Archive for category Virtual reality rehabilitation

[ARTICLE] Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training – Full Text

Robot-assisted therapy affords effective advantages to the rehabilitation training of patients with motion impairment problems. To meet the challenge of integrating the active participation of a patient in robotic training, this study presents an admittance-based patient-active control scheme for real-time intention-driven control of a powered upper limb exoskeleton. A comprehensive overview is proposed to introduce the major mechanical structure and the real-time control system of the developed therapeutic robot, which provides seven actuated degrees of freedom and achieves the natural ranges of human arm movement. Moreover, the dynamic characteristics of the human-exoskeleton system are studied via a Lagrangian method. The patient-active control strategy consisting of an admittance module and a virtual environment module is developed to regulate the robot configurations and interaction forces during rehabilitation training. An audiovisual game-like interface is integrated into the therapeutic system to encourage the voluntary efforts of the patient and recover the neural plasticity of the brain. Further experimental investigation, involving a position tracking experiment, a free arm training experiment, and a virtual airplane-game operation experiment, is conducted with three healthy subjects and eight hemiplegic patients with different motor abilities. Experimental results validate the feasibility of the proposed scheme in providing patient-active rehabilitation training.


Stroke is a severe neurological disease caused by the blockages or rupture of cerebral blood vessels, leading to significant physical disability and cognitive impairment (12). The recent statistics from the World Health Organization indicate that worldwide 15 million people annually suffer from the effect of stroke, and more than 5 million stroke patients survive and, however, require a prolonged physical therapy to recover motor function. Recent trends predict increased stroke incidence at younger ages in the upcoming years (34). Approximately four-fifths of all survived stroke patients suffer from the problems of hemiparesis or hemiplegia and, as a result, have difficulties in performing activities of daily living (ADL). Stroke causes tremendous mental and economic pressure on the patients and their families (5). Medical research has proved that, owing to the neural plasticity of the human brain, appropriate rehabilitation trainings are beneficial for stroke survivors to recover musculoskeletal motor abilities. Repetitive and task-oriented functional activities have substantial positive effects on improving motor coordination and avoiding muscle atrophy (67). Traditional stroke rehabilitation therapy involves many medical disciplines, such as orthopedics, physical medicine, and neurophysiology (89). Physiotherapists and medical personnel are required to provide for months one-on-one interactions to patients that are labor intensive, time consuming, patient-passive, and costly. Besides, the effectiveness of traditional therapeutic trainings is limited by the personal experiences and skills of therapists (1011).

In recent decades, robot-assisted rehabilitation therapies have attracted increasing attention because of their unique advantages and promising applications (1213). Compared with the traditional manual repetitive therapy, the use of robotic technologies helps improve the performance and efficiency of therapeutic training (14). Robot-assisted therapy can deliver high-intensive, long-endurance, and goal-directed rehabilitation treatments and reduce expense. Besides, the physical parameters and the training performance of patients can be monitored and evaluated via built-in sensing systems that facilitate the improvement of the rehabilitation strategy (1516). Many therapeutic robots have been developed to improve the motor functions of the upper extremity of disabled stroke patients exhibiting permanent sensorimotor arm impairments (17). The existing robots used for upper limb training can be basically classified into two types: end-point robots and exoskeleton robots. End-point robots work by applying external forces to the distal end of impaired limbs, and some examples are MIME (18), HipBot (19), GENTLE/s (20), and TA-WREX (21). Comparatively, exoskeleton robots have complex structures similar to anatomy of the human skeleton; some examples of such robots are NMES (22), HES (23), NEUROExos (24), CAREX-7 (25), IntelliArm (26), BONES (27), and RUPERT (28). The joints of the exoskeleton need to be aligned with the human anatomical joints for effective transfer of interactive forces.

The control strategies applied in therapeutic robots are important to ensure the effectiveness of rehabilitation training. So far, according to the training requirement of patients with different impairment severities, many control schemes have been developed to perform therapy and accelerate recovery. Early rehabilitation robot systems implemented patient-passive control algorithms to imitate the manual therapeutic actions of therapists. These training schemes are suitable for patients with severe paralysis to passively execute repetitive reaching tasks along predefined trajectories. Primary clinical results indicate that patient-passive training contributes to motivating muscle contraction and preventing deterioration of arm functions. The control of the human–robot interaction system is a great challenge due to its highly nonlinear characteristics. Many control algorithms have been proposed to enhance the tracking accuracy of passive training, such as the robust adaptive neural controller (29), fuzzy adaptive backstepping controller (30), neural proportional–integral–derivative (PID) controller (31), fuzzy sliding mode controller (32), and neuron PI controller (33).

The major disadvantage of patient-passive training is that the active participation of patients is neglected during therapeutic treatment (34). Several studies suggest that, for the patients who have regained parts of motor functions, the rehabilitation treatment integrated with the voluntary efforts of patients facilitates the recovery of lost motor ability (35). The patient-active control, normally referred as patient-cooperative control and assist-as-needed control, is capable of regulating the human–robot interaction depending on the motion intention and the disability level of patients. Keller et al. proposed an exoskeleton for pediatric arm rehabilitation. A multimodal patient-cooperative control strategy was developed to assist upper limb movements with an audiovisual game-like interface (36). Duschauwicke et al. proposed an impedance-based control approach for patient-cooperative robot-aided gait rehabilitation. The affected limb was constrained with a virtual tunnel around the desired spatial path (37). Ye et al. proposed an adaptive electromyography (EMG) signals-based control strategy for an exoskeleton to provide efficient motion guidance and training assistance (38). Oldewurtel et al. developed a hybrid admittance–impedance controller to maximize the contribution of patients during rehabilitation training (39). Banala et al. developed a force-field assist-as-need controller for intensive gait rehabilitation training (40). However, there are two limitations in the existing patient-cooperative control strategies. Firstly, the rehabilitation training process is not completely patient-active, as the patient needs to perform training tasks along a certain predefined trajectory. Secondly, existing control strategies are executed in self-designed virtual scenarios that are generally too simple, rough, and uninteresting. Besides, applying a certain control strategy to different virtual reality scenarios is difficult.

Taking the above issues into consideration, the main contribution of this paper is to develop a control strategy for an upper limb exoskeleton to assist disabled patients in performing active rehabilitation training in a virtual scenario based on their own active motion intentions. Firstly, the overall structure design and the real-time control system of the exoskeleton system are briefly introduced. A dynamic model of the human–robot interaction system is then established using the Lagrangian approach. After that, an admittance-based patient-active controller combined with an audiovisual therapy interface is proposed to induce the active participation of patients during training. Existing commercial virtual games without a specific predetermined training trajectory can be integrated into the controller via a virtual keyboard unit. Finally, three types of experiments, namely the position tracking experiment without interaction force, the free arm movement experiment, and the virtual airplane-game operation experiment, are conducted with healthy and disabled subjects. The experimental results demonstrate the feasibility of the proposed exoskeleton and control strategy.

Exoskeleton Robot Design

The architecture of the proposed exoskeleton is shown in Figure 1. This wearable force-feedback exoskeleton robot has seven actuated degrees of freedom (DOFs) and two passive DOFs covering the natural range of movement (ROM) of humans in ADL. The robot has been designed with an open-chain structure to mimic the anatomy of the human right arm and provide controllable assistance torque to each robot joint. There are three actuated DOFs at the shoulder for internal/external rotation, abduction/adduction, and flexion/extension; two DOFs at the elbow for flexion/extension and pronation/supination; and two DOFs at the wrist for flexion/extension and ulnal/radial deviation. Besides, since the center of rotation of the glenohumeral joint varies with the shoulder girdle movement, the robot is mounted on a self-aligning platform with two passive translational DOFs to compensate the human–robot misalignment and to guarantee interaction comfort. […]

Figure 1. Architecture of upper limb rehabilitation exoskeleton (1-Self-aligning platform; 2-AC servo motor; 3-Bowden cable components; 4-Support frame; 5-Wheelchair; 6-Elbow flexion/extension; 7-Proximal force/torque sensor; 8-Wrist flexion/extension; 9-Wrist ulnal/radial deviation; 10-Distal force/torque sensor; 11-Forearm pronation/supination; 12-Auxiliary links; 13-Shoulder flexion/extension; 14-Shoulder abduction/adduction; 15-Shoulder internal/external; 16-Free-length spring).


Continue —>  Frontiers | Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training | Neurology

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[TEDx Talks] Can Virtual Reality Ease Post-traumatic Stress Disorder? | Dr. Brenda Wiederhold | TEDxChapmanU – YouTube

Δημοσιεύτηκε στις 2 Σεπ 2015
A licensed clinical psychologist in the U.S. and Europe, a visiting professor at the Catholic University in Milan, and an entrepreneur, Dr. Brenda Wiederhold completed the first randomized, controlled clinical trial to provide virtual reality medical therapy for war veterans suffering from post-traumatic stress disorder (PTSD).
Her most recent achievement is working with coalition troops to provide stress inoculation training prior to deployment. She is further exploring the use of VR in treating patients of all ages suffering from ailments such as claustrophobia to stress disorders. In the spirit of ideas worth spreading, TEDx is a program of local, self-organized events that bring people together to share a TED-like experience. These local, self-organized events are branded TEDx, where x = independently organized TED event. The TED Conference provides general guidance for the TEDx program, but individual TEDx events are self-organized. Dr. Wiederhold is CEO of the Virtual Reality Medical Institute in Belgium and the Executive Vice President of the Virtual Reality Medical Center in California.
She completed the first randomized, controlled clinical trial to provide virtual reality medical therapy for war veterans suffering from post-traumatic stress disorder (PTSD). Her most recent achievement is working with coalition troops to provide stress inoculation training prior to deployment. She is further exploring the use of VR in treating patients of all ages suffering from ailments such as claustrophobia to stress disorders.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at


via  Can Virtual Reality Ease Post-traumatic Stress Disorder? | Dr. Brenda Wiederhold | TEDxChapmanU – YouTube

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[Press Release] Virtual Rehab Founder and CEO Interviewed At NASDAQ – Digital Journal

Oct. 9, 2018 / PRZen / TALLINN, Estonia — Virtual Rehab‘s Founder & CEO, Dr. Raji Wahidy, was interviewed by Jane King at NASDAQ MarketSite in Times Square, New York City.

Virtual Rehab is the market leader in offering psychological rehabilitation for vulnerable populations using virtual reality, artificial intelligence, and blockchain technologies for pain management, prevention of substance use disorders, and rehabilitation of repeat offenders. Since inception, the efficacy of Virtual Rehab’s evidence-based solution along with their team have been globally recognized for their accomplishment.

Dr. Wahidy spoke to Jane about Virtual Rehab’s business along with their ongoing Private Token Sale.

The complete interview can be viewed below:

The minimum investment to take part in the Virtual Rehab Private Token Sale is 15,000 USD with varying bonus structures subject to contribution levels. The cost of each $VRH token is 0.10 USD. Payments are accepted in Fiat, Ethereum Coin (ETH), Binance Coin (BNB), and Credits Coin (CS). Countries excluded from Private Token Sale include the United States (except for Accredited Investors), Canada, China, Republic of Korea, and New Zealand.

Interested parties may send an e-mail to or join the Virtual Rehab telegram group at for any questions or clarifications needed.

About Virtual Rehab

Virtual Rehab’s evidence-based solution leverages the advancements in virtual reality, artificial intelligence, and blockchain technologies for pain management, prevention of substance use disorders, and rehabilitation of repeat offenders. Virtual Rehab has been recognized as a market leader for their innovative work within the addiction and the corrections industries. Since inception, Virtual Rehab has been recognized with global awards and recognition for their accomplishments. Virtual Rehab is headquartered in Estonia with presence across Canada and the US.

Follow the full story here:



via Virtual Rehab Founder and CEO Interviewed At NASDAQ – Press Release – Digital Journal


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[WEB SITE] The Newest Technology Impacting Physical Therapy – Virtual Reality

Digital technologies are increasingly becoming more important in the medical sphere every single day. Already, technologies like telemedicine have proven to be an effective method of treatment and has quickly gained in popularity over the years proving that technology can swiftly replace old systems with new, more efficient methods of treatment. Now, a new technology called Virtual Reality is coming into the therapy world and is changing it forever.
Virtual Reality (VR) is now being used by physical therapists for the successful treatment of stroke victims, walking disorders and back pain. The technology has been shown to improve the patients motor learning and coordination skills by using gamified, immersive environments that have been created to help patients suffering from pain and injury relearn the use of their limbs in a way that is motivating and fun.
Lets be honest, most times physical therapy can be a painful and overwhelming experience. With VR, the patient is able to experience a three-dimensional world surrounding their vision that is quite convincing to the sense’s. Many people report that they actually feel present in another environment, separate from reality. This is the element that aids in eliminating pain during exercises and encourages more repeat workouts. For example, if the patient was exercising their lower limbs, they would be able to appear as if they are walking on a beach or in a forest instead of on a boring treadmill. In another scenario, if the patient was exercising their upper extremities, then they could experience the thrill of being rewarded for successfully climbing up a mountain. Games like this provide motivation at home for the patient to continue exercising, enabling them with visual data on how they are improving their range of motion. These type of “experiences” help to keep the patient on the right path outside of the treatment room, which is a huge bonus because studies have shown that only 30% of exercises get accomplished after leaving rehabilitation.
What this will do to the therapy industry is still unknown but it is obvious that there is enormous potential for this technology to impact it in a large way.


via The Newest Technology Impacting Physical Therapy – Virtual Reality

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[ARTICLE] Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke – Full Text



Impairment of upper extremity function is a common outcome following stroke, to the detriment of lifestyle and employment opportunities. Yet, access to treatment may be limited due to geographical and transportation constraints, especially for those living in rural areas. While stroke rates are higher in these areas, stroke survivors in these regions of the country have substantially less access to clinical therapy. Home therapy could offer an important alternative to clinical treatment, but the inherent isolation and the monotony of self-directed training can greatly reduce compliance.


We developed a 3D, networked multi-user Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system for home therapy. Within this environment, stroke survivors can interact with therapists and/or fellow stroke survivors in the same virtual space even though they may be physically remote. Each user’s own movement controls an avatar through kinematic measurements made with a low-cost, Kinect™ device. The system was explicitly designed to train movements important to rehabilitation and to provide real-time feedback of performance to users and clinicians. To obtain user feedback about the system, 15 stroke survivors with chronic upper extremity hemiparesis participated in a multisession pilot evaluation study, consisting of a three-week intervention in a laboratory setting. For each week, the participant performed three one-hour training sessions with one of three modalities: 1) VERGE system, 2) an existing virtual reality environment based on Alice in Wonderland (AWVR), or 3) a home exercise program (HEP).


Over 85% of the subjects found the VERGE system to be an effective means of promoting repetitive practice of arm movement. Arm displacement averaged 350 m for each VERGE training session. Arm displacement was not significantly less when using VERGE than when using AWVR or HEP. Participants were split on preference for VERGE, AWVR or HEP. Importantly, almost all subjects indicated a willingness to perform the training for at least 2–3 days per week at home.


Multi-user VR environments hold promise for home therapy, although the importance of reducing complexity of operation for the user in the VR system must be emphasized. A modified version of the VERGE system is currently being used in a home therapy study.


Chronic upper extremity impairment is all too common among the more than 7 million stroke survivors in the U.S. [1]. These impairments have disabling effects on all facets of life, including self-care, employment, and leisure activities. Repetitive practice of movement, such as arm movement, is thought to improve outcomes for stroke survivors [234], but access to the clinic for therapy is often limited by geography or lack of transportation. While almost 50 million Americans live in rural areas, 90% of physical and occupational therapists live in major urban areas [5]. Per capita ratios of therapists to overall population are 50% larger in urban as compared to rural regions of the country [6]. Rates of stroke in these rural areas, however, exceed those of major urban areas [789]. Thus, a large number of stroke survivors have limited access to skilled treatment. Data from 21 states found that only 30% of stroke survivors received outpatient rehabilitation, a much lower percentage than that recommended by clinical practice guidelines [10]. Declines seen following discharge from inpatient rehabilitation are undoubtedly exacerbated by limited access to clinical therapy [11].

Disparity in quality of care has been recognized in the acute treatment of stroke for a number of years. This situation has led to the development of telemedicine to extend expert care to individuals during the initial hours and days following the stroke, advance site-independent treatment, and create models of care in rural areas [121314]. Therapy options after this acute period, however, generally remain limited for stroke survivors in rural areas. Akin to the telemedicine efforts, telerehabilitation treatments have been proposed. However, telerehabilitation interactions are typically limited to off-line monitoring by the therapist [8915], phone calls between a therapist and client [1617], or videoconferencing [181920]. While systems allowing more direct interaction have been proposed, the hardware cost and complexity limit applicability for home-based therapy [212223]. Hence, the therapist is relegated to the role of observer and the intimacy of a clinical therapy session is lost. Therapy options are substantially restricted, as is the available feedback.

Recently, multiple investigators have been exploring means of improving home-based therapy through the development of systems or serious games which permit multiple, simultaneous users [24252627282930]. These efforts have proposed the inclusion of multiple users as a means to overcome resistance to home-based therapy that may result due to isolation or lack of engagement. Indeed, studies have observed a preference for multi-user vs, single-user therapy when utilizing these systems [2629]. However, these systems have largely been limited to control of a one-dimensional or two-dimensional space and both users remain in the same physical location (e.g., side by side). One team of researchers did develop a framework for supporting distant users (such as a therapist in the hospital and a stroke survivor in their home), but game control was limited to one or two dimensions [3132].

Here, we describe the development of a fully three-dimensional (3D) virtual reality environment (VRE) for home-based therapy in which multiple, remote users can interact in real time. In this Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system [33], movement of the user is mapped to corresponding movement of an avatar to foster a sense of presence in and engagement with the VRE. The 3D environment encompasses aspects of clinical therapy, such as transport of objects or movement of the hand into specified regions of the upper extremity workspace. Although the importance of 3D movements in VR environments is a topic of debate [3435], movements tested in environments with lesser degrees-of-freedom (DOF) are often very limited and dictated by a one DOF robot. These movements differ substantially from the types of movements normally seen in 3D reaching movements [436]. The network architecture of the system allows users to be located remotely from each other, such as a stroke survivor in their home, a therapist in a clinic, or a stroke survivor’s friend or relative living in another city or state. The virtual nature of the environment allows even very limited movements in the physical world to have successful functional outcomes in the virtual world, thereby offering a sense of accomplishment and motivation for successive attempts. Additionally, task difficulty can easily be modified in order to maintain the proper level of challenge, which is important for motor learning in general [37] and rehabilitation in particular [38].

We developed and performed preliminary testing of the VERGE system to gauge user response in comparison to two other therapy modalities that could be used for home therapy: an existing virtual reality system based on the Alice in Wonderland story (AWVR) [39] and a home exercise program (HEP). Fifteen stroke survivors completed three, one-hour therapy sessions per week with each of the three therapy modalities (9 sessions total). We hypothesized that the use of the VERGE system would not decrease the amount of arm movement promoted, in comparison with the AWVR and HEP modalities. We further expected that users’ self-described engagement would be greatest for the VERGE system due to the presence of a partner.


VERGE System


At its core, VERGE consists of a 3D VRE in which avatars interact with virtual objects. To date, we have created two such VREs, one depicting a dining room and the other a kitchen. The scenes were created in Maya (Autodesk Inc., San Rafael, CA) and imported into Unity 3D (Unity 4.5, Unity Technologies, San Francisco, CA), the software platform controlling VERGE. The VREs are rich in detail in order to provide depth cues [40]. Thus, depth can be conveyed without the need for stereovision, such as that provided by head mounted displays (HMDs). We have found that HMDs can be difficult for stroke survivors to use due to the limited field-of-view and, especially, involuntary coupling between neck and arm motion [4142]. The latter may lead to complications with moving the arm while keeping the head steady.

The avatars were created from a custom skeleton in Maya (Autodesk Inc., San Rafael, CA), which was rigged to an existing mesh of the “casual young man” 3D model, purchased and modified for our project (Fig. 1). We created the custom skeleton to match the topology of the existing character while corresponding to the skeletal joint naming convention in Unity 3D. The skeleton (and thus avatar) is animated according to joint angle data captured with a Kinect™ I optical tracker (Microsoft Corp., Redmont, WA). The 3D motion data from the Kinect™ are transmitted to the Unity code through UDP to drive the movement of the avatar in the virtual environment.


Continue —> Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke – Full Text



Virtual reality (VR) training with motion-controlled console games can be incorporated into stroke rehabilitation programs. The use of a variety of gaming software can provide the patient with an opportunity to perform activities that are exciting, entertaining, and that may not be feasible in clinical environments. The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke.


Thirty patients, who were within six months following the diagnosis of stroke, were randomly allocated to either the experimental group (n=15) or the control group (n=15). All participants participated in a conventional rehabilitation program. Also, the experimental group (n=15) performed the VR canoe paddling training for 30 minutes each day, three times per week, for five weeks. After five weeks, outcomes of changes in postural balance and upper extremity function were evaluated and compared between the two groups.


At five weeks, postural balance and upper extremity function showed significant improvements in both patients groups when compared with the baseline measurements (p<0.05). However, postural balance and upper extremity function were significantly improved in the experimental group when compared with the control group (p<0.05).


Game-based VR canoe paddling training is an effective rehabilitation therapy that enhances postural balance and upper extremity function in patients with subacute stroke when combined with conventional physical rehabilitation programs.


The maintenance of the core or upper body control, is essential for maintaining posture and stability while changing positions, performing activities of daily living (ADL), and ambulating [1,2]. Patients who are undergoing physical rehabilitation following stroke, tend to deviate towards the affected side, as a result of postural instability, which induces both asymmetrical trunk movement and trunk muscle weakness. Upper body instability makes it difficult to maintain postural control when performing tasks and leads to functional disability [3]. The lack of postural stability also affects the balance of patients following stroke, increasing the risk of falls, and negatively impacting on patient independence and safety. For example, it has been reported that up to 73% of patients with stroke experience a fall within six months after leaving hospital [4]. Falls following a stroke can have severe consequences, including hip fractures and reduced physical activity due to fear of repeat falls [5]. Therefore, because these factors can have a negative impact on patient rehabilitation following stroke, the improvement of postural stability is an important goal of patient rehabilitation following stroke [6].

Sports that involve paddling with a single oar, such as canoeing and kayaking, are effective outdoor activities that improve postural stability and upper body stabilization [7]. Continuous body adjustment and compensation are required during the single-oar paddling motion to maintain balance during perturbations caused by the movement of the canoe or kayak and the paddle in the water [8]. Currently, canoe paddling training can be conducted using an ergometer to provide a training opportunity that is independent of outdoor conditions and to better control training progression [9]. A paddling ergometer has also been studied for rehabilitation training of patients with paraplegia and has been shown to be effective in improving postural control, balance, motor performance, and upper extremity strength [8,9].

Game-based virtual reality (VR) using gaming consoles is now used as a therapeutic approach for the rehabilitation of patients with stroke and provides an opportunity for patients to perform activities that are difficult in a clinical setting. Furthermore, VR programs are often designed to be more entertaining and enjoyable than traditional physical therapy tasks, thereby encouraging patients to participate in the rehabilitation program.

The use of VR equipment specifically designed for physical rehabilitation is not yet commonly available in clinical settings. Therefore, VR rehabilitation programs using a game-based, motion-controlled console that can be used in clinical settings and at low cost that can utilize a variety of gaming software are needed.

The aim of this preliminary randomized controlled study was to investigate the effects of game-based VR canoe paddling training, when combined with conventional physical rehabilitation programs, on postural balance and upper extremity function in 30 patients with subacute stroke.[…]


Continue —>  Game-Based Virtual Reality Canoe Paddling Training to Improve Postural Balance and Upper Extremity Function: A Preliminary Randomized Controlled Study of 30 Patients with Subacute Stroke

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Figure 2
Game-based virtual reality (VR) canoe paddling training.

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[WEB SITE] Virtual Reality Reduces Pain and Increases Performance During Exercise – Neuroscience News

Summary: Researchers report virtual reality can help to lower pain levels and increase performance when undertaking physical activity. Participants using VR reported a pain intensity 10% lower than those not using the technology when performing isometric bicep curls.

Source: University of Kent.

The research, led by PhD candidate Maria Matsangidou from EDA, set out to determine how using VR while exercising could affect performance by measuring a raft of criteria: heart rate, including pain intensity, perceived exhaustion, time to exhaustion and private body consciousness.

To do this they monitored 80 individuals performing an isometric bicep curl set at 20% of the maximum weight they could lift, which they were then asked to hold for as long as possible. Half of the group acted as a control group who did the lift and hold inside a room that had a chair, a table and yoga mat on the floor.

The VR group were placed in the same room with the same items. They then put on a VR headset and saw the same environment, including a visual representation of an arm and the weight (see image below). They then carried out the same lift and hold as the non-VR group.

The results showed a clear reduction in perception of pain and effort when using VR technology. The data showed that after a minute the VR group had reported a pain intensity that was 10% lower than the non-VR group.

Furthermore the time to exhaustion for the VR group was around two minutes longer than those doing conventional exercise. The VR group also showed a lower heart rate of three beats per minute than the non-VR group.

Results from the study also showed no significant effect of private body consciousness on the positive impact of VR. Private body consciousness is the subjective awareness each of us has to bodily sensations.

the vr system

Previous research has shown that individuals who have a high private body consciousness tend to better understand their body and as a result perceive higher pain when exercising. However, the study’s findings revealed that VR was effective in reducing perceived pain and that private body consciousness did not lessen this effect.

As such, the improvements shown by the VR group suggest that it could be a possible way to encourage less active people to exercise by reducing the perceived pain that exercise can cause and improving performance, regardless of private body consciousness.

Lead researcher Maria Matsangidou said: ‘It is clear from the data gathered that the use of VR technology can improve performance during exercise on a number of criteria. This could have major implications for exercise regimes for everyone, from occasional gym users to professional athletes.’



Dr Jim Ang from EDA and Dr Alex Mauger from the School of Sport and Exercise Sciences at Kent were also involved in the research.

Source: Dan Worth – University of Kent
Publisher: Organized by
Image Source: image is credited to Maria Matsangidou.
Original Research: Abstract for “Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations” by Maria Matsangidou, Chee Siang Ang, Alexis R. Mauger, Jittrapol Intarasirisawat, Boris Otkhmezuri, and Marios N. Avraamides in Psychology of Sports and Exercise. Published July 18 2018.

University of Kent”Virtual Reality Reduces Pain and Increases Performance During Exercise.” NeuroscienceNews. NeuroscienceNews, 1 October 2018.


Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations

Past research has shown that Virtual Reality (VR) is an effective method for reducing the perception of pain and effort associated with exercise. As pain and effort are subjective feelings, they are influenced by a variety of psychological factors, including one’s awareness of internal body sensations, known as Private Body Consciousness (PBC). The goal of the present study was to investigate whether the effectiveness of VR in reducing the feeling of exercise pain and effort is moderated by PBC.

Design and methods
Eighty participants were recruited to this study and were randomly assigned to a VR or a non-VR control group. All participants were required to maintain a 20% 1RM isometric bicep curl, whilst reporting ratings of pain intensity and perception of effort. Participants in the VR group completed the isometric bicep curl task whilst wearing a VR device which simulated an exercising environment. Participants in the non-VR group completed a conventional isometric bicep curl exercise without VR. Participants’ heart rate was continuously monitored along with time to exhaustion. A questionnaire was used to assess PBC.

Participants in the VR group reported significantly lower pain and effort and exhibited longer time to exhaustion compared to the non-VR group. Notably, PBC had no effect on these measures and did not interact with the VR manipulation.

Results verified that VR during exercise could reduce negative sensations associated with exercise regardless of the levels of PBC.


via Virtual Reality Reduces Pain and Increases Performance During Exercise – Neuroscience News


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[ARTICLE] Non-Immersive Virtual Reality for Upper Limb Rehabilitation in Stroke Survivors – A Feasibility Study – Full Text PDF


We present the results of a feasibility study for the use of a commercially available non-immersive virtual reality system (SeeMe®) in upper limb motor rehabilitation of stroke survivors. The study included 8 chronic phase stroke survivors. All patients received 12
sessions with the system over 2 weeks, each session comprising 20 minutes of motor training using a sequence of 8 serious games. Outcome measures included the Fugl-Meyer assessment scale – upper limb section (FMA), the Stroke Impact Scale (SIS), the ingame assessment procedure of the SeeMe system and a feedback questionnaire.
Following the rehabilitation program, we found no change on the clinical scales. Although some of the system generated parameters (score, endurance and reaction time or movement amplitude for each game) have improved significantly, in 3 of the 8 games none of the recorded variables has shown significant changes, with only one game showing significant improvement in 2 out of 3 parameters. The satisfaction questionnaire did not generally correlate with game performance (although this has happened in some of the games), but reflected correctly the increased interest of the subjects for the intervention and also their awareness of its real influence on motor abilities.
This initial pilot study indicates that the SeeMe virtual reality system has the potential to be of use in clinical settings as a complement to conventional therapy. Future studies should include larger number of subjects, longer training duration, use more sensitive/dedicated measurements of improvement, and focus on a single game/exercise type.[…]

Full Text PDF

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[Abstract] Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results



Facilitating neural activity using non-invasive brain stimulation may improve extinction-based treatments for posttraumatic stress disorder (PTSD).


Here, we examined the feasibility of simultaneous transcranial direct current stimulation (tDCS) application during virtual reality (VR) to reduce psychophysiological arousal and symptoms in Veterans with PTSD.


Twelve Veterans with PTSD received six combat-related VR exposure sessions during sham-controlled tDCS targeting ventromedial prefrontal cortex. Primary outcome measures were changes in skin conductance-based arousal and self-reported PTSD symptom severity.


tDCS + VR components were combined without technical difficulty. We observed a significant interaction between reduction in arousal across sessions and tDCS group (p = .03), indicating that the decrease in physiological arousal was greater in the tDCS + VR versus sham group. We additionally observed a clinically meaningful reduction in PTSD symptom severity.


This study demonstrates feasibility of applying tDCS during VR. Preliminary data suggest a reduction in psychophysiological arousal and PTSD symptomatology, supporting future studies.

via Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[Abstract] Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial



Virtual reality game system is one of novel approaches, which can improve hemiplegicextremity functions of stroke patients. We aimed to evaluate the effect of the Microsoft Xbox 360 Kinect video game system on upper limb motor functions for subacute stroke patients.


The study included 42 stroke patients of which 35 (19 Virtual reality group, 16 control group) completed the study. All patients received 60 minutes of conventional therapy for upper extremity, 5 times per-week for 4 weeks. Virtual reality group additionally received Xbox Kinect game system 30 minutes per-day. Patients were evaluated prior to the rehabilitation and at the end of 4 weeks. Box&Block Test, Functional independence measure self-care score, Brunnstorm stage and Fugl-Meyer upper extremity motor function scale were used as outcome measures.


The Brunnstrom stages and the scores on the Fugl-Meyer upper extremity, Box&Block Test and Functional independence measure improved significantly from baseline to post-treatment in both the experimental and the control groups. The Brunnstrom stage-upper extremity and Box&Block Test gain for the experimental group were significantly higher compared to the control group, while the Brunnstrom stage-hand, the Functional independence measure gain and Fugl-Meyer gain were similar between the groups.


We found evidence that kinect-based game system in addition to conventional therapy may have supplemental benefit for stroke patients. However, for virtual reality game systems to enter the routine practice of stroke rehabilitation, randomized controlled clinical trials with longer follow-up periods and larger sample sizes are needed especially to determine an optimal duration and intensity of the treatment.

via Virtual Reality in Upper Extremity Rehabilitation of Stroke Patients: A Randomized Controlled Trial – ScienceDirect

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