Clinical usefulness of augmented reality using infrared camera based real-time feedback on gait function in cerebral palsy: a case study

Research Status and Emerging Trends in Virtual Reality Rehabilitation: Bibliometric and Knowledge Graph Study

BACKGROUND

Virtual reality (VR) technology has been widely used in rehabilitation training because of its immersive, interactive, and imaginative features. A comprehensive bibliometric review is required to help researchers focus on future directions based on the new definitions of VR technologies in rehabilitation, which reveal new situations and requirements.

OBJECTIVE

Herein, we aimed to summarize effective research methods for and potential innovative approaches to VR rehabilitation by evaluating publications from various countries to encourage research on efficient strategies to improve VR rehabilitation.

METHODS

The SCIE (Science Citation Index Expanded) database was searched on January 20, 2022, for publications related to the application of VR technology in rehabilitation research. We found 1617 papers, and we created a clustered network, using the 46,116 references cited in the papers. CiteSpace V (Drexel University) and VOSviewer (Leiden University) were used to identify countries, institutions, journals, keywords, cocited references, and research hot spots.

RESULTS

A total of 63 countries and 1921 institutes have contributed publications. The United States of America has taken the leading position in this field; it has the highest number of publications; the highest h-index; and the largest collaborative network, which includes other countries. The reference clusters of SCIE papers were divided into the following nine categories: kinematics, neurorehabilitation, brain injury, exergames, aging, motor rehabilitation, mobility, cerebral palsy, and exercise intensity. The research frontiers were represented by the following keywords: video games (2017-2021), and young adults (2018-2021).

CONCLUSIONS

Our study comprehensively assesses the current research state of VR rehabilitation and analyzes the current research hot spots and future trends in the field, with the aims of providing resources for more intensive investigation and encouraging more researchers to further develop VR rehabilitation.

Effects of Augmented Reality Interventions on the Function of Upper Extremity and Balance in Children With Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial

Objective

To determine the effects of augmented reality (AR) interventions on the function of the upper extremity (UE) and balance in children with spastic hemiplegic cerebral palsy (SHCP).

Methods

In total, 30 children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game, i.e., Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE function and balance were assessed at the baseline and after 8 weeks of intervention through the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and Pediatric Balance Scale (PBS), respectively. The mixed ANOVA was used to determine the combined with-in and between-the-groups differences in the function of the upper extremity. The Wilcoxon sign ranked test was used for with-in group changes, while the Kruskal Wallis test with the bonferroni correction post-hoc analysis was used to compare the groups in terms of balance. The data were analyzed by using SPSS version 21 and the level of significance was set at p < 0.05. Paired sample t-test and Wilcoxon signed-rank test was used for analyzing the changes in the total DASH and PBS scores within the groups, respectively. One-way ANOVA was used to determine the differences between the groups in the total DASH and PBS scores, while the Kruskal Wallis test was used for the differences between the groups in the PBS items. The data were analyzed by using SPSS version 21.

Results

All the groups improved significantly in the total DASH and PBS scores post-intervention. A significant difference was determined in standing with one foot in front between Bubble Pop and Balance It groups (p = 0.03). The total score of PBS also showed a significant difference between Bubble Pop and Balance It groups (p = 0.02).

Conclusion

The AR interventions used in this study were found to be effective in improving the UE function and balance of children with SHCP. The Balance It game showed more promising results in improving the balance as compared with the other games, however, no significant difference was determined between the three AR games in terms of the UE function of the participants.

An AI-Assisted and Self-Powered Smart Robotic Gripper Based on Eco-EGaIn Nanocomposite for Pick-and-Place Operation

High compliance and muscle-alike soft robotic grippers have shown promising performance in addressing the challenges in traditional rigid grippers. Nevertheless, a lack of control feedback (gasping speed and contact force) in a grasping operation can result in undetectable slipping and false positioning. In this study, a pneumatically driven and self-powered soft robotic gripper that can recognize the grabbed object is reported. We integrated pressure (P-TENG) and bend (B-TENG) triboelectric sensors into a soft robotic gripper to transduce the features of gripped objects in a pick-and-place operation. Both the P-TENG and B-TENG sensors are fabricated using a porous structure made of soft Ecoflex and Euthethic Gallium-Indium nanocomposite (Eco-EGaIn). The output voltage of this porous setup has been improved by 63%, as compared to the non-porous structure. The developed soft gripper successfully recognizes three different objects, cylinder, cuboid, and pyramid prism, with a good accuracy of 91.67% and has shown its potential to be beneficial in the assembly lines, sorting, VR/AR application, and education training.

Effects of Augmented Reality Intervention on the Range of Motion and Muscle Strength of Upper Extremity in Children with Spastic Hemiplegic Cerebral Palsy: A Randomized Clinical Trial

Objective: To determine the effects of augmented reality (AR) interventions on the upper extremity's (UE's) range of motion (ROM) and muscle strength in children with spastic hemiplegic cerebral palsy (SHCP). Materials and Methods: Thirty children with SHCP, aged 6 to 12 years, were randomly divided into three interventional groups. Each group received an AR game that is, Balance It, Bubble Pop, or Scoop'd (WonderTree, Pakistan). The UE's ROM and muscle strength were assessed at the baseline and after 8 weeks of intervention through goniometer and manual muscle testing, respectively. Paired-sample t-test and Wilcoxon signed-rank test were used for analyzing the changes in ROM and muscle strength within the groups respectively. One-way analysis of variance (ANOVA) and Tukey's test were used for the differences in ROM, whereas the Kruskal-Wallis test was used for the differences in muscle strength, between the groups. Results: Within-group analysis revealed that all the groups significantly improved in ROM of the majority of joints and in the strength of various muscles of UE (P < 0.05). The elbow extension ROM was significantly different when a comparison was made between the interventional groups (P < 0.05). Balance It group showed more significant improvement in the elbow extension ROM as compared with the Scoop'd group. However, the comparison between the groups showed no significant difference in the muscle strength of UE (P > 0.05). Conclusion: The AR games intervention was beneficial and effective for improving the ROM of majority of the joints and strength of various muscles of UE in children with SHCP. Clinical Trial Registration number: NCT04171232.

Relationships between jaw deformity and the occlusal plane in cone beam computed tomography scans

STATEMENT OF PROBLEM

Consistent findings about the relationships between jaw deformity and the occlusal plane are lacking.

PURPOSE

The purpose of this clinical study was to explore the relationships between the occlusal plane and jaw deformity by measuring data obtained from cone beam computed tomography (CBCT) scans.

MATERIAL AND METHODS

Reconstructed images simulated by using the Materialise Interactive Medical Image Control System (Mimics) software program of CBCT data of 80 participants with facial asymmetry and 42 participants from the normal control group were measured with a new 3-dimensional geometric morphologic measurement system. Fifteen craniofacial surfaces were marked at a point, line, or plane, measuring correlation distances and angles to analyze the relationship between jaw deformity and the inclination of the occlusal plane and other relevant facial features. The Student t test was used to analyze whether the difference in the occlusal plane between the jaw deformity group and the normal group was statistically significant (α=.05). The Pearson correlation was used to analyze the correlation among the jaw deformity, the occlusal plane, and other landmarks, and linear regression was used to analyze the relationships among them.

RESULTS

A significant difference was found between the occlusal plane of the jaw deformity and that of the normal group (P<.001) and a significant positive correlation between the degree of mandibular deformity and the inclination of occlusal plane (P<.001). A linear relationship was found between the linear regression equation of the angle of the left occlusal plane and the midsagittal sagittal plane Y and the distance between the mental apex of chin and the midsagittal plane X (the mandibular deflection to the right was defined as positive) as Y=90.646+0.388X. Statistically significant differences were found in the deviation of the chin vertex from the midsagittal plane and the distance between the midlines of the maxillary and mandibular central incisors by more than 2 mm (P<.001).

CONCLUSIONS

A positive correlation was found between the inclination of the occlusal plane and the degree of jaw deformity, with a linear relationship between them. These findings provide a theoretical basis for the clinical reconstruction of occlusal relationships with jaw deformity.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis

AIM

The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP).

METHOD

The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability.

RESULTS

Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function.

INTERPRETATION

There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects.

WHAT THIS PAPER ADDS

Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.

Inclination of standing posture due to the presentation of tilted view through an immersive head-mounted display

[Purpose] The purpose of the present study is to clarify whether tilted scenery presented through an immersive head-mounted display (HMD) causes the inclination of standing posture. [Subjects and Methods] Eleven healthy young adult males who provided informed consent participated in the experiment. An immersive HMD and a stereo camera were employed to develop a visual inclination system. The subjects maintained a standing posture twice for 5s each while wearing the visual inclination system. They performed this task under two conditions: normal view and 20° leftward tilted view. A three-dimensional motion analysis system was used to measure the subjects’ postures, and two force plates were used to measure the vertical component of the floor reaction force of each leg. [Results] In the 20° leftward tilted view, the head and trunk angles in the frontal plane were similarly inclined toward the left, and the vertical component of the floor reaction force increased in the left leg, whereas it decreased in the right leg. [Conclusion] When the view in the immersive HMD was tilted, the participants’ trunk side bent toward the same side as that of the view. This visual inclination system seems to be a simple intervention for changing standing posture.