being of these children. However, to understand how and why these interventions are motivating children, we need a better understanding of the playful elements of technology-supported hand therapy.

OBJECTIVE

This scoping review aims to identify the playful elements and the innovative technologies currently used in hand therapy for children with CP.

METHODS

We included studies that design or evaluate interventions for children with CP that use innovative technologies with game or play strategies. Data were extracted and analyzed based on the type of technology, description of the system, and playful elements according to the Lenses of Play, a play design toolkit. A total of 31 studies were included in the analysis.

RESULTS

Overall, 54 papers were included in the analysis. The results showed high use of consumer technologies in hand therapy for children with CP. Although several studies have used a combination of consumer technologies with therapeutic-specific technologies, only a few studies focused on the exclusive use of therapeutic-specific technologies. To analyze the playfulness of these interventions that make use of innovative technologies, we focused our review on 3 lenses of play: Open-ended Play, where it was found that the characteristics of ludus, such as a structured form of play and defined goals and rules, were the most common, whereas strategies that relate to paidia were less common. The most commonly used Forms of Play were physical or active form and games with rules. Finally, the most popular Playful experiences were control, challenge, and competition.

CONCLUSIONS

The inventory and analysis of innovative technology and playful elements provided in this study can be a starting point for new developments of fun and engaging tools to assist hand therapy for children with CP.

Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study

BACKGROUND

Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living.

OBJECTIVE

This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE.

METHODS

The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction.

RESULTS

The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist's evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value.

CONCLUSIONS

The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology.

Efficacy assessment of virtual reality therapy for neuromotor rehabilitation in home environment: a systematic review

PURPOSE

Neuromotor impairments can affect any part of the body. It leads to many disorders, injuries, or disabilities, conventional rehabilitation is a long, rigorous, and tedious process. There is a need to inculcate new and innovative techniques in rehabilitation processes, to increase individuals' interest and overall performance with such therapies. Virtual Reality is considered a new technology that has the potential to be a useful aid in overcoming therapeutic problems in clinical and home-based environments. However, providing home-based rehabilitation is more practicable, cost-effective, and even safer than in-hospital rehabilitation. In addition, the need for home-based rehabilitation is growing as the number of neuromotor disorders rises and the capacity of acute inpatient rehabilitation decreases. Therefore, the main objective of this study was to assess the efficacy of a home-based Virtual Reality exercise treatment to identify the areas for future rehabilitation research.

MATERIALS AND METHODS

Data Extraction of 24,257 articles from seven databases were identified and the review is narrowed down and only 45 studies were focussed on efficacy assessment of Virtual Reality in the home environment.

RESULTS

The significant outcome of the effective home-based therapy system for the exercise improved functional ability, increasing range of motion, and motivation through Virtual reality-based rehabilitation is inferred.

CONCLUSION

Unlike clinical settings, a home-based system provides efficacious therapy with a controlled environment. This survey facilitates bettering methods and devices for neuromotor disorders. It is a good living long-term problem-solving approach and investigates awareness, needs, and a preferred component of home-based rehabilitation services.IMPLICATIONS FOR REHABILITATIONVR-based rehabilitation in the home environment has many physical and mental benefits in persons with neuromotor disorders.The most commonly neuromotor disorders considered in the study were Stroke, Spinal Cord Injury, Parkinson's disease, and Cerebral Palsy.Assistive technologies in home environments can compensate for long-term disorders or be used in rehabilitation as an addition to conventional therapy.The study gives an overview of current interventions and how they can be of benefit for a person suffering from neuromotor disorders in the home environment.

Does the Level of Focus in Serious Games in Immersive VR Correlate with the Quality of Movement? Preliminary Results from an Ongoing Study on Rehabilitation of Children with Cerebral Palsy

Cerebral palsy (CP), one of the diseases that cause motor deficiency, is a childhood condition characterized by a motor disability (palsy) caused by a non-progressive static lesion in the brain (cerebral) [1], [2]. Rehabilitation of patients with CP is typically accomplished through exercises performed by a team of several specialists so that the patient can act independently or with as little reliance on third parties as possible. In CP, motor disorders are often present together with sensory, perceptual, cognitive, behavioural and communication disorders. Regarding motor disorders, the most frequent outcome is hemiplegia, although diplegic and paraplegic patients are also present [1].

Home-based immersive virtual reality physical rehabilitation in paediatric patients for upper limb motor impairment: a feasibility study

Upper limb motor impairment (ULMI) rehabilitation is a long-term, demanding and challenging process to recover motor functionality. Children and adolescents may be limited in daily life activities due to reduced functions such as decreased joint movement or muscle weakness. Home-based therapy with Immersive Virtual Reality can offer greater accessibility, delivery and early rehabilitation to significantly optimise functional outcomes and quality of life. This feasibility study aimed to explore the perceptions and impacts of an immersive and interactive VR scenario suitable for ULMI rehabilitation for children at home. It was analysed using mixed methods (quantitative and qualitative) and from a multidirectional perspective (patients, clinicians and family members). Amongst the main results, it was found that IVR for ULMI home rehabilitation (1) is easy to learn and acceptable; (2) improves motor function; (3) reduces the difficulty in the reproduction of therapeutic movements; (4) is motivating and enjoyable and (5) improves quality of life. This study is the first study on the use of IVR applied to home rehabilitation of ULMI in children. These results suggested that similar outcomes may be possible with self-directed IVR home rehabilitation compared to face to face conventional rehabilitation, which can be costly to both the patient and the healthcare system, decreasing the length of stay at the hospital and treatment duration. It has also presented an innovative solution to the Covid-19 emergency where children could not receive their clinic therapy. Further research is recommended to understand better the mechanisms involved in physiotherapeutic recovery and how IVR rehabilitation helps to improve conventional treatments. Trial Registration Protocol ID NCT05272436. Release Date: 9th March 2022.

The use of virtual reality in the stimulation of manual function in children with cerebral palsy: a systematic review

OBJECTIVE

To identify in national and international literature the use of virtual reality to develop manual skills of children with cerebral palsy.

METHODS

This is a systematic review carried out in the PubMed database, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and the Online System for Search and Analysis of Medical Literature (Ovid Medline) using the keywords "cerebral palsy", "virtual reality", "occupational therapy", "child", "daily activities/activities of daily living", in English and in Portuguese. The selected articles had their methodological quality evaluated through the Physiotherapy Evidence Database (PEDro scale).

RESULTS

228 studies were selected, as they included children with cerebral palsy undergoing treatment with exposure to virtual reality to improve manual function in daily activities. Studies on other themes, incomplete, and duplicated reviews were excluded. Three evaluators conducted the study selection process and included 14 articles in the analysis.

CONCLUSIONS

The findings suggest that virtual reality therapy has contributed to an improvement in the manual function of children with cerebral palsy, constituting a useful resource for a supporting intervention to enhance traditional therapies.

Collaborative and individual learning of geography in immersive virtual reality: An effectiveness study

Many university-taught courses moved to online form since the outbreak of the global pandemic of coronavirus disease (COVID-19). Distance learning has become broadly used as a result of the widely applied lockdowns, however, many students lack personal contact in the learning process. A classical web-based distance learning does not provide means for natural interpersonal interaction. The technology of immersive virtual reality (iVR) may mitigate this problem. Current research has been aimed mainly at specific instances of collaborative immersive virtual environment (CIVE) applications for learning. The fields utilizing iVR for knowledge construction and skills training with the use of spatial visualizations show promising results. The objective of this study was to assess the effectiveness of collaborative and individual use of iVR for learning geography, specifically training in hypsography. Furthermore, the study's goals were to determine whether collaborative learning would be more effective and to investigate the key elements in which collaborative and individual learning were expected to differ-motivation and use of cognitive resources. The CIVE application developed at Masaryk University was utilized to train 80 participants in inferring conclusions from cartographic visualizations. The collaborative and individual experimental group underwent a research procedure consisting of a pretest, training in iVR, posttest, and questionnaires. A statistical comparison between the geography pretest and posttest for the individual learning showed a significant increase in the score (p = 0.024, ES = 0.128) and speed (p = 0.027, ES = 0.123), while for the collaborative learning, there was a significant increase in the score (p<0.001, ES = 0.333) but not in speed (p = 1.000, ES = 0.000). Thus, iVR as a medium proved to be an effective tool for learning geography. However, comparing the collaborative and individual learning showed no significant difference in the learning gain (p = 0.303, ES = 0.115), speed gain (p = 0.098, ES = 0.185), or performance motivation (p = 0.368, ES = 0.101). Nevertheless, the collaborative learning group had significantly higher use of cognitive resources (p = 0.046, ES = 0.223) than the individual learning group. The results were discussed in relation to the cognitive load theories, and future research directions for iVR learning were proposed.

ARMIA: A Sensorized Arm Wearable for Motor Rehabilitation

In this paper, we present ARMIA: a sensorized arm wearable that includes a combination of inertial and sEMG sensors to interact with serious games in telerehabilitation setups. This device reduces the cost of robotic assistance technologies to be affordable for end-users at home and at rehabilitation centers. Hardware and acquisition software specifications are described together with potential applications of ARMIA in real-life rehabilitation scenarios. A detailed comparison with similar medical technologies is provided, with a specific focus on wearable devices and virtual and augmented reality approaches. The potential advantages of the proposed device are also described showing that ARMIA could provide similar, if not better, the effectivity of physical therapy as well as giving the possibility of home-based rehabilitation.

Haptic Feedback-Based Virtual Reality Intervention for a Child With Infantile Hemiplegia: A Case Report

Virtual reality (VR) refers to an advanced technology that provides real life-like experience in a virtual environment. Numerous commercially available systems provide gaming opportunities with VR, while a few also provide haptic feedback along with VR. In the recent past, VR has been explored as a viable intervention in the field of neurorehabilitation. Although there are promising results for adults with hemiplegia, the research involving children with infantile hemiplegia is in the nascent stage. Infantile hemiplegia is manifested by sensory and motor deficits predominantly on one side of the body resulting in adverse effects on the functionality of the affected side since early life. VR gaming has an intense, motivational component that encourages children to put sustained voluntary effort to use both upper extremities. A six-year-old male with infantile hemiplegia presented with difficulty in using the left upper extremity. Pre-intervention scores of the nine-hole peg test (9HPT) and box and block test (BBT) were used to evaluate the manual dexterity, while those of ABILHAND-kids and functional independence measure for children (WeeFIM self-care section) assessed the functional independence. The child underwent treatment for six weeks (five days/week), with each session lasting for 60 minutes/day that included VR gaming with haptic feedback for 30 minutes and conventional physiotherapy for 30 minutes. Post-intervention scores were recorded and were compared with pre-intervention scores. Marked improvement in left upper extremity function was noted not only objectively by the outcome measures but also subjectively by the parents as well as by the child. Moreover, the child remarked that he enjoyed the therapy sessions. The findings of this report would facilitate the design of further research in this area in the form of larger trials.

Virtual Reality in Clinical Practice and Research: Viewpoint on Novel Applications for Nursing

Virtual reality is a novel technology that provides users with an immersive experience in 3D virtual environments. The use of virtual reality is expanding in the medical and nursing settings to support treatment and promote wellness. Nursing has primarily used virtual reality for nursing education, but nurses might incorporate this technology into clinical practice to enhance treatment experience of patients and caregivers. Thus, it is important for nurses to understand what virtual reality and its features are, how this technology has been used in the health care field, and what future efforts are needed in practice and research for this technology to benefit nursing. In this article, we provide a brief orientation to virtual reality, describe the current application of this technology in multiple clinical scenarios, and present implications for future clinical practice and research in nursing.

Effect of virtual reality and haptic feedback on upper extremity function and functional independence in children with hemiplegic cerebral palsy: a research protocol

Hemiplegic cerebral palsy (CP) is a subcategory of CP which is characterized by sensory motor deficits primarily on one side of the body that adversely affects functionality. Virtual reality (VR) systems have been advanced in the recent past for the use in rehabilitation of patients with neurological conditions. Virtual reality has an inherent motivational component that provides the much-needed compliance for active participation by children. The rationale of the proposed study is to investigate the effect of VR and haptic feedback for improvement of upper extremity function of children with hemiplegic cerebral palsy. This comparative experimental study will be recruiting 36 children with hemiplegic CP and will be treating them by VR and haptic feedback along with conventional physiotherapy in group A and by conventional physiotherapy only in group B. The children will undergo the treatment for six weeks (five days/week) with each session extending for 60 minutes/day. The primary outcome measures including `nine-hole peg test´ (9HPT) and `box and block test´ (BBT) will assess the manual dexterity and secondary outcome measures including `ABILHAND-kids´ and `WeeFIM (self-care)´ will assess the functional independence that are hypothesized to be gained by haptic enhanced VR intervention when combined with the conventional therapy.

The influence of wearables on healthcare outcomes in chronic disease: a systematic review (Preprint)

Background

Chronic diseases contribute to high rates of disability and mortality. Patient engagement in chronic disease self-management is an essential component of chronic disease models of health care. Wearables provide patient-centered health data in real time, which can help inform self-management decision-making. Despite the perceived benefits of wearables in improving chronic disease self-management, their influence on health care outcomes remains poorly understood.

Objective

This review aimed to examine the influence of wearables on health care outcomes in individuals with chronic diseases through a systematic review of the literature.

Methods

A narrative systematic review was conducted by searching 6 databases for randomized and observational studies published between January 1, 2016, and July 1, 2021, that included the use of a wearable intervention in a chronic disease group to assess its impact on a predefined outcome measure. These outcomes were defined as any influence on the patient or clinician experience, cost-effectiveness, or health care outcomes as a result of the wearable intervention. Data from the included studies were extracted based on 6 key themes, which formed the basis for a narrative qualitative synthesis. All outcomes were mapped against each component of the Quadruple Aim of health care. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed in this study.

Results

A total of 30 articles were included; studies reported 2446 participants (mean age: range 10.1-74.4 years), and the influence of 14 types of wearables on 18 chronic diseases was presented. The most studied chronic diseases were type 2 diabetes (4/30, 13%), Parkinson disease (3/30, 10%), and chronic lower back pain (3/30, 10%). The results were mixed when assessing the impact on a predefined primary outcome, with 50% (15/30) of studies finding a positive influence on the studied outcome and 50% (15/30) demonstrating a nil effect. There was a positive effect of 3D virtual reality systems on chronic pain in 7% (2/30) of studies that evaluated 2 distinct chronic pain syndromes. Mixed results were observed in influencing exercise capacity; weight; and biomarkers of disease, such as hemoglobin A_1c, in diabetes. In total, 155 outcomes were studied. Most (139/155, 89.7%) addressed the health care outcomes component. This included pain (11/155, 7.5%), quality of life (7/155, 4.8%), and physical function (5/155, 3.4%). Approximately 7.7% (12/155) of outcome measures represented the patient experience component, with 1.3% (2/155) addressing the clinician experience and cost.

Conclusions

Given their popularity and capability, wearables may play an integral role in chronic disease management. However, further research is required to generate a strong evidence base for safe and effective implementation.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42021244562; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=244562

Virtual Reality-Based Intervention for Enhancing Upper Extremity Function in Children With Hemiplegic Cerebral Palsy: A Literature Review

Cerebral palsy (CP) is the most common cause of motor disability in the pediatric population, with hemiplegia as one of the most widely seen subtypes of spastic CP. Although most of the children with hemiplegic CP are independent ambulators, deficits in hand function of the affected side remain a major concern of caregivers and children themselves. Children use the unaffected upper extremity to compensate for the weakness in the affected one, which consequently leads to the disuse of the hemiparetic upper extremity. Interactive virtual environments can enhance the activation of brain areas during training by providing feedback that can catalyze neuroplastic changes for improved function. Although numerous studies have been conducted on the impact of virtual reality (VR)-based rehabilitation in adults with stroke, studies on its use in the pediatric population are scarce. The three broad categories of VR systems based on the type of human-computer interactions are feedback-focused, gesture-based, and haptic-based. Preliminary studies have shown promising results of VR intervention in improving motor function, including upper extremity function, in children with hemiplegic CP. It is an engaging and entertaining intervention that adds an advantage of high compliance due to motivation. The current literature consists of studies with highly heterogeneous groups of participants and small sample sizes. Further investigation on children with a specific type of CP with advanced VR systems technology is warranted.

Gaming Technology for Pediatric Neurorehabilitation: A Systematic Review

INTRODUCTION

The emergence of gaming technologies, such as videogames and virtual reality, provides a wide variety of possibilities in intensively and enjoyably performing rehabilitation for children with neurological disorders. Solid evidence-based results are however required to promote the use of different gaming technologies in pediatric neurorehabilitation, while simultaneously exploring new related directions concerning neuro-monitoring and rehabilitation in familiar settings.

AIM OF THE STUDY AND METHODS

In order to analyze the state of the art regarding the available gaming technologies for pediatric neurorehabilitation, Scopus and Pubmed Databases have been searched by following: PRISMA statements, PICOs classification, and PEDro scoring.

RESULTS

43 studies have been collected and classified as follows: 11 feasibility studies; six studies proposing home-system solutions; nine studies presenting gamified robotic devices; nine longitudinal intervention trials; and eight reviews. Most of them rely on feasibility or pilot trials characterized by small sample sizes and short durations; different methodologies, outcome assessments and terminologies are involved; the explored spectrum of neurological conditions turns out to be scanty, mainly including the most common and wider debilitating groups of conditions in pediatric neurology: cerebral palsy, brain injuries and autism.

CONCLUSION

Even though it highlights reduced possibilities of drawing evidence-based conclusions due to the above outlined biases, this systematic review raises awareness among pediatricians and other health professionals about gaming technologies. Such a review also points out a definite need of rigorous studies that clearly refer to the underlying neuroscientific principles.

A novel upper-limb tracking system in a virtual environment for stroke rehabilitation

BACKGROUND

The transfer of the behaviors of a human's upper limbs to an avatar is widely used in the field of virtual reality rehabilitation. To perform the transfer, movement tracking technology is required. Traditionally, wearable tracking devices are used for tracking; however, these devices are expensive and cumbersome. Recently, non-wearable upper-limb tracking solutions have been proposed, which are less expensive and more comfortable. However, most products cannot track the upper limbs, including the arms and all the fingers at the same time, which limits the limb parts for tracking in a virtual environment and may lead to a limited rehabilitation effect.

METHODS

In this paper, a novel virtual reality rehabilitation system (VRRS) was developed for upper-limb rehabilitation. The VRRS could track the motion of both upper limbs, integrate fine finger motion and the range of motion of the entire arm and map the motion to an avatar. To test the performance of VRRS, two experiments were designed. In the first experiment, we investigated the effect of VRRS on virtual body ownership, agency and location of the body and usability in 8 healthy participants by comparing it with a partial upper-limb tracking method based on a Leap Motion controller (LP) in the same virtual environments. In the second experiment, we examined the feasibility of VRRS in upper-limb rehabilitation with 27 stroke patients.

RESULTS

VRRS improved the users' senses of body ownership, agency, and location of the body. The users preferred using the VRRS to using the LP. In addition, we found that although the upper limb motor function of patients from all groups was improved, the difference between the FM scores tested on the first day and the last day of the experimental group was more significant than that of the control groups.

CONCLUSIONS

A VRRS with motion tracking of the upper limbs and avatar control including the arms and all the fingers was developed. It resulted in an improved user experience of embodiment and effectively improved the effects of upper limb rehabilitation in stroke patients.

TRIAL REGISTRATION

The study was registered at the First Affiliated Hospital of Jinan University Identifier: KY-2020-036; Date of registration: June 01, 2020.

A Twisted String, Flexure Hinges Approach for Design of a Wearable Haptic Thimble

Wearable haptic devices in the shape of actuated thimbles are used to render the sense of touch in teleoperation and virtual reality scenarios. The design of similar devices has to comply with concurring requirements and constraints: lightweight and compactness, intensity and bandwidth of the rendered signals. Micro-sized motors require a mechanical reduction to increase the output force, at the cost of noise and vibrations introduced by conventional gear reducers. Here we propose a different actuation method, based on a miniaturized twisted string actuator and a flexure hinge transmission mechanism. The latter is required to transmit and transform the pulling force of the twist actuator to a pushing force of the plate in contact with the fingerpad. It achieves a lightweight and noiseless actuation in a compact mechanism. In this work, we present design guidelines of the proposed approach, optimization, and FEM analysis of the flexure hinge mechanism, implementation of the prototype, and experimental characterization of the twist actuator measuring frequency response and output force capabilities.

Virtual Reality Intervention to Help Improve Motor Function in Patients Undergoing Rehabilitation for Cerebral Palsy, Parkinson's Disease, or Stroke: A Systematic Review of Randomized Controlled Trials

There are many successful interventions in medicine, especially in neurology and rehabilitation. The neurosciences represent an area of medicine with tremendous recent research innovations, one of which is virtual reality. This paper aims to discover the powerful relationship between virtual reality and rehabilitation. We assessed the effectiveness of virtual reality-based rehabilitation compared to conventional rehabilitation on motor function recovery of three patient groups: patients with a diagnosis of cerebral palsy, Parkinson's disease, or stroke. We conducted a systematic review using PubMed and included only articles that were randomized controlled trials that were published in the last five years. We used a general search in combination with a more focused Medical Subject Headings (MeSH) search. After thorough assessment and risk of bias evaluation using the Cochrane risk of bias tool, we included thirteen studies in this review. The majority of the clinical trials showed a statistically significant effect for improved motor function. More specifically, improvements in upper extremity motor function, gait, and balance in patients diagnosed with stroke were seen. Similarly, when evaluating patients with Parkinson's disease, improved gait and posture were also seen. When it came to cerebral palsy, however, there were no significant differences between the experimental group and the control. The level of improvement in motor function with a virtual reality intervention was striking, particularly since a few studies demonstrated sustained motor improvement a few months post-trial as well. Virtual reality-based rehabilitation has promising results for adult patients diagnosed with stroke or Parkinson's disease. For pediatric patients, on the other hand, a larger number of clinical trials would still need to be conducted to validate if virtual reality interventions have the capability of providing improved motor function recovery.

Haptic Glove TV Device for People with Visual Impairment

Immersive video is changing the way we enjoy TV. It is no longer just about receiving sequential images with audio, but also playing with other human senses through smells, vibrations of movement, 3D audio, feeling water, wind, heat, and other emotions that can be experienced through all human senses. This work aims to validate the usefulness of an immersive and interactive solution for people with severe visual impairment by developing a haptic glove that allows receiving signals and generating vibrations in hand, informing about what happens in a scene. The study case presented here shows how the haptic device can take the information about the ball’s location in the playing field, synchronized with the video reception, and deliver it to the user in the form of vibrations during the re-transmission of a soccer match. In this way, we take visually impaired people to live a new sensory experience, allowing digital and social inclusion and accessibility to audiovisual technologies that they could not enjoy before. This work shows the methodology used for the design, implementation, and results evaluation. Usability tests were carried out with fifteen visually impaired people who used the haptic device to attend a soccer match synchronized with the glove’s vibrations.