Archive for category Virtual reality rehabilitation

[Abstract + References] Virtual System Using Haptic Device for Real-Time Tele-Rehabilitation of Upper Limbs

Abstract

This paper proposes a tool to support the rehabilitation of upper limbs assisted remotely, which makes it possible for the physiotherapist to be able to assist and supervise the therapy to patients who can not go to rehabilitation centers. This virtual system for real-time tele-rehabilitation is non-invasive and focuses on involving the patient with mild or moderate mobility alterations within a dynamic therapy based on virtual games; Haptics Devices are used to reeducate and stimulate the movement of the upper extremities, at the same time that both motor skills and Visual-Motor Integration skills are developed. The system contains a virtual interface that emulates real-world environments and activities. The functionality of the Novint Falcon device is exploited to send a feedback response that corrects and stimulates the patient to perform the therapy session correctly. In addition, the therapy session can vary in intensity through the levels presented by the application, and the amount of time, successes and mistakes made by the patient are registered in a database. The first results show the acceptance of the virtual system designed for real-time tele-rehabilitation.

References

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via Virtual System Using Haptic Device for Real-Time Tele-Rehabilitation of Upper Limbs | SpringerLink

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[ARTICLE] Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Full Text

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming.

Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT).

Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures.

Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Better medical treatments in the acute phase after stroke have increased survival and with that the number of patients needing rehabilitation with an associated increased burden on the health care system.1 Novel technologies have sought to meet this increased rehabilitation demand and to potentially allow patients to continue rehabilitation at home after they leave the hospital.2 Also, technology has the potential to gather massive and detailed data (eg, kinematic and performance data) that might be useful in understanding recovery after stroke better, improving the quality of diagnostic tools and developing more successful treatment approaches.3 Given these promises, several studies and meta-analyses have evaluated the effectiveness of technologies that use virtual reality (VR) in stroke rehabilitation. In a first review, Crosbie et al4 analyzed 6 studies that used VR to provide upper-limb rehabilitation. Although they found a positive effect, they concluded that the evidence was only weak to moderate given the low quality of the research. A later meta-analysis analyzing 5 randomized controlled trials (RCTs) and 7 observational studies suggested a positive effect on a patient’s upper-limb function after training.5 Another meta-analysis of 26 studies by Lohse et al,6 which compared specific VR (SVR) systems with commercial VR games, found a significant benefit for SVR systems as compared with conventional therapy (CT) in both body function and activity but not between the 2 types of systems. This study, however, included a variety of systems that would treat upper-limb, lower-limb, and cognitive deficits. Saywell et al7 analyzed 30 “play-based” interventions, such as VR systems including commercial gaming consoles, rehabilitation tools, and robot-assisted systems. They found a significant effect of play-based versus control interventions in dose-matched studies in the Fugl-Meyer Assessment of the Upper Extremity (FM-UE).7 In contrast, a more recent large-scale analysis of a study with Nintendo Wii–based video games, including 121 patients concluded that recreational activities are as effective as VR.8A later review evaluated 22 randomized and quasi–randomized controlled studies and concluded that there is no evidence that the use of VR and interactive video gaming is more beneficial in improving arm function than CT.9 In all, 31% of the included studies tested nonspecific VR (NSVR) systems (Nintendo Wii, Microsoft Xbox Kinect, Sony PlayStation EyeToy). Hence, although VR-based interventions have been in use for almost 2 decades, their benefit for functional recovery, especially for the upper limb, remains unknown. Possibly, these contradictory results indicate that, at present, studies are too few or too small and/or the recruited participants too variable to be conclusive.10 However, alternative conclusions can be drawn. First, VR is an umbrella term. Studies comparing its impact often include heterogeneous systems or technologies, customized or noncustomized for stroke treatment, addressing a broad range of disabilities. However, effectiveness can only be investigated if similar systems that rehabilitate the same impairment are contrasted. This has been achieved by meta-analyses that investigated VR-based interventions for the lower limb, concluding that VR systems are more effective in improving balance or gait than CT.11Second, a clear understanding of the “active ingredients”3 that should make VR interventions effective in promoting recovery is missing. Therapeutic advantages of VR identified in current meta-analyses are that it might apply principles relevant to neuroplasticity,5,9 such as providing goal-oriented tasks,5,9 increasing repetition and dosage,5,9 providing therapists and patients with additional feedback,5,6,9 and allowing to adjust task difficulty.6 In addition, it has been suggested that the use of VR increases patient motivation,6 enjoyment,8,9 and engagement7; makes intensive task-relevant training more interesting4,7; and offers enriched environments.9 Although motivational aspects are important in the rehabilitation process because they possibly increase adherence,3 their contribution to recovery is difficult to quantify because it relies on patients’ subjective evaluation.7,1215 Rehabilitation methods, whether VR or not, however, need to be objectively beneficial in increasing the patient’s functional ability. Hence, an enormous effort has been expended to identify principles of neurorehabilitation that enhance motor learning and recovery.1624 Consequently, an effective VR system should besides be motivating, also augment CT by applying these principles in the design.23 Following this argument, we advance the hypothesis that custom-made VR rehabilitation systems might have incorporated these principles, unlike off-the-shelf VR tools, because they were created for recreational purposes. Combining the effects of both approaches in one analysis might, thus, mask their real impact on recovery. Again, in the rehabilitation of the lower limb, this effect has been observed. Two meta-analyses investigating the effect of using commercial VR systems for gait and balance training did not find a superior effect, which contradicts the conclusions of the other systematic reviews.11 In upper-limb rehabilitation, this question has not been properly addressed until the most recent review by Aminov et al.25 However, there are several flaws in the method applied that could invalidate the results they found. Specifically, studies were included regardless of their quality, and it is not clear which outcome measurements were taken for the analysis according to the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO).26 In addition, a specifically designed rehabilitation system (Interactive Rehabilitation Exercise [IREX])27 was misclassified as an off-the-shelf VR tool. Because their search concluded in June 2017, the more recent evidence is missing. We decided to address these issues by conducting a well-controlled meta-analysis that focuses only on RCTs that use VR technologies for the recovery of the upper limb after stroke. We analyze the effect of VR systems specifically built for rehabilitation (ie, SVR systems) and off-the-shelf systems (ie, NSVR commercial systems) against CT according to the ICF-WHO categories. Also, we extracted 11 principles of motor learning and recovery from established literature that could act as “active ingredients” in the protocols of effective VR systems. Through a content analysis, we identified which principles are present in the included studies and compared their presence between SVR and NSVR systems. We hypothesized, first, that SVR systems might be more effective than NSVR systems as compared with CT in the recovery of upper-limb movement and, second, that this superior effect might be a result of the specific principles included in SVR systems.

 

This meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.28

Identification of RCTs

We define VR as a computer-based technology that provides the user with a sense of presence in a virtual environment,29 which is induced by exposing the user to computer-generated sources of sensory stimulation that satisfy their perceptual predictions and expected sensorimotor contingencies.30 The studies included aimed at training the upper extremity of stroke patients through active participation, without assistive robotic devices (eg, exoskeleton, end-effector devices) or exogenous stimulation. We compared the impact on body function and activity of 2 kinds of VR systems with CT: SVR and NSVR systems. SVR systems were developed exclusively for neurorehabilitation purposes. NSVR systems, on the other hand, are recreational and/or off-the-shelf video games (eg, Nintendo Wii, Microsoft Xbox). As CT, we considered occupational therapy and physical therapy. To identify all RCTs in these 2 categories, we performed a computerized search in the bibliographic databases MEDLINE (OVID), Cochrane Library Plus (including EMBASE), CINAHL, APA PsycNET, DARE, and PEDro for studies that were published in English from inception until August 7, 2018, the day of the conclusion of the search. The search strategy (Supplementary Table 1) included only RCTs that tested the efficacy of SVR or NSVR systems in recovering the upper limbs of stroke patients who were either in the acute (up to 21 days poststroke), subacute (between 3 weeks and 3 months poststroke), or chronic (after 3 months poststroke) stage. We combined the effects of various chronicity bands because the current literature suggests that principles of motor learning interact constantly with the biological processes of recovery,31 and therefore, no differential effect between SVR and NSVR systems resulting from chronicity should be expected. This notion has also been confirmed by the latest meta-analysis.25 In addition, splitting the identified literature into VR type, ICF-WHO category, and chronicity reduces statistical power because of the small number of studies remaining in each band. Two reviewers (BRB and MM) assessed the studies for eligibility. We excluded studies that were not carried out on humans, lacked a control group, included less than 5 participants per experimental condition, did not target upper-extremity rehabilitation, used exoskeletons as interfaces, used exogenous stimulation (such as transcranial stimulation), or did not provide information on standard clinical scales (Figure 1). Exoskeletons and exogenous stimulation protocol where excluded for the passive or active support provided in the rehabilitation process that might lead to different outcomes.

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Figure 1. Study flow diagram (PRISMA). The selection process of identified randomized controlled trials.

[…]

 

Continue —>  Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Martina Maier, Belén Rubio Ballester, Armin Duff, Esther Duarte Oller, Paul F. M. J. Verschure, 2019

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[ARTICLE] Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury – Full Text

Abstract

After traumatic brain injury (TBI), motor impairment is less common than neurocognitive or behavioral problems. However, about 30% of TBI survivors have reported motor deficits limiting the activities of daily living or participation. After acute primary and secondary injuries, there are subsequent changes including increased GABA-mediated inhibition during the subacute stage and neuroplastic alterations that are adaptive or maladaptive during the chronic stage. Therefore, timely and appropriate neuromodulation by transcranial direct current stimulation (tDCS) may be beneficial to patients with TBI for neuroprotection or restoration of maladaptive changes.

Technologically, combination of imaging-based modelling or simultaneous brain signal monitoring with tDCS could result in greater individualized optimal targeting allowing a more favorable neuroplasticity after TBI. Moreover, a combination of task-oriented training using virtual reality with tDCS can be considered as a potent tele-rehabilitation tool in the home setting, increasing the dose of rehabilitation and neuromodulation, resulting in better motor recovery.

This review summarizes the pathophysiology and possible neuroplastic changes in TBI, as well as provides the general concepts and current evidence with respect to the applicability of tDCS in motor recovery. Through its endeavors, it aims to provide insights on further successful development and clinical application of tDCS in motor rehabilitation after TBI.

Background

Traumatic brain injury (TBI) is defined as “an alteration in brain function (loss of consciousness, post-traumatic amnesia, and neurologic deficits) or other evidence of brain pathology (visual, neuroradiologic, or laboratory confirmation of damage to the brain) caused by external force” [1]. The incidence and prevalence of TBI are substantial and increasing in both developing and developed countries. TBI in older age groups due to falling has been on the rise in recent years, becoming the prevalent condition in all age groups [23]. TBI causes broad spectrum of impairments, including cognitive, psychological, sensory or motor impairments [45], which may increase the socioeconomic burdens and reduce the quality of life [67]. Although motor impairment, such as limb weakness, gait disturbance, balance problem, dystonia or spasticity, is less common than neurocognitive or behavioral problems after TBI, about 30% of TBI survivors have reported motor deficits that severely limited activities of daily living or participation [8].

Motor impairment after TBI is caused by both focal and diffuse damages, making it difficult to determine the precise anatomo-clinical correlations [910]. According to previous clinical studies, recovery after TBI also seems worse than that after stroke, although the neuroplasticity after TBI may also play an important role for recovery [11]. Therefore, a single unimodal approach for motor recovery, including conventional rehabilitation, may be limiting, and hence, requiring a novel therapeutic modality to improve the outcome after TBI.

Transcranial direct current stimulation (tDCS) – one of the noninvasive brain stimulation (NIBS) methods – can increase or decrease the cortical excitability according to polarity (anodal vs. cathodal) and be used to modulate the synaptic plasticity to promote long-term functional recovery via long-term depression or potentiation [1213]. Recent clinical trials evaluating patients with stroke have reported the potential benefits of tDCS for motor recovery [14]. Neuroplastic changes after TBI and results from animal studies also suggest that tDCS could improve the motor deficit in TBI, although clinical trials using tDCS for motor recovery in TBI are currently lacking [14].

In this review, we will cover (1) the pathophysiology and possible neuroplastic changes in TBI; (2) physiology of tDCS; (3) current clinical evidence of tDCS in TBI for motor recovery; (4) general current concept of tDCS application for motor recovery; and (5) the future developments and perspectives of tDCS for motor recovery after TBI. Although the scope of motor recovery is wide, this review will focus primarily on the recovery of limb function, especially that of the upper limb. We expect that this review can provide insights on further successful development and clinical application of tDCS in motor rehabilitation after TBI.[…]

 

Continue —> Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 3Schematic classification of personalized tDCS for motor recovery. Depending on electrode size, shape, and arrangement, tDCS can be broadly classified into a Conventional tDCS, b Customized Electrode tDCS, and c Distributed Array or High-Definition tDCS. Red color represents anodes and blue color represents cathodes

Fig. 5Merged system with tDCS and virtual reality. Patient with TBI can use this system in the hospital setting with the supervision of clinican (a) and can continue to use it at their home with tele-monitored system (b)

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[Abstract] Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview.

OBJECTIVE:This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals.
METHODS:Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms “VR,” “rehabilitation,” and “stroke.”
RESULTS:Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training.
CONCLUSIONS:Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.

via Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview. – Abstract – Europe PMC

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[NEWS] Meet Addison, a Virtual Caregiver Set to Debut at CES 2019 – Rehab Managment

Addison-square-PR

Electronic Caregiver, a division of SameDay Security Inc, announces Addison Care, described as reportedly the world’s first virtual caregiver. The technology will make its debut at the Consumer Electronics Show January 2019 in Las Vegas.

Addison Care, named after its ambient augmented reality virtual caregiver, Addison, is a state-of-the-art, 3D animated caregiver designed to engage aging and chronically ill clients throughout the home to supplement their care and to provide various health and safety features. Appearing on 15-inch monitors strategically placed throughout the residence, she carries on two-way conversations, and she is programed for a user’s personal needs and plans of care.

Addison’s capabilities include 24/7 in-home checkups that include activity monitoring, medication reminders, adherence verification, and real-time assessments if a client develops evidence of increased risk of falling or health decline. She is also programmed to measure health performance, reward users for making progress, collect vitals and conduct in-home examinations, explains a media release from Electronic Caregiver.

“The aging population commonly lives with comorbidities (multiple chronic diseases). There is a lot of pressure for patients and families, and adherence to treatment regimens are often difficult to manage at home,” says Anthony Dohrmann, founder and CEO of SameDay Security and the visionary behind Addison, in the release.

“Only 3% of the US population can afford live caregiving,” Dohrmann adds. “We are bringing affordable, effective care alternatives to the world through Addison. Working with home care providers and hospitals across America, we will provide service and product line extensions to serve market need, while delivering alternatives individuals and families can afford. Our goal is to cut costs, improve care, and extend functional independence.”

[Source(s): Electronic Caregiver, PR Newswire]

via Meet Addison, a Virtual Caregiver Set to Debut at CES 2019 – Rehab Managment

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[NEWS] From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds

 Jan. 15, 2019, 07:52 AM

IRVINE, Calif.Jan. 15, 2019 /PRNewswire/ — Since the beginning, virtual reality paired with an omnidirectional treadmill that allows users to move through the virtual world in any direction has been relegated to realms of fiction…until now. A new company, OmniPad, (OmniPad.com), is looking to change the world of virtual reality with its sleek and innovative game-changing VR treadmill that allows for fully immersive natural 360-degree movement through virtual space.

The OmniPad utilizes a ball-bearing encrusted omnidirectional platform that supports a flattened spherical, revolving treadmill track. The OmniPad platform enables the locomotion surface to freely revolve endlessly, in any direction, creating a unique omnidirectional treadmill. With the OmniPad, gamers, first responders, architects, virtual tourists, and even the military, can freely walk and run around in real time virtual environments, experiencing the most comprehensive and fully immersive VR experience available.

“Being a professional 3D animator for over 25 years, and having worked on very high-end virtual reality projects, the challenge of ‘how to enable 360-degree locomotion on a stationary surface‘ is a question that burned in my mind since the late 1990’s. I contemplated this obstacle to freedom of VR locomotion for months and years. Then, I was lying in bed one night further toiling with the omnidirectional locomotion surface question, and it dawned on me . . . a water balloon!” said Neil Epstein, OmniPad’s CEO and president. “I realized that when you take a small water balloon, press it firmly between your palms so that the top and bottom surfaces are completely flat, and then motion your hands in opposing circular directions, the flattened water balloon freely revolves in all directions while still remaining completely flat on both sides. Hence, the core mechanics of the OmniPad were born.”

The benefits and features of the OmniPad will include:

  • A Unique Omnidirectional Treadmill Design: The circular moving omnidirectional platform sets the company apart in the VR industry.
  • Unmatched Virtual Reality Immersion: The OmniPad lets virtual reality users experience the most immersive VR experience available by letting users freely and naturally walk, jog and run around in the virtual reality world.
  • Patented Treadmill Design and Construction: The dynamic, never before implemented design mechanics that grant the OmniPad its unique immersive locomotion abilities make it the only VR accessory of its type available in the industry.
  • A Multitude Of Uses Possible Uses: With the appropriate Virtual Reality environments, the OmniPad offers a comprehensive gaming experience, as well as highly-effective training of training first responders and soldiers, and allows architects, engineers, and home buyers to visualize buildings and real estate, and even has significant applications in sports training, eSports competitions, and rehabilitation, among so many other applications.

OmniPad has launched a SEC regulation crowdfunding equity campaign, (https://wefunder.com/omnipad.company ), to share awareness and the potential capabilities of this awe-inspiring product. You can check out the company’s YouTube channel, (https://www.youtube.com/channel/UCsR1sCPunIZs2G28DFmmn9A), to see the OmniPad in action.

ABOUT OmniPad

OmniPad is a startup company comprised of some of the brightest and creative minds available. The company’s team includes the world’s foremost expert on omnidirectional locomotion surface technology and Stanford Engineering graduate, David Carmein, the EMMY award-winning 3-D artist and conceptual mind behind OmniPad, Neil Epstein, J.D., and the marketing specialties of Jordan Robinson, Orentheal Williams, and Kenneth Dunn.

Media Contact:
George Pappas
Conservaco/The Ignite Agency
949-339-2002
207740@email4pr.com
https://ignitecfp.com

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SOURCE OmniPad

 

via From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds | Markets Insider

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[WEB SITE] How Virtual Reality Will Transform Medicine – Scientific American

Anxiety disorders, addiction, acute pain and stroke rehabilitation are just a few of the areas where VR therapy is already in use

How Virtual Reality Will Transform Medicine

Credit: Celia Krampien

If you still think of virtual reality as the province of dystopian science fiction and geeky gamers, you had better think again. Faster than you can say “Ready Player One,” VR is starting to transform our world, and medicine may well be the first sector where the impact is profound. Behavioral neuroscientist Walter Greenleaf of Stanford University has been watching this field develop since the days when VR headsets cost $75,000 and were so heavy, he remembers counterbalancing them with a brick. Today some weigh about a pound and cost less than $200. Gaming and entertainment are driving current sales, but Greenleaf predicts that “the deepest and most significant market will be in clinical care and in improving health and wellness.”

Even in the early days, when the user entered a laughably low-resolution world, VR showed great promise. By the mid-1990s research had shown it could distract patients from painful medical procedures and ease anxiety disorders. One initial success was SnowWorld, which immersed burn patients in a cool, frozen landscape where they could lob snowballs at cartoon penguins and snowmen, temporarily blocking out the real world where nurses were scrubbing wounds, stretching scar tissue and gingerly changing dressings. A 2011 study with 54 children in burn units found an up to 44 percent reduction in pain during VR sessions—with the bonus that these injured kids said they had “fun.”

Another success came in the wake of 9/11. Psychologist JoAnn Difede of NewYork-Presbyterian/Weill Cornell Medical Center began using VR with World Trade Center survivors suffering from post-traumatic stress disorder (PTSD) and later with soldiers returning from Afghanistan and Iraq.

In Difede’s laboratory, I saw the original 9/11 VR program with its scenes of lower Manhattan and the newer Bravemind system, which depicts Iraqi and Afghan locales. Developed with Department of Defense funding by Albert “Skip” Rizzo and Arno Hartholt, both at the University of Southern California, Bravemind is used to treat PTSD at about 100 U.S. sites. The approach is based on exposure therapy, in which patients mentally revisit the source of their trauma guided by a therapist who helps them form a more coherent, less intrusive memory. In VR, patients do not merely reimagine the scene, they are immersed in it.

Difede showed me how therapists can customize scenes in Bravemind to match a patient’s experience. A keystroke can change the weather, add the sound of gunfire or the call to prayers. It can detonate a car bomb or ominously empty a marketplace. An optional menu of odors enables the patient to sniff gunpowder or spices through a metal tube. “What you do with exposure therapy is systematically go over the trauma,” Difede explains. “We’re teaching the brain to process and organize the memory so that it can be filed away and no longer intrudes constantly in the patient’s life.” The results, after nine to 12 gradually intensifying sessions, can be dramatic. One 2010 study with 20 patients found that 16 no longer met the criteria for PTSD after VR treatment.

Until recently, large-scale studies of VR have been missing in action. This is changing fast with the advent of cheaper, portable systems. Difede, Rizzo and three others just completed a randomized controlled trial with nearly 200 PTSD patients. Expected to be published this year, it may shed light on which patients do best with this high-tech therapy and which do not. In a study with her colleague, burn surgeon Abraham Houng, Difede is aiming to quantify the pain-distraction effects of a successor to SnowWorld called Bear Blast, a charming VR game in which patients toss balls at giggly cartoon bears. They will measure whether burn patients need lower doses of intravenous painkillers while playing.

Greenleaf counts at least 20 clinical arenas, ranging from surgical training to stroke rehabilitation to substance abuse where VR is being applied. It can, for example, help recovering addicts avoid relapses by practicing “refusal skills”—turning down drinks at a virtual bar or heroin at a virtual party. Brain imaging suggests that such scenes can evoke very real cravings, just as Bravemind can evoke the heart-racing panic of a PTSD episode. Researchers foresee a day when VR will help make mental health care cheaper and more accessible, including in rural areas.

In a compelling 2017 paper that reviews 25 years of work, Rizzo and co-author Sebastian Koenig ask whether clinical VR is finally “ready for primetime.” If today’s larger studies bear out previous findings, the answer seems to be an obvious “yes.”

via How Virtual Reality Will Transform Medicine – Scientific American

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[Abstract] A Virtual Reality based Training and Assessment System for Hand Rehabilitation – IEEE Conference Publication

Abstract

Virtual reality is widely applied in rehabilitation robot to help post-stoke patients complete rehabilitation training for the body function recovery. Most of virtual rehabilitation training systems lack scientific assessment standards and doctors don’t usually use quantitative examinations but qualitative observation and conversation with patients to evaluate the motor function of limb. Based on this situation, a virtual rehabilitation training and assessment system is designed, which contains two rehabilitation training games and one assessment system. The virtual system can attract patient attention and decrease the boredom of rehabilitation training and assessment. Compared with the existing rehabilitation assessment methods, the proposed virtual assessment system can give the assessment results similar to Fugl-Meyer Assessment, which is more quantitative, interesting and convenient. Five volunteers participate in the study of assessment system and the experimental results confirm the effectiveness of assessment system.

I. Introduction

In recent years, according to American Heart Association, stroke is the leading cause of serious long-term disability in the US and about 795,000 people suffer from a stroke each year [1]. China is also facing the same problem. The stroke is the first leading cause of death. Every year, 2.4 million people suffer from stroke [2]. Fortunately, about 60-75 percent of those can survive. However, about 65 percent of them still remain severely handicapped because of the neurological damage caused by stroke, for example, movement disorders, hemiparesis and so on [3], [4]. Those sequelae have an effect on body movement function, especially arm and hand function [4], [5]. The lost of hand movement function will affect the Activities of Daily Living (ADLs), which will decrease the quality of life [6].[…]

via A Virtual Reality based Training and Assessment System for Hand Rehabilitation – IEEE Conference Publication

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[ARTICLE] Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial – Full Text

Abstract

Background

Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery.

Objective

The aim of this study was to directly compare virtual reality-based training with conventional therapy.

Methods

In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16×45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects.

Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale).

Results

54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20–81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences.

Conclusions

Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients.

Introduction

Virtual reality-based rehabilitation systems are gaining popularity because of their ease of use, applicability to wide range of patients, and ability to provide patient-personalized training []. Additional reported benefits of virtual reality systems for both patients and health providers include increased therapy efficiency and a high level of attention in patients during training [].

One of the main struggles therapists encounter is keeping patients motivated throughout conventional training sessions. The Yerkes-Dodson Law describes the relationship between arousal or motivation and performance []. At first, an increase in arousal and motivation leads to an increase in performance. But once a certain point is reached, this point can vary based on many factors including the task, the participant, and the context, the relationship becomes inverse and increases in arousal caused decreases in performance. In line with these ideas, previous research has shown that increased performance leads to greater improvement in patients after stroke up to a certain point. Virtual reality-based systems allow manipulation of arousal through training settings to ensure that peak performance is maintained for as large a portion of the therapy time as possible [].

Laver et al. systematically evaluated the literature regarding the efficacy of virtual reality-based training in stroke rehabilitation in 2011 and in its updates in 2015 and 2017 []. Their current meta-analysis of 22 trials including 1038 patients after stroke that focused on upper limb function did not reveal a statistically significant difference between VR-based training and conventional therapy (0.07 standard deviation higher in virtual reality-based compared to conventional therapy. Furthermore, the authors rated the quality of evidence as low, based on the GRADE system. However, for ADL function the experimental groups showed a 0.25 higher standard deviation than the conventional therapy groups based on ten studies, including 466 patients after a stroke with moderate quality of evidence.

Only 10% of the included studies included more than 50 participants, with mean ages between 46 to 76 years. However, due to the different systems used no conclusion could be drawn regarding grip strength, dosage, type or program of the virtual reality-based training. Furthermore, the authors pointed out the low sample sizes and the low methodological quality of the reported trials. In their recommendations for further research, the authors encouraged researchers and clinicians again to conduct larger trials and to increase the detail in reporting to enable more firm conclusions.

YouGrabber (now renamed Bi-Manu Trainer), a game-based virtual reality system designed for upper-limb rehabilitation, has been shown to be effective in children with cerebral palsy. A 2-subject feasibility study indicated that the findings might extend to chronic stroke patients []. Both male subjects, who were trained three years after insult onset, showed increases in scores for the bimanual activities of daily living focused Chedoke McMaster Arm and Hand Activity Inventory (CAHAI) that persisted at the final follow-up, and corresponding cortical changes measured with fMRI.

Based on these findings the present multicenter parallel group randomized single-blinded trial aimed to investigate the efficacy of a virtual reality-based training with the YouGrabber training device (now renamed Bi-Manu Trainer) compared to conventional therapy. The study was designed to test the hypothesis that patients in the chronic stage after stroke in the virtual reality-based training group will show no higher post-intervention performance in the Box and Block Test (BBT) compared to patients receiving an equal training time of physiotherapy or occupational therapy.

For comparison with published and ongoing international studies we selected the Box and Block Test as the primary outcome measure and the CAHAI as the secondary outcome measure.

Methods and materials

Study design

This prospective, multicenter, single-blinded, parallel-group randomized trial was conducted in the outpatient departments of three rehabilitation hospitals in the German and French speaking parts of Switzerland: University hospital Inselspital Bern, Buergerspital Solothurn, and Reha Rheinfelden. In the study plan, each hospital was responsible for the recruitment, assessment, and therapy of 20 patients: 10 patients for the experimental group (EG) and 10 for the control group (CG), respectively.

More details regarding the study methodology can be found in the study flow chart in Fig 1 and the previously published study protocol strictly followed by each center (http://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-15-350) []. Ethics approval was warranted by the ethics committee of the Canton Aargau (2012/065) and the Canton Berne (220/12). The study was registered with ClinicalTrials.gov: NCT01774669 before the start of patient recruitment.

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Fig 1
Patient flow chart.BS = Buergerspital Solothurn, IS = Inselspital Bern, Reha Rheinfelden Measurement sessions: twice within one to two weeks before intervention start (BL, T0), once after eight (T1) and after 16 (T2) intervention sessions, and after a two months follow-up period (FU).

[…]

Continue —> Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial

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[WEB SITE] Addison, the Virtual Caregiver set to debut in January at CES

LAS VEGASJan. 8, 2019 /PRNewswire/ — She has a face, body and endearing personality. Meet Addison, a conversational speech interface including visual, Artificial Intelligence and ambient augmented reality, created by electronic caregiver™, a division of SameDay Security, Inc. Designed to transform the home into a fulltime health and wellness environment, Addison appears on 15-inch media screens throughout a residence and provides support to consumers with features including medication management, care plan adherence, social experiences and emergency response.

What began as a futuristic concept for Anthony Dohrmann, Founder and Chief Executive Officer of SameDay Security, Inc., quickly became reality with the design, innovation and creation of Addison Care™. “We wanted to give new life to voice-based virtual assistants in a way that dramatically expands the utility of voice platforms, while significantly enhancing the user experience. Addison will transform the way people interact with technology. She uniquely inspires a feeling of affection, helping people connect and better embrace their new tech,” Dohrmann said.

 

Built using Amazon Sumerian, a service provided by Amazon Web Services (AWS) that helps organizations create and run virtual reality (VR), augmented reality (AR), and 3D applications quickly and easily without requiring any specialized programming or 3D graphics expertise, the team at electronic caregiver™ was able to bring to life something others thought impossible. They sing the praises of Sumerian saying it changed the way and speed at which they were able to develop Addison. “Having a web-based platform like Sumerian that will host the complexity of artwork, skill and technology behind Addison has already set us apart,” says Joseph Baffoe, company President of SameDay Security, Inc. “What used to take us months or even years to create, now takes a matter of days. Amazon Sumerian has saved time and millions of dollars and can be credited with enabling us to create Addison.”

With the significant growth of the aging population, Addison has set her sights on creating an enjoyable user experience in the home, while also helping to shoulder some of the burden home healthcare is experiencing. High costs and low employee retention are two of the consistent pains in home healthcare. “10,000 people turn 65 every day and of the people needing home healthcare, only about 3% can afford it,” said Dohrmann. “We are encouraged that we will be the option these companies are able to provide to a prospective client who otherwise would have been turned away.”

Imagine a 3D, crystal clear health professional and personal assistant in your home. Though she lives with you, Addison is presented in stunning scenes and interactive environments that develop over time and are uniquely targeted to you and your needs. Her features, combined with just a one-hour set up time, will make Addison a staple in home technology. “Addison powered by Sumerian are cutting-edge interactive solutions that can transform home and healthcare. Addison Care represents a quantum leap forward in addressing the medical, financial, and social realities of an aging population and their caregivers,” stated Mark Francis, Head of Product Marketing for Amazon Sumerian, AWS.

Addison currently provides peace of mind with immediate response to emergencies. She monitors vitals via Bluetooth devices while also providing a demonstration. Addison assists with nutrition, weight loss goals, plans of care management, examinations and monitored medication reminders. She even assesses movement and changes in gait during your day-to-day activities to evaluate your risk of falling, all while working to check health status for trends of improvement or decline.

The future looks bright for Addison Care™ and the features that we can expect in the future. “People have always wondered what voice assistants might look like in the real world, and we’re going to show them at CES in January,” said Dohrmann. The company is actively applying features to provide a better user experience for accessing local business services, transportation, physician-on-demand and environmental information. “We want Addison to be the total package – including home healthcare, rehabilitation support, fitness programs, virtual companionship and social engagement with peers,” said Dohrmann. “Addison is already remarkable, but we’re going to continue innovating and researching to continuously create a superior in-home experience.”

In preparation for CES in Las Vegas, Nevada, new disclosures and websites are scheduled to go live in late December 2018. Until recently, most of Addison has been confidential.

Las Vegas, Nevada – Consumer Electronics Show; January 8-11, 2019
Booth: Sands Convention Center Halls A-D – 42142

About SameDay Security, Inc. and Electronic Caregiver

SameDay Security (SDS) is one of the fastest growing monitored technology providers in the U.S. and one of only a handful of nationwide service providers. Known as electronic caregiver™ and founded in 2009, SDS currently provides automated home care solutions and safety devices nationwide to thousands of clients. SDS has invested over $35,000,000 in patient screenings, research and development. SDS will disclose a new capital offering after CES to fuel new product launches and expansion. SDS has developing contracts with hundreds of home care partners across America who will participate in Addison Care™ marketing to their clients. New clinical trials are scheduled with G60 Trauma of Phoenix, Arizona, involving 500 patients over 3 years to determine the impact on patient outcomes, cost reduction, lower hospitalization, chronic disease management and long-term care. electronic caregiver™ employs over 70 employees and is headquartered in Las Cruces, New Mexico.  www.electroniccaregiver.com

About Amazon Sumerian

Amazon Sumerian is a browser-based authoring tool from AWS designed to create and run for the development and publishing of AR, VR and 3D applications. Using Amazon Sumerian, developers and designers can build immersive apps quickly and easily without requiring any specialized programming or 3D graphics expertise. Experiences built with Sumerian are designed to be embedded into a web page or be consumed on popular hardware such as HTC Vive and HTC Vive Pro, as well as Android and iOS mobile devices. For more information, visit https://aws.amazon.com/sumerian.

SOURCE Electronic Caregiver

Related Links

http://electroniccaregiver.com

 

via Addison, the Virtual Caregiver set to debut in January at CES

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