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Stammler B, Lambert M, Schuster T, Flammer K, Karnath HO. Using augmented reality to assess spatial neglect: The Free Exploration Test (FET). J Int Neuropsychol Soc 2024; 30:635-642. [PMID: 39291435 DOI: 10.1017/s1355617724000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
BACKGROUND To capture the distortion of exploratory activity typical of patients with spatial neglect, traditional diagnostic methods and new virtual reality applications use confined workspaces that limit patients' exploration behavior to a predefined area. Our aim was to overcome these limitations and enable the recording of patients' biased activity in real, unconfined space. METHODS We developed the Free Exploration Test (FET) based on augmented reality technology. Using a live stream via the back camera on a tablet, patients search for a (non-existent) virtual target in their environment, while their exploration movements are recorded for 30 s. We tested 20 neglect patients and 20 healthy participants and compared the performance of the FET with traditional neglect tests. RESULTS In contrast to controls, neglect patients exhibited a significant rightward bias in exploratory movements. The FET had a high discriminative power (area under the curve = 0.89) and correlated positively with traditional tests of spatial neglect (Letter Cancellation, Bells Test, Copying Task, Line Bisection). An optimal cut-off point of the averaged bias of exploratory activity was at 9.0° on the right; it distinguished neglect patients from controls with 85% sensitivity. DISCUSSION FET offers time-efficient (execution time: ∼3 min), easy-to-apply, and gamified assessment of free exploratory activity. It supplements traditional neglect tests, providing unrestricted recording of exploration in the real, unconfined space surrounding the patient.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Thomas Schuster
- XPACE GmbH, Pforzheim, Germany
- Pforzheim University of Applied Sciences, Pforzheim, Germany
| | | | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Gouret A, Le Bars S, Porssut T, Waszak F, Chokron S. Advancements in brain-computer interfaces for the rehabilitation of unilateral spatial neglect: a concise review. Front Neurosci 2024; 18:1373377. [PMID: 38784094 PMCID: PMC11111994 DOI: 10.3389/fnins.2024.1373377] [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: 01/19/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
This short review examines recent advancements in neurotechnologies within the context of managing unilateral spatial neglect (USN), a common condition following stroke. Despite the success of brain-computer interfaces (BCIs) in restoring motor function, there is a notable absence of effective BCI devices for treating cerebral visual impairments, a prevalent consequence of brain lesions that significantly hinders rehabilitation. This review analyzes current non-invasive BCIs and technological solutions dedicated to cognitive rehabilitation, with a focus on visuo-attentional disorders. We emphasize the need for further research into the use of BCIs for managing cognitive impairments and propose a new potential solution for USN rehabilitation, by combining the clinical subtleties of this syndrome with the technological advancements made in the field of neurotechnologies.
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Affiliation(s)
- Alix Gouret
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Solène Le Bars
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Thibault Porssut
- Research and Innovation Department, Capgemini Engineering, Paris, France
| | - Florian Waszak
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
| | - Sylvie Chokron
- Integrative Neuroscience and Cognition Center (INCC), CNRS, Université Paris Cité, Paris, France
- Research and Innovation Department, Capgemini Engineering, Paris, France
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Painter DR, Norwood MF, Marsh CH, Hine T, Woodman C, Libera M, Harvie D, Dungey K, Chen B, Bernhardt J, Gan L, Jones S, Zeeman H. Virtual reality gameplay classification illustrates the multidimensionality of visuospatial neglect. Brain Commun 2024; 6:fcae145. [PMID: 39165478 PMCID: PMC11333965 DOI: 10.1093/braincomms/fcae145] [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: 10/31/2023] [Revised: 01/19/2024] [Accepted: 05/01/2024] [Indexed: 08/22/2024] Open
Abstract
Brain injuries can significantly impact mental processes and lead to hidden disabilities not easily detectable. Traditional methods for assessing these impacts are imprecise, leading to unreliable prevalence estimates and treatments with uncertain effectiveness. Immersive virtual reality has shown promise for assessment, but its use as a standalone tool is rare. Our research focused on developing and validating a standalone immersive virtual reality classification system for unilateral spatial neglect, a condition common following brain injury characterized by inattention to one side of space. Our study involved 51 brain injury inpatients and 30 controls, all engaging with 'The Attention Atlas', an immersive virtual reality game for testing visual search skills. Our classification system aimed to identify patients with neglect, 'minor atypicality' (indicative of inattention not consistent enough to be labelled as neglect) or non-neglect. This categorization was based on a simple mathematical definition, utilizing gameplay to describe spatial orientation (to the left or right side) and attentional challenge (indicative of search inefficiency). These metrics were benchmarked against a normative model to detect atypical visual search, which refers to gameplay beyond the usual bounds. The combination of neglected side, orientation and challenge factors was used to categorize neglect. We discovered a strong correlation between atypical visual search patterns and neglect risk factors, such as middle cerebral artery stroke, parietal injuries and existing neglect diagnoses (Poisson regression incidence rate ratio = 7.18, 95% confidence interval = 4.41-11.90). In our study, immersive virtual reality-identified neglect in one-fourth of the patients (n = 13, 25.5%), minor atypicality in 17.6% (n = 9) and non-neglect in the majority, 56.9% (n = 29). This contrasts with standard assessments, which detected neglect in 17.6% (n = 9) of cases and had no intermediate category. Our analysis determined six categories of neglect, the most common being left hemispace neglect with above-median orientation and challenge scores. Traditional assessments were not significantly more accurate (accuracy = 84.3%, P = 0.06) than a blanket assumption of non-neglect. Traditional assessments were also relatively insensitive in detecting immersive virtual reality-identified neglect (53.8%), particularly in less severe cases and those involving right-side inattention. Our findings underline the effectiveness of immersive virtual reality in revealing various dimensions of neglect, surpassing traditional methods in sensitivity and detail and operating independently from them. To integrate immersive virtual reality into real-world clinical settings, collaboration with healthcare professionals, patients and other stakeholders is crucial to ensure practical applicability and accessibility.
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Affiliation(s)
- David R Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Michael F Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
| | - Chelsea H Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Queensland, 4215, Australia
| | - Trevor Hine
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
- School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, 4215, Australia
| | - Christie Woodman
- Neurosciences Rehabilitation Unit, Gold Coast University Hospital, Gold Coast, Queensland, 4215, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, Queensland, 4131, Australia
| | - Daniel Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University South Australia, Adelaide, 5001, South Australia, Australia
| | - Kelly Dungey
- School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, 4215, Australia
| | - Ben Chen
- Allied Health and Rehabilitation, Emergency and Specialty Services, Gold Coast Health, Gold Coast, Queensland, 4215, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, 3084, Victoria, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, Queensland, 4131, Australia
| | - Susan Jones
- School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, 4215, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, 4111, Australia
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Belger J, Wagner S, Gaebler M, Karnath HO, Preim B, Saalfeld P, Schatz A, Villringer A, Thöne-Otto A. Application of immersive virtual reality for assessing chronic neglect in individuals with stroke: the immersive virtual road-crossing task. J Clin Exp Neuropsychol 2024; 46:254-271. [PMID: 38516790 DOI: 10.1080/13803395.2024.2329380] [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: 06/01/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Neglect can be a long-term consequence of chronic stroke that can impede an individual's ability to perform daily activities, but chronic and discrete forms can be difficult to detect. We developed and evaluated the "immersive virtual road-crossing task" (iVRoad) to identify and quantify discrete neglect symptoms in chronic stroke patients. METHOD The iVRoad task requires crossing virtual intersections and placing a letter in a mailbox placed either on the left or right. We tested three groups using the HTC Vive Pro Eye: (1) chronic right hemisphere stroke patients with (N = 20) and (2) without (N = 20) chronic left-sided neglect, and (3) age and gender-matched healthy controls (N = 20). We analyzed temporal parameters, errors, and head rotation to identify group-specific patterns, and applied questionnaires to measure self-assessed pedestrian behavior and usability. RESULTS Overall, the task was well-tolerated by all participants with fewer cybersickness-induced symptoms after the VR exposure than before. Reaction time, left-sided errors, and lateral head movements for traffic from left most clearly distinguished between groups. Neglect patients committed more dangerous crossings, but their self-rated pedestrian behavior did not differ from that of stroke patients without neglect. This demonstrates their reduced awareness of the risks in everyday life and highlights the clinical relevance of the task. CONCLUSIONS Our findings suggest that a virtual road crossing task, such as iVRoad, has the potential to identify subtle symptoms of neglect by providing virtual scenarios that more closely resemble the demands and challenges of everyday life. iVRoad is an immersive, naturalistic virtual reality task that can measure clinically relevant behavioral variance and identify discrete neglect symptoms.
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Affiliation(s)
- Julia Belger
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sebastian Wagner
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Michael Gaebler
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Patrick Saalfeld
- Department of Simulation and Graphics, University of Magdeburg, Magdeburg, Germany
| | - Anna Schatz
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Arno Villringer
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Berlin School of Mind and Brain, Humboldt University Berlin, Berlin, Germany
| | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Drazich BF, McPherson R, Gorman EF, Chan T, Teleb J, Galik E, Resnick B. In too deep? A systematic literature review of fully-immersive virtual reality and cybersickness among older adults. J Am Geriatr Soc 2023; 71:3906-3915. [PMID: 37560978 DOI: 10.1111/jgs.18553] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Virtual reality technology holds great promise in improving the health and well-being of older adults; however, this technology is associated with potential risks that may outweigh the benefits. The purpose of this systematic review is to synthesize and critique the existing literature on fully-immersive virtual reality interventions for older adults and the associated risk of cybersickness. METHODS We searched eight databases for studies that utilized fully-immersive virtual reality, stated the population as older adults, provided outcomes related to cybersickness, and were written or translated into the English language. Our search generated 332 articles, 39 of which were selected for inclusion in this systematic synthesis and appraisal. RESULTS We found that the majority of studies utilized a one-time session. The studies generally had weak sample generalizability and methodological design, but strong data collection and participant retention. The studies nearly all used the Simulator Sickness Questionnaire to measure cybersickness, but the scoring for the Simulator Sickness Questionnaire varied or was not mentioned. Most included studies reported only minor cybersickness among older adult participants. CONCLUSION Researchers might conclude that the benefits of virtual reality interventions outweigh the risk of cybersickness in this population. Going forward, researchers should concentrate on the efficacy of virtual reality interventions among older adults, using larger samples and randomized controlled study design, along with measuring dosage effects.
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Affiliation(s)
- Brittany F Drazich
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Rachel McPherson
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Emily F Gorman
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland, USA
| | - Thomas Chan
- Health Equity Research and Education Center & Autonomy Research Center for STEAHM, California State University Northridge, Northridge, California, USA
| | - Jejomar Teleb
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Elizabeth Galik
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Barbara Resnick
- School of Nursing, University of Maryland Baltimore, Baltimore, Maryland, USA
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Painter DR, Norwood MF, Marsh CH, Hine T, Harvie D, Libera M, Bernhardt J, Gan L, Zeeman H. Immersive virtual reality gameplay detects visuospatial atypicality, including unilateral spatial neglect, following brain injury: a pilot study. J Neuroeng Rehabil 2023; 20:161. [PMID: 37996834 PMCID: PMC10668447 DOI: 10.1186/s12984-023-01283-9] [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] [Received: 05/26/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND In neurorehabilitation, problems with visuospatial attention, including unilateral spatial neglect, are prevalent and routinely assessed by pen-and-paper tests, which are limited in accuracy and sensitivity. Immersive virtual reality (VR), which motivates a much wider (more intuitive) spatial behaviour, promises new futures for identifying visuospatial atypicality in multiple measures, which reflects cognitive and motor diversity across individuals with brain injuries. METHODS In this pilot study, we had 9 clinician controls (mean age 43 years; 4 males) and 13 neurorehabilitation inpatients (mean age 59 years; 9 males) recruited a mean of 41 days post-injury play a VR visual search game. Primary injuries included 7 stroke, 4 traumatic brain injury, 2 other acquired brain injury. Three patients were identified as having left sided neglect prior to taking part in the VR. Response accuracy, reaction time, and headset and controller raycast orientation quantified gameplay. Normative modelling identified the typical gameplay bounds, and visuospatial atypicality was defined as gameplay beyond these bounds. RESULTS The study found VR to be feasible, with only minor instances of motion sickness, positive user experiences, and satisfactory system usability. Crucially, the analytical method, which emphasized identifying 'visuospatial atypicality,' proved effective. Visuospatial atypicality was more commonly observed in patients compared to controls and was prevalent in both groups of patients-those with and without neglect. CONCLUSION Our research indicates that normative modelling of VR gameplay is a promising tool for identifying visuospatial atypicality after acute brain injury. This approach holds potential for a detailed examination of neglect.
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Affiliation(s)
- David R Painter
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
| | - Michael F Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia.
| | - Chelsea H Marsh
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Gold Coast, QLD, Australia
| | - Trevor Hine
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- School of Applied Psychology, Griffith University, Mount Gravatt, QLD, Australia
| | - Daniel Harvie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health (IIMPACT in Health), University South Australia, Adelaide, SA, Australia
| | - Marilia Libera
- Psychology Department, Logan Hospital, Logan, QLD, Australia
| | - Julie Bernhardt
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Leslie Gan
- Rehabilitation Unit, Logan Hospital, Meadowbrook, QLD, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, QLD, 4111, Australia
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Kremer T, Murray N, Buckley J, Rowan NJ. Use of real-time immersive digital training and educational technologies to improve patient safety during the processing of reusable medical devices: Quo Vadis? THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 900:165673. [PMID: 37481083 DOI: 10.1016/j.scitotenv.2023.165673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/24/2023]
Abstract
Hospital acquired infections stemming from contaminated reusable medical devices are of increasing concern. This issue is exaggerated with the introduction of complex medical devices like endoscopes and robotic instrumentation. Although medical device manufacturers validate their cleaning instructions for use, evidence in the literature demonstrates that effective device processing is not being performed consistently within sterile processing departments in clinical settings. The result is increased risks to patient safety. As a solution to this problem, focused one-on-one training increases compliance to the medical device manufacturer's processing instruction. However, often this is not a practical solution for the volume of healthcare staff responsible for device processing activities. This constitutes the first paper to address the blended use of educational and digital technologies to address these challenges and as a result inform safety and sustainability for the medical device sector. Cognitive learning theory is an evidence-based framework for learning. It supports the use of immersive educational experiences using emerging extended reality technologies (e.g., virtual or augmented reality) to increase learning comprehension. The delivery of educational content via these technologies provides an innovative option for repeatable leaning and training outcomes. The motivation is to decrease patient risk of contaminated reusable medical devices. The proposed approach while primary motivated by safety can also enhance sustainability and efficiency enabled by artificial intelligence and robotic instrumentation.
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Affiliation(s)
- T Kremer
- Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202 South Raritan, NJ 08869, USA; Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon, Midlands Midwest, Athlone Campus, Ireland.
| | - N Murray
- Faculty of Engineering and Informatics, Technological University of the Shannon, Midlands West, Athlone Campus, Ireland
| | - J Buckley
- Faculty of Engineering and Informatics, Technological University of the Shannon, Midlands West, Athlone Campus, Ireland
| | - N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon, Midlands Midwest, Athlone Campus, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon, Midlands Midwest, Athlone Campus, Ireland
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Salatino A, Zavattaro C, Gammeri R, Cirillo E, Piatti ML, Pyasik M, Serra H, Pia L, Geminiani G, Ricci R. Virtual reality rehabilitation for unilateral spatial neglect: A systematic review of immersive, semi-immersive and non-immersive techniques. Neurosci Biobehav Rev 2023; 152:105248. [PMID: 37247829 DOI: 10.1016/j.neubiorev.2023.105248] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION In recent decades, new virtual reality (VR)-based protocols have been proposed for the rehabilitation of Unilateral Spatial Neglect (USN), a debilitating disorder of spatial awareness. However, it remains unclear which type of VR protocol and level of VR immersion can maximize the clinical benefits. To answer these questions, we conducted a systematic review of the use of VR for the rehabilitation of USN. METHOD Studies between 2000 and 2022 that met the inclusion criteria were classified according to their research design and degree of immersion (non-immersive, NIVR; semi-immersive, SIVR; immersive, IVR). RESULTS A total of 375 studies were identified, of which 26 met the inclusion criteria. Improvements were found in 84.6% of the reviewed studies: 85.7% used NIVR, 100% used SIVR and 55.6% used IVR. However, only 42.3% of them included a control group and only 19.2% were randomized control trials (RCT). CONCLUSION VR protocols may offer new opportunities for USN rehabilitation, although further RCTs are needed to validate their clinical efficacy.
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Affiliation(s)
- Adriana Salatino
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; Department of Life Sciences, Royal Military Academy, Hobbema 8, 1000 Brussels, Belgium
| | - Claudio Zavattaro
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Roberto Gammeri
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Emanuele Cirillo
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Luisa Piatti
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Maria Pyasik
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy
| | - Hilary Serra
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy
| | - Lorenzo Pia
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAMBA (SpAtial, Motor and Bodily Awareness) Research Group, Department of Psychology, University of Turin, Via Verdi, 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Giuliano Geminiani
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy
| | - Raffaella Ricci
- Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; SAN Lab (Space Attention and Action), Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy; NIT - Neuroscience Institute of Turin, Via Verdi, 8, 10124 Turin, Italy.
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Kulkarni CA, Wadhokar OC. Virtual reality a technological miracle transforming physical rehabilitation: A scoping review. J Family Med Prim Care 2023; 12:1257-1260. [PMID: 37649752 PMCID: PMC10465040 DOI: 10.4103/jfmpc.jfmpc_1216_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 02/14/2023] [Indexed: 09/01/2023] Open
Abstract
Physical rehabilitation is evolving day by day. In the same way, simulation in rehabilitation is increasing and has now become a cornerstone for rehabilitation programs. Increase in the number of new protocols, clinical methods, and treatment standardization, virtual reality is appearing as a new medium to deliver the simulation. Virtual reality gives the benefits of forming standardized treatment protocols on demand for various conditions repetitively with a cost-effective delivery system. This was an observational retrospective study. The PubMed database was used to obtain the available material related to virtual reality and rehabilitation and was searched using the same keywords. The articles were then sorted as the subject to the recent decade. The basic information was then obtained, which included timespan, sources of the document, average years of publication, document types we collected, and average citation per year per document. Analysis of the literature that was available online related to virtual reality and rehabilitation between 2011 and 2021 generated a list of 813 documents from 275 sources, of which 810 were from journal articles and 3 were book chapters with an average year of publication of 2.16. The highest number of publications was 480 in 2020, followed by 150 in 2019, 95 in 2018, and 28 in 2017. The annual growth rate percentage of scientific publications was 26.1%. Therefore, more studies should be performed on virtual reality.
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Affiliation(s)
- Chaitanya A. Kulkarni
- Phd Scholar, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Assistant Professor, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Om C. Wadhokar
- Phd Scholar, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Assistant Professor, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pune, India
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10
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Stammler B, Flammer K, Schuster T, Lambert M, Karnath HO. Negami: An Augmented Reality App for the Treatment of Spatial Neglect After Stroke. JMIR Serious Games 2023; 11:e40651. [PMID: 36848215 PMCID: PMC10012013 DOI: 10.2196/40651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is "visual exploration training." Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. OBJECTIVE This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. METHODS The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. RESULTS Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. CONCLUSIONS The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants' natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients' motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation.
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Affiliation(s)
- Britta Stammler
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
| | | | | | | | - Hans-Otto Karnath
- Center of Neurology, Division of Neuropsychology, University of Tübingen, Tübingen, Germany
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Knobel SEJ, Kaufmann BC, Geiser N, Gerber SM, Müri RM, Nef T, Nyffeler T, Cazzoli D. Effects of Virtual Reality-Based Multimodal Audio-Tactile Cueing in Patients With Spatial Attention Deficits: Pilot Usability Study. JMIR Serious Games 2022; 10:e34884. [PMID: 35612894 PMCID: PMC9178455 DOI: 10.2196/34884] [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: 11/17/2021] [Revised: 02/17/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) devices are increasingly being used in medicine and other areas for a broad spectrum of applications. One of the possible applications of VR involves the creation of an environment manipulated in a way that helps patients with disturbances in the spatial allocation of visual attention (so-called hemispatial neglect). One approach to ameliorate neglect is to apply cross-modal cues (ie, cues in sensory modalities other than the visual one, eg, auditory and tactile) to guide visual attention toward the neglected space. So far, no study has investigated the effects of audio-tactile cues in VR on the spatial deployment of visual attention in neglect patients. OBJECTIVE This pilot study aimed to investigate the feasibility and usability of multimodal (audio-tactile) cueing, as implemented in a 3D VR setting, in patients with neglect, and obtain preliminary results concerning the effects of different types of cues on visual attention allocation compared with noncued conditions. METHODS Patients were placed in a virtual environment using a head-mounted display (HMD). The inlay of the HMD was equipped to deliver tactile feedback to the forehead. The task was to find and flag appearing birds. The birds could appear at 4 different presentation angles (lateral and paracentral on the left and right sides), and with (auditory, tactile, or audio-tactile cue) or without (no cue) a spatially meaningful cue. The task usability and feasibility, and 2 simple in-task measures (performance and early orientation) were assessed in 12 right-hemispheric stroke patients with neglect (5 with and 7 without additional somatosensory impairment). RESULTS The new VR setup showed high usability (mean score 10.2, SD 1.85; maximum score 12) and no relevant side effects (mean score 0.833, SD 0.834; maximum score 21). A repeated measures ANOVA on task performance data, with presentation angle, cue type, and group as factors, revealed a significant main effect of cue type (F30,3=9.863; P<.001) and a significant 3-way interaction (F90,9=2.057; P=.04). Post-hoc analyses revealed that among patients without somatosensory impairment, any cue led to better performance compared with no cue, for targets on the left side, and audio-tactile cues did not seem to have additive effects. Among patients with somatosensory impairment, performance was better with both auditory and audio-tactile cueing than with no cue, at every presentation angle; conversely, tactile cueing alone had no significant effect at any presentation angle. Analysis of early orientation data showed that any type of cue triggered better orientation in both groups for lateral presentation angles, possibly reflecting an early alerting effect. CONCLUSIONS Overall, audio-tactile cueing seems to be a promising method to guide patient attention. For instance, in the future, it could be used as an add-on method that supports attentional orientation during established therapeutic approaches.
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Affiliation(s)
| | - Brigitte Charlotte Kaufmann
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute (ICM), Inserm, Centre national de la recherche scientifique, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - René M Müri
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland
- Institute of Psychology, University of Bern, Bern, Switzerland
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Kaiser AP, Villadsen KW, Samani A, Knoche H, Evald L. Virtual Reality and Eye-Tracking Assessment, and Treatment of Unilateral Spatial Neglect: Systematic Review and Future Prospects. Front Psychol 2022; 13:787382. [PMID: 35391965 PMCID: PMC8982678 DOI: 10.3389/fpsyg.2022.787382] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/26/2022] [Indexed: 11/17/2022] Open
Abstract
Unilateral spatial neglect (USN) is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality (VR) systems in combination with eye-tracking (ET) have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. (1) All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. (2) No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding (3) ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found (4) no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person's needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs.
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Affiliation(s)
- Alexander Pilgaard Kaiser
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Westergaard Villadsen
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark,*Correspondence: Lars Evald,
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