Head-Mounted Display-Based Application for Cognitive Training

The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions

In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration.

The impact of virtual reality on manual dexterity of Parkinson's disease subjects: a systematic review

PURPOSE

To present the latest available evidence on the effects of a VR-based therapy on the manual dexterity of PD subjects.

MATERIALS AND METHODS

The search was conducted in PubMed, EMBASE, and PEDro databases. Were included in the systematic review Randomized Clinical Trials, Pilot and Feasibility studies published up to December 2020. The studies should include at least one of the following assessments: Box and Blocks Test, 9-Hole Peg Test; Purdue Pegboard Test. PEDro Scale was used to assess the methodological quality of the included studies.

RESULTS

Eight studies were included in the review. Most studies have shown an improvement in outcomes for manual dexterity, but most of them presented a high risk of bias with low methodological quality. A high heterogeneity was observed in the protocols used for each study.

CONCLUSION

The results suggest that VR-based therapy has great potential and feasibility to be used as a manual dexterity rehabilitation protocol in PD subjects. However, these results must be interpreted carefully and studies with greater methodological rigor must be conducted.Implications For RehabilitationRehabilitation programs using virtual reality seem to have greater adherence to the user.Immersive virtual reality systems seem to do better in manual dexterity than non-immersive systems.It is plausible to use virtual reality systems in telerehabilitation for manual dexterity training in subjects with Parkinson's' Disease.The use of Virtual Reality by the therapist in a rehabilitation program allows him to modulate the exercises, enabling a wide variety of therapeutic options.

Influence of Hand Tracking in Immersive Virtual Reality for Memory Assessment

Few works analyze the parameters inherent to immersive virtual reality (IVR) in applications for memory evaluation. Specifically, hand tracking adds to the immersion of the system, placing the user in the first person with full awareness of the position of their hands. Thus, this work addresses the influence of hand tracking in memory assessment with IVR systems. For this, an application based on activities of daily living was developed, where the user must remember the location of the elements. The data collected by the application are the accuracy of the answers and the response time; the participants are 20 healthy subjects who pass the MoCA test with an age range between 18 to 60 years of age; the application was evaluated with classic controllers and with the hand tracking of the Oculus Quest 2. After the experimentation, the participants carried out presence (PQ), usability (UMUX), and satisfaction (USEQ) tests. The results indicate no difference with statistical significance between both experiments; controller experiments have 7.08% higher accuracy and 0.27 ys. faster response time. Contrary to expectations, presence was 1.3% lower for hand tracking, and usability (0.18%) and satisfaction (1.43%) had similar results. The findings indicate no evidence to determine better conditions in the evaluation of memory in this case of IVR with hand tracking.

Recognition of Attentional States in VR Environment: An fNIRS Study

An improvement in ecological validity is one of the significant challenges for 21st-century neuroscience. At the same time, the study of neurocognitive processes in real-life situations requires good control of all variables relevant to the results. One possible solution that combines the capability of creating realistic experimental scenarios with adequate control of the test environment is virtual reality. Our goal was to develop an integrative research workspace involving a CW-fNIRS and head-mounted-display (HMD) technology dedicated to offline and online cognitive experiments. We designed an experimental study in a repeated-measures model on a group of BCI-naïve participants to verify our assumptions. The procedure included a 3D environment-adapted variant of the classic n-back task (2-back version). Tasks were divided into offline (calibration) and online (feedback) sessions. In both sessions, the signal was recorded during the cognitive task for within-group comparisons of changes in oxy-Hb concentration in the regions of interest (the dorsolateral prefrontal cortex-DLPFC and middle frontal gyrus-MFG). In the online session, the recorded signal changes were translated into real-time feedback. We hypothesized that it would be possible to obtain significantly higher than the level-of-chance threshold classification accuracy for the enhanced attention engagement (2-back task) vs. relaxed state in both conditions. Additionally, we measured participants' subjective experiences of the BCI control in terms of satisfaction. Our results confirmed hypotheses regarding the offline condition. In accordance with the hypotheses, combining fNIRS and HMD technologies enables the effective transfer of experimental cognitive procedures to a controlled VR environment. This opens the new possibility of creating more ecologically valid studies and training procedures.

VR-PEER: A Personalized Exer-Game Platform Based on Emotion Recognition

Motor rehabilitation exercises require recurrent repetitions to enhance patients’ gestures. However, these repetitive gestures usually decrease the patients’ motivation and stress them. Virtual Reality (VR) exer-games (serious games in general) could be an alternative solution to address the problem. This innovative technology encourages patients to train different gestures with less effort since they are totally immersed in an easy to play exer-game. Despite this evolution, patients, with available exer-games, still suffer in performing their gestures correctly without pain. The developed applications do not consider the patients psychological states when playing an exer-game. Therefore, we believe that is necessary to develop personalized and adaptive exer-games that take into consideration the patients’ emotions during rehabilitation exercises. This paper proposed a VR-PEER adaptive exer-game system based on emotion recognition. The platform contain three main modules: (1) computing and interpretation module, (2) emotion recognition module, (3) adaptation module. Furthermore, a virtual reality-based serious game is developed as a case study, that uses updated facial expression data and provides dynamically the patient’s appropriate game to play during rehabilitation exercises. An experimental study has been conducted on fifteen subjects who expressed the usefulness of the proposed system in motor rehabilitation process.

Gamification and Hazard Communication in Virtual Reality: A Qualitative Study

An effective warning attracts attention, elicits knowledge, and enables compliance behavior. Game mechanics, which are directly linked to human desires, stand out as training, evaluation, and improvement tools. Immersive virtual reality (VR) facilitates training without risk to participants, evaluates the impact of an incorrect action/decision, and creates a smart training environment. The present study analyzes the user experience in a gamified virtual environment of risks using the HTC Vive head-mounted display. The game was developed in the Unreal game engine and consisted of a walk-through maze composed of evident dangers and different signaling variables while user action data were recorded. To demonstrate which aspects provide better interaction, experience, perception and memory, three different warning configurations (dynamic, static and smart) and two different levels of danger (low and high) were presented. To properly assess the impact of the experience, we conducted a survey about personality and knowledge before and after using the game. We proceeded with the qualitative approach by using questions in a bipolar laddering assessment that was compared with the recorded data during the game. The findings indicate that when users are engaged in VR, they tend to test the consequences of their actions rather than maintaining safety. The results also reveal that textual signal variables are not accessed when users are faced with the stress factor of time. Progress is needed in implementing new technologies for warnings and advance notifications to improve the evaluation of human behavior in virtual environments of high-risk surroundings.

Procedural Learning through Action Observation: Preliminary Evidence from Virtual Gardening Activity in Intellectual Disability

Intellectual disability (ID) compromises intellectual and adaptive functioning. People with an ID show difficulty with procedural skills, with loss of autonomy in daily life. From an embodiment perspective, observation of action promotes motor skill learning. Among promising technologies, virtual reality (VR) offers the possibility of engaging the sensorimotor system, thus, improving cognitive functions and adaptive capacities. Indeed, VR can be used as sensorimotor feedback, which enhances procedural learning. In the present study, fourteen subjects with an ID underwent progressive steps training combined with VR aimed at learning gardening procedures. All participants were trained twice a week for fourteen weeks (total 28 sessions). Participants were first recorded while sowing zucchini, then they were asked to observe a virtual video which showed the correct procedure. Next, they were presented with their previous recordings, and they were asked to pay attention and to comment on the errors made. At the end of the treatment, the results showed that all participants were able to correctly garden in a real environment. Interestingly, action observation facilitated, not only procedural skills, but also specific cognitive abilities. This evidence emphasizes, for the first time, that action observation combined with VR improves procedural learning in ID.

Mixed Assessment of Virtual Serious Games Applied in Architectural and Urban Design Education

The creation and usage of serious games on virtual reality (VR) and/or interactive platforms for the teaching of architecture, construction, urban planning, and other derived areas, such as security and risk prevention, require design processes, studies, and research that lead to further consolidation expansion. In that sense, this paper presents two main aims developed: the improvement of a virtual navigation system through the results of previous user studies and mixed research (quantitative and qualitative) improved based on the user perception for educational and professional uses. The VR system used is based on Unreal Engine programming of the HTC Vive sensor. This study is related to the GAME4City 3.0 and a broader project focused on gamified visualization and its educational uses in architectural and urban projects. The results reflect great interest, good usability, and high motivation for further usage for all types of users. However, an apparent resistance to deepen its use continues to be perceived in academia. Based on the research results, weak points of educational gamified systems have been identified, and the main differences and needs in user profiles’ function. With these data, progress regarding implementing this kind of system at the teaching and professional levels must be pursued.

A Virtual Reality-Based Cognitive Telerehabilitation System for Use in the COVID-19 Pandemic

The COVID-19 pandemic has changed people’s lives and the way in which certain services are provided. Such changes are not uncommon in healthcare services and they will have to adapt to the new situation by increasing the number of services remotely offered. Limited mobility has resulted in interruption of treatments that traditionally have been administered through face-to-face modalities, especially those related to cognitive impairments. In this telerehabilitation approach, both the patient and the specialist physician enter a virtual reality (VR) environment where they can interact in real time through avatars. A spaced retrieval (SR) task is implemented in the system to analyze cognitive performance. An experimental group (n = 20) performed the SR task in telerehabilitation mode, whereas a control group (n = 20) performed the SR task through a traditional face-to-face mode. The obtained results showed that it is possible to carry out cognitive rehabilitation processes through a telerehabilitation modality in conjunction with VR. The cost-effectiveness of the system will also contribute to making healthcare systems more efficient, overcoming both geographical and temporal limitations.