Archive for category Video Games/Exergames

[Abstract] Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology

ABSTRACT

Background

Nowadays, information technologies are being widely adopted to promote healthcare and rehabilitation. Owing to their affordability and use of hand-free controllers, vision-based systems have gradually been integrated into motor rehabilitation programs and have greatly drawn the interest of healthcare practitioners and the research community. Many studies have illustrated the effectiveness of these systems in rehabilitation. However, the report and design aspects of the reported clinical trials were disregarded.

Objective

In this paper, we present a systematic literature review of the use of vision-based serious games and virtual reality systems in motor rehabilitation programs. We aim to propose a research methodology that engineers can use to improve the designing and reporting processes of their clinical trials.

Methods

We conducted a review of published studies that entail clinical experiments. Searches were performed using Web of Science and Medline (PubMed) electronic databases, and selected studies were assessed using the Downs and Black Checklist and then analyzed according to specific research questions.

Results

We identified 86 studies and our findings indicate that the number of studies in this field is increasing, with Korea and USA in the lead. We found that Kinect, EyeToy system, and GestureTek IREX are the most commonly used technologies in studying the effects of vision-based serious games and virtual reality systems on rehabilitation. Findings also suggest that cerebral palsy and stroke patients are the main target groups, with a particular interest on the elderly patients in this target population. The findings indicate that most of the studies focused on postural control and upper extremity exercises and used different measurements during assessment.

Conclusions

Although the research community’s interest in this area is growing, many clinical trials lack sufficient clarity in many aspects and are not standardized. Some recommendations have been made throughout the article.

via Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology – ScienceDirect

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[Abstract + References] Arm Games for Virtual Reality Based Post-stroke Rehabilitation – Conference paper

Abstract

Stroke is a leading cause of serious long-term disability. World Health Organization (WHO) published that the second leading of death is stroke accident and every year, 15 million people worldwide suffer from stroke attack, two-thirds of them have a permanent disability. Muscle impairment can be treated by intensive movements involving repetitive task, task-oriented and task-variegated. Conventional stroke rehabilitation is expensive, less engaging and at the same time need more time for the rehabilitation process and need more energy and time for the therapist to guide the stroke-survivor. Modern stroke rehabilitation is more promising and more effective with modern rehabilitation aids allowing the rehabilitation process to be faster, however, this therapist method can be obtained in the big cities. To cover the lack of rehabilitation process in this research will develop and improve post-stroke rehabilitation using games. This research using electromyography (EMG) device to analyze the muscle contraction during the rehabilitation process and using Kinect XBOX to record trajectory hands movements. Five games from movements sequence have designed and will be examined in this research. This games obtained two results, the first is the EMG signal and the second is trajectory data. EMG signal can recognize muscle contractions during playing game and the trajectory data can save the pattern of movements and showed the pattern to the monitor. EMG signal processing using time or frequency feature extractions is a good idea to obtain more information from muscle contractions, also velocity, similarities and error movements can be obtained by study the possible approaches.

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[ARTICLE] What is the impact of user affect on motor learning in virtual environments after stroke? A scoping review – Full Text

Abstract

Purpose

The purported affective impact of virtual reality (VR) and active video gaming (AVG) systems is a key marketing strategy underlying their use in stroke rehabilitation, yet little is known as to how affective constructs are measured or linked to intervention outcomes. The purpose of this scoping review is to 1) explore how motivation, enjoyment, engagement, immersion and presence are measured or described in VR/AVG interventions for patients with stroke; 2) identify directional relationships between these constructs; and 3) evaluate their impact on motor learning outcomes.

Methods

A literature search was undertaken of VR/AVG interventional studies for adults post-stroke published in Medline, PEDro and CINAHL databases between 2007 and 2017. Following screening, reviewers used an iterative charting framework to extract data about construct measurement and description. A numerical and thematic analytical approach adhered to established scoping review guidelines.

Results

One hundred fifty-five studies were included in the review. Although the majority (89%; N = 138) of studies described at least one of the five constructs within their text, construct measurement took place in only 32% (N = 50) of studies. The most frequently described construct was motivation (79%, N = 123) while the most frequently measured construct was enjoyment (27%, N = 42). A summative content analysis of the 50 studies in which a construct was measured revealed that constructs were described either as a rationale for the use of VR/AVGs in rehabilitation (76%, N = 38) or as an explanation for intervention results (56%, N = 29). 38 (76%) of the studies proposed relational links between two or more constructs and/or between any construct and motor learning. No study used statistical analyses to examine these links.

Conclusions

Results indicate a clear discrepancy between the theoretical importance of affective constructs within VR/AVG interventions and actual construct measurement. Standardized terminology and outcome measures are required to better understand how enjoyment, engagement, motivation, immersion and presence contribute individually or in interaction to VR/AVG intervention effectiveness.

Introduction

An increasing evidence base supports the use of virtual reality (VR) and active video gaming (AVG) systems to promote motor learning in stroke rehabilitation [1234]. However, practical and logistical barriers to VR/AVG implementation in clinical sites have been well described [567]. To support their use, researchers and developers often emphasize the potential advantages of VR/AVG systems over conventional interventions, including that these technologies may enhance a patient’s affective experience in therapy for the purpose of facilitating recovery [891011]. Examining the role of affective factors for motor learning is an emerging area of emphasis in rehabilitation [212131415].

VR/AVG use may enhance patients’ motivation to participate in rehabilitation as well as their engagement in therapeutic tasks. Motivation encourages action toward a goal by eliciting and/or sustaining goal-directed behavior [16]. Motivation can be intrinsic (derived from personal curiosity, importance or relevance of the goal) or extrinsic (elicited via external reward) [17]. Engagement is a cognitive and affective quality or experience of a user during an activity [16]. Many characteristics of VR/AVG play can contribute to user motivation and engagement, such as novelty, salient audiovisual graphics, interactivity, feedback, socialization, optimal challenge [14], extrinsic rewards, intrinsic curiosity or desire to improve in the game, goal-oriented tasks, and meaningful play [18].

Motivation and engagement are hypothesized to support motor learning either indirectly, through increased practice dosage leading to increased repetitive practice, or directly, via enhanced dopaminergic mechanisms influencing motor learning processes [1516]. Yet evidence is required to support these claims. A logical first step is to understand how these constructs are being measured within VR/AVG intervention studies. Several studies have used practice dosage or intensity as an indicator of motivation or engagement [192021]. To the authors’ knowledge, few have specifically evaluated the indirect mechanistic pathway by correlating measurement of patient motivation or engagement in VR/AVGs with practice dosage or intensity. While participants in VR/AVG studies report higher motivation as compared to conventional interventions [222324], conclusions regarding the relationship between motivation and intervention outcomes are limited by lack of consistency and rigour in measurement, including the use of instruments with poor psychometric properties [2223].

The body of research exploring the direct effects of engagement or motivation on motor learning is still in its infancy. Lohse et al. [16] were the first to evaluate whether a more audiovisually enriched as compared to more sterile version of a novel AVG task contributed to skill acquisition and retention in typically developing young adults, finding that participants who played under the enriching condition had greater generalized learning and complex skill retention. Self-reported engagement (User Engagement Scale; UES) was higher in the enriched group, but the only difference in self-reported motivation was in the Effort subscale of the Intrinsic Motivation Inventory (IMI), where the enriched group reported less effort as compared to the sterile group. The authors did not find a significant correlation between engagement, motivation and retention scores. A follow-up study using electroencephalography did not replicate the finding that the more enriched practice condition enhanced learning, it did show that more engaged learners had increased information processing, as measured by reduced attentional reserve [25].

Enjoyment, defined as ‘the state or process of taking pleasure in something’ [26], has less frequently been the subject of study in motor learning research, but has become popular as a way of describing patient interaction with VR/AVGs. Enjoyment may be hypothesized to be a precursor to both motivation and engagement. Given that the prevailing marketing of VR/AVGs is that they are ‘fun’ and ‘enjoyable’ [131427], it is important to evaluate its measurement in the context of other constructs.

Motivation, engagement and enjoyment in VR/AVGs may be influenced by the additional constructs of immersion and presence. Immersion is defined as “the extent to which the VR system succeeds in delivering an environment which refocuses a user’s sensations from the real world to a virtual world” [1328]. Immersion is considered as an objective construct referring to how the computational properties of the technology can deliver an illusion of reality through hardware, software, viewing displays and tracking capabilities [2930]. A recent systematic review [13] could not conclusively state effect of immersion on user performance. Immersion is distinct from presence, defined as the “psychological product of technological immersion” [31]. Presence is influenced by many factors, including the characteristics of the user, the VR/AVG task, and the VR/AVG system [28]. While presence is thought to be related to enhanced motivation and performance [32], relationships between this and other constructs of interest require exploration. Table 1 outlines definitions of constructs of interest to this scoping review.

Table 1

Construct definitions

Construct

Definition

Reference

Motivation

Motivation encourages action toward a goal by eliciting and/or sustaining goal-directed behavior.

[16]

Engagement

Engagement is a cognitive and affective quality or experience of a user during an activity.

[16]

Enjoyment

The state or process of taking pleasure in something.

[26]

Immersion

The extent to which the VR system succeeds in delivering an environment which refocuses a user’s sensations from the real world to a virtual world.

[1328]

Presence

The psychological product of technological immersion.

[31]

The purpose of this scoping review is to explore the impact of these affective constructs on motor learning after stroke. This greater understanding will enhance the clinical rationale for VR/AVG use and inform directions for subsequent research. Specifically, our objectives were to:

  1. 1.

    Describe how VR/AVG studies measure or report client enjoyment, motivation, engagement, immersion and presence.

  2. 2.

    Evaluate the extent to which motivation, enjoyment, engagement, immersion, and presence impact motor learning.

  3. 3.

    Propose directional relationships between enjoyment, motivation, engagement, immersion, presence and motor learning.

[…]

 

Continue —> What is the impact of user affect on motor learning in virtual environments after stroke? A scoping review | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 2Proposed relationships between the five constructs and motor learning

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[Abstract] Virtual Reality Environment for the Cognitive Rehabilitation of Stroke Patients

Abstract

We present ongoing work to develop a virtual reality environment for the cognitive rehabilitation of patients as a part of their recovery from a stroke. A stroke causes damage to the brain and problem solving, memory and task sequencing are commonly affected. The brain can recover to some extent, however, and stroke patients have to relearn to carry out activities of daily learning. We have created an application called VIRTUE to enable such activities to be practiced using immersive virtual reality. Gamification techniques enhance the motivation of patients such as by making the level of difficulty of a task increase over time. The design and implementation of VIRTUE is presented together with the results of a small acceptability study.

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[ARTICLE] FarMyo: A Serious Game for Hand and Wrist Rehabilitation Using a Low-Cost Electromyography Device – Full Text PDF

Abstract

One of the strategies used in recent years to increase the commitment and motivation of patients undergoing rehabilitation is the use of graphical systems, such as virtual environments and serious games. In addition to contributing to the motivation, these systems can simulate real life activities and provide means to measure and assess user performance. The use of natural interaction devices, originally conceived for the game market, has allowed the development of low cost and minimally invasive rehabilitation systems. With the advent of natural interaction devices based on electromyography, the user’s electromyographic data can also be used to build these systems. This paper shows the development of a serious game focused on aiding the rehabilitation process of patients with hand motor problems, targeting to solve problems related to cost, adaptability and patient motivation in this type of application. The game uses an electromyography device to recognize the gestures being performed by the user. A gesture recognition system was developed to detect new gestures, complementing the device’s own recognition system, which is responsible for interpreting the signals. An initial evaluation of the game was conducted with professional physiotherapists.

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[NEWS] New Gaming Platform Aims to Use Virtual Rehab to Help Stroke Survivors

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VirtualRehab

Researchers at UK-based University of East Anglia (UEA), in collaboration with Evolv Rehabilitation Technologies, have created a new virtual reality (VR) gaming platform designed to help improve the lives of stroke patients suffering from complex neurological syndromes caused by their stroke.

The new technology, which has been funded by the National Institute for Health Research (NIHR), was recently unveiled at RehabWeek in Toronto.

Around 30% to 50% of stroke survivors experience Œhemispatial neglect, which leaves people unaware of things located on one side of their body and greatly reduces their ability to live independently.

“A stroke can damage the brain, so that it no longer receives information about the space around one side of the world,” lead researcher Dr Stephanie Rossit, from UEA’s school of Psychology, explains in a media release from UEA.

“If this happens, people may not be aware of anything on one side, usually the same side they also lost their movement. This is called hemispatial neglect.

“These people tend to have very poor recovery and are left with long-term disability. Patients with this condition tell us that it is terrifying. They bump into things, they’re scared to use a wheelchair, so it really is very severe and life-changing.”

Current rehabilitation treatments involve different types of visual and physical coordination tasks (visuomotor) and cognitive exercises, ­ many of which are Œpaper and pen-based.

The new non-immersive VR technology being showcased updates these paper and pen tasks for the digital age – using videogame technology instead, per the release.

“We know that adherence is key to recovery – so we wanted to create something that makes it fun to stick to a rehabilitation task,” Roissit adds.

In one such game, the patient sees a random series of apples, some complete and some with a piece bitten off. The apples vibrate and move to provide greater stimulation to the patient.

“The aim for the patient is to choose the maximum number of complete apples that they see in the quickest time possible,” states David Fried, CEO of Evolv.

“A person with visual neglect would quite often only see a small number of correct targets to the right-hand side of the screen. Therapists can control the complexity of the game by increasing or reducing the number of apples on screen.”

As well as aiding diagnosis, the new game aims to improve rehabilitation by including elements such as scoring and rewards to engage the patient and improve adherence to their treatment.

Fried said: “Traditional rehabilitation treatment is quite monotonous and boring, so this gamification aspect is really important to help people stick with their treatment,” Fried adds.

“Our goal is to use technology to make rehabilitation fun and engaging, and we have applied this to our Spatial Neglect therapy solution. The great thing about it is that it can be used not only in clinics but also in patients’ homes, thereby giving them access to personalized rehabilitation without leaving their living room.”

The team has previously worked with stroke survivors, carers, and clinicians to assess the feasibility, usability, and acceptability of new gaming technology, per the release.

Dr Rossit said: ³This technology has the potential to improve both independence and quality of life of stroke survivors,” Rossit shares.

“This innovative therapy could also improve long-term care after stroke by providing a low-cost, enjoyable therapy that can be self-administered anywhere and anytime, without the need for a therapist to be present on every occasion.”

[Source: University of East Anglia]

 

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[NEWS] NEOFECT Wins Design Week VirtualTech Award for Second Year In a Row

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SmartBoardforHome

NEOFECT was once again honored at the San Francisco Design Week (SFDW) Awards, winning the VirtualTech award for its new Smart Board for Home NextGen, a gamified rehabilitation device for stroke survivors to use at home.

This marks the second consecutive year that the company has received the VirtualTech award, according to a company announcement.

“The Smart Board for Home NextGen is the epitome of the 2019 SFDW Awards theme, and we’re humbled to have won this year after receiving Honorable Mention in the VirtualTech category last year for our Smart Glove for Home,” says Scott Kim, co-founder and CEO of NEOFECT USA, in the release.

“We took every aspect of the patient experience into account when redesigning the Smart Board for Home NextGen,” Kim adds.

“For example, stroke patients’ grip is often weak, so we re-engineered the handle to be more secure. We developed more interactive virtual reality games, like tennis, so patients can have more variety, and also created a dual-player option.”

SFDW is an international design competition that honors projects encouraging thought leadership in design, focusing on “Where Innovation Meets Social Responsibility.”

The awards celebrate and recognize exemplary work in all fields of design, including architecture, interior design, industrial design, communication design, and user experience design.

Twenty-four winning projects and 11 honorable mentions were selected by a jury comprised of professionals—including executives from Lyft, Google, Microsoft, and Fitbit—who reviewed submissions from a pool of applicants from the USA and Europe. Each winning project was judged based on impact, singularity, inclusiveness, social responsibility, ease of use, visual appeal, and feasibility.

Award winners from leading design firms, in-house teams, and creative individuals were honored recently during a ceremony that took place at Pier 27 in San Francisco, the release explains.

“We are extremely excited the San Francisco Design Week Awards returned this year,” states SFDW Executive Director Dawn Zidonis.

“As with last year, the quality of the many entries exceeded our expectations. Congratulations to this year’s outstanding and diverse winners, including NEOFECT.”

[Source(s): NEOFECT, Business Wire]

 

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[ARTICLE] Virtual reality in the rehabilitation of patients with stroke: an integrative review – Full Text

ABSTRACT

Objective: To describe the intervention protocols to using commercial video games as virtual reality (VR) in rehabilitation of patients with stroke.

Methods: Integrative review using the descriptors “rehabilitation”, “virtual reality exposure therapy” and “videogames” in the LILACS and PUBMED databases. Articles published from 2011 to 2018 were selected.

Results: We found 1,396 articles, 1,383 were excluded and 13 were selected. Most of the articles were randomized clinical trials published in 2014 or later. The sample size varied from 5–47 adults, or adults and elders, with chronic stroke. The Nintendo Wii® was the most used video game system. The intervention happened two or three times a week, each session lasting from 30 to 60 minutes, over 2–12 weeks. Balance, upper limb motor functions, quality of life and daily living activities were the most common evaluated outcomes. The Fugl-Meyer Assessment, Berg Balance Scale, Timed Up and Go test, Barthel Scale and SF-36 were the most common outcome measurement tools.

Conclusions: The studies indicated improvement in dynamic balance, upper limb motor function and quality of life after rehabilitation using VR. The VR was more effective than conventional treatments for the outcome of dynamic balance. Two studies did not find any changes in static balance and daily living activities. Physical aspects and quality of life were the outcomes most evaluated by the researchers; as were the population with chronic strokes and protocols of long duration and low intensity. Few studies targeted immediate VR effects, performance in daily living activities and social participation.

 

Rehabilitation of a patient is a process that involves the knowledge of the professional regarding the health condition and the repercussion it has on the life of the individual, as well as a broad scientific knowledge about the functioning of the human body, so that consistent decisions may be made1. In this process, assessing the situation, planning and choosing the best available evidences to perform clinical tasks is paramount to systematize decisions and optimize results2.

Many rehabilitation techniques described in the literature may help guide the intervention of professionals, such as physical training, kinesitherapy, robotic therapy, hydrotherapy, music therapy, intracortical stimulation and mental health practices, task-oriented training, mirror therapy, among others36. Virtual reality (VR) is a therapeutic approach that has been used in the field of rehabilitation in recent years. In this approach, users interact with virtual objects through the movements of their hands and body, or through tactile interfaces (gloves, joysticks, mouse), performing actions in a simulated environment7. The invention of low-cost human movement sensors in commercial game systems has made it easier to use video games for rehabilitation8. Examples of these systems include the Kinect for Microsoft’s Xbox®, the Nintendo Wii® and the PlayStationMove® by Sony.

The use of VR has increased the potential for motor learning and neuroplasticity during rehabilitation. A study using magnetic resonance imaging found consistent results, showing a reorganization of the sensorimotor cortex9. Functional improvements have also been associated with the use of VR by rehabilitation professionals. Allain et al.10 pointed out that performing a task in a virtual kitchen anticipated carrying out the task in real life. The virtual practice of shopping for groceries is associated with an improvement in the performance of actual grocery shopping11, and patients who interact with the virtual world have fewer limitations when performing daily activities12.

When VR has been applied in the rehabilitation of patients after strokes, it has mainly been used to help in the functional recovery of upper limbs, cognitive function, posture control and balance13,14. Deficiencies in the upper limb after strokes may negatively impact the daily life of patients, by limiting their ability to carry out essential tasks that are necessary for an independent life15. The VR offers a rich environment in which patients may, after a stroke, solve problems and develop new abilities16. Considering the above, this study aimed to review and analyze information from the literature on the main intervention protocols delineated by rehabilitation professionals, using VR in commercial video game systems for the treatment of patients who had suffered strokes, while also identifying the most common outcomes found by these professionals.[…]

Continue —>  Virtual reality in the rehabilitation of patients with stroke: an integrative review

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[Abstract + References] Serious Game Based on Myo Armband for Upper-Limb Rehabilitation Exercises – Conference paper

Abstract

The purpose of a rehabilitation processes is to restore a person to a state of optimal functioning. A wide variety of rehabilitation processes consist of repetition tasks. Thus, Serious Games (SG) can be used as a technology to assist in this process by motivating patients to perform the exercises during rehabilitation sessions using a variety of devices, with goals or scores to be achieved during sessions. This work addresses the development and usage of SG based on the Myo Armband, an affordable-access device, which is used to build an Assistive Technology for upper-limb rehabilitation. This SG has a circus target shooting as theme, in which the individuals must make the selected upper-limb rehabilitation exercise (the full fist position), in order to shoot with the gun and hit the targets. To test these SG, five healthy volunteers used them during 3 sessions of 10 repetitions each. To evaluate this SG, the volunteers answered a System Usability Scale (SUS) questionnaire and a free questionnaire with questions about the structure of the SG. Results showed that these SG have good potential to be used as a rehabilitation tool, and the suggestions of the free form questionnaire will be useful to make the necessary changes before its usage with impaired patients.

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[Abstract + References] Virtual Reality Game Development Using Accelerometers for Post-stroke Rehabilitation – Conference paper

Abstract

Stroke can generate several types of sequelae, including motor difficulties in both upper and lower limbs. One way to eliminate or reduce these difficulties is through physical therapy, but this type of treatment can often become tiresome and monotonous, decreasing the patient’s interest. Thus, aiming to assist in the rehabilitation of patients, this work seeks to use immersive virtual reality games with the purpose of interacting with physiotherapy exercises. In this type of game the individual must use special equipment (glasses) to feel in an environment where they can interact in different ways with the scenery. Among the possible equipment used for immersive virtual reality was chosen to use a smartphone in conjunction with a virtual reality glasses. In this way an environment was developed that allows the individual to move through the scenario by the control of the upper virtual members by accelerometry sensors, which will be positioned properly to identify the actual movement of the limbs. Thus, an equipment was developed capable of reading the movements and sending this information to a smartphone that executes the developed game.

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