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Selvan K, Mina M, Abdelmeguid H, Gulsha M, Vincent A, Sarhan A. Virtual reality headsets for perimetry testing: a systematic review. Eye (Lond) 2024; 38:1041-1064. [PMID: 38036608 PMCID: PMC11009299 DOI: 10.1038/s41433-023-02843-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/05/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Standard automated perimetery is considered the gold standard for evaluating a patient's visual field. However, it is costly and requires a fixed testing environment. In response, perimetric devices using virtual reality (VR) headsets have emerged as an alternative way to measure visual fields in patients. This systematic review aims to characterize both novel and established VR headsets in the literature and explore their potential applications within visual field testing. A search was conducted using MEDLINE, Embase, CINAHL, and the Core Collection (Web of Science) for articles published until January 2023. Subject headings and keywords related to virtual reality and visual field were used to identify studies specific to this topic. Records were first screened by title/abstract and then by full text using predefined criteria. Data was extracted accordingly. A total of 2404 records were identified from the databases. After deduplication and the two levels of screening, 64 studies describing 36 VR headset perimetry devices were selected for extraction. These devices encompassed various visual field measurement techniques, including static and kinetic perimetry, with some offering vision rehabilitation capabilities. This review reveals a growing consensus that VR headset perimetry devices perform comparably to, or even better than, standard automated perimetry. They are better tolerated by patients in terms of gaze fixation, more cost-effective, and generally more accessible for patients with limited mobility.
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Affiliation(s)
- Kavin Selvan
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mina Mina
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hana Abdelmeguid
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Muhammad Gulsha
- Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada
| | - Ajoy Vincent
- Genetics and Genome Biology (GGB) Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Sarhan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- RetinaLogik Inc., Calgary, Alberta, Canada
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Bargeri S, Scalea S, Agosta F, Banfi G, Corbetta D, Filippi M, Sarasso E, Turolla A, Castellini G, Gianola S. Effectiveness and safety of virtual reality rehabilitation after stroke: an overview of systematic reviews. EClinicalMedicine 2023; 64:102220. [PMID: 37745019 PMCID: PMC10514431 DOI: 10.1016/j.eclinm.2023.102220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023] Open
Abstract
Background Virtual reality (VR) is an innovative neurorehabilitation modality that has been variously examined in systematic reviews. We assessed VR effectiveness and safety after cerebral stroke. Methods In this overview of systematic reviews, we searched eleven databases (Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, SCOPUS, ISI Web of Science, CINAHL, PsycINFO, Pedro, Otseeker, Healthevidence.org, Epistemonikos) and grey literature from inception to January 17, 2023. Studies eligible for inclusion were systematic reviews published in English that included adult patients with a clinical diagnosis of stroke (acute to chronic phase) undergoing any kind of immersive, semi-immersive or non-immersive VR intervention with or without conventional therapy versus conventional therapy alone. The primary outcome was motor upper limb function and activity. The secondary outcomes were gait and balance, cognitive and mental function, limitation of activities, participation, and adverse events. We calculated the degree of overlap between reviews based on the corrected covered area (CCA). Methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) and the Certainty of Evidence (CoE) using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Discordances between results were examined using a conceptual framework based on the Jadad algorithm. This overview is registered with PROSPERO, CRD42022329263. Findings Of the 58 reviews included (n = 345 unique primary studies), 42 (72.4%) had conducted meta-analysis. More than half of the reviews (58.6%) were published between 2020 and 2022 and many (77.6%) were judged critically low in quality by AMSTAR 2. Most reported the Fugl Meyer Assessment scale (FMA-UE) to measure upper limb function and activity. For the primary outcome, there was a moderate overlap of primary studies (CCA 9.0%) with discordant findings. Focusing on upper limb function (FMA-UE), VR with or without conventional therapy seems to be more effective than conventional therapy alone, with low to moderate CoE and probable to definite clinical relevance. For secondary outcomes there was uncertainty about the superiority or no difference between groups due to substantial heterogeneity of measurement scales (eg, methodological choices). A few reviews (n = 6) reported the occurrence of mild adverse events. Interpretation Current evidence suggests that multiple meta-analyses agreed on the superiority of VR with or without conventional therapy over conventional therapy on FME-UE for upper limb. Clinicians may consider embedding VR technologies into their practice as appropriate with patient's goals, abilities, and preferences. However, caution is needed given the poor methodological quality of reviews. Funding Italian Ministry of Health.
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Affiliation(s)
- Silvia Bargeri
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | | | - Federica Agosta
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Davide Corbetta
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Massimo Filippi
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Sarasso
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences – DIBINEM, Alma Mater Università di Bologna, Bologna, Italy
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Greta Castellini
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
| | - Silvia Gianola
- IRCCS Istituto Ortopedico Galeazzi, Unit of Clinical Epidemiology, Milan, Italy
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Baik JS, Min JH, Ko SH, Yun MS, Lee B, Kang NY, Kim B, Lee H, Shin YI. Effects of Home-Based Computerized Cognitive Training in Community-Dwelling Adults With Mild Cognitive Impairment. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:97-105. [PMID: 38088994 PMCID: PMC10712670 DOI: 10.1109/jtehm.2023.3317189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE There is a growing importance for the home-based (HB) support services, and computerized cognitive training (CCT) has been reported as an effective intervention for cognitive impairment. However, there is still a need for further verification of the effect of HB-CCT. This study aimed to determine the effectiveness of HB-CCT on the cognitive function of community-dwelling adults with mild cognitive impairment (MCI) as well as safety in its use. METHODS Fifty community-dwelling adults with MCI were included, of which 25 each were randomized to either HB-CCT or control groups. Evaluations of comprehensive cognition, memory, attention, language, executive function, and depression were performed before and after the intervention, including three times a week for eight weeks in the intervention group and eight weeks apart with no intervention in the control group. RESULTS In baseline and post-evaluation comparisons, the HB-CCT group showed significant improvements, while the control group did not show significant changes. Statistically significant variations were noted between the HB-CCT and control groups in all post-intervention evaluations relative to baseline. Additionally, no side effects were observed. CONCLUSION Beneficial effects on cognition and depression were noted in the intervention group compared with the control group, suggesting that HB-CCT may be a positive tool for cognitive improvement in adults with MCI.
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Affiliation(s)
- Ji Soo Baik
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Sung-Hwa Ko
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
- Department of Rehabilitation MedicineThe Graduate School of MedicinePusan National UniversityYangsan50612Republic of Korea
| | - Mi Sook Yun
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan HospitalYangsan50612Republic of Korea
| | - Byunghoon Lee
- Department of Rehabilitation MedicinePusan National University HospitalBusan46241Republic of Korea
| | - Nae Yoon Kang
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
| | | | | | - Yong-Il Shin
- Department of Rehabilitation MedicinePusan National University Yangsan HospitalYangsan50612Republic of Korea
- Department of Rehabilitation MedicineThe Graduate School of MedicinePusan National UniversityYangsan50612Republic of Korea
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Di Giusto V, Purpura G, Zorzi CF, Blonda R, Brazzoli E, Meriggi P, Reina T, Rezzonico S, Sala R, Olivieri I, Cavallini A. Virtual reality rehabilitation program on executive functions of children with specific learning disorders: a pilot study. Front Psychol 2023; 14:1241860. [PMID: 37637891 PMCID: PMC10457143 DOI: 10.3389/fpsyg.2023.1241860] [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: 06/17/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Background The application of Virtual Reality (VR) in the field of rehabilitation has been widely studied, because it has already proven to be an effective intervention for a variety of physical and cognitive conditions. Nevertheless, its application in pediatric rehabilitation is more recent. This pilot study aims to examine whether a VR-rehabilitation program may have positive effects on the Executive Functions (EFs) of children with Specific Learning Disorders (SLD). Materials and methods Twenty-four children with diagnosis of SLD participated to the study (range 7-11 years) and performed the VR-training across 6 weeks in the CARE Lab, that was designed with appropriate structural measures and ad hoc fittings, to hide the sophisticated technology necessary to allow the child to experience a rehabilitative setting with recreational and semi-immersive features. Children were evaluated across three main time-points: T0, assessment of cognitive level and EFs immediately before the start of the intervention; T1, assessment of EFs immediately after the end of VR intervention; T2, follow-up of EFs after 6 months from the end of the VR intervention. The rehabilitation programs were customized according to clinical needs and/or single patient's characteristics, proposing different games with variable complexity levels. Results Results showed that scores for visual attention, inhibition, flexibility, and planning abilities were significantly higher than before the intervention, and the most part of these ameliorations were maintained after 6 months. Conclusion These findings provide important inputs for the development of new innovative rehabilitation interventions for children with SLD that must be founded in ecological and evidence-based approaches.
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Affiliation(s)
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | | | | | - Tarjn Reina
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | | | - Roberta Sala
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Gupta S, Wilcocks K, Matava C, Wiegelmann J, Kaustov L, Alam F. Creating a Successful Virtual Reality-Based Medical Simulation Environment: Tutorial. JMIR MEDICAL EDUCATION 2023; 9:e41090. [PMID: 36787169 PMCID: PMC9975916 DOI: 10.2196/41090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Innovation in medical education is not only inevitable but a requirement. Manikin-based simulation is currently the gold standard for supplemental clinical training; however, this modality requires significant equipment and personnel to operate. Virtual reality (VR) is emerging as a new method of delivering medical simulation sessions that requires less infrastructure but also allows for greater accessibility and flexibility. VR has slowly been integrated into the medical curriculum in some hospitals; however, more widespread adoption would transform the delivery of medical education for future clinicians. This tutorial introduces educators to the BUILD REALITY (begin, use, identify, leverage, define, recreate, educate, adapt, look, identify, test, amplify) framework, a series of practical tips for designing and implementing a VR-based medical simulation environment in their curriculum. The suggestions are based on the relevant literature and the authors' personal experience in creating and implementing VR environments for medical trainees. Altogether, this paper provides guidance on conducting a needs assessment, setting objectives, designing a VR environment, and incorporating the session into the broader medical curriculum.
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Affiliation(s)
- Sanchit Gupta
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kyle Wilcocks
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Julian Wiegelmann
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Lilia Kaustov
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fahad Alam
- Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
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Shen J, Koterba C, Samora J, Leonard J, Li R, Shi J, Yeates KO, Xiang H, Taylor G. Usability and validity of a virtual reality cognitive assessment tool for pediatric traumatic brain injury. Rehabil Psychol 2022; 67:587-596. [PMID: 36048061 PMCID: PMC10165731 DOI: 10.1037/rep0000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Deficits in executive functions are prevalent among children with traumatic brain injury (TBI). Assessing cognitive impairment is critical for evaluating and monitoring recovery. The present article reports a pilot study to evaluate the preliminary usability and validity of a virtual reality cognitive assessment tool (VR-CAT) specifically designed for children with TBI. RESEARCH METHOD/DESIGN A total of 54 children, 24 with TBI and 30 with orthopedic injury, participated in a cross-sectional cohort study at a Level-1 trauma center. The VR-CAT was evaluated in terms of user experience as well as preliminary psychometric properties including test-retest reliability, face validity, concurrent validity with two standard executive function assessment tools, and utility in distinguishing the TBI and orthopedic injury groups. RESULTS Children in both groups reported high levels of usability (i.e., enjoyment and motivation). The VR-CAT composite and scores on tests of inhibitory control and working memory demonstrated modest test-retest reliability across two independent assessment visits, as well as acceptable face validity, modest concurrent validity, and clinical utility. CONCLUSIONS/IMPLICATIONS The present study is among the first to evaluate the applicability of an immersive VR-CAT in children with TBI. The findings support high usability, adequate psychometric properties, and satisfactory clinical utility of the VR-CAT, suggesting it is a promising tool for assessing executive functions in this vulnerable population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Christine Koterba
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Julie Samora
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jeffery Leonard
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Rui Li
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Junxin Shi
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Henry Xiang
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gerry Taylor
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Shen J, Lundine JP, Koterba C, Udaipuria S, Busch T, Rausch J, Yeates KO, Crawfis R, Xiang H, Taylor G. VR-based cognitive rehabilitation for children with traumatic brain injuries: Feasibility and safety. Rehabil Psychol 2022; 67:474-483. [PMID: 35862105 PMCID: PMC10165732 DOI: 10.1037/rep0000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Traumatic brain injury (TBI) is a leading cause of acquired disability in children, who are at risk of significant impairment in executive function (EF). Virtual reality technology provides a novel strategy to offer rich and immersive training content that is both appealing to children and of potential value in improving their daily functioning. The present study aimed to evaluate the feasibility and safety of implementing an innovative VR-based interactive cognitive training (VICT) system for EF rehabilitation designed to meet the developmental and clinical needs of children with TBI. RESEARCH METHOD/DESIGN A parallel-group random-block randomized controlled trial was conducted among 26 children 7-17 years with TBI, who completed baseline, postintervention, and 2-month follow-up visits. Feasibility was assessed for recruiting children, measuring outcomes, and implementing the intervention. VR satisfaction was assessed via 5-point Likert scales. Safety outcomes included simulator sickness (0-4) and physical exertion (6-20). Preliminary efficacy was assessed by NIH Toolbox Cognitive Battery tasks. RESULTS Findings supported the feasibility of recruitment, outcome assessment, and delivery of the intervention. The intervention group reported adequate VR satisfaction in terms of pleasure (M = 3.25, SD = .50) and motivation (M = 2.75, SD = .96), as well as low levels of physical exertion (M = 6.25, SD = .50) and simulator sickness (M = .16, SD = .19). Preliminary evidence supported potential efficacy of the intervention, particularly for moderate and severe TBIs. CONCLUSION/IMPLICATIONS The present study found high feasibility, safety, and preliminary efficacy of the VICT system. Further research is required to fully examine the intervention's efficacy as a possible rehabilitation tool for children with TBI. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Jennifer P. Lundine
- Department of Speech and Hearing Science, Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Christine Koterba
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Nationwide Children’s Hospital, Columbus, OH, USA
| | - Shivika Udaipuria
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Tyler Busch
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Joseph Rausch
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | | | - Roger Crawfis
- Department of Computer Science and Engineering, Ohio State University, Columbus, OH, USA
| | - Henry Xiang
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Center for Injury Research and Policy, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gerry Taylor
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Center for Behavioral Health, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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Corti C, Butti N, Bardoni A, Strazzer S, Urgesi C. Body Processing in Children and Adolescents with Traumatic Brain Injury: An Exploratory Study. Brain Sci 2022; 12:brainsci12080962. [PMID: 35892403 PMCID: PMC9331706 DOI: 10.3390/brainsci12080962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 01/27/2023] Open
Abstract
Dysfunctions in body processing have been documented in adults with brain damage, while limited information is available for children. This study aimed to investigate body processing in children and adolescents with traumatic brain injury (TBI) (N = 33), compared to peers with typical development. Two well-known computerized body-representation paradigms, namely Visual Body Recognition and Visuo-spatial Imagery, were administered. Through the first paradigm, the body inversion and composite illusion effects were tested with a matching to sample task as measures of configural and holistic processing of others’ bodies, respectively. The second paradigm investigated with a laterality judgement task the ability to perform first-person and object-based mental spatial transformations of own body and external objects, respectively. Body stimuli did not convey any emotional contents or symbolic meanings. Patients with TBI had difficulties with mental transformations of both body and object stimuli, displaying deficits in motor and visual imagery abilities, not limited to body processing. Therefore, cognitive rehabilitation of body processing in TBI might benefit from the inclusion of both general training on visuo-spatial abilities and specific exercises aimed at boosting visual body perception and motor imagery.
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Affiliation(s)
- Claudia Corti
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
- Correspondence:
| | - Niccolò Butti
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, 34127 Trieste, Italy
| | - Alessandra Bardoni
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
| | - Sandra Strazzer
- Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza 20, 23842 Bosisio Parini, Italy; (N.B.); (A.B.); (S.S.)
| | - Cosimo Urgesi
- Scientific Institute, IRCCS E. Medea, 33078 San Vito al Tagliamento, Italy;
- Laboratory of Cognitive Neuroscience, Department of Languages and Literatures, Communication, Education and Society, University of Udine, 33100 Udine, Italy
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Borgnis F, Baglio F, Pedroli E, Rossetto F, Uccellatore L, Oliveira JAG, Riva G, Cipresso P. Available Virtual Reality-Based Tools for Executive Functions: A Systematic Review. Front Psychol 2022; 13:833136. [PMID: 35478738 PMCID: PMC9036486 DOI: 10.3389/fpsyg.2022.833136] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/17/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Executive dysfunctions constitute a significant public health problem: their high impact on everyday life makes it a priority to identify early strategies for evaluating and rehabilitating these disorders in a real-life context. The ecological limitation of traditional neuropsychological tests and several difficulties in administering tests or training in real-life scenarios have paved the way to use Virtual Reality-based tools to evaluate and rehabilitate Executive Functions (EFs) in real-life. Objective This work aims to conduct a systematic review to provide a detailed description of the VR-based tools currently developed for the evaluation and rehabilitation of EFs. Methods We systematically searched for original manuscripts regarding VR tools and EFs by looking for titles and abstracts in the PubMed, Scopus, PsycInfo, and Web of Science databases up to November 2021 that contained the following keywords “Virtual Reality” AND “Executive function*.” Results and Conclusion We analyzed 301 articles, of which 100 were included. Our work shows that available VR-based tools appear promising solutions for an ecological assessment and treatment of EFs in healthy subjects and several clinical populations.
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Affiliation(s)
- Francesca Borgnis
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Faculty of Psychology, eCampus University, Milan, Italy
| | | | - Lidia Uccellatore
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | | | - Giuseppe Riva
- Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Psychology, University of Turin, Turin, Italy
- *Correspondence: Pietro Cipresso
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Bu X, Ng PH, Tong Y, Chen PQ, Fan R, Tang Q, Cheng Q, Li S, Cheng AS, Liu X. A Mobile-based Virtual Reality Speech Rehabilitation App for Patients With Aphasia After Stroke: Development and Pilot Usability Study. JMIR Serious Games 2022; 10:e30196. [PMID: 35389349 PMCID: PMC9031062 DOI: 10.2196/30196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 01/29/2023] Open
Abstract
Background Stroke has the highest disability-adjusted life-years lost in any disease, and approximately one-third of the patients get aphasia. Computers and tablets are innovative and aid in intensive treatments in speech rehabilitation for patients with aphasia. However, mechanical training limits the help to patients. Objective This study aims to provide a framework for an integrated virtual reality (VR) app to provide speech rehabilitation for patients with aphasia. Methods The content was generated through an in-depth literature review and discussion with experienced rehabilitation physicians and occupational therapists. We then conducted a 2-round Delphi study with 15 experts from hospitals and universities to rate the content using a 5-point Likert scale. The app was developed by an interdisciplinary team involving VR, medical science of rehabilitation, and therapeutic rehabilitation. Pilot usability testing of this novel app was conducted among 5 patients with aphasia, 5 healthy volunteers, 5 medical staff, and 2 VR experts. Results We designed 4 modules of speech rehabilitation: oral expression, auditory comprehension, cognition, and comprehensive application. Our VR-based interactive and intelligent app was developed to provide an alternative option for patients with aphasia. Pilot usability testing revealed user satisfaction with the app. Conclusions This study designed and tested a novel VR-based app for speech rehabilitation specifically adapted to patients with aphasia. This will guide other studies to develop a similar program or intelligent system in a clinical setting.
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Affiliation(s)
- Xiaofan Bu
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Peter Hf Ng
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ying Tong
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Peter Q Chen
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Rongrong Fan
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qingping Tang
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Qinqin Cheng
- Faculty of Medicine, Nethersole School of Nursing, Chinese University of Hong Kong, Hong Kong, China
| | - Shuangshuang Li
- Department of Nursing, Second Xiangya Hospital of Central South University, Changsha, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiangyu Liu
- Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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11
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Ammann-Reiffer C, Kläy A, Keller U. Virtual reality is a promising therapy tool for walking activities in pediatric neurorehabilitation: Evaluation of usability and user experience (Preprint). JMIR Serious Games 2022; 10:e38509. [PMID: 35834316 PMCID: PMC9335180 DOI: 10.2196/38509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Corinne Ammann-Reiffer
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
| | - Andrina Kläy
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
| | - Urs Keller
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
- Children's Research Center, University Children's Hospital Zurich - Eleonore Foundation, Zurich, Switzerland
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12
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Hocking DR, Ardalan A, Abu-Rayya HM, Farhat H, Andoni A, Lenroot R, Kachnowski S. Feasibility of a virtual reality-based exercise intervention and low-cost motion tracking method for estimation of motor proficiency in youth with autism spectrum disorder. J Neuroeng Rehabil 2022; 19:1. [PMID: 34996473 PMCID: PMC8742363 DOI: 10.1186/s12984-021-00978-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
Background Motor impairment is widely acknowledged as a core feature in children with autism spectrum disorder (ASD), which can affect adaptive behavior and increase severity of symptoms. Low-cost motion capture and virtual reality (VR) game technologies hold a great deal of promise for providing personalized approaches to motor intervention in ASD. The present study explored the feasibility, acceptability and potential efficacy of a custom-designed VR game-based intervention (GaitWayXR™) for improving gross motor skills in youth with ASD. Methods Ten children and adolescents (10–17 years) completed six, 20-min VR-based motor training sessions over 2 weeks while whole-body movement was tracked with a low-cost motion capture system. We developed a methodology for using motion tracking data to quantify whole-body movement in terms of efficiency, synchrony and symmetry. We then studied the relationships of the above quantities with standardized measures of motor skill and cognitive flexibility. Results Our results supported our presumption that the VR intervention is safe, with no adverse events and very few minor to moderate side-effects, while a large proportion of parents said they would use the VR game at home, the most prohibitive reasons for adopting the system for home therapy were cost and space. Although there was little evidence of any benefits of the GaitWayXR™ intervention in improving gross motor skills, we showed several positive correlations between the standardized measures of gross motor skills in ASD and our measures of efficiency, symmetry and synchrony from low-cost motion capture. Conclusions These findings, though preliminary and limited by small sample size, suggest that low-cost motion capture of children with ASD is feasible with movement exercises in a VR-based game environment. Based on these preliminary findings, we recommend conducting larger-scale studies with methods for improving adherence to VR gaming interventions over longer periods.
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Affiliation(s)
- Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Adel Ardalan
- Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY, USA
| | - Hisham M Abu-Rayya
- School of Social Sciences and Humanities, Doha Institute for Graduate Studies, Doha, Qatar.,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Hassan Farhat
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Anna Andoni
- HITLAB, Healthcare Innovation & Technology Lab, Columbia University, New York, NY, USA
| | - Rhoshel Lenroot
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Stan Kachnowski
- HITLAB, Healthcare Innovation & Technology Lab, Columbia University, New York, NY, USA
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13
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Ammann-Reiffer C, Keller U, Kläy A, Meier L, VAN Hedel HJA. DO YOUTHS WITH NEUROMOTOR DISORDER AND THEIR THERAPISTS PREFER A MIXED OR VIRTUAL REALITY HEAD-MOUNTED DISPLAY? JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2021; 4:1000072. [PMID: 34804416 PMCID: PMC8591301 DOI: 10.2340/20030711-1000072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 02/01/2023]
Abstract
Objective To evaluate the usability of 2 head-mounted displays in youths undergoing neurorehabilitation; a mixed reality head-mounted display and a virtual reality head-mounted display. Design Observational cross-sectional study. Patients Thirteen youths (age range 7.8–16.5 years) with neuromotor disorder. Methods Youths wore a mixed reality or a virtual reality head-mounted display while being verbally guided through a scene with virtual objects. Differences between the 2 systems, regarding usability, user experience, and acceptability, were evaluated using standardized questions for the youths and their therapists. System preferences and symptoms of cybersickness were noted. Results Both head-mounted displays were easy to mount and adjust to the children’s heads, but the mixed reality system was unstable in 40% of the youths. Participants stated that they could move naturally with both devices. Object appearance scored higher with the virtual reality system, while therapists rated youths’ movement execution and needed additional support in favour of the mixed reality system. Most youths preferred the virtual reality device, mainly due to the more distinct appearance of objects and the objects’ richer colours. Therapists’ preferences were balanced. Two children reported minimal signs of cybersickness. Conclusion Youths and therapists accepted both systems well, with advantages regarding usability, user experience, and preference for the virtual reality, and acceptability for the mixed reality head-mounted display.
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Affiliation(s)
- Corinne Ammann-Reiffer
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Urs Keller
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Andrina Kläy
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Lea Meier
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Swiss Children's Rehab - Physiotherapy Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland
| | - Hubertus J A VAN Hedel
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich - Eleonore Foundation, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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14
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Zhang Q, Fu Y, Lu Y, Zhang Y, Huang Q, Yang Y, Zhang K, Li M. Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e31007. [PMID: 34787571 PMCID: PMC8663637 DOI: 10.2196/31007] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788
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Affiliation(s)
- Qi Zhang
- School of Nursing, Peking University, Beijing, China
| | - Yu Fu
- Department of Computer Science, Aberystwyth University, Wales, United Kingdom
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing, China
| | - Yating Zhang
- School of Nursing, Peking University, Beijing, China
| | - Qifang Huang
- School of Nursing, Peking University, Beijing, China
| | - Yajie Yang
- School of Nursing, Peking University, Beijing, China
| | - Ke Zhang
- Department of Psychology, Shanxi Datong University, Datong City, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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15
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Immersive virtual reality in patients with moderate and severe traumatic brain injury: a feasibility study. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00582-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Brassel S, Power E, Campbell A, Brunner M, Togher L. Recommendations for the Design and Implementation of Virtual Reality for Acquired Brain Injury Rehabilitation: Systematic Review. J Med Internet Res 2021; 23:e26344. [PMID: 34328434 PMCID: PMC8367177 DOI: 10.2196/26344] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/25/2021] [Accepted: 05/24/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Virtual reality (VR) is increasingly being used for the assessment and treatment of impairments arising from acquired brain injuries (ABIs) due to perceived benefits over traditional methods. However, no tailored options exist for the design and implementation of VR for ABI rehabilitation and, more specifically, traumatic brain injury (TBI) rehabilitation. In addition, the evidence base lacks systematic reviews of immersive VR use for TBI rehabilitation. Recommendations for this population are important because of the many complex and diverse impairments that individuals can experience. OBJECTIVE This study aims to conduct a two-part systematic review to identify and synthesize existing recommendations for designing and implementing therapeutic VR for ABI rehabilitation, including TBI, and to identify current evidence for using immersive VR for TBI assessment and treatment and to map the degree to which this literature includes recommendations for VR design and implementation. METHODS This review was guided by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A comprehensive search of 11 databases and gray literature was conducted in August 2019 and repeated in June 2020. Studies were included if they met relevant search terms, were peer-reviewed, were written in English, and were published between 2009 and 2020. Studies were reviewed to determine the level of evidence and methodological quality. For the first part, qualitative data were synthesized and categorized via meta-synthesis. For the second part, findings were analyzed and synthesized descriptively owing to the heterogeneity of data extracted from the included studies. RESULTS In the first part, a total of 14 papers met the inclusion criteria. Recommendations for VR design and implementation were not specific to TBI but rather to stroke or ABI rehabilitation more broadly. The synthesis and analysis of data resulted in three key phases and nine categories of recommendations for designing and implementing VR for ABI rehabilitation. In the second part, 5 studies met the inclusion criteria. A total of 2 studies reported on VR for assessment and three for treatment. Studies were varied in terms of therapeutic targets, VR tasks, and outcome measures. VR was used to assess or treat impairments in cognition, balance, and anxiety, with positive outcomes. However, the levels of evidence, methodological quality, and inclusion of recommendations for VR design and implementation were poor. CONCLUSIONS There is limited research on the use of immersive VR for TBI rehabilitation. Few studies have been conducted, and there is limited inclusion of recommendations for therapeutic VR design and implementation. Future research in ABI rehabilitation should consider a stepwise approach to VR development, from early co-design studies with end users to larger controlled trials. A list of recommendations is offered to provide guidance and a more consistent model to advance clinical research in this area.
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Affiliation(s)
- Sophie Brassel
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Speech Pathology, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Andrew Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Brunner
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Leanne Togher
- Discipline of Speech Pathology, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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17
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Salisbury JP. Using Medical Device Standards for Design and Risk Management of Immersive Virtual Reality for At-Home Therapy and Remote Patient Monitoring. JMIR BIOMEDICAL ENGINEERING 2021; 6:e26942. [PMID: 38907371 PMCID: PMC11041430 DOI: 10.2196/26942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/22/2021] [Accepted: 04/17/2021] [Indexed: 01/25/2023] Open
Abstract
Numerous virtual reality (VR) systems have received regulatory clearance as therapeutic medical devices for in-clinic and at-home use. These systems enable remote patient monitoring of clinician-prescribed rehabilitation exercises, although most of these systems are nonimmersive. With the expanding availability of affordable and easy-to-use head-mounted display (HMD)-based VR, there is growing interest in immersive VR therapies. However, HMD-based VR presents unique risks. Following standards for medical device development, the objective of this paper is to demonstrate a risk management process for a generic immersive VR system for remote patient monitoring of at-home therapy. Regulations, standards, and guidance documents applicable to therapeutic VR design are reviewed to provide necessary background. Generic requirements for an immersive VR system for home use and remote patient monitoring are identified using predicate analysis and specified for both patients and clinicians using user stories. To analyze risk, failure modes and effects analysis, adapted for medical device risk management, is performed on the generic user stories and a set of risk control measures is proposed. Many therapeutic applications of VR would be regulated as a medical device if they were to be commercially marketed. Understanding relevant standards for design and risk management early in the development process can help expedite the availability of innovative VR therapies that are safe and effective.
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