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De Pasquale P, Bonanno M, Mojdehdehbaher S, Quartarone A, Calabrò RS. The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions. Bioengineering (Basel) 2024; 11:538. [PMID: 38927774 PMCID: PMC11200415 DOI: 10.3390/bioengineering11060538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration.
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Affiliation(s)
- Paolo De Pasquale
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Sepehr Mojdehdehbaher
- Department of Mathematics, Computer Science, Physics and Earth Sciences (MIFT), University of Messina, Viale Ferdinando Stagno d’Alcontres, 31, 98166 Messina, Italy;
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
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O’Neil J, Barnes K, Morgan Donnelly E, Sheehy L, Sveistrup H. Identification and description of telerehabilitation assessments for individuals with neurological conditions: A scoping review. Digit Health 2023; 9:20552076231183233. [PMID: 37377560 PMCID: PMC10291871 DOI: 10.1177/20552076231183233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Background The clinical adoption of telerehabilitation accelerated rapidly over the last few years, creating opportunities for clinicians and researchers to explore the use of digital technologies and telerehabilitation in the assessment of deficits related to neurological conditions. The objectives of this scoping review were to identify outcome measures used to remotely assess the motor function and participation in people with neurological conditions and report, when available, the psychometric data of these remote outcome measures. Methods MEDLINE (Ovid), CINAHL, PubMed, PsychINFO, EMBASE, and Cochrane databases were searched between December 13, 2020, and January 4, 2021, for studies investigating the use of remote assessments to evaluate motor function and participation in people with neurological conditions. An updated search was completed on May 9, 2022, using the same databases and search terms. Two reviewers independently screened each title and abstract, followed by full-text screening. Data extraction was completed using a pre-piloted data extraction sheet where outcome measures were reported as per the International Classification of Functioning, Disability and Health. Results Fifty studies were included in this review. Eighteen studies targeted outcomes related to body structures and 32 targeted those related to activity limitation and participation restriction. Seventeen studies reported psychometric data; of these, most included reliability and validity data. Conclusion Clinical assessments of motor function of people living with neurological conditions can be completed in a telerehabilitation or remote context using validated and reliable remote assessment measures.
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Affiliation(s)
- Jennifer O’Neil
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Keely Barnes
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Lisa Sheehy
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Heidi Sveistrup
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
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Scott H, Griffin C, Coggins W, Elberson B, Abdeldayem M, Virmani T, Larson-Prior LJ, Petersen E. Virtual Reality in the Neurosciences: Current Practice and Future Directions. Front Surg 2022; 8:807195. [PMID: 35252318 PMCID: PMC8894248 DOI: 10.3389/fsurg.2021.807195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 01/05/2023] Open
Abstract
Virtual reality has made numerous advancements in recent years and is used with increasing frequency for education, diversion, and distraction. Beginning several years ago as a device that produced an image with only a few pixels, virtual reality is now able to generate detailed, three-dimensional, and interactive images. Furthermore, these images can be used to provide quantitative data when acting as a simulator or a rehabilitation device. In this article, we aim to draw attention to these areas, as well as highlight the current settings in which virtual reality (VR) is being actively studied and implemented within the field of neurosurgery and the neurosciences. Additionally, we discuss the current limitations of the applications of virtual reality within various settings. This article includes areas in which virtual reality has been used in applications both inside and outside of the operating room, such as pain control, patient education and counseling, and rehabilitation. Virtual reality's utility in neurosurgery and the neurosciences is widely growing, and its use is quickly becoming an integral part of patient care, surgical training, operative planning, navigation, and rehabilitation.
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Affiliation(s)
- Hayden Scott
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- *Correspondence: Hayden Scott
| | - Connor Griffin
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - William Coggins
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Brooke Elberson
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Mohamed Abdeldayem
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Tuhin Virmani
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Linda J. Larson-Prior
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Erika Petersen
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Toldo JMP, Arjona M, Campos Neto GC, Vitor T, Nogueira SA, Amaro E, Saba RA, Silva SMCA, Ferraz HB, Felício AC. Virtual Rehabilitation in Parkinson Disease: A Dopamine Transporter Imaging Study. Am J Phys Med Rehabil 2021; 100:359-366. [PMID: 33727518 DOI: 10.1097/phm.0000000000001574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to verify the effect of a virtual rehabilitation protocol for patients with Parkinson disease, primarily assessing striatal dopamine transporters and secondarily motor symptoms and quality of life. DESIGN Nineteen patients with Parkinson disease underwent an 8-wk virtual rehabilitation protocol using XBOX 360S. Evaluation of dopamine transporters was performed by single-photon emission computed tomography using TRODAT-1 as the radioligand. Participants were clinically assessed using the Unified Parkinson Disease Rating Scale to quantify motor symptoms. Moreover, the Parkinson Disease Questionnaire and Short-Form Health Status Survey were used to assess quality of life and the Berg Balance Scale to assess balance. RESULTS Regarding our primary outcome, dopamine transporter was significantly increased in the putamen contralateral to the clinically most affected body side (P = 0.034) considering preintervention and postintervention measurements. Furthermore, we observed significant improvement in Unified Parkinson Disease Rating Scale (10-point reduction, P = 0.001), Parkinson Disease Questionnaire (11.3-point reduction, P = 0.001), Short-Form Health Status Survey ("Functional capacity," P = 0.001; "Pain," P = 0.006; and "Mental Health" domains, P < 0.001), and Berg Balance Scale (5-point increase, P = 0.015). CONCLUSIONS In our group of Parkinson disease patients, this virtual rehabilitation protocol enabled a dopamine transporter increase in the region of the putamen contralateral to the clinically most affected body side. Moreover, motor signs and quality of life were significantly improved.
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Affiliation(s)
- Juliana M P Toldo
- From the Hospital Israelita Albert Einstein, São Paulo, Brazil (JMPT, MA, GCCN, TV, SAN, EAJ, ACF); Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, Brazil (RAS, SMCAS); and Universidade Federal de São Paulo, São Paulo, Brazil (RAS, SMCAS, HBF)
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Saldana D, Neureither M, Schmiesing A, Jahng E, Kysh L, Roll SC, Liew SL. Applications of Head-Mounted Displays for Virtual Reality in Adult Physical Rehabilitation: A Scoping Review. Am J Occup Ther 2020; 74:7405205060p1-7405205060p15. [PMID: 32804624 PMCID: PMC7430729 DOI: 10.5014/ajot.2020.041442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Head-mounted displays for virtual reality (HMD-VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds. OBJECTIVE To explore how HMD-VR has been used in adult physical rehabilitation. DATA SOURCES A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review. STUDY SELECTION AND DATA COLLECTION This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD-VR in a physical rehabilitation context and within the scope of occupational therapy practice. FINDINGS HMD-VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson's disease. CONCLUSIONS AND RELEVANCE HMD-VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes. WHAT THIS ARTICLE ADDS We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.
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Affiliation(s)
- David Saldana
- David Saldana, MA, OTR/L, is Occupational Therapist, Beverly Hospital, Montebello, CA. At the time of the research, he was Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Meghan Neureither
- Meghan Neureither, OTD, OTR/L, is Occupational Therapist, Riverside Community Hospital, Riverside, CA. At the time of the research, she was Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Allie Schmiesing
- Allie Schmiesing, OTD, OTR/L, is Occupational Therapist, Stanford Hospital, Palo Alto, CA. At the time of the research, she was Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Esther Jahng
- Esther Jahng, MA, OTR/L, is Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Lynn Kysh
- Lynn Kysh, MS, is Clinical and Research Librarian, Institute for Nursing and Interprofessional Research, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Shawn C Roll
- Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA, FAIUM, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Sook-Lei Liew
- Sook-Lei Liew, PhD, OTR/L, is Assistant Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles;
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Dermody G, Whitehead L, Wilson G, Glass C. The Role of Virtual Reality in Improving Health Outcomes for Community-Dwelling Older Adults: Systematic Review. J Med Internet Res 2020; 22:e17331. [PMID: 32478662 PMCID: PMC7296414 DOI: 10.2196/17331] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/05/2020] [Accepted: 04/10/2020] [Indexed: 01/27/2023] Open
Abstract
Background Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made. Trial Registration PROSPERO CRD42019143504; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=143504
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Affiliation(s)
- Gordana Dermody
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | | | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
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De Sousa A, Lodha P, Karia S. Virtual reality and its therapeutic uses in the elderly: A narrative clinical review. JOURNAL OF GERIATRIC MENTAL HEALTH 2020. [DOI: 10.4103/jgmh.jgmh_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The role of virtual reality on outcomes in rehabilitation of Parkinson's disease: meta-analysis and systematic review in 1031 participants. Neurol Sci 2019; 41:529-536. [PMID: 31808000 PMCID: PMC7040061 DOI: 10.1007/s10072-019-04144-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/06/2019] [Indexed: 12/16/2022]
Abstract
Introduction Parkinson’s disease (PD) is managed primarily by dopamine agonists and physiotherapy while virtual reality (VR) has emerged recently as a complementary method. The present study reviewed the effectiveness of VR in rehabilitation of patients with PD. Methods Literature search up to June 2019 identified ten studies (n = 343 participants) suitable for meta-analysis and 27 studies (n = 688 participants) for systematic review. Standard mean difference (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. Results In meta-analysis, compared with active rehabilitation intervention, VR training led to greater improvement of stride length, SMD = 0.70 (95%CI = 0.32–1.08, p = 0.0003), and was as effective for gait speed, balance and co-ordination, cognitive function and mental health, quality of life and activities of daily living. Compared with passive rehabilitation intervention, VR had greater effects on balance: SMD = 1.02 (95%CI = 0.38–1.65, p = 0.002). Results from single randomised controlled trials showed that VR training was better than passive rehabilitation intervention for improving gait speed SMD = 1.43 (95%CI = 0.51–2.34, p = 0.002), stride length SMD = 1.27 (95%CI = 0.38–2.16, p = 0.005) and activities of daily living SMD = 0.96 (95%CI = 0.02–1.89). Systematic review showed that VR training significantly (p < 0.05) improved motor function, balance and co-ordination, cognitive function and mental health, and quality of life and activities of daily living. Conclusion VR used in rehabilitation for patients with PD improves a number of outcomes and may be considered for routine use in rehabilitation. Electronic supplementary material The online version of this article (10.1007/s10072-019-04144-3) contains supplementary material, which is available to authorized users.
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Cikajlo I, Peterlin Potisk K. Advantages of using 3D virtual reality based training in persons with Parkinson's disease: a parallel study. J Neuroeng Rehabil 2019; 16:119. [PMID: 31623622 PMCID: PMC6798369 DOI: 10.1186/s12984-019-0601-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/25/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Parkinson's disease (PD) is a slowly progressive neurodegenerative disease. There are mixed reports on success of physiotherapy in patients with PD. Our objective was to investigate the functional improvements, motivation aspects and clinical effectiveness when using immersive 3D virtual reality versus non-immersive 2D exergaming. METHODS We designed a randomized parallel study with 97 patients, but only 20 eligible participants were randomized in 2 groups; the one using 3D Oculus Rift CV1 and the other using a laptop. Both groups participated in the 10-session 3 weeks training with a pick and place task in the virtual world requiring precise hand movement to manipulate the virtual cubes. The kinematics of the hand was traced with Leap motion controller, motivation effect was assessed with modified Intrinsic Motivation Inventory and clinical effectiveness was evaluated with Box & Blocks Test (BBT) and shortened Unified Parkinson's disease rating scale (UPDRS) before and after the training. Mack-Skilling non-parametrical statistical test was used to identify statistically significant differences (p < 0.05) and Cohen's U3 test to find the effect sizes. RESULTS Participants in the 3D group demonstrated statistically significant and substantially better performance in average time of manipulation (group x time, p = 0.009), number of successfully placed cubes (group x time, p = 0.028), average tremor (group x time, p = 0.002) and UPDRS for upper limb (U3 = 0.35). The LCD and 3D groups substantially improved their BBT score with training (U3 = 0.7, U3 = 0.6, respectively). However, there were no statistically significant differences in clinical tests between the groups (group x time, p = 0.2189, p = 0.2850, respectively). In addition the LCD group significantly decreased the pressure/tension (U3 = 0.3), the 3D did not show changes (U3 = 0.5) and the differences between the groups were statistically different (p = 0.037). The 3D group demonstrated important increase in effort (U3 = 0.75) and perceived competences (U3 = 0.9). CONCLUSIONS The outcomes of the study demonstrated that the immersive 3D technology may bring increased interests/enjoyment score resulting in faster and more efficient functional performance. But the 2D technology demonstrated lower pressure/tension score providing similar clinical progress. A study with much larger sample size may also confirm the clinical effectiveness of the approaches. TRIAL REGISTRATION The small scale randomized pilot study has been registered at ClinicalTrials.gov Identifier: NCT03515746 , 4 May 2018.
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Affiliation(s)
- Imre Cikajlo
- University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI-1000 Ljubljana, Slovenia
- School of Engineering and Management, University of Nova Gorica, Vipavska 13, SI-5000 Nova Gorica, Slovenia
| | - Karmen Peterlin Potisk
- University Rehabilitation Institute, Republic of Slovenia, Linhartova 51, SI-1000 Ljubljana, Slovenia
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Kamińska MS, Miller A, Rotter I, Szylińska A, Grochans E. The effectiveness of virtual reality training in reducing the risk of falls among elderly people. Clin Interv Aging 2018; 13:2329-2338. [PMID: 30532523 PMCID: PMC6241865 DOI: 10.2147/cia.s183502] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Virtual reality (VR) training using modern game consoles is an innovative rehabilitation method for fall-prone elderly people. The aim of this study was to assess the effectiveness of VR training using the "Xbox 360 Kinect" in people over 60 years of age. Materials and methods The study involved 23 people, including 19 women and 4 men (mean age 75.74±8.09 years). The following functional tests were employed as research instruments: the 6-minute walking test (6MWT), the Dynamic Gait Index (DGI), the tandem stance test (TST), the tandem walk test (TWT), and the Beck Depression Inventory (BDI). A "spring hand dynamometer" was also used. The participants underwent 30-day VR training using an Xbox 360 Kinect. They trained 3 times a week, with each exercise lasting 30 minutes. Results The 6MWT (P<0.001), the DGI (P=0.008), the TST (P<0.001), the TWT (P=0.002), and the BDI (P<0.001) outcomes were significantly improved. There were differences in the results for the strength of the "pressing muscles" in the right (P=0.106) and left (P=0.043) hands of the participants. Both participants under 80 years of age and those aged 80 years and over had visibly better results on the 6MWT (P<0.001 and P=0.008, respectively), the TST (P<0.001 and P=0.008, respectively), and the BDI (P=0.003 and P=0.012, respectively). Conclusion Training based on VR increases the possibilities of motor training and can help reduce the risk of falls by improving the static and dynamic balance.
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Affiliation(s)
- Magdalena Sylwia Kamińska
- Department of Primary Health Care, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland,
| | | | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Aleksandra Szylińska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland
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Bonnechère B, Jansen B, Haack I, Omelina L, Feipel V, Van Sint Jan S, Pandolfo M. Automated functional upper limb evaluation of patients with Friedreich ataxia using serious games rehabilitation exercises. J Neuroeng Rehabil 2018; 15:87. [PMID: 30286776 PMCID: PMC6172838 DOI: 10.1186/s12984-018-0430-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Friedreich ataxia (FRDA) is a disease with neurological and systemic involvement. Clinical assessment tools commonly used for FRDA become less effective in evaluating decay in patients with advanced FRDA, particularly when they are in a wheelchair. Further motor worsening mainly impairs upper limb function. In this study, we tested if serious games (SG) developed for rehabilitation can be used as an assessment tool for upper limb function even in patients with advanced FRDA. Methods A specific SG has been developed for physical rehabilitation of patients suffering from neurologic diseases. The use of this SG, coupled with Kinect sensor, has been validated to perform functional evaluation of the upper limbs with healthy subjects across lifespan. Twenty-seven FRDA patients were included in the study. Patients were invited to perform upper limb rehabilitation exercises embedded in SG. Motions were recorded by the Kinect and clinically relevant parameters were extracted from the collected motions. We tested if the existence of correlations between the scores from the serious games and the severity of the disease using clinical assessment tools commonly used for FRDA. Results of patients were compared with a group a healthy subjects of similar age. Results Very highly significant differences were found for time required to perform the exercise (increase of 76%, t(68) = 7.22, P < 0.001) and for accuracy (decrease of 6%, t(68) = − 3.69, P < 0.001) between patients and healthy subjects. Concerning the patients significant correlations were found between age and time (R = 0.65, p = 0.015), accuracy (R = − 0.75, p = 0.004) and the total displacement of upper limbs. (R = 0.55, p = 0.031). Statistically significant correlations were found between the age of diagnosis and speed related parameters. Conclusions The results of this study indicate that SG reliably captures motor impairment of FRDA patients due to cerebellar and pyramidal involvement. Results also show that functional evaluation of FRDA patients can be performed during rehabilitation therapy embedded in games with the patient seated in a wheelchair. Trial registration The study was approved as a component of the EFACTS study (Clinicaltrials.gov identifier NCT02069509, registered May 2010) by the local institutional Ethics Committee (ref. P2010/132).
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Affiliation(s)
- Bruno Bonnechère
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO) [CP 619], Université Libre de Bruxelles, Lennik Street 808, 1070, Brussels, Belgium. .,Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Brussels, Belgium. .,imec, Leuven, Belgium.
| | - Bart Jansen
- Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Brussels, Belgium.,imec, Leuven, Belgium
| | - Inès Haack
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO) [CP 619], Université Libre de Bruxelles, Lennik Street 808, 1070, Brussels, Belgium
| | - Lubos Omelina
- Department of Electronics and Informatics - ETRO, Vrije Universiteit Brussel, Brussels, Belgium.,imec, Leuven, Belgium
| | - Véronique Feipel
- Laboratory of Functional Anatomy (LAF), Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO) [CP 619], Université Libre de Bruxelles, Lennik Street 808, 1070, Brussels, Belgium
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Cook DJ, Schmitter-Edgecombe M, Jonsson L, Morant AV. Technology-Enabled Assessment of Functional Health. IEEE Rev Biomed Eng 2018; 12:319-332. [PMID: 29994684 DOI: 10.1109/rbme.2018.2851500] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The maturation of pervasive computing technologies has dramatically altered the face of healthcare. With the introduction of mobile devices, body area networks, and embedded computing systems, care providers can use continuous, ecologically valid information to overcome geographic and temporal barriers and thus provide more effective and timely health assessments. In this paper, we review recent technological developments that can be harnessed to replicate, enhance, or create methods for assessment of functional performance. Enabling technologies in wearable sensors, ambient sensors, mobile technologies, and virtual reality make it possible to quantify real-time functional performance and changes in cognitive health. These technologies, their uses for functional health assessment, and their challenges for adoption are presented in this paper.
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da Costa RQM, Pompeu JE, de Mello DD, Moretto E, Rodrigues FZ, Dos Santos MD, Nitrini R, Morganti F, Brucki SMD. Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability. Dement Neuropsychol 2018; 12:196-204. [PMID: 29988338 PMCID: PMC6022991 DOI: 10.1590/1980-57642018dn12-020013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Spatial orientation is a cognitive domain frequently impaired in Alzheimer's Disease and can be one of its earliest symptoms.
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Affiliation(s)
| | - José Eduardo Pompeu
- Departamento de Fisioterapia, Fonoaudiologia e Terapia ocupacional da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Daniel Donadio de Mello
- Departamento de Fisioterapia, Fonoaudiologia e Terapia ocupacional da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Emerson Moretto
- Departamento de Engenharia de Sistemas Eletrônicos, Escola Politécnica, Universidade de São Paulo, SP, Brazil
| | - Fernanda Zillig Rodrigues
- Departamento de Fisioterapia, Fonoaudiologia e Terapia ocupacional da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Michelle Didone Dos Santos
- Departamento de Fisioterapia, Fonoaudiologia e Terapia ocupacional da Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Francesca Morganti
- Dipartimento di Scienze umane e sociali, Università degli studi di Bergamo, Bergamo, Italy
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Kim A, Kretch KS, Zhou Z, Finley JM. The quality of visual information about the lower extremities influences visuomotor coordination during virtual obstacle negotiation. J Neurophysiol 2018; 120:839-847. [PMID: 29742030 DOI: 10.1152/jn.00931.2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Successful negotiation of obstacles during walking relies on the integration of visual information about the environment with ongoing locomotor commands. When information about the body and the environment is removed through occlusion of the lower visual field, individuals increase downward head pitch angle, reduce foot placement precision, and increase safety margins during crossing. However, whether these effects are mediated by loss of visual information about the lower extremities, the obstacle, or both remains to be seen. Here we used a fully immersive, virtual obstacle negotiation task to investigate how visual information about the lower extremities is integrated with information about the environment to facilitate skillful obstacle negotiation. Participants stepped over virtual obstacles while walking on a treadmill with one of three types of visual feedback about the lower extremities: no feedback, end-point feedback, and a link-segment model. We found that absence of visual information about the lower extremities led to an increase in the variability of leading foot placement after crossing. The presence of a visual representation of the lower extremities promoted greater downward head pitch angle during the approach to and subsequent crossing of an obstacle. In addition, having greater downward head pitch was associated with closer placement of the trailing foot to the obstacle, further placement of the leading foot after the obstacle, and higher trailing foot clearance. These results demonstrate that the fidelity of visual information about the lower extremities influences both feedforward and feedback aspects of visuomotor coordination during obstacle negotiation. NEW & NOTEWORTHY Here we demonstrate that visual information about the lower extremities is utilized for precise foot placement and control of safety margins during obstacle negotiation. We also found that when a visual representation of the lower extremities is present, this information is used in the online control of foot trajectory. Together, our results highlight how visual information about the body and the environment is integrated with motor commands for planning and online control of obstacle negotiation.
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Affiliation(s)
- Aram Kim
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, California
| | - Kari S Kretch
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, California
| | - Zixuan Zhou
- Department of Aerospace and Mechanical Engineering, University of Southern California , Los Angeles, California
| | - James M Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California , Los Angeles, California.,Neuroscience Graduate Program, University of Southern California , Los Angeles, California
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Alves MLM, Mesquita BS, Morais WS, Leal JC, Satler CE, Dos Santos Mendes FA. Nintendo Wii™ Versus Xbox Kinect™ for Assisting People With Parkinson's Disease. Percept Mot Skills 2018; 125:546-565. [PMID: 29665760 DOI: 10.1177/0031512518769204] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study investigated changes in motor and cognitive skills, anxiety levels, and quality of life perception among patients with Parkinson's Disease (PD) following training with different commercial gaming devices-Nintendo Wii™ and Xbox Kinect™. We used a quasi-experimental, simple blinded clinical trial, dividing 27 patients with PD into three equal groups of nine members: (a) Nintendo Wii™, (b) Xbox Kinect™, and (c) control group. After pretests, experimental group participants spent 10 sessions playing four games of the selected gaming device, while control group participants received no intervention. Only those engaged with the Nintendo Wii™ significantly improved their performance on single and dual task gait tests, decreased anxiety levels, and improved memory, attention, and reversibility. The control group showed no changes on any measures.
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Affiliation(s)
- Melissa L M Alves
- 1 Faculty of Physical Education, 28127 University of Brasilia , Brazil
| | | | | | - Josevan C Leal
- 3 Federal District Secretary of Health, Brasilia, Brazil
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Rocha RSB, De Oliveira Rocha LS, Pena ESM, Caldas LCP, Moreno MA. Analysis of autonomic modulation of heart rate in patients with Parkinson's disease and elderly individuals submitted to game therapy training. Geriatr Gerontol Int 2017; 18:20-25. [DOI: 10.1111/ggi.13130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/10/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Rodrigo Santiago Barbosa Rocha
- Physiotherapy Course; University of Amazon - UNAMA; Belém Brazil
- Physiotherapy Course; Pará State University - UEPA; Belém Brazil
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
| | - Larissa Salgado De Oliveira Rocha
- Physiotherapy Course; University of Amazon - UNAMA; Belém Brazil
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
| | | | | | - Marlene Aparecida Moreno
- Postgraduate Program in Sciences of Human Movement; Methodist University of Piracicaba - UNIMEP; Piracicaba Brazil
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Parkinson Patients' Initial Trust in Avatars: Theory and Evidence. PLoS One 2016; 11:e0165998. [PMID: 27820864 PMCID: PMC5098734 DOI: 10.1371/journal.pone.0165998] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 10/23/2016] [Indexed: 11/19/2022] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disease that affects the motor system and cognitive and behavioral functions. Due to these impairments, PD patients also have problems in using the computer. However, using computers and the Internet could help these patients to overcome social isolation and enhance information search. Specifically, avatars (defined as virtual representations of humans) are increasingly used in online environments to enhance human-computer interaction by simulating face-to-face interaction. Our laboratory experiment investigated how PD patients behave in a trust game played with human and avatar counterparts, and we compared this behavior to the behavior of age, income, education and gender matched healthy controls. The results of our study show that PD patients trust avatar faces significantly more than human faces. Moreover, there was no significant difference between initial trust of PD patients and healthy controls in avatar faces, while PD patients trusted human faces significantly less than healthy controls. Our data suggests that PD patients' interaction with avatars may constitute an effective way of communication in situations in which trust is required (e.g., a physician recommends intake of medication). We discuss the implications of these results for several areas of human-computer interaction and neurological research.
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Effects of movement imitation training in Parkinson's disease: A virtual reality pilot study. Parkinsonism Relat Disord 2016; 26:17-23. [PMID: 26972526 DOI: 10.1016/j.parkreldis.2016.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/19/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypometria is a clinical motor sign in Parkinson's disease. Its origin likely emerges from basal ganglia dysfunction, leading to an impaired control of inhibitory intracortical motor circuits. Some neurorehabilitation approaches include movement imitation training; besides the effects of motor practice, there might be a benefit due to observation and imitation of un-altered movement patterns. In this sense, virtual reality facilitates the process by customizing motor-patterns to be observed and imitated. OBJECTIVE To evaluate the effect of a motor-imitation therapy focused on hypometria in Parkinson's disease using virtual reality. METHODS We carried out a randomized controlled pilot-study. Sixteen patients were randomly assigned in experimental and control groups. Groups underwent 4-weeks of training based on finger-tapping with the dominant hand, in which imitation was the differential factor (only the experimental group imitated). We evaluated self-paced movement features and cortico-spinal excitability (recruitment curves and silent periods in both hemispheres) before, immediately after, and two weeks after the training period. RESULTS Movement amplitude increased significantly after the therapy in the experimental group for the trained and un-trained hands. Motor thresholds and silent periods evaluated with transcranial magnetic stimulation were differently modified by training in the two groups; although the changes in the input-output recruitment were similar. CONCLUSIONS This pilot study suggests that movement imitation therapy enhances the effect of motor practice in patients with Parkinson's disease; imitation-training might be helpful for reducing hypometria in these patients. These results must be clarified in future larger trials.
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Samani A, Pontonnier C, Dumont G, Madeleine P. Shoulder kinematics and spatial pattern of trapezius electromyographic activity in real and virtual environments. PLoS One 2015; 10:e0116211. [PMID: 25768123 PMCID: PMC4358981 DOI: 10.1371/journal.pone.0116211] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/05/2014] [Indexed: 11/29/2022] Open
Abstract
The design of an industrial workstation tends to include ergonomic assessment steps based on a digital mock-up and a virtual reality setup. Lack of interaction and system fidelity is often reported as a main issue in such virtual reality applications. This limitation is a crucial issue as thorough ergonomic analysis is required for an investigation of the biomechanics. In the current study, we investigated the biomechanical responses of the shoulder joint in a simulated assembly task for comparison with the biomechanical responses in virtual environments. Sixteen male healthy novice subjects performed the task on three different platforms: real (RE), virtual (VE), and virtual environment with force feedback (VEF) with low and high precision demands. The subjects repeated the task 12 times (i.e., 12 cycles). High density electromyography from the upper trapezius and rotation angles of the shoulder joint were recorded and split into the cycles. The angular trajectories and velocity profiles of the shoulder joint angles over a cycle were computed in 3D. The inter-subject similarity in terms of normalized mutual information on kinematics and electromyography was investigated. Compared with RE the task in VE and VEF was characterized by lower kinematic maxima. The inter-subject similarity in RE compared with intra-subject similarity across the platforms was lower in terms of movement trajectories and greater in terms of trapezius muscle activation. The precision demand resulted in lower inter- and intra-subject similarity across platforms. The proposed approach identifies biomechanical differences in the shoulder joint in both VE and VEF compared with the RE platform, but these differences are less marked in VE mostly due to technical limitations of co-localizing the force feedback system in the VEF platform.
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Affiliation(s)
- Afshin Samani
- Laboratory for Ergonomics and Work-related Disorders, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, 9220, Aalborg East, Denmark
| | - Charles Pontonnier
- Centre de Recherche des Ecoles de Coëtquidan, Ecoles Militaires de Saint-Cyr Coëtquidan, 56 381, Guer, France
- MimeTIC, IRISA/INRIA Centre de Bretagne, Campus de Beaulieu, 35042, Rennes, France
| | - Georges Dumont
- MimeTIC, IRISA/INRIA Centre de Bretagne, Campus de Beaulieu, 35042, Rennes, France
- ENS Rennes, Campus de Ker Lann, 35170, Bruz, France
| | - Pascal Madeleine
- Laboratory for Ergonomics and Work-related Disorders, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D-3, 9220, Aalborg East, Denmark
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Robles-García V, Arias P, Sanmartín G, Espinosa N, Flores J, Grieve KL, Cudeiro J. Motor facilitation during real-time movement imitation in Parkinson's disease: A virtual reality study. Parkinsonism Relat Disord 2013; 19:1123-9. [DOI: 10.1016/j.parkreldis.2013.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/21/2013] [Accepted: 08/06/2013] [Indexed: 11/27/2022]
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Mirelman A, Maidan I, Deutsch JE. Virtual reality and motor imagery: Promising tools for assessment and therapy in Parkinson's disease. Mov Disord 2013; 28:1597-608. [DOI: 10.1002/mds.25670] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 08/06/2013] [Accepted: 08/08/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Anat Mirelman
- Movement Disorders Unit, Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- School of Health Related Professions; Ben Gurion University; Beer Sheba Israel
| | - Inbal Maidan
- Movement Disorders Unit, Department of Neurology; Tel-Aviv Sourasky Medical Center; Tel Aviv Israel
- RiVERS Lab, Department of Rehabilitation and Movement Science; Rutgers Biomedical and Health Sciences; Newark New Jersey USA
| | - Judith E. Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Science; Rutgers Biomedical and Health Sciences; Newark New Jersey USA
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Wiederhold BK. Time to Port Augmented Reality Health Apps to Smart Glasses? CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2013; 16:157-8. [DOI: 10.1089/cyber.2013.1503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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