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Hernan G, Ingale N, Somayaji S, Veerubhotla A. Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review. Brain Sci 2024; 14:429. [PMID: 38790408 PMCID: PMC11119161 DOI: 10.3390/brainsci14050429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury. METHODS Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait". RESULTS A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair. DISCUSSION Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.
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Affiliation(s)
| | | | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, Grossman School of Medicine, New York University, New York, NY 10016, USA; (G.H.); (N.I.); (S.S.)
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Snowden T, Morrison J, Boerstra M, Eyolfson E, Acosta C, Grafe E, Reid H, Brand J, Galati M, Gargaro J, Christie BR. Brain changes: aerobic exercise for traumatic brain injury rehabilitation. Front Hum Neurosci 2023; 17:1307507. [PMID: 38188504 PMCID: PMC10771390 DOI: 10.3389/fnhum.2023.1307507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Traumatic Brain Injury (TBI) accounts for millions of hospitalizations and deaths worldwide. Aerobic exercise is an easily implementable, non-pharmacological intervention to treat TBI, however, there are no clear guidelines for how to best implement aerobic exercise treatment for TBI survivors across age and injury severity. Methods We conducted a PRISMA-ScR to examine research on exercise interventions following TBI in children, youth and adults, spanning mild to severe TBI. Three electronic databases (PubMed, PsycInfo, and Web of Science) were searched systematically by two authors, using keywords delineated from "Traumatic Brain Injury," "Aerobic Exercise," and "Intervention." Results Of the 415 papers originally identified from the search terms, 54 papers met the inclusion criteria and were included in this review. The papers were first grouped by participants' injury severity, and subdivided based on age at intervention, and time since injury where appropriate. Discussion Aerobic exercise is a promising intervention for adolescent and adult TBI survivors, regardless of injury severity. However, research examining the benefits of post-injury aerobic exercise for children and older adults is lacking.
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Affiliation(s)
- Taylor Snowden
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Jamie Morrison
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Meike Boerstra
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Eric Eyolfson
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Crystal Acosta
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Erin Grafe
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Hannah Reid
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | - Justin Brand
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
| | | | - Judith Gargaro
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Brian R. Christie
- Division of Medical Sciences, University of Victoria, Victoria, BC, Canada
- Island Medical Program and Department of Cellular and Physiological Sciences, The University of British Columbia, Victoria, BC, Canada
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Shirazi F, Nasab NZ, Jaberi A. Comparing the Effects of Virtual Reality and Home Chair-Based Exercises on Balance, Daily Living Activities, and Loneliness Among Older Adults With Balance Disorders. Res Gerontol Nurs 2023; 16:33-42. [PMID: 36692435 DOI: 10.3928/19404921-20230105-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current quasi-experimental study aimed to compare the effects of virtual reality (VR) and home chair-based (HCB) exercises on balance, daily living activities, and loneliness among older adults (N = 90) with balance disorders living in nursing homes. Participants were assigned to three groups: (a) VR exercises, (b) HCB exercises, and (c) routine nursing home programs. Findings indicated that VR and HCB exercises significantly increased participants' balance and daily living activities compared to routine programs (p < 0.001). However, there was no clinical difference among groups regarding Berg Balance Scale and Barthel Index scores. Main effect of time regarding loneliness mean score (p = 0.991) was not significant among groups. The minimal detectable change pre-set standard for loneliness also showed no significant clinical difference. Exercise had no significant impact on loneliness; however, it had a positive role in improving balance and daily living activities, with no significant difference between VR and HCB exercises. Further studies are recommended to evaluate adherence to such exercises. [Research in Gerontological Nursing, 16(1), 33-42.].
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Koulouris D, Menychtas A, Maglogiannis I. An IoT-Enabled Platform for the Assessment of Physical and Mental Activities Utilizing Augmented Reality Exergaming. SENSORS 2022; 22:s22093181. [PMID: 35590871 PMCID: PMC9102367 DOI: 10.3390/s22093181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Augmented reality (AR) and Internet of Things (IoT) are among the core technological elements of modern information systems and applications in which advanced features for user interactivity and monitoring are required. These technologies are continuously improving and are available nowadays in all popular programming environments and platforms, allowing for their wide adoption in many different business and research applications. In the fields of healthcare and assisted living, AR is extensively applied in the development of exergames, facilitating the implementation of innovative gamification techniques, while IoT can effectively support the users’ health monitoring aspects. In this work, we present a prototype platform for exergames that combines AR and IoT on commodity mobile devices for the development of serious games in the healthcare domain. The main objective of the solution was to promote the utilization of gamification techniques to boost the users’ physical activities and to assist the regular assessment of their health and cognitive statuses through challenges and quests in the virtual and real world. With the integration of sensors and wearable devices by design, the platform has the capability of real-time monitoring the users’ biosignals and activities during the game, collecting data for each session, which can be analyzed afterwards by healthcare professionals. The solution was validated in real world scenarios and the results were analyzed in order to further improve the performance and usability of the prototype.
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Affiliation(s)
| | | | - Ilias Maglogiannis
- Department of Digital Systems, University of Piraeus, 80, M. Karaoli & A. Dimitriou St., 18534 Piraeus, Greece
- Correspondence:
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Fusco A, Giovannini S, Castelli L, Coraci D, Gatto DM, Reale G, Pastorino R, Padua L. Virtual Reality and Lower Limb Rehabilitation: Effects on Motor and Cognitive Outcome-A Crossover Pilot Study. J Clin Med 2022; 11:jcm11092300. [PMID: 35566424 PMCID: PMC9103855 DOI: 10.3390/jcm11092300] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 02/07/2023] Open
Abstract
The effectiveness of virtual reality (VR) in the motor and cognitive rehabilitation of patients with severe acquired brain injury (sABI) is unclear. This randomized, controlled, crossover, single-blinded, pilot study investigates the cognitive and motor effects of lower limb robotic therapy with and without VR visual feedback in a group of patients with ABI. A total of 23 patients with ABI were randomized into two groups: one group (VR-NVR) underwent a 2-week rehabilitation for the lower limbs training with a robotic device (Omego®) with VR feedback, followed by 2 weeks without VR; the other group (NVR-VR) performed the protocol in the opposite order. Patients were evaluated at baseline, after two and four weeks of treatment using the Level of Cognitive Functioning scale (LCF), Disability Rating Scale (DRS), and Motricity Index for Lower Limb (MI-LL) in the most affected limb. At the end of the intervention, both groups significantly improved in all the outcomes. A significant difference was found between VR treatment versus non-VR treatment for LCF (p = 0.024) and for DRS (p = 0.043) after the second week, while no significant differences were found in the group NVR-VR at T1. Our study indicates how the combination of robotic treatment with VR is effective in enhancing the recovery of cognitive function in patients with ABI, also improving disability and muscular function. Further, VR seems to enhance the early recovery process of motor and cognitive functions.
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Affiliation(s)
- Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Letizia Castelli
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-06-3015-4382
| | - Daniele Coraci
- Dipartimento di Neuroscienze, Università di Padova, 35128 Padova, Italy;
| | - Dario Mattia Gatto
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Reale
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Pastorino
- Department of Woman and Child Health and Public Health—Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Luca Padua
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.F.); (D.M.G.); (G.R.); (L.P.)
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
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Wade L, Needham L, McGuigan P, Bilzon J. Applications and limitations of current markerless motion capture methods for clinical gait biomechanics. PeerJ 2022; 10:e12995. [PMID: 35237469 PMCID: PMC8884063 DOI: 10.7717/peerj.12995] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Markerless motion capture has the potential to perform movement analysis with reduced data collection and processing time compared to marker-based methods. This technology is now starting to be applied for clinical and rehabilitation applications and therefore it is crucial that users of these systems understand both their potential and limitations. This literature review aims to provide a comprehensive overview of the current state of markerless motion capture for both single camera and multi-camera systems. Additionally, this review explores how practical applications of markerless technology are being used in clinical and rehabilitation settings, and examines the future challenges and directions markerless research must explore to facilitate full integration of this technology within clinical biomechanics. METHODOLOGY A scoping review is needed to examine this emerging broad body of literature and determine where gaps in knowledge exist, this is key to developing motion capture methods that are cost effective and practically relevant to clinicians, coaches and researchers around the world. Literature searches were performed to examine studies that report accuracy of markerless motion capture methods, explore current practical applications of markerless motion capture methods in clinical biomechanics and identify gaps in our knowledge that are relevant to future developments in this area. RESULTS Markerless methods increase motion capture data versatility, enabling datasets to be re-analyzed using updated pose estimation algorithms and may even provide clinicians with the capability to collect data while patients are wearing normal clothing. While markerless temporospatial measures generally appear to be equivalent to marker-based motion capture, joint center locations and joint angles are not yet sufficiently accurate for clinical applications. Pose estimation algorithms are approaching similar error rates of marker-based motion capture, however, without comparison to a gold standard, such as bi-planar videoradiography, the true accuracy of markerless systems remains unknown. CONCLUSIONS Current open-source pose estimation algorithms were never designed for biomechanical applications, therefore, datasets on which they have been trained are inconsistently and inaccurately labelled. Improvements to labelling of open-source training data, as well as assessment of markerless accuracy against gold standard methods will be vital next steps in the development of this technology.
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Affiliation(s)
- Logan Wade
- Department for Health, University of Bath, Bath, United Kingdom,Centre for Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Laurie Needham
- Department for Health, University of Bath, Bath, United Kingdom,Centre for Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - Polly McGuigan
- Department for Health, University of Bath, Bath, United Kingdom,Centre for Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom
| | - James Bilzon
- Department for Health, University of Bath, Bath, United Kingdom,Centre for Analysis of Motion, Entertainment Research and Applications, University of Bath, Bath, United Kingdom,Centre for Sport Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, United Kingdom
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A Review on the Use of Microsoft Kinect for Gait Abnormality and Postural Disorder Assessment. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4360122. [PMID: 34760141 PMCID: PMC8575610 DOI: 10.1155/2021/4360122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022]
Abstract
Gait and posture studies have gained much prominence among researchers and have attracted the interest of clinicians. The ability to detect gait abnormality and posture disorder plays a crucial role in the diagnosis and treatment of some diseases. Microsoft Kinect is presented as a noninvasive sensor essential for medical diagnostic and therapeutic purposes. There are currently no relevant studies that attempt to summarise the existing literature on gait and posture abnormalities using Kinect technology. The purpose of this study is to critically evaluate the existing research on gait and posture abnormalities using the Kinect sensor as the main diagnostic tool. Our studies search identified 458 for gait abnormality, 283 for posture disorder of which 26 studies were included for gait abnormality, and 13 for posture. The results indicate that Kinect sensor is a useful tool for the assessment of kinematic features. In conclusion, Microsoft Kinect sensor is presented as a useful tool for gait abnormality, postural disorder analysis, and physiotherapy. It can also help track the progress of patients who are undergoing rehabilitation.
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Finch WH, Miller JE. A Comparison of Regularized Maximum-Likelihood, Regularized 2-Stage Least Squares, and Maximum-Likelihood Estimation with Misspecified Models, Small Samples, and Weak Factor Structure. MULTIVARIATE BEHAVIORAL RESEARCH 2021; 56:608-626. [PMID: 32324059 DOI: 10.1080/00273171.2020.1753005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several structural equation modeling estimation methods have recently been developed to alleviate problems associated with model misspecification. Two of the more popular such approaches are 2-stage least squares and regularization methods. Prior work examining the performance of these estimators has generally focused on problems with adequately sized samples and relatively large factor loadings. In contrast, relatively little research has been conducted comparing these estimation techniques with small samples and weak loadings, though both conditions are not uncommon in the multivariate modeling. The current simulation study focused on comparing these relatively new structural estimation methods for misspecified models (e.g., misspecified interactions and cross-loadings) with small samples and relatively weak factor loadings. Results indicated that regularized 2-stage least squares estimation performed better compared to the regularized structural equation modeling framework for small samples and with weak factor loadings. Implications and guidelines for applied researchers are presented.
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Affiliation(s)
- W Holmes Finch
- Department of Educational Psychology, Ball State University
| | - J E Miller
- Department of Educational Psychology, Ball State University
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9
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Teferi GH, Tilahun BC, Guadie HA, Amare AT. Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study. JMIR Mhealth Uhealth 2021; 9:e19310. [PMID: 33769303 PMCID: PMC8096376 DOI: 10.2196/19310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/26/2020] [Accepted: 01/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff. Objective The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia. Methods An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78) Results In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use. Conclusions Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.
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Affiliation(s)
- Gizaw Hailiye Teferi
- Department of Health Informatics, College of Medicine and Health Science, Debre-Markos University, Debre Markos, Ethiopia
| | - Binyam Cheklu Tilahun
- Department of Health Informatics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habtamu Alganeh Guadie
- School of Public Health, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Ashenafi Tazebew Amare
- Department of Pediatrics, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Chanpimol S, Benson K, Maloni H, Conroy S, Wallin M. Acceptability and outcomes of an individualized exergaming telePT program for veterans with multiple sclerosis: a pilot study. Arch Physiother 2020; 10:18. [PMID: 33014426 PMCID: PMC7528243 DOI: 10.1186/s40945-020-00089-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/17/2020] [Indexed: 01/01/2023] Open
Abstract
Background Physical rehabilitation services are an important component of treatment for persons with multiple sclerosis (PwMS) to improve and maintain physical mobility. However, PwMS often have significant barriers to outpatient physical therapy (PT) services including mobility deficits and lack of transportation. The integration of exercise gaming (exergaming) and telehealth into clinical PT practices may overcome these barriers. The overarching purpose of this pilot study was to evaluate the acceptability and effects of an individualized telePT intervention using exergaming. Methods Ten individuals with multiple sclerosis (MS) completed a 12-week exergaming (Jintronix®) telerehabilitation intervention. In order to measure the acceptability of the telerehabilitation intervention, adherence was measured through the tablet-based rehabilitation software and each participant completed a satisfaction questionnaire. Clinical outcome measures were assessed at baseline and post-intervention. To evaluate the efficacy of this intervention, the following measures of physical function and fatigue were included; the Short Physical Performance Battery (SPPB), 25-Foot Walk (25FW), Modified Fatigue Impact Scale (MFIS), Multiple Sclerosis Walking Scale-12 (MSWS), and the 2-Minute Walk Test (2MWT). Clinical outcomes were analyzed using the Sign test and Wilcoxon signed rank test. All other data were evaluated using descriptive statistics. Results After the intervention, participants demonstrated significant improvements in ambulation speed during the 25FW (p = 0.04) and ambulation distance during the 2MWT (p = 0.002). Statistically significant increases of SPPB total score (p = .04) and sub-scores were also found. Participants did not demonstrate significant changes in the MFIS (p = 0.31) or MSWS-12 (p = 0.06) after the intervention. Participants had a 58.3% adherence rate during the intervention and performed their exercise program an average of 2.5 times per week. All participants reported that they were either ‘satisfied or ‘very satisfied’ with their telerehabilitation experience, would use telerehabilitation again, and would recommend telerehabilitation to others. Conclusion This individualized telerehabilitation intervention which integrates exergaming and clinical video teleconferencing is acceptable to patients and may offer a viable alternative to traditional PT for PwMS. Trial registration NCT03655431, retrospectively registered on August 31st, 2018.
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Affiliation(s)
- Shane Chanpimol
- Neurology Service, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC 20422 USA.,MS Center of Excellence, Veterans Affairs Medical Center, Washington, DC USA
| | - Kimberly Benson
- Physical Medicine & Rehabilitation Service, Veterans Affairs Medical Center, Washington, DC USA
| | - Heidi Maloni
- Neurology Service, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC 20422 USA.,MS Center of Excellence, Veterans Affairs Medical Center, Washington, DC USA
| | - Susan Conroy
- Research Service, VA Maryland Medical System, Baltimore VA Medical Center, Baltimore, USA.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, USA
| | - Mitchell Wallin
- Neurology Service, Veterans Affairs Medical Center, 50 Irving St. NW, Washington, DC 20422 USA.,MS Center of Excellence, Veterans Affairs Medical Center, Washington, DC USA
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Aulisio MC, Han DY, Glueck AC. Virtual reality gaming as a neurorehabilitation tool for brain injuries in adults: A systematic review. Brain Inj 2020; 34:1322-1330. [PMID: 32791020 DOI: 10.1080/02699052.2020.1802779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evidence of the effectiveness of virtual reality (VR) in motor and cognitive rehabilitation for traumatic brain injury (TBI) continues to be mixed. Therefore, we conducted a systematic literature review in accordance with PRISMA guidelines to strategically evaluate the strength of evidence supporting the use of VR as a rehabilitation tool for motor function and cognition in patients with TBI. METHOD The van Tulder criteria were modified to determine the quality of the outcomes of studies deemed eligible for inclusion in the review. OUTCOMES AND RESULTS Twelve studies were considered eligible for inclusion in the systematic review. These studies utilized methods of varying quality such as case and quasi-experimental studies and found moderately positive support for the effectiveness of VR-enhanced rehabilitation for both motor skills and cognitive deficits. CONCLUSIONS AND IMPLICATIONS The varying quality of the included studies provides moderate support for use of VR-enhanced rehabilitation techniques per the van Tulder criteria. This highlights the continued gap in the literature for robust studies that enable providers, policy makers, and the public to draw conclusions about the effectiveness of VR-enhanced rehabilitation for traumatic brain injury. Continued pursuit of analyses in the context of newer immersive VR-enhanced rehabilitation is recommended.
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Affiliation(s)
- Madeline C Aulisio
- Department of Health Management and Policy, College of Public Health , Lexington, KY, USA
| | - Dong Y Han
- Department of Neurology, College of Medicine , Lexington, KY, USA
| | - Amanda C Glueck
- Department of Neurology, College of Medicine , Lexington, KY, USA
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12
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Guerra J, Smith L, Vicinanza D, Stubbs B, Veronese N, Williams G. The use of sonification for physiotherapy in human movement tasks: A scoping review. Sci Sports 2020. [DOI: 10.1016/j.scispo.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parke S, Hough CL, E Bunnell A. The Feasibility and Acceptability of Virtual Therapy Environments for Early ICU Mobilization. PM R 2020; 12:1214-1221. [PMID: 32107863 DOI: 10.1002/pmrj.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early mobilization in critically ill patients has been documented to reduce neuromuscular complications, but access to rehabilitation services is often limited in the intensive care unit (ICU). Virtual platforms that deliver therapy may increase access to rehabilitation services and improve patient motivation to participate. Xbox Kinect Jintronix software delivers interventions using games and activities designed for therapy. OBJECTIVE To determine the feasibility of the Jintronix virtual therapy system in an ICU setting by observing outcomes related to patient satisfaction, adverse events, and technical applicability. DESIGN Prospective observational feasibility study. SETTING Medical ICU at a Level 1 Trauma Center within an academic medical center. PARTICIPANTS Twenty adults admitted to ICU. INTERVENTION Participants engaged in one therapy session with a maximum of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion, and endurance. OUTCOME MEASURES A trained physician-observer recorded events related to adverse events and technical applicability. Participants completed a survey to determine patient satisfaction. RESULTS A total of 188 modules were completed. Participants completed a median of nine modules each. Five participants completed the maximum of 14 modules. Fatigue was the most common reason for cessation. Mean intervention time was 29 minutes. There were no falls, lines dislodged, or medical events. Participants required physical assistance or verbal cues in 36% of modules. Technical errors affected 25% of modules and led to activity cessation in one case. Nearly all participants reported the activity was enjoyable, comfortable, safe, easy to understand, would improve range of motion and strength, and would motivate them to continue. CONCLUSIONS Use of a virtual therapy environment in an intensive care setting is feasible.
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Affiliation(s)
- Sara Parke
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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SUN TIENLUNG, LEE CHIAHSUAN, LAI CHUNGLIANG, JIANG BERNARDC. CORRELATING COMMON CLINICAL POSTURAL STABILITY MEASUREMENTS WITH BALANCE ASSESSMENTS. J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postural stability assessments are typically used for training and tracking. The training results of stroke patients are investigated in terms of task execution and experimental methods. However, the selection of evaluation and training tools has not been discussed in depth. To explore the postural stability evaluation index, we used a range of widely applied assessment tools in occupational therapy. Methods: We studied the rehabilitation of 15 patients who had suffered chronic strokes for at least two years. The tools include the Timed Up and Go Test, which is used by rehabilitation professionals in postural stability evaluations, the biodex balance evaluation instrument, and a Kinect game developed for virtual reality therapy. Results: We propose an active and a passive assessment model. For training, we recommend combining active and passive assessments for confirmations. For assessments, the evaluation tool should be selected according to the postural stability task (active or passive). In the predictive models, if the different tools are considered simultaneously, static postural stability should be used as the main investigation. We suggest that by first studying the tools used to investigate postural stability assessments, balance assessments in stroke patients can also be improved.
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Affiliation(s)
- TIEN LUNG SUN
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan, R. O. C
| | - CHIA HSUAN LEE
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da’an District, Taipei 106, Taiwan, R. O. C
| | - CHUNG LIANG LAI
- Department of Physical Medicine and Rehabilitation, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
- Department of Occupational Therapy, Asia University, Taichung, Taiwan
| | - BERNARD C. JIANG
- Department of Industrial Management, National Taiwan University of Science and Technology, No. 43, Sec. 4, Keelung Road, Da’an District, Taipei 106, Taiwan, R. O. C
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Time Coherent Full-Body Poses Estimated Using Only Five Inertial Sensors: Deep versus Shallow Learning. SENSORS 2019; 19:s19173716. [PMID: 31461958 PMCID: PMC6749312 DOI: 10.3390/s19173716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/30/2019] [Accepted: 08/21/2019] [Indexed: 11/16/2022]
Abstract
Full-body motion capture typically requires sensors/markers to be placed on each rigid body segment, which results in long setup times and is obtrusive. The number of sensors/markers can be reduced using deep learning or offline methods. However, this requires large training datasets and/or sufficient computational resources. Therefore, we investigate the following research question: "What is the performance of a shallow approach, compared to a deep learning one, for estimating time coherent full-body poses using only five inertial sensors?". We propose to incorporate past/future inertial sensor information into a stacked input vector, which is fed to a shallow neural network for estimating full-body poses. Shallow and deep learning approaches are compared using the same input vector configurations. Additionally, the inclusion of acceleration input is evaluated. The results show that a shallow learning approach can estimate full-body poses with a similar accuracy (~6 cm) to that of a deep learning approach (~7 cm). However, the jerk errors are smaller using the deep learning approach, which can be the effect of explicit recurrent modelling. Furthermore, it is shown that the delay using a shallow learning approach (72 ms) is smaller than that of a deep learning approach (117 ms).
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16
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Pinto SM, Newman MA, Hirsch MA. Perceived Barriers to Exercise in Adults with Traumatic Brain Injury Vary by Age. J Funct Morphol Kinesiol 2018; 3:E47. [PMID: 33466976 PMCID: PMC7739410 DOI: 10.3390/jfmk3030047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 08/20/2018] [Accepted: 09/11/2018] [Indexed: 02/03/2023] Open
Abstract
Physical activity and exercise are important adjuncts to medical treatment for overall health in individuals with traumatic brain injury (TBI); however, many individuals do not partake in the recommended weekly exercise. The objective of this study was to investigate the barriers to exercise after TBI and determine whether these barriers varied by age. The sample was 172 adults with moderate to severe TBI who completed Barriers to Physical Exercise and Disability (B-PED) survey. Lack of interest, motivation, and energy as well as cost, lack of counseling on exercise by a physician, not having home equipment, and being too lazy were reported as barriers to exercise by all age groups. Those aged 35 to 54-years-old were more likely to report that cost, lack of transportation, having health concerns, not knowing where to exercise, and fear of leaving the home as barriers to exercise than those aged 18 to 34-years-old or 55-years-old and older. Overall, adults with TBI report multiple barriers to exercise, and these barriers vary by age.
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Affiliation(s)
- Shanti M. Pinto
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, NC 28203, USA
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Ma M, Proffitt R, Skubic M. Validation of a Kinect V2 based rehabilitation game. PLoS One 2018; 13:e0202338. [PMID: 30142631 PMCID: PMC6108894 DOI: 10.1371/journal.pone.0202338] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 08/01/2018] [Indexed: 12/21/2022] Open
Abstract
Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isle is a multi-planar full-body rehabilitation game developed using the Microsoft Kinect® V2. It aims to help stroke patients improve their motor function and daily activity performance and to assess the motions of the players. It is important that the assessment results generated from Mystic Isle are accurate. The Kinect V2 has been validated for tracking lower limbs and calculating gait-specific parameters. However, few studies have validated the accuracy of the Kinect® V2 skeleton model in upper-body movements. In this paper, we evaluated the spatial accuracy and measurement validity of a Kinect-based game Mystic Isle in comparison to a gold-standard optical motion capture system, the Vicon system. Thirty participants completed six trials in sitting and standing. Game data from the Kinect sensor and the Vicon system were recorded simultaneously, then filtered and sample rate synchronized. The spatial accuracy was evaluated using Pearson’s r correlation coefficient, signal to noise ratio (SNR) and 3D distance difference. Each arm-joint signal had an average correlation coefficient above 0.9 and a SNR above 5. The hip joints data had less stability and a large variation in SNR. Also, the mean 3D distance difference of joints were less than 10 centimeters. For measurement validity, the accuracy was evaluated using mean and standard error of the difference, percentage error, Pearson’s r correlation coefficient and intra-class correlation (ICC). Average errors of maximum hand extent of reach were less than 5% and the average errors of mean and maximum velocities were about 10% and less than 5%, respectively. We have demonstrated that Mystic Isle provides accurate measurement and assessment of movement relative to the Vicon system.
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Affiliation(s)
- Mengxuan Ma
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, United States of America
- * E-mail:
| | - Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO, United States of America
| | - Marjorie Skubic
- Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, MO, United States of America
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18
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Ferraz DD, Trippo KV, Duarte GP, Neto MG, Bernardes Santos KO, Filho JO. The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial. Arch Phys Med Rehabil 2018; 99:826-833. [PMID: 29337023 DOI: 10.1016/j.apmr.2017.12.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/04/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the effects of functional training, bicycle exercise, and exergaming on walking capacity of elderly with Parkinson disease (PD). DESIGN A pilot randomized, controlled, single-blinded trial. SETTING A state reference health care center for elderly, a public reference outpatient clinic for the elderly. PARTICIPANTS Elderly individuals (≥60 years of age; N=62) with idiopathic PD (stage 2 to 3 of modified Hoehn and Yahr staging scale) according to the London Brain Bank. INTERVENTION The participants were randomly assigned to three groups. Group 1 (G1) participated in functional training (n=22); group 2 (G2) performed bicycle exercise (n=20), and group 3 (G3) trained with Kinect Adventures (Microsoft, Redmond, WA) exergames (n=20). MAIN OUTCOME MEASURES The primary outcome measure was the 6-minute walk test (6MWT); secondary outcome measures were the 10-m walk test (10MWT), sitting-rising test (SRT), body mass index, Parkinson Disease Questionnaire-39, World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and 15-item Geriatric Depression Scale. RESULTS All groups showed significant improvements in 6MWT (G1 P=.008; G2 P=.001; G3 P=.005), SRT (G1 P<.001; G2 P=.001; G3 P=.003), and WHODAS 2.0 (G1 P=.018; G2 P=.019; G3 P=.041). Only G3 improved gait speed in 10MWT (P=.11). G1 (P=.014) and G3 (P=.004) improved quality of life. No difference was found between groups. CONCLUSIONS Eight weeks of exergaming can improve the walking capacity of elderly patients with PD. Exergame training had similar outcomes compared with functional training and bicycle exercise. The three physical exercise modalities presented significant improvements on walking capacity, ability to stand up and sit, and functionality of the participants.
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Affiliation(s)
| | | | | | - Mansueto Gomes Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil
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