Posts Tagged technology

[ARTICLE] Home-based virtual reality training after discharge from hospital-based stroke rehabilitation: a parallel randomized feasibility trial – Full Text



Virtual reality training (VRT) uses computer software to track a user’s movements and allow him or her to interact with a game presented on a television screen. VRT is increasingly being used for the rehabilitation of arm function, balance and walking after stroke. Patients often require ongoing therapy post discharge from inpatient rehabilitation. Outpatient therapy may be limited or inaccessible due to waiting lists, transportation issues, distance etc.; therefore, home-based VRT could provide the required therapy in a more convenient and accessible setting. The objectives of this parallel randomized feasibility trial are to determine (1) the feasibility of using VRT in the home post stroke and (2) the feasibility of a battery of quantitative and qualitative outcome measures of stroke recovery.


Forty patients who can stand for at least 2 min and are soon to be discharged from inpatient or outpatient rehabilitation post stroke are being recruited in Ottawa, Canada and being randomized to control and experimental groups. Participants in the experimental group use home-based VRT to do rehabilitative exercises for standing balance, stepping, reaching, strengthening and gentle aerobic fitness. Control group participants use an iPad with apps selected to rehabilitate cognition, hand fine motor skills and visual tracking/scanning. Both groups are instructed to perform 30 min of exercise 5 days a week for 6 weeks. VRT intensity and difficulty are monitored and adjusted remotely. Weekly telephone contact is made with all participants. Ability to recruit participants, ability to handle the technology and learn the activities, compliance, safety, enjoyment, perceived efficacy and cost of program delivery will be assessed. A battery of assessments of standing balance, gait and community integration will be assessed for feasibility of completion within this population and potential for improvement following the intervention. Effect sizes will be calculated.


The results of this study will be used to support the creation of a definitive randomized controlled trial on the efficacy of home-based VRT for rehabilitation post stroke.

Introduction and objectives

Stroke causes approximately 17,600 hospital admissions per year in Ontario and 50% of individuals who have had a stroke are left with moderate to severe impairment [12]. Most patients who are discharged from inpatient stroke rehabilitation are only 8–10 weeks post stroke and have not completely recovered. Their central nervous systems are still in a period of enhanced neuroplasticity, during which great functional change can be made [34]. Therapy outcomes are dose-dependent; intensive, high-repetition, task-oriented and task-specific therapies are most effective [56]. Therefore, for the greatest recovery possible, these patients require ongoing, intensive therapy. Most are offered this on an outpatient basis. However, for many reasons (transportation difficulties, distance from the rehabilitation center, weather etc.), not all eligible patients are able to attend outpatient therapy. Also, there is a waiting list and a limited number of outpatient therapy sessions are offered to each patient. Home-based therapy may fill an important role towards increasing the availability of rehabilitation, enabling patients to enhance or prolong their therapy and potentially improving outcomes.

Non-immersive virtual reality training (VRT) uses computer software to track the user’s movements and allow him or her to interact with a game or activity presented on a TV screen. It is convenient, timely, enjoyable and may be used for an unlimited period post stroke [78]. VRT has been shown to benefit upper extremity function, standing balance, gait and overall function in the sub-acute and chronic phases post stroke, at least as much as or more than conventional therapy [7910111213].

Home-based VRT offers a promising addition or alternative to existing rehabilitation programs that could make a significant difference in the lives of stroke survivors. A few preliminary studies have investigated the use of home-based VRT for standing balance and upper extremity recovery after stroke and shown potential feasibility of these systems for ongoing rehabilitation in the home [1415161718]. Some VRT platforms allow the user to interface via tactile devices (for example, a dynamic standing frame [14] or robotic glove [18]) while others use motion-tracking via a camera [16]. Some platforms use asynchronous monitoring to allow the therapist to monitor VRT usage and performance after the actual event [16] while others use synchronous monitoring to enable the therapist to watch in while the participant exercises; some even require constant real-time patient/therapist interaction [1719] throughout the therapy session. Users report high satisfaction with home-based VRT [1617], although actual usage can vary greatly [18]. Barriers to the use of home-based VRT include technical issues and lack of previous technical experience [18]. While some previous experience with computers is helpful, those who play video games regularly can become bored with VRT. Facilitators include the flexibility of home-based exercise, support from family and motivation from the VRT itself. Early results, available from a single randomized controlled trial (RCT) with 30 participants, suggest that home-based VRT improves standing balance and gait equally to in-clinic VRT, but that the costs are 44% lower [16].

We wish to add to these early studies of home-based VRT using a virtual reality system (Jintronix Inc.) that was initially developed for stroke rehabilitation and has also been used extensively with healthy and frail elderly individuals. The Jintronix system is marketed for institutional and home use and has a simple-to-use interface, but its home use has not yet been fully evaluated. The games are designed to incorporate motor learning principles such as multiple forms of feedback and task-specific practice that can be progressed to maintain an appropriate level of challenge. Unlike systems used in previous research, the Jintronix system includes a wide selection of games and exercises designed for the rehabilitation of sitting and standing balance, gait and upper extremity use. The system is simple to use and relatively inexpensive; a motion-tracking camera and software eliminates the need for gloves/controllers etc. It is straightforward enough for the patient to use independently; asynchronous monitoring is used to track usage and the therapist can change games and parameters remotely. The purpose of this study is to investigate the feasibility, acceptance and safety of this new, simple-to-use VRT system for use in the home, combined with asynchronous, remote support for the user. The results of this trial will support a definitive RCT in the future.

The primary objective is to assess the feasibility of using VRT in the home with patients post stroke, using quantitative and qualitative methods. Specific objectives are:

  1. 1.

    To estimate the recruitment rate of participants into the study;

  2. 2.

    To assess the ability and compliance of the participants with respect to the components of the research protocol (ability to learn VRT through the training program; ability to comply with the exercise protocol; participant retention);

  3. 3.

    To determine the safety of home-based VRT (presence of minor and major adverse events);

  4. 4.

    To assess the ability of stroke survivors and their study partners to use VRT technology in the home (i.e. technical difficulties, difficulty learning the games);

  5. 5.

    To assess the acceptability of the VRT intervention (enjoyment; perceived efficacy);

  6. 6.

    To estimate the cost for a future definitive RCT on in-home VRT.

The secondary objective is to assess the feasibility of the outcome measures, using quantitative and qualitative methods. Specific objectives are:

  1. 1.

    To assess the feasibility and acceptance of a battery of outcome measures, including physical assessments, questionnaires, an interview and a log book;

  2. 2.

    To assess the potential that home-based VRT might maintain or improve physical outcomes of standing balance, gait and general function and community integration after discharge from hospital-based stroke rehabilitation, compared to those who perform a program of iPad apps designed for fine hand motor skills and cognitive training;

  3. 3.

    To determine the sample size required for a future definitive RCT on in-home VRT.

This study is a prospective, single-site, single-blinded, parallel-group (1:1 ratio) randomized, superiority feasibility trial on the use of VRT for ongoing stroke rehabilitation after discharge from inpatient or outpatient stroke rehabilitation. A feasibility RCT was chosen in order to provide the most useful results to prepare for a future definitive RCT on the efficacy of home-based VRT. iPad apps were chosen as a comparator to VRT because they provide a control group that has equal contact with the researchers and equal time spent in an engaging activity. The use of an active control group (rather than providing control group participants with nothing) was also chosen to facilitate recruitment. The iPad apps chosen to work on hand fine motor control and cognition were not deemed to have any influence on the physical outcome measures of standing balance, gait and gross motor function. The Standard Protocol Items: Recommendation for Interventional Trials (SPIRIT) checklist is available as Additional file 1: Figure S1.[…]


Continue —>  Home-based virtual reality training after discharge from hospital-based stroke rehabilitation: a parallel randomized feasibility trial | Trials | Full Text

Fig. 1a  Experimental intervention – home-based virtual reality training targeting standing balance, stepping, reaching, strengthening and aerobic exercise. b Control intervention – iPad apps targeting cognition and hand fine motor control

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[NEWS] Anti-Tremor Function is One of this Mouse Adapter’s Cool Features

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AMAneo BTi

Inclusive Technology releases the AMAneo BTi, an adapter designed to enable people with disabilities to operate an iPad or iPhone directly with any mouse or assistive mouse, including track ball, joystick, head mouse, thumb mouse, and more.

Previously, the most common iPad or iPhone operation method was using Switch Control of the iOS.

However, to use this adapter, simply plug in the mouse and connect it to the iPhone, iPad, or iPad Mini using Bluetooth. A touch pointer then automatically appears on the device’s screen enabling full control over the iPad. There are no additional apps to install, according to a media release from UK-based Inclusive Technology. Its US distributor is located in Waxhaw, NC.

Other interaction options include click and drag, auto click and click delay. Two switch ports are also provided, enabling the option of controlling the left and right mouse button with two external switches.

Additional features include instant access to Apple’s AssistiveTouch Menu, which gives users access to several iPad controls such as volume control and the Home button, as well as an innovative anti-tremor function to filter out any shaking of the hand or head and ensure that the on-screen cursor moves smoothly, according to a media release.

The AMAneo BTi charges using a Micro USB and lasts for up to 20 hours of operation.

[Source: Inclusive Technology]


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[ARTICLE] Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review



Individuals with mild cognitive impairment (MCI) are at heightened risk of developing dementia. Rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. This systematic review aims to evaluate the effects of technology-based cognitive training or rehabilitation interventions to improve cognitive function among individuals with MCI.


We conducted a systematic review using the following criteria: individuals with MCI, empirical studies, and evaluated a technology-based cognitive training or rehabilitation intervention. Twenty-six articles met the criteria.


Studies were characterized by considerable variation in study design, intervention content, and technologies applied. The major types of technologies applied included computerized software, tablets, gaming consoles, and virtual reality. Use of technology to adjust the difficulties of tasks based on participants’ performance was an important feature. Technology-based cognitive training and rehabilitation interventions had significant effect on global cognitive function in 8 out of 22 studies; 8 out of 18 studies found positive effects on attention, 9 out of 16 studies on executive function, and 16 out of 19 studies on memory. Some cognitive interventions improved non-cognitive symptoms such as anxiety, depression, and ADLs.


Technology-based cognitive training and rehabilitation interventions show promise, but the findings were inconsistent due to the variations in study design. Future studies should consider using more consistent methodologies. Appropriate control groups should be designed to understand the additional benefits of cognitive training and rehabilitation delivered with the assistance of technology.


Due to the aging of the world’s population, the number of people who live with dementia is projected to triple to 131 million by the year 2050 []. Development of preventative strategies for individuals at higher risk of developing dementia is an international priority []. Mild cognitive impairment (MCI) is regarded as an intermediate stage between normal cognition and dementia []. Individuals with MCI usually suffer with significant cognitive complaints, yet do not exhibit the functional impairments required for a diagnosis of dementia. These people typically have a faster rate of progression to dementia than those without MCI [], but the cognitive decline among MCI subjects has the potential of being improved []. Previous systematic reviews of cognitive intervention studies, both cognitive training and cognitive rehabilitation, have demonstrated promising effects on improving cognitive function among subjects with MCI [].

Recently, rapid advances in computing technology have enabled researchers to conduct cognitive training and rehabilitation interventions with the assistance of technology. A variety of technologies, including virtual reality (VR), interactive video gaming, and mobile technology, have been used to implement cognitive training and rehabilitation programs. Potential advantages to using technology-based interventions include enhanced accessibility and cost-effectiveness, providing a user experience that is immersive and comprehensive, as well as providing adaptive responses based on individual performance. Many computerized cognitive intervention programs are easily accessed through a computer or tablet, and the technology can objectively collect data during the intervention to provide real-time feedback to participants or therapists. Importantly, interventions delivered using technology have shown better effects compared to traditional cognitive training and rehabilitation programs in improving cognitive function and quality of life []. The reasons for this superiority are not well-understood but could be related to the usability and motivational factors related to the real-time interaction and feedback received from the training system [].

Three recent reviews of cognitive training and rehabilitation for use with individuals with MCI and dementia suggest that technology holds promise to improve both cognitive and non-cognitive outcomes []. The reviews conducted by Coyle, et al. [] and Chandler, et al. [] were limited by accessing articles from only two databases, and did not comprehensively cover available technologies. Hill, et al. [] limited their review to papers published until July 2016 and included only older adults aged 60 and above. More technology-based intervention studies have been conducted since then, and only including studies with older adults 60 and above could limit the scope of the review given that adults can develop early-onset MCI in their 40s []. Therefore, the purpose of this review is to 1) capture more studies using technology-based cognitive interventions by conducting a more comprehensive search using additional databases 2) understand the effect of technology-based cognitive interventions on improving abilities among individuals with MCI; and 3) examine the effects of multimodal technology-based interventions and their potential superiority compared to single component interventions.[…]


Continue —-> Technology-based cognitive training and rehabilitation interventions for individuals with mild cognitive impairment: a systematic review

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[NEWS] Stroke of Genius: Outfitting the Clinic for Neuro Recovery – Rehab Managment

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Compiled by Frank Long, Editorial Director

No two stroke cases are exactly alike. And, since the effects of stroke are many-factored, rehabilitation technologies designed to treat this patient population must move patients toward functional recovery with flexibility and safety. To learn more about the technological DNA behind some of these devices, Rehab Management interviewed representatives from several leading manufacturers. Their insights help explain the specialized applications this equipment provides to therapists and patients working through the process of stroke recovery.


Bionik Inc

Watertown, Mass
Renaud Maloberti, Chief Commercial Officer, discusses InMotion Interactive Therapy

Technology overview: InMotion Interactive Therapy is valuable for the evaluation and treatment of stroke and other neurological conditions during the acute, subacute, and chronic phases of recovery across inpatient, outpatient, and research settings. The InMotion Robots allow patients to access greater therapy intensity, prolong the phase of rapid neuro-recovery, and enable the clinician to better focus on functional versus compensatory retraining. InMotion therapy also inspires hope, especially for chronic patients, as motor recovery has often been seen to occur long after an injury or disease onset. Additionally, InMotion Interactive Therapy motivates patients with engaging therapeutic activities as well as timely and objective performance feedback.

How it improves on previous technologies: The InMotion Robots have evolved to provide additional evidence-based protocols for arm, wrist, and hand therapy. With a new graphical user interface and numerous ergonomic improvements, the InMotion Robots are easier to use for clinicians and more comfortable for patients. Appearance, size, and weight have also improved, allowing easier integration of this technology into today’s active rehabilitation environments.

Customer feedback: Clinicians comment most about how InMotion Robots enhance therapy and inspire hope in patients. Patients’ feedback often reflects how motivating it is to see their performance and progress on a daily basis. Patients also state how their progress in therapy translates into daily activities.

Billing codes and reimbursement tips: Encourage clinicians to use InMotion EVAL to first evaluate and then track their patient’s progress and motor performance. InMotion EVAL is a precise, objective, and reproducible evaluation tool that correlates with evidence-based clinical scales. Pre- and post therapy evaluations allow the clinician to accurately document and report on the efficacy of any therapy approach and the progress of motor recovery, justifying the use of robotics and providing supporting data for reimbursement claims.


Clarke Health Care Products Inc

Oakdale, Pa
Jay Everett, Product Manager, discusses the Dynamic Stair Trainer

Technology overview: Using a Dynamic Stair Trainer (DST) for stroke therapy in therapy clinics or assistive care facilities provides multiple benefits. It combines progressive gait training on steps or incline and balance training on a flat surface, or a combination of step training, parallel bar, and incline training for a real world experience. A DST can replace several pieces of equipment, freeing up floor space. An optional on-board computer produces reports to compare sessions or estimate potential improvement. It aims to make the best use of a therapist’s time with each client.

How it improves on previous technologies: The electronically elevating steps can be adjusted to each patient’s ability in each session, unlike static wooden steps at set heights. Approaching the DST patients can begin with the unit in a flat position and using the rails to walk across the surface. The steps can be raised in 1 cm increments as therapy progresses. A digital display shows progress and encourages improvement and practice, and accessory rails allow use as parallel bars. It is wide enough for wheelchair entry to practice on steps or inclines. Comparing cost per square foot, the DST provides more rehabilitation options to allow clients to return to everyday life activities.

Customer feedback: Clients can start stair training at an earlier stage of the rehabilitation process. Therapists found the hand control was very easy to use and the handrails easy to adjust. Patients were less fearful and had less frustration than normally associated with nonadjustable steps. Patients reported greater sense of success, security, and self-confidence.


CIR Systems

Franklin, NJ
Karen Toepper, Vice President, Sales, discusses the GAITRite System

Technology overview: Measurement of stride-to-stride variability has shown to be an invaluable tool in evaluating or monitoring interventions aimed at improving balance and gait with post-stroke patients. GAITRite can collect, record, and measure the essential components of gait and balance quickly and easily. The software’s spatio-temporal gait parameters cover the asymmetries and deviations from normal or previous test time and distance values, which allows for quick evaluations of the effectiveness of current interventions. The GAITRite walkway is most often used in outpatient and rehab centers by physical therapists, and has been cited in many peer-reviewed publications worldwide.

How it improves on previous technologies: In recent years, four new models have been added to the GAITRite family of products, with additional overall sizes and sensor densities making GAITRite even a better fit in any existing physical location. One model’s new clinical version is now priced at roughly 40% less. We have consistently improved our software technology to offer our clients ease of use and numerous new measurements. We have also added faster video cameras as well as tracking upper body motion options.

Customer feedback: Users of GAITRite Walkways tell us that it is the easiest, fastest, and most practical system to use in a rehab setting. The patient is non-instrumented, and the software is intuitive. The ability to get consistent measurements, independent of the clinician administering the data collection, allows for efficient status sharing between all clinicians involved, ultimately leading to improved efficiency. Our customers say that in the outpatient setting, the ability to demonstrate to the patient the effectiveness of treatment between visits has led to improved and quicker outcomes and sustained compliance.

Billing codes: CPT codes per the AMA: 97110 Therapeutic Exercise; 97112 Neuromuscular Re-Education; 97116 Gait Training; 97164 PT Re-Evaluation; 97750 FCE/Performance Test; 97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported).


Gorbel Medical

Victor, NY
Pooja Sinha, Product Marketing Manager, Gorbel Inc, Rehabilitation Division, discusses the SafeGait 360 Balance & Mobility Trainer

Technology overview: In inpatient, outpatient, and skilled nursing facility settings, SafeGait 360 provides the physical assist and guarding typically performed by the therapist. This allows the therapist’s focus to shift to patient gait mechanics, error facilitation, and the practice of self-correction techniques. SafeGait off-weights a patient by up to 50% of their body weight (225 pounds maximum). Proprietary fall protection software protects the patient and therapist as they practice activities of daily living that include floor work, walking, transfers, and stairs. SafeGait enables early mobilization, high intensity and challenging exercises that would otherwise be too risky, all while reducing the number of staff required to work with individual patients.

How it improves on previous technologies: SafeGait enables dynamic and more challenging interventions, including error facilitation, which are not possible with gait belts, parallel bars, and static fall protection systems. Gorbel’s velocity-based fall protection and dynamic fall recovery allow therapists to challenge patient’s balance and teach self-correction. Working barrier-free and 1:1 with patients, therapists can administer limitless interventions and keep their focus on the patient while SafeGait software captures performance metrics by session and task.

Customer feedback: Customers note how confident patients feel while using SafeGait, leading them to work harder and try activities they would have avoided due to fear of falling. This has led to improved recovery time and reduced readmissions. Therapists tell us they can pursue more challenging activities and safely step back and focus on the patient. Patients tell us the system is comfortable and fun, and they love seeing the progress they make through the real-time metrics captured in the patient management software.

Billing codes and reimbursement tips: Standard billing codes apply using SafeGait, including: TherEx, TherAct, Neuro Re-ed. Tip: Therapeutic Activity has a higher payment, which means you are causing the company you work for to lose out on additional profit by coding everything as TherEx.


Hocoma Inc

Norwell, Mass
Jose Tovar, Clinical Applications Manager, discusses the Lokomat

Technology overview: The adjustable exoskeleton ensures a physiological gait pattern through the individual adjustment of movement parameters, combined with its dynamic body weight support system. Patients are motivated to reach their goals with game-like exercises that provide real-time feedback and interaction with the game-like interface. Furthermore, it enhances efficiency and safety, leading to higher training intensity, more treatments per therapist, and consistent, superior patient care. The Lokomat is used in settings that include inpatient and outpatient clinics, and research institutes.

How it improves on previous technologies: It offers several advantages, including a software package with a user-friendly interface that integrates many tools to tailor therapy sessions to specific patient needs and goals. Lokomat also allows for pediatric training, manual training, and records training data for reporting and therapy progression purposes. With an intensive gait training that incorporates robotic intervention, the therapist can provide multiple gait therapy sessions not otherwise possible due to human resources needed, time, and physical strain on staff.

Customer feedback: Dale B. Hull, executive director, Neuroworx USA, tells us the Lokomat allows them to provide their patients with more intensive gait therapy. They experience more repetitions and are motivated by the augmented performance feedback to actively contribute with maximum effort to their therapy. Martin Niedermeier from Hochzirl, Austria, tells us that the Lokomat allows the operating clinician to observe the patient’s motion sequence more easily and from another perspective, and to intervene whenever necessary.

Billing codes and reimbursement tips: For a patient with gait impairment and physical therapy goal(s) related to gait, the most common CPT code charged when the patient uses the Lokomat during physical therapy is Gait Training (97116). When the Lokomat is used during physical therapy to address goals unrelated to gait, a different CPT code is selected to reflect the purpose of the treatment. Donning equipment is considered pre-therapeutic and can be charged under the same code as the treatment.


Mobility Research Inc

Tempe, Ariz
Nechama Karman, PT, MS, PCS, discusses the LiteGait and GaitSens

Technology overview: The LiteGait supports the user in a fall-free environment with postural correction, aligning the user in a symmetrical, upright posture to normalize the biomechanical forces acting on the joints and promote energy-efficient gait and movement patterns. The GaitSens treadmill performs instrumented spatiotemporal gait analysis in real time, during treatment, providing outcomes data and support for therapy interventions to third-party payors. It is used in settings from acute care/ICU/bedside to inpatient rehabilitation to outpatient to home/community-based.

How it improves on previous technologies: LiteGait is portable, as is the GaitKeeper mini treadmill, and can be taken bedside for early mobilization. One of the LiteGait’s notable characteristics is that it is a body weight support system designed for postural correction/control. The seamless data collection and instantaneous analysis of the GaitSens minimizes time to generate documentation/justification and helps the clinician to prioritize treatment. GaitSens provides patient feedback necessary to change specific gait parameters.

Customer feedback: Customers are thrilled that they can use LiteGait without being “tied” to a specific location. They love the postural alignment provided by LiteGait, which makes gait facilitation easier, and the immediate availability of gait analysis results and patient feedback provided by the GaitSens system. They use the system to measure the effectiveness of a client’s therapy as well as to select the best intervention technique for the individual client and evaluate programs. They “raise the bar on their outcomes expectations” when using LiteGait and GaitSens.

Billing codes and reimbursement tips: Commonly used codes are gait training, functional training, neuromotor re-education, and therapeutic exercise. The GaitSens can demonstrate improvement not seen with our “usual” outcome measures such as 10-meter and 2, 4 or 6-minute walk tests. Small changes become obvious and measurable, and can be used to justify ongoing care.

PK Rehab Management


Havertown, Pa
Patrick Roscher, Chief Technical Support Engineer, discusses the Zeno Walkway and PKMAS software

Technology overview: Data is used to identify functional deficiencies following stroke and track progress following treatment, and our technology is utilized in all categories. The research market was the first area we entered because, without accurate data collection protocols and data interpretation, these data could not be translated into the clinical environment. Currently, the technology is used equally within inpatient and outpatient settings.

How it improves on previous technologies: Our footfall identification is superior to any other walkway software currently available. Capturing and analyzing difficult gaits such as overlapping footfalls, weaving walker tracks, quad canes, and toe drags are often necessary for analyzing gait data post-stroke. Ignoring or removing these data from gait trials isn’t representative of the patient’s actual abilities. ProtoKinetics has just introduced our Limits of Stability (LOS) balance protocol. Our implementation of this commonly utilized clinical protocol offers clinicians static and dynamic stability measures and calculations that illustrate unilateral contributions to the task.

Customer feedback: At the 2019 APTA Combined Sections Meeting, customers commented about how our product is consistently improving. Our newly improved footfall editor has decreased the amount of processing time necessary for even the most difficult gait patterns. This allows for more efficient results using the system to obtain our descriptive gait data. Customers were excited about the prospects of using our newly automated protocols, the LOS and FSST, to expand their testing procedures and learn more about the balance of their patients.

Billing codes and reimbursement tips: The most commonly utilized billing code for direct reimbursement of a Zeno Walkway test is 97750, a physical performance test. However, the data gathered from our system can be used to aid in securing reimbursement for other therapies and treatments. Quantified outcome measures from gait assessments can be used in order to justify the efficacy and necessity of treatments.

VistaMedical_sanding on perturbed surface with ball

Vista Medical Ltd

Winnipeg, Manitoba, Canada
Andrew Frank, Chief Operating Officer, discusses the BodiTrak2 Balance Assessment system and BodiTrak2 Treadmill Gait Assessment system

Overview: Our systems have been used for over two decades in inpatient and outpatient clinics, and in support of rehabilitation research around the world.

How it improves on previous technologies: BodiTrak Balance systems are portable, flexible, easy to use, and cost a fraction of traditional force plate solutions. A clinic can actually have one or more of our systems as front line tools for assessment and training, and provide objective documentation of the patient’s challenges and progress in rehabilitation. These devices are built to provide objective information for tests such as mCTSIB and CTSIB that were previously done subjectively; or were performed with equipment that some facilities may have considered too expensive to own as a regular front line modality.

Customer feedback: They love them and consider them comparable to tools they have purchased for 10 times as much money. The sensor is very flexible, so therapists can place it on steps or on top of various densities of foam, creating a progressively perturbed surface during rehabilitation. That is not something that can be done with force plates. Some therapists are using them in very innovative ways, as well. For example, some customers have reported that therapists have taken the system and hung it on the wall for use with upper body physio.
Billing codes and reimbursement tips: While therapist do get paid for time using the tool, there are no direct reimbursement codes for the use of the tool itself. RM


via Stroke of Genius: Outfitting the Clinic for Neuro Recovery – Rehab Managment

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[Abstract] Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials



To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke.


A systematic literature search was conducted in 6 databases from January 2000 to May 2018.


Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies.


The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable.


A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low.


The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke.


via Effectiveness of Technology-Based Distance Physical Rehabilitation Interventions for Improving Physical Functioning in Stroke: A Systematic Review … – PubMed – NCBI

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[WEB PAGE] Gait & Balance Technology Showcase – Rehab Managment

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The market for gait and balance products is robust. The rising number of aging Baby Boomers and those affected by neurological conditions continues to stimulate a need for technologies designed to help rehabilitate and restore function when mobility becomes impaired. Rehab Management has gathered a select group of products to showcase some of the latest technologies on the market being used in clinical settings and research. These products are powered by features that can help patients regain the functional abilities to meet the everyday challenges of living safely and comfortably in their environments. Review the products in this section to better understand how they can help improve safety, efficiency, and outcomes in the rehab setting.


Optimal-G Pro – Get One Step Ahead

Optimal G Pro, an advanced robotic gait rehabilitation platform, is designed to accelerate the rehabilitation journey and to improve outcomes in both adults and pediatric patients suffering from post-neurological trauma and orthopedic injury. Incorporating Enhanced Learning Intelligence Technology (E.L.I.T.E.) pro-active motor learning technology, the Optimal G Pro is made to enhance clinical decision-making via an adaptive and progressive therapy session. The robotic system can constantly challenge and engage the patient through various modes of operation, feedback threshold control, interactive exercises and games, virtual reality, alongside instant visual and auditory feedback — all personalized to each patient’s needs. Based on clinical principles of brain recovery in gait rehabilitation with breakthrough technology, the Optimal-G Pro enables neuromuscular re-education and brain retraining.

For more information, contact Motorika USA Inc, (877) 236-0313,




The Gait Trainer 3 treadmill, from Biodex Medical Systems Inc, headquartered in Shirley, NY, features sensorimotor music enhancements developed in collaboration with physical and music therapists. The library of tempo-to-cadence-matched music selections are composed to inspire correct movement. Its instrumented track can detect where each foot strikes as a patient walks, and displays those footsteps on a large LCD screen. The Gait Trainer’s track records and analyzes step length, step speed, and step symmetry, documenting the effectiveness of gait therapy. This combination of music, biofeedback and gait repetition is aimed at enhancing neuroplasticity, to recover movement lost to injury or disease.

For more information, contact Biodex Medical Systems Inc, (800) 224-6339;



Clarke Health Care Products Inc, Oakdale, Pa, introduces the Dynamic Stair Trainer DST8000 Triple Pro, designed to motivate and increase a patient’s rehabilitation and make easy work for therapist’s reports. The stair trainer features electronically elevating steps that allow clients to start stair climbing at a level appropriate to their ability. The remote-controlled elevating steps start from a flat plane and rise to 6.5 inches. On the other side is an increasing incline, which raises and lowers. The patient’s performance in past and current sessions is displayed on the computer. DST Factor is a parameter which summarizes the patient’s status and estimated potential for future improvement.

For more information, contact Clarke Health Care Products Inc, (888) 347-4537;

Exertools Strobe Glasses


The Senaptec Strobe from Exertools, Petaluma, Calif, is designed to train the connections between an individual’s eyes, brain, and body. Using liquid crystal technology, the lenses flicker between clear and opaque, removing visual information and forcing the individual to process more efficiently. The Senaptec Strobe can be integrated into existing sports training drills and exercises, or be added to vision therapy protocols as an uploading technique. As an athlete, the strobes can help move training to a higher level. The curved liquid crystals provide a full 180-degree field of view that allows users to enhance their visuals skills in the training room, or on the field of play.

For more information, contact Exertools, (707) 570-5158;

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G&W Heel Lift, Cuba, Mo, offers Clearly Adjustable Full Foot & Combination Lifts, engineered to provide minimal ankle angulation using a foundation of the entire length of the foot and made with clear vinyl in true 1 mm layers. According to the company, keeping the foot as level as possible helps reduce gait changes, foot pressure, and tendon length. The lift is adjustable to 8 mm, and the Combination is adjustable to 18 mm. It is available in various shoes sizes, for both left and right foot.

For more information, contact G&W Heel Lift Inc, (800) 235-4387;



GAITRite systems, from CIR Systems Inc, Franklin, NJ, is engineered to capture objective data to reliably document patient condition and progression. The software identifies, through a multitude of specific Spatial-Temporal Gait parameters, objective numbers which allow for informed assessment of targeted interventions and readily synchronizes with other systems, including video, EMG, etc. Robust reporting options allow for tailorable reports with multiple export functions available.

For more information, contact CIR Systems Inc, (888) 482-2362;



SafeGait ACTIVE from Gorbel Medical, Victor, NY, is an overhead fall protection device that allows patients to move dynamically through treatment sessions. It is designed to treat patients further along the continuum of care and is ideal for hospital-based or private practice outpatient clinics. SafeGait ACTIVE is designed to allow for multi-directional movement while also protecting patients as they practice gait, balance, jumps, transfer, and stair exercises. Exclusive Dynamic Fall Protection (DFP) technology distinguishes between a patient’s intentional movement downward and a fall so therapists can safely challenge patients and facilitate error.

For more information, contact Gorbel Medical, (844) 846-8744;



C-Mill, available from Hocoma Inc, Norwell, Mass, is engineered as complete, advanced evaluation and training treadmill, with the ability to simulate everyday life challenges through augmented and virtual reality in a safe and comfortable environment. C-Mill can help patients train for everyday life’s environments and changing circumstances, such as walking in a crowded area or avoiding obstacles. A patient’s performance is measured and saved to provide both short- and long-term results and insights. The optional Body Weight Support (BWS) System and additional versatile balance exercise applications enable extended training possibilities.

For more information, contact Hocoma Inc, (877) 944-2200;



LiteGait is a gait training device that simultaneously controls weight-bearing, posture, and balance over a treadmill or overground. Offered by Mobility Research, Tempe, Ariz, LiteGait creates an ideal environment for treating patients with a range of impairments and functional levels. Its harness design not only permits unilateral or bilateral support, allowing progression of the weight-bearing load from non to full weight bearing, but also allows the clinician to manually assist the legs and pelvis. LiteGait provides proper posture, reduces weight-bearing, eliminates balance concerns, and facilitates training of coordinated lower extremity movement.

For more information, contact Mobility Research, (800) 332-9255;



Managing and synthesizing accurate gait data is essential to outcomes-driven healthcare. The Zeno Walkway from ProtoKinetics, Havertown, Pa, has a wide surface that allows for the capture of assistive device performance in addition to the loading patterns of the patient’s footsteps. PKMAS software is engineered to automatically eliminate walker tracks, while expertly identifying overlapping steps, to provide robust temporal-spatial measurements for even the most complicated gait patterns. Recent implementation of the enhanced Gait Variability Index (eGVI) and automated Four Square Step Test are two examples of rehabilitation-related outcome measures which may assist in clinical decisions about balance control to plan therapy and discharge from the hospital.

For more information, contact ProtoKinetics, (610) 449-4879;



Strideway, available from Tekscan, South Boston, is a modular system designed to calculate spatial, temporal, and kinetic parameters essential for a comprehensive gait analysis. Data is presented in easy-to-understand tables and graphs to quickly compare patient progress between visits. Symmetry tables provide quick insights into differences between left and right sides. The pressure data provided by the Strideway is useful to identify asymmetries, potential problem areas, pain points, or areas of ulceration. Featuring a smooth, flush surface, the Strideway is ideal for patients of all ages and its width easily accommodates those with walking aids. It is available in multiple lengths and provides flexibility to add or subtract length at any time. With a quick set-up time, full data collection can be completed in minutes.

For more information, contact Tekscan, (800) 248-3669;



Vista Medical, Winnipeg, Manitoba, Canada, introduces the BodiTrak Balance Mat, designed to assess steadiness, symmetry, and dynamic stability as an aid for fall prevention, concussion evaluation and recovery, athlete rehabilitation, and general postural/sway. The BodiTrak Balance Mat measures weight-bearing, like a force plate, but also pressure-maps each foot individually, including heel/toe segmentation. Additionally, the BodiTrak Balance Mat tracks center-of-pressure (COP) total distance moved, maximum COP displacement, and velocity of COP movement The Mat is engineered to bring quantification and objectivity to balance tests such as mCTSIB, which have historically been observational and subjective. By displaying and reporting detailed data about various balance-related metrics, it is designed to enable the detection of even slight improvements in outcomes over time—thereby enhancing the quality and value of reports for both physicians and insurers.

For more information, contact Vista Medical, (800) 822-3553;


via Gait & Balance Technology Showcase – Rehab Managment

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[WEB SITE] Healthcare Virtual Reality Enhances Clinician, Patient Satisfaction

Healthcare virtual reality is a versatile technology that can significantly impact education and patient engagement.

healthcare virtual reality

Source: Thinkstock

 By Elizabeth O’Dowd

 – Healthcare organizations are considering new technology as innovative IT infrastructure tools make themselves available. Healthcare virtual reality (VR) is no exception and as its medical uses grow, more providers are considering it as part of their digital transformation.

The healthcare virtual reality is expected to grow at a CAGR of 54.5 percent through 2023, according to a recent Research and Markets report.

While the initial uses of VR in healthcare may not be immediately apparent, its applications can be spread through many facets in healthcare including surgery, education, pain management, rehabilitation, and therapy.

VR and closely related augmented reality (AR) technology are quickly progressing through the healthcare industry. A Kalorama Information report released late last year indicated that while healthcare organizations have not had the need or budget for VR, that view is beginning to change.

The Kalorama report discovered that the most effective use of VR and AR is in surgical settings to assist surgeons. The technology can give surgeons better precision and also help enhance robot-assisted surgery. Using technology this way can reduce the risk of patient harm through medical error which is currently one of the leading causes of death in the US.

“Augmented reality or ‘mixed reality,’ integrates, injects or superimposes virtual elements and visualizations over the real world,” Kalorama report authors explained. “Via virtual reality in healthcare applications, VR technology is able to produce VEs such as an operating room, surgical site, patient anatomy, or therapeutic simulation.”

The report qualified VR and AR applications based on their ability to manipulate medical imaging data or other inputs to generate virtual environments or overlay virtual elements over the user’s sight.

VR and AR  in surgery are closely tied with surgical navigation and robot-assisted surgery. Organizations hope to eventually embrace virtual and augmented reality to help surgeons work more quickly and accurately, and eliminate potential human error during surgery.

The technology is not meant to replace surgeons;, it’s meant to provide them with more accurate information and visuals to help doctors make faster and more accurate decisions.

Medical education is another practical application of VR and AR in healthcare. Realistic surgical simulators can better prepare student surgeons for operating on actual patients by providing realistic views of surgical situations.

The report, Augmented Reality in Healthcare Education, said that there are many challenges in healthcare education and augmented reality can provide learning opportunities where “virtual learning experiences can be embedded in a real physical context.”

The Augmented Reality in Healthcare Education study found that 96 percent of the material studied claimed that AR is useful for improving healthcare education. The material outlined benefits of educational AR to include decreased amount of practice, reduced failure rate, improved performance accuracy, accelerated learning, and better understanding of special relationships.

VR and AR also have many patient facing uses as well for pain management, therapy, and can even be used to reduce fear in patients.

VR can be used for patient care and help patients gain a better understanding of their health. By showing the patient a virtual tour of their medical condition, such as a gastrointestinal test, she can better understand her medical condition.

Another example is controlling the environment to manipulate how a patient views something. For example the hematology clinic at Nationwide Children’s Hospital uses VR to put patients in a calming or entertaining environment while they undergo painful needle pricks and other treatment.

VR can also be used to put patients into a fearful environment to overcome it for therapeutic purposes.

VR and AR are complex technologies but are proving their worth in a healthcare setting. Visually enhancing clinician and patient experiences can significantly improve outcomes and both patient and clinician satisfaction.

via Healthcare Virtual Reality Enhances Clinician, Patient Satisfaction

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[Abstract] The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed methods study.



To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.


Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14-25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl-Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.


Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p < 0.05 for all measures).


Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability. Implications for rehabilitation To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need. Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation. Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment. Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.


via The feasibility, acceptability and preliminary efficacy of a low-cost, virtual-reality based, upper-limb stroke rehabilitation device: a mixed meth… – PubMed – NCBI

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[Abstract] A smart brace to support spasticity management in post-stroke rehabilitation – Master Thesis


This report covers the design of a product to help stroke survivors who are suffering from chronic spasticity manage their everyday activities. In the Netherlands alone, 44.000 people suffer from a Cerebro-Vascular Accident (CVA) each year. A CVA, more commonly known as a stroke, results in brain trauma with afflictions such as paralysis, fatigue and spasticity. It is possible to recover some, if not all, motor function though intensive physiotherapy, which requires long-term stay at a rehabilitation clinic in severe cases. Due to limited room and staff, only 12% of stroke survivors end up rehabilitating in a clinic. The remaining survivors are sent home, and will to travel to the clinic 3-5 times per week for therapy as part of the outpatient rehabilitation. Adjuvo Motion, a young start-up, aims to improve the situation of stroke survivors by bringing the rehabilitation centre to their home through the Adjuvo Platform, which allows them to perform exercises in the context of virtual tasks. They proposed an assignment to extend their product portfolio with a Range of Motion assessment device that is suited for those suffering from spasticity. Spasticity occurs in roughly 60% of stroke survivors with varying degrees of intensity. It is caused by the damaged parts of the brain sending conflicting signals to the muscles, causing them to contract. This inhibits the survivor’s ability to perform daily tasks, but can be solved temporarily with stretching exercises. A solution to compensate for these spastic forces using a passive-assist device was proposed at the start of this project. The project was divided into four stages: Analysis, Synthesis, Embodiment and Evaluation. During the Analysis stage, interviews with a Physiotherapist and stroke survivor and literature studies regarding anatomy, the state of the art and relevant technologies were used to create a framework for the design of a smart passive-assist glove. Looking at competing products, there is a demand for passive assist and Range of Motion assessment functionalities, yet a combination of these in a single device is not yet present in the market. During the Synthesis stage, the design problem of the passive assist device was split into three groups: Orthoses; the connections to the body, Passive Assist; the compensation medium, and RoM measurement; the sensing mechanism(s). These three groups were further split into sub-problems, the solutions to which were compiled into a Morphological Chart. By combining the solution within this chart, three promising concept designs were created: One upgrade to the existing sensor glove, one full integration of sensing and passive assist, and one passive assist glove with removeable sensors. To evaluate these concepts, eight criteria were established and weighted with the help of a physiotherapist. In order to create an objective assessment, the criteria were kept strictly quantitative and the three designs were first scored against the Raphael Smart Glove by Neofect using early prototypes. These scores were then used to evaluate the designs relative to each other, which resulted in an overall higher score for the concept with separable electronics. Making the sensor part of the brace removeable allowed the product to be used during daily life as well as physiotherpy exercises, and proved a key benefit in keeping the product clean. Based on the chosen design, four iterations of prototypes were made, which were tested with healthy subject. During this stage, it became clear that flex sensors are be best suited to create a range of motion assessment for spastic stroke patients, since it is less important to know how well they perform a task, and more important to know if they can actually perfrom it. Based on a quantified use case, the four sub-assemblies; the Wrist Wrap, Finger Modules and Sensor Module, and their connections were materialized in the Embodiment design stage. When selecting production methods, the main challenge was a small batch size of 1000 units, which made conventional techniques for mass production, such as Injection Molding, less attractive. This stage ended in an assesment of the product’s production price and durability: The product would cost €250 to make, and would last for 2.5 years before the Velcro connection on the Wrist Wrap would become too weak to sustain the spasticity forces. In the Evaluation stage, the product was evaluated on the seven most important requirements established during the analysis stage. For several of these, a user test was performed, again with healthy subject. While the Adjuvo Auxilius passed most theoretical requirements, the user tests on healthy subjects could not be used to draw any conclusions regarding its effectiveness on spastic stroke patients. However, since the product’s working principle is based on that of existing spasticity compensation products, the prediction is that the Auxilius will be an effective therapy supplement. The result of this project is the Adjuvo Auxilius; a spasticity-compensation glove with modular sensors, which can be added to allow virtual (stretching) exercises through the Adjuvo Motion’s platform. The results of these exercises are used to create a remote assessment of the patients motor skills, and to adjust the therapy if needed.

via A smart brace to support spasticity management in post-stroke rehabilitation | TU Delft Repositories


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[ARTICLE] A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation – Full Text


Background: Worldwide, there has been a marked increase in stress and anxiety, also among patients with traumatic brain injury (TBI). Access to psychology services is limited, with some estimates suggesting that over 50% of sufferers are not accessing the existing services available to them for reasons such as inconvenience, embarrassment, or stigmatization concerns around mental health. Health service providers have increasingly been turning to drug-free therapies, such as mindfulness programs, as complementary treatments.

Objective: Virtual reality (VR) as a new delivery method for meditation-based stress and anxiety reduction therapy offers configurable environments and privacy protection. Our objective was to design a serious learning-meditation environment and to test the feasibility of the developed telemindfulness approach based on cloud technologies.

Methods: We developed a cloud-based system, which consisted of a Web interface for the mindfulness instructor and remote clients, who had 3D VR headsets. The mindfulness instructor could communicate over the Web interface with the participants using the headset. Additionally, the Web app enabled group sessions in virtual rooms, 360-degree videos, and real interactions or standalone meditation. The mindfulness program was designed as an 8-week Mindfulness-Based Stress Reduction course specifically for the developed virtual environments. The program was tested with four employees and four patients with TBI. The effects were measured with psychometric tests, the Mindful Attention Awareness Scale (MAAS) and the Satisfaction With Life Scale (SWLS). Patients also carried out the Mini-Mental State Examination (MMSE). An additional objective evaluation has also been carried out by tracking head motion. Additionally, the power spectrum analyses of similar tasks between sessions were tested.

Results: The patients achieved a higher level of life satisfaction during the study (SWLS: mean 23.0, SD 1.8 vs mean 18.3, SD 3.9) and a slight increase of the MAAS score (mean 3.4, SD 0.6 vs mean 3.3, SD 0.4). Particular insight into the MAAS items revealed that one patient had a lower MAAS score (mean 2.3). Employees showed high MAAS scores (mean 4.3, SD 0.7) and although their SWLS dropped to mean 26, their SWLS was still high (mean 27.3, SD 2.8). The power spectrum showed that the employees had a considerable reduction in high-frequency movements less than 0.34 Hz, particularly with the 360-degree video. As expected, the patients demonstrated a gradual decrease of high-frequency movements while sitting during the mindfulness practices in the virtual environment.

Conclusions: With such a small sample size, it is too early to make any specific conclusions, but the presented results may accelerate the use of innovative technologies and challenge new ideas in research and development in the field of mindfulness/telemindfulness.


Attention impairment has often been considered a hallmark of mental illness. Attention training is an important part of meditation, and has proven to augment the ability to sustain attention [1]. Mindfulness as a meditation tool has an important role in psychology, self-awareness, and well-being. The authors Brown and Ryan [2] reported that mindfulness over time was related to a reduction in variable mood and stress in patients with cancer. Mindfulness is an internationally recognized therapy that teaches self-awareness, maintaining own thoughts, sensations, feelings, emotions, and appreciation of your living environment [3]. The mindfulness meditation technique may help patients manage potentially negative outcomes and improve well-being by controlling unselfconsciousness (thoughts on failure). Avoiding problems associated with the future, focusing on the present, being “now,” and controlling the tracking of time may, in addition to well-being, lead to mindfulness. A person who can achieve such an active and open attention state can control thoughts from a distance, free to judge whether they are good or not [4]. In this context, mindfulness can also be considered an important tool for managing anxiety and stress in patients [2]. Kabat-Zinn [3] designed an 8-week meditation course, Mindfulness-Based Stress Reduction, which provides 2 hours of meditation in a group with additional homework. Mindfulness-Based Stress Reduction has demonstrated that awareness of the mind, unconscious thoughts, feelings, and other emotions positively affect major physiological processes and thus decreases the level of stress-related disorders [46].

Anxiety and stress disorders can be related to pressure at work, incurable diseases, or neuromuscular disorders, such as Parkinson disease, light traumatic brain injury (TBI), multiple sclerosis, or other diseases of the muscular or central nervous system. Deficits in executive functions, memory, and learning are often documented after TBI. In addition, at least half of those suffering from TBI experience chronic pain and/or sleep disorders, depression, and substance abuse [7].

A review of the literature shows that neural systems are modifiable networks and changes in the neural structure can occur in adults as a result of training [8]. The study reported on anatomical magnetic resonance imaging (MRI) images from 16 healthy meditation-naïve participants who underwent the 8-week mindfulness program [8]. The results obtained before and after the program suggested that participation in a Mindfulness-Based Stress Reduction course was associated with changes in gray matter concentration in the regions of the brain involved in learning and memory processes, emotion regulation, self-referential processing, and perspective taking.

Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI [9]. A significant drawback is that patients often stay in hospital for a limited time and are soon discharged for recovery at home. Afterward they can visit an outpatients’ clinic. Patients residing close may find the outpatient service convenient, but it could be very inconvenient for those who are in need of ongoing care, are dependent on public transport, or in the worst case do not have access to transport at all. Consequently, external factors such as travel fatigue may hinder the effectiveness of the therapy and, in some, may even increase anxiety and stress. In addition, modern diseases caused by stress and anxiety in the workplace are on the increase, but access to treatment and therapy is usually not possible during working hours [10].

Innovative technologies can ensure real-time communication and data recording/sharing over long distances, even within larger groups of participants [11]. Nowadays, privacy, data security, shyness, and pride are among the most frequent reasons to avoid therapy if a mental disease or neuromuscular disorder is related to work or social status [12].

Some patients prefer to remain anonymous and do not want to reveal their problems, even to colleagues. The sense of “total immersion” created by virtual reality (VR) is an emerging technology that may entirely replace mainstream videoconferencing techniques [13]. These technologies may fulfill patient expectations [14] regarding anonymity and enhance presence [15]. Patients can hide their identify using an avatar and their voices can be disguised. Psychologists and other experts may observe the kinematic changes in motion patterns, gestures, face mimics, and other measurable features [12]. If there is a group, the VR avatars can be synchronized and controlled in real time, using cloud-based technologies. The operator can form groups, deliver individual or group tasks, or lead a private conversation with selected participants. We have developed a technology that is available for home and workplace use, called Realizing Collaborative Virtual Reality for Well-being and Self-Healing (ReCoVR), for which the VR headset is coupled with a mobile phone. The only requirement is a connection to Wi-Fi/4G Internet, plus communication with the cloud server allows remote interaction with other users residing thousands of miles away.

This cloud-based app is used for interaction and communication between a mindfulness expert and participants. Each participant uses a commercially available mobile phone and a simple head-mounted VR headset to join the mindfulness session in the virtual environment (VE). Our main objectives were to design a suitable mindfulness protocol based on Mindfulness-Based Stress Reduction, with tasks in the VE with 360-degree videos, and to test the feasibility of the developed mindfulness/telemindfulness app in a real environment. Additionally, we analyzed head movements during mindfulness sessions to stimulate further initiatives in this research space. […]

Continue —> JRP-A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation | Cikajlo | JMIR Research Protocols

Figure 1. The ReCoVR system consists of a cloud server, serving information for the WebGL scenery and synchronization of the data (audio, video, data) between the server and clients. The clients connect to the server as mindfulness experts (using a computer with Web browser) and as mindfulness therapy participants (using Samsung GearVR 3D headset with Wi-Fi/LTE).

Figure 2. The mindfulness instructor uses the Web interface to manage the group therapy in the virtual room. The Web interface enables video-audio communication with the participants (below left), making subgroups, and assigning tasks (right) for mindfulness sessions. Additionally, the therapist can share documents and lead the session, while everybody can send/receive messages and talk to other group members.


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