Posts Tagged Virtual Reality Rehabilitation

[ARTICLE] What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes – Full Text

Abstract

Background

Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.

Methods

Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/FunctionActivity, and Participation levels of the International Classification of Functioning.

Results

Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activityoutcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participationoutcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.

Conclusion

VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

Background

Stroke is one of the leading global causes of disability [12], with over 17 million individuals worldwide sustaining a stroke each year [2]. Although stroke mortality is decreasing with improvements in medical technology [3], the neurological trauma resulting from stroke can be devastating, and the majority of stroke survivors have substantial motor [45], cognitive [6789] and functional rehabilitation needs [31011], and much reduced quality of life [31213]. Targeted rehabilitation can help address some of these post-stroke deficits, however, historically, many individuals, in particular patients with cognitive impairment, have difficulty engaging in standard therapies [141516] at a level that will produce meaningful and lasting improvements [16171819]. Enriched and interactive rehabilitation programs are clearly needed to minimize functional disability [1320], increase participation in age-appropriate roles and activities [21], lead to greater motivation and treatment compliance [1722], and reduce the long-term expense of care in stroke survivors [202324].[…]

 

Continue —> What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes | Journal of NeuroEngineering and Rehabilitation | Full Text

 

Fig. 1 Population, Intervention, Comparison, Outcome (PICO) Question and the main variables included in the systematic literature review and meta-analysis

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[Abstract] An intelligent, adaptive, performance-sensitive, and virtual reality-based gaming platform for the upper limb.

Abstract

Stroke is a leading cause of adult disability, characterized by a spectrum of muscle weakness and movement abnormalities related to the upper limb. About 80% of individuals who had a stroke suffer from upper limb dysfunction. Conventional rehabilitation aims to improve one’s ability to use paralyzed limbs through repetitive exercise under one-on-one supervision by physiotherapists. This poses difficulty given the limited availability of healthcare resources and the high cost of availing specialized services at healthcare centers, particularly in developing countries like India. Thus, the design of cost-effective, home-based, and technology-assisted individualized rehabilitation platform that can deliver real-time feedback on one’s skill progress is critical. This paper describes the design of a novel, multimodal, virtual reality (VR)-based, and performance-sensitive exercise platform that can intelligently adapt its task presentation to one’s performance. Here, we aim to address unilateral shoulder abduction and adduction that are essential for the performance of daily living activities. We designed an experimental study in which six individuals who had chronic stroke (post-stroke period: >6 months) participated. While they interacted with our VR-based tasks, we recorded their physiological signals in a synchronized manner. Preliminary results indicate the potential of our VR-based, adaptive individualized system in the performance of individuals who had a stroke suffering from upper limb movement disorders.

© 2018 John Wiley & Sons, Ltd.

 

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[WEB SITE] Augmented and virtual reality will involve human senses in verifying the operations of information systems — ScienceDaily

Many new applications aim to make information systems and machines identify their users and take their individual needs and emotions into account. VTT Technical Research Centre of Finland Ltd studied how ordinary consumers could reliably verify the operation of systems by using human senses.

In the future, machines and AI systems will have a deeper understanding of the actions of their human users. Even now, AI is able to generate an image of what a human is watching on the screen just by recording brain activity or deduce the emotions of people from microexpressions taken from their faces.

In the Human Verifiable Computing project, VTT used augmented and virtual reality to develop solutions for building trust between people and systems and facilitating the verification of information security. This is a vital aspect of the digital future, in which interaction between people and computers will be an effortless part of everyday life. “Augmented and virtual reality technologies let us make fuller use of our senses and enable the constant mutual evaluation of reliability between humans and machines,” says Senior Scientist Kimmo Halunen of VTT.

Making cryptographically verifiable computing available to human users was a key part of the project.

The project demonstrated functionalities involving computing verified with human senses. For example, augmented reality was utilized to distribute single-use passwords, which could then be used through voice recognition. Augmented reality was also utilized to give multisensory feedback by showing visual instructions to a maintenance worker who turns a valve and receives an error message if the valve is operated incorrectly. The message can be implemented as an interactive image and also presented through audio on the user’s smart glasses. In addition, haptic feedback can be provided by making the user’s smart watch or other mobile device vibrate.

The results of the project indicate that the basic technology required for the verification of computing with the human senses is already available. The combination of augmented reality and safety information will also enable new services. Current cryptographic methods and protocols are nearly always applied to communication between machines. Including the user in the interaction will nevertheless require more research and system and application development, as well as more study of human behaviour.

Story Source:

Materials provided by VTT Technical Research Centre of FinlandNote: Content may be edited for style and length.

 

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[ARTICLE] Kinect-based individualized upper extremity rehabilitation is effective and feasible for individuals with stroke using a transition from clinic to home protocol – Full Text PDF

Purpose: To investigate the effectiveness and feasibility of Kinect-based upper
extremity rehabilitation on functional performance in chronic stroke survivors.
Methods: This was a single cohort pre-post test study. Participants (N=10; mean age =
62.5 ± 9.06) engaged in Kinect-based training three times a week for four to five weeks
in a university laboratory. To simulate a clinic to home transfer condition,
individualized guidance was given to participants at the initial three sessions followed
by independent usage. Outcomes included Fugl-Meyer assessment of upper extremity,
Wolf Motor Function Test, Stroke Impact Scale, Confidence of Arm and Hand
Movement and Active Range of Motion. Participant experience was assessed using a
structured questionnaire and a semi-structured interview.
Results. Improvement was found in Fugl-Meyer assessment scores (p=0.001), Wolf
Motor Function Test, (p=0.008), Active Range of Motion (p<0.05) and Stroke Impact
Scale-Hand function (p=0.016). Clinically important differences were found in FuglMeyer
assessment scores (Δ= 5.70 ± 3.47) and Wolf Motor Function Test (Δ Time= –
4.45 ± 6.02; ∆ Functional Ability Scores= 0.29 ± 0.31). All participants could use the
system independently and recognized the importance of exercise individualization by
the therapist.
Conclusions. The Kinect-based UE rehabilitation provided clinically important
functional improvements to our study participants.

Introduction

Stroke is the leading cause of long-term adult disability in the United States [1].
More than a half of survivors continue suffering from upper-limb hemiparesis poststroke with only 5% of people recovering their full arm function [2]. The persistent
upper-limb dysfunction significantly impairs motor performance, and results in a
serious decline in functional ability as well as quality of life [3]. Intensive and repeated
practice with the paretic arm appears necessary to enhance arm recovery and facilitate
neural reorganization [4-7]. Nevertheless, the healthcare system provides limited
amounts and duration of therapy, making it difficult for stroke survivors to achieve
maximal arm recovery before discharge from outpatient rehabilitation or home care
[8,9]. Therefore, identifying novel modalities that are accessible and affordable to the
general public while allowing continued practice of the arm is imperative for improving
long-term upper-limb outcomes after stroke.
One potential approach is the use of low-cost virtual reality (VR)-based systems,
for example, the Microsoft Kinect system. The Kinect is a vision-based motion
capturing system that can detect gesture and movements of the body through its RGA
camera and depth sensors. It allows users to interact with the VR-based system without
holding or wearing specialized equipment or markers for tracking. Users can play
games or practice exercises using natural movements while observing the performance of their virtual avatars shown in real-time on the computer screen. Through this interactive observation and feedback, stroke survivors can correct their movements towards more normal patterns. Furthermore, the Kinect is small and portable, thus enabling stroke survivors to practice exercises in a familiar and private environment. […]

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[Abstract] User experience and interaction performance in 2D/3D telecollaboration

Abstract

Affordable 3D cameras, mixed reality headsets, and 3D displays have recently pushed the Augmented Reality (AR) and Virtual Reality (VR) technologies into the consumer market. While these technologies have been adopted in video-game and entertainment industry, the adoption for professional use, such as in industrial and business environment, health-care, and education is still lagging behind. In light of recent advances in mobile communications, AR/VR could pave the way for novel interaction and collaboration of geographically distributed users. Despite the technology being available, majority of communication is still accomplished using traditional video conferencing technology which lacks interactivity, depth perception, and ability to convey non-verbal cues in communication. 3D systems for communication have been proposed to overcome these limitations; however, very few studies looked into the performance and interaction with such technologies. In this paper, we report on a study that examined telecollaboration scenario with three different modalities: 2D video-conferencing, 3D stereoscopic interface, and 3D stereoscopic interface with augmented visual feedback. Twenty participants worked in pairs, assuming the roles of instructor and worker, to remotely interact and perform a set of assembly tasks.

 

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[WEB SITE] Virtual Reality for Stroke Rehabilitation

stroke rehabilitation

Researchers piloted a study to investigate the potential of using virtual reality (VR) training systems in stroke rehabilitation.

Following a stroke, survivors are often left with physical and mental disabilities. Nine out of ten stroke survivors are left with some degree of upper limb motor impairment, thus making it the most prevalent post-stroke disability suffered. Not only does stroke rehabilitation training need to be long-lasting, repetitive, task-specific and challenging, the training must also be motivating and intensive.

What is the Role of Virtual Reality?

Virtual reality (VR) is a relatively new approach to stroke rehabilitation that has shown to have moderate effectiveness in improving motor functions. VR can allow for embodied sensorimotor feedback where patients’ movements are reproduced in a virtual environment via motion capture technology. This enhanced VR experience has previously demonstrated an ability to increase patient motivation and stimulate neural circuits in the motor system to aid in functional recovery.

Can Virtual Reality Help with Stroke Rehabilitation?

In a pilot study published in the Journal of NeuroEngineering and Rehabilitation, researchers in Switzerland investigated the potential use of a VR-based stroke rehabilitation training targeted to the upper motor limbs. The study’s main goal was to assess the training intensity (the number of repetitions divided by the number of minutes of active therapy) and rehabilitation dose (number of repetitions). They also examined VR-based training improvements in functional upper limb outcomes and the safety and tolerance of this technology.

Ten stroke patients with one-sided weakness were included in the study, utilizing the Mind Motion PRO VR-based motor rehabilitation system. The intervention consisted of two one-hour sessions per week for five weeks with a physical therapist to guide the tasks according to the patient’s needs and abilities. Assessments were conducted at baseline (prior to training), post-treatment, and at a four-week follow-up. The participants engaged in VR treatment exercises that stimulated shoulder, elbow, forearm, and wrist movements at varying difficulties through game-like scenario tasks that included pointing, reaching, and grabbing objects in virtual space.

How Effective was the Virtual Reality Therapy?

All ten of the study’s participants completed the full ten training sessions in the treatment. The study found that the median duration of training increased by approximately ten minutes and the median effective training time (number of minutes that the participants actively trained, excluding breaks) per session doubled by the last session of the intervention. The intensity of the training (number of goal-directed movements per minute of effective training time) progressively increased from the first to last training session.

Secondarily, the study evaluated upper limb function, active range of motion and muscle strength, which all showed an increase from baseline. No adverse events were reported and pain and stress levels were low throughout the treatment, thus indicating that VR treatment is well tolerated. Lastly, the participants showed a high degree of concentration and comfort with the movements and expressed interest in continuing the training after the ten sessions, suggesting a high level of adherence and motivation for VR treatment – a key component to stroke rehabilitation treatment outcomes.

Overall, this pilot study demonstrated the ability of VR-based treatment to provide efficient training sessions, as the efficiency rate (relation between time of therapy session and time in active therapy) was 86.3%, which is higher than conventional therapies. The study supports the potential for VR-based intervention as stroke rehabilitation therapy to improve functional and motor outcomes. This should be further explored in future studies that incorporate control groups, a larger sample size, stratified groups and more intensive interventions with a variety of motor assessments.

Written by Maggie Leung, PharmD

Reference: Perez-Marcos, D., Chevalley, O., Schmidlin, T., Garipelli, G., Serino, A., Vuadens, P., . . . Millán, J. D. (2017). Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. Journal of NeuroEngineering and Rehabilitation,14(1). doi:10.1186/s12984-017-0328-9

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[ARTICLE] Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial – Full Text

Abstract

Background

Fifty percent of all stroke survivors remain with functional impairments of their upper limb. While there is a need to improve the effectiveness of rehabilitative training, so far no new training approach has proven to be clearly superior to conventional therapy. As training with rewarding feedback has been shown to improve motor learning in humans, it is hypothesized that rehabilitative arm training could be enhanced by rewarding feedback. In this paper, we propose a trial protocol investigating rewards in the form of performance feedback and monetary gains as ways to improve effectiveness of rehabilitative training.

Methods

This multicentric, assessor-blinded, randomized controlled trial uses the ArmeoSenso virtual reality rehabilitation system to train 74 first-ever stroke patients (< 100 days post stroke) to lift their impaired upper limb against gravity and to improve the workspace of the paretic arm. Three sensors are attached to forearm, upper arm, and trunk to track arm movements in three-dimensional space while controlling for trunk compensation. Whole-arm movements serve as input for a therapy game. The reward group (n = 37) will train with performance feedback and contingent monetary reward. The control group (n = 37) uses the same system but without monetary reward and with reduced performance feedback. Primary outcome is the change in the hand workspace in the transversal plane. Standard clinical assessments are used as secondary outcome measures.

Discussion

This randomized controlled trial will be the first to directly evaluate the effect of rewarding feedback, including monetary rewards, on the recovery process of the upper limb following stroke. This could pave the way for novel types of interventions with significantly improved treatment benefits, e.g., for conditions that impair reward processing (stroke, Parkinson’s disease).

Background

After stroke, 50% of survivors are left with impairments in arm function [12], which is associated with reduced health-related quality of life [3]. While there is evidence for a positive correlation between therapy dose and functional recovery [456], a higher therapy dose is challenging to implement, as it usually leads to an increase in costs commonly not covered by health insurances. However, when dose is matched, most randomized controlled trials introducing new types of rehabilitative interventions (e.g., robot-assisted therapy [7]) failed to show a superior effect compared to standard therapy. Thus, the need for improving therapy effectiveness remains. In search for elements of effective therapy, we hypothesize that performance feedback and monetary rewards can improve effectiveness.

It has been shown that reward enhances procedural [8] and motor-skill learning [910] and has a positive effect on motor adaptation [11]. Rewards mainly improve retention of motor skills and motor adaptations [91011]. This effect was not explained by training duration (dose) as rewarded and non-rewarded groups underwent similar training schedules [891011]. In a functional magnetic resonance imaging (fMRI) study, Widmer et al. reported that adding monetary rewards after good performance leads to better consolidation and higher ventral striatum activation than knowledge of performance alone [10]. The striatum is a key locus of reward processing [12], and its activity was shown to be increased by both intrinsic and extrinsic reward [13]. Being a brain structure that receives substantial dopaminergic input from the midbrain, ventral striatal activity can be seen as a surrogate marker for dopaminergic activity in the substantia nigra/ventral tegmental area [14]. In rodents, Hosp et al. found that dopaminergic projections from the midbrain also terminate directly in the primary motor cortex (M1) [15]. Dopamine in M1 is necessary for long-term potentiation of certain cortico-cortical connections and successful motor-skill learning [16]. As mechanisms of motor learning are also thought to play a role in motor recovery [17], rehabilitative interventions may benefit from neuroplasticity enhanced by reward.

Here, we describe a trial protocol to test the effect of enhanced feedback and reward on arm rehabilitation after stroke at matched training dose (time and intensity). We use the ArmeoSenso, a standardized virtual reality (VR)-based training system [18] that is delivered in two versions for two different study groups, one version with and one without reward and enhanced performance feedback. […]

 

Continue —> Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial | Trials | Full Text

Fig. 2a Healthy subject using the ArmeoSenso training system. b Arm workspace assessment: gray cubic voxels arranged in the transverse plane reflecting 10 cm × 10 cm active workspace relative to the patient’s trunk

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

ABSTRACT

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.

Introduction

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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[Abstract] Virtual reality for stroke rehabilitation – Review

Abstract

BACKGROUND:
Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015.

OBJECTIVES:
Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.

SEARCH METHODS:
We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists.

SELECTION CRITERIA:
Randomised and quasi-randomised trials of virtual reality (“an advanced form of human-computer interface that allows the user to ‘interact’ with and become ‘immersed’ in a computer-generated environment in a naturalistic fashion”) in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function.

DATA COLLECTION AND ANALYSIS:
Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information.

MAIN RESULTS:
We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach.

PRIMARY OUTCOME:
results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence).

SECONDARY OUTCOMES:
when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild.

AUTHORS’ CONCLUSIONS:
We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.

Update of
Virtual reality for stroke rehabilitation. [Cochrane Database Syst Rev. 2015]

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[Abstract] A Dual-cable Hand Exoskeleton System for Virtual Reality

Abstract

In this paper, a hand exoskeleton system for virtual reality is proposed. As a virtual reality interface for the hand, a wearable system should be able to measure the finger joint angles and apply force feedback to the fingers at the same time with a simple and light structure. In the proposed system, two different cable mechanisms are applied to achieve such requirements; three finger joint angles in the direction of the flexion/extension (F/E) motion are measured by a tendon-inspired cable mechanism and another cable is used for force feedback to the finger for one degree of freedom (DOF) actuation per finger. As two different types of cables are used, the system is termed a dual-cable hand exoskeleton system. Using the measured finger joint angles and motor current, the cable-driven actuation system applies the desired force to the fingers. That is, when the desired force is zero, the motor position is controlled to follow the finger posture while maintaining the appropriate cable slack; when the desired force needs to be applied, the motor current is controlled to generate the desired force. To achieve a smooth transition between the two control strategies, the control inputs were linearly integrated; and the desired motor position was generated to prevent a sudden motor rotation. A prototype of the proposed system was manufactured with a weight of 320g, a volume of 13 × 23 × 8cm3, maximum force up to 5 N. The proposed control algorithms were verified by experiments with virtual reality applications.

 

via A Dual-cable Hand Exoskeleton System for Virtual Reality

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