Posts Tagged Virtual-reality therapy

[Abstract] Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects  

Abstract:

Rehabilitation robots have become increasingly popular for stroke rehabilitation. However, the high cost of robots hampers their implementation on a large scale. This study implements the concept of a modular and reconfigurable robot, reducing its cost and size by adopting different therapeutic end effectors for different training movements using a single robot. The challenge is to increase the robot’s portability and identify appropriate kinds of modular tools and configurations. Because literature on the effectiveness of this kind of rehabilitation robot is still scarce, this paper presents the design of a portable and reconfigurable rehabilitation robot and describes its use with a group of post-stroke patients for wrist and forearm training. Seven stroke subjects received training using a reconfigurable robot for 30 sessions, lasting 30 minutes per session. Post-training, statistical analysis showed significant improvement of 3.29 points (16.20%, p = 0.027) on the Fugl-Meyer Assessment Scale for forearm and wrist components (FMA-FW). Significant improvement of active range of motion (AROM) was detected in both pronation-supination (75.59%, p = 0.018) and wrist flexion-extension (56.12%, p = 0.018) after the training. These preliminary results demonstrate that the developed reconfigurable robot could improve subjects’ wrist and forearm movement.

Source: Portable and Reconfigurable Wrist Robot Improves Hand Function for Post-Stroke Subjects – IEEE Xplore Document

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[ARTICLE] Application of head-mounted devices with eye-tracking in virtual reality therapy – Full Text

Abstract:

Using eye-tracking to assess visual attention in head-mounted devices (HMD) opens up many possibilities for virtual reality (VR)-based therapy. Existing therapy concepts where attention plays a major role can be transferred to VR. Furthermore, they can be expanded to a precise real-time attention assessment, which can serve as a foundation for new therapy approaches. Utilizing HMDs and eye-tracking in a clinical environment is challenging because of hygiene issues and requirements of patients with heterogeneous cognitive and motor impairments. In this paper, we provide an overview of those challenges, discuss possible solutions and present preliminary results of a study with patients.

1 Introduction

Virtual Reality (VR) is a promising field for new forms of therapy. It is a flexible tool for therapists to provide an immersive and interactive environment for patients. VR has been used in the treatment of phobias [1], therapy of addictions [2] and motor rehabilitation [3]. Implementing eye-tracking into head-mounted devices (HMD) introduces a precise real-time assessment of attention and opens up new possibilities for VR-based therapy, e.g. analyzing cognitive processes [4] or diagnosing medical conditions [5]. Additionally to common VR-related issues, specific conditions persist when using HMDs in a clinical context. Strict hygiene requirements have to be met to protect patients, particularly considering the prevalence of multi-resistant organisms.

To achieve sufficient positional accuracy of the eye-tracking, a re-calibration is required every time the HMD has been moved [6]. Hence, eye-tracking creates additional workload for patients and therapists through the calibration procedure. Adequate procedures have to be found to minimize this additional workload in order to be applicable for patients with cognitive deficits.

Setting up eye-tracking systems in head-mounted devices in a way that it (i) meets the hygiene requirements for use in clinical applications, (ii) is suitable for patients with heterogeneous motor and cognitive limitations and (iii) still yields valid and reliable attention data throughout a therapy session is a complex challenge we like to address in this paper.

Continue —> Application of head-mounted devices with eye-tracking in virtual reality therapy : Current Directions in Biomedical Engineering

 

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[ARTICLE] Self-directed arm therapy at home after stroke with a sensor-based virtual reality training system – Full Text

Abstract

Background

The effect of rehabilitative training after stroke is dose-dependent. Out-patient rehabilitation training is often limited by transport logistics, financial resources and a lack of motivation/compliance. We studied the feasibility of an unsupervised arm therapy for self-directed rehabilitation therapy in patients’ homes.

Methods

An open-label, single group study involving eleven patients with hemiparesis due to stroke (27 ± 31.5 months post-stroke) was conducted. The patients trained with an inertial measurement unit (IMU)-based virtual reality system (ArmeoSenso) in their homes for six weeks. The self-selected dose of training with ArmeoSenso was the principal outcome measure whereas the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the Wolf Motor Function Test (WMFT) and IMU-derived kinematic metrics were used to assess arm function, training intensity and trunk movement. Repeated measures one-way ANOVAs were used to assess differences in training duration and clinical scores over time.

Results

All subjects were able to use the system independently in their homes and no safety issues were reported. Patients trained on 26.5 ± 11.5 days out of 42 days for a duration of 137 ± 120 min per week. The weekly training duration did not change over the course of six weeks (p = 0.146). The arm function of these patients improved significantly by 4.1 points (p = 0.003) in the FMA-UE. Changes in the WMFT were not significant (p = 0.552). ArmeoSenso based metrics showed an improvement in arm function, a high number of reaching movements (387 per session), and minimal compensatory movements of the trunk while training.

Conclusions

Self-directed home therapy with an IMU-based home therapy system is safe and can provide a high dose of rehabilitative therapy. The assessments integrated into the system allow daily therapy monitoring, difficulty adaptation and detection of maladaptive motor patterns such as trunk movements during reaching.

 

Background

Functional outcome following stroke is positively correlated with the dose of the applied rehabilitative intervention [1]. Therefore, post-stroke therapy should be provided at a high intensity, a high frequency and over long periods of time [1, 2]. However, the delivery of intensive physical therapy requires extensive therapist support, is expensive, and is often limited by the low compliance and lack of motivation to perform rehabilitative training at the recommended frequency [3]. This can lead to functional deterioration, e.g., by learned non-use of the affected limb [4].

Self-directed home therapy, supported by dedicated instrumented devices [5, 6, 7] or virtual reality gaming platforms [8, 9, 10, 11, 12, 13], could help to increase the dose of rehabilitation at low cost without the need for direct supervision by a therapist. It is important that such home therapy adapts to changes in the subject’s performance in order for it to remain challenging and motivating [8]. On the other hand, unsupervised rehabilitative training could lead to inefficient or harmful (i.e. maladaptive) movement sequences or pain, and could potentially worsen performance [8, 11, 14]. Home therapy should, therefore, include monitoring of movement quantity and quality. Several platforms dedicated to upper-extremity home rehabilitation have been proposed [6, 7, 15, 16, 17]. However, to the best of our knowledge only few were actually installed in the patients’ homes for several weeks and tested for feasibility beyond case studies. These home studies always involved some external supervision, in the form of e.g. on-site visits [16, 17], tele-monitoring and adaption [16, 17] or telephone calls [6, 7], which might have affected compliance and motivation and thereby therapy dosage. However, such an approach requires manpower, which limits the affordability and scalability of home-based therapy. The feasibility and compliance of completely unsupervised upper-limb stroke therapy over the course of several weeks remains to be investigated.

In this paper we investigate the feasibility of self-directed home training with the custom-designed ArmeoSenso system [18], a virtual reality arm rehabilitation platform based on wearable inertial measurement units (IMU). In a clinical study involving eleven patients with hemiparesis of the arm due to stroke, we evaluated the ability to deliver therapy at a high dose through simple-to-use and entertaining, yet functionally relevant and adaptive rehabilitation games. Unsupervised, automated assessments integrated into each therapy session allowed monitoring of arm function, and detection of undesired compensatory movements.

Methods

ArmeoSenso training system

ArmeoSenso comprises a motion capture system based on wearable sensors in combination with an all-in-one touch screen computer (Inspiron 2330, Dell Inc., Fig. 1a). The therapy software provides a user-friendly graphical user interface, two therapy games, and two short automated assessments of arm function [18]. For real-time tracking of arm and trunk movements, the patient wears three IMUs (MotionPod 3, Movea Inc.) fixed to the lower and upper arm as well as the trunk (Fig. 1a). The IMUs measure acceleration, angular velocity and the magnetic field, all in three dimensions, and stream this data wirelessly to a receiver block, which is connected to the computer via USB and serves as a docking station to charge the sensors. A kinematic reconstruction estimates the orientation of the trunk, the upper- and the lower arm based on the Madgwick algorithm [19] and the corresponding joint positions are computed with forward kinematics [20]. This reconstruction serves as input for the assessments and therapeutic virtual reality games (Fig. 1b). By using the same virtual kinematic parameters for each patient, virtual sizes, e.g. distances or the size of targets, are normalized to the patient’s body size. To discourage trunk inclination or rotation during pointing movements, the arm movements are computed and displayed relative to the trunk.

Fig. 1 System Overview and Study Outline. a: Photograph of a healthy subject using ArmeoSenso. b: Screenshot of the pointing task assessment: the virtual upper- and lower arm and the trunk are displayed. The arm points to a target. c: Sequence of a training session. Before each training session, two automated assessments are performed. d: Study outline: The ArmeoSenso system is installed in the patient’s home for six weeks. The patients are assessed clinically before the start, after three weeks, and after six weeks of training. Abbreviations: WMFT: Wolf Motor Function Test; FMA-UE: Fugl-Meyer Assessment Upper Extremity; NIHSS: National Institute of Health Stroke Scale. *system installation and patient instruction by a therapist

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[ARTICLE] Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial – Full Text HTML/PDF

Abstract

Background

Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.

Methods

The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl–Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen–Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention.

Results

The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group.

Conclusions

VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL.

Trial registration

This study is registered under the title “Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke” and can be located in https://clinicaltrials.gov with the study identifier NCT02029651.

Background

Regaining upper extremity function is one of the major goals in stroke survivors, as it is important for performing activities of daily living (ADLs). However, approximately 80 % of stroke survivors have upper extremity limitations, and these limitations persist in approximately half of these survivors in the chronic phase [1, 2]. Distal upper extremity function is vital for performing ADLs, such as holding objects like utensils, turning a doorknob or key in a lock, telephone or computer use, and writing, and is strongly related to quality of life (QoL) in stroke survivors [3]. In stroke survivors, the distal upper extremity is severely affected and is the last body part to recover [4]. Therefore, improving distal upper extremity function is of primary importance in the rehabilitation of stroke survivors.

Recent studies have emphasized the use of interventions that are focused and repetitive, relevant to real-life, and actively performed in order to promote cortical reorganization and neuroplasticity [58]. In this context, conventional interventions have been complemented by novel technologies such as virtual reality (VR).

VR-based rehabilitation is promising in stroke survivors, and many types of VR-based rehabilitation apparatus from commercial video game equipment to robotics are currently being developed and used. In the area of upper limb rehabilitation, a large number of studies have been performed in stroke survivors, and a recent systematic review concluded that the use of VR-based rehabilitation is superior to amount-matched conventional rehabilitation for improving upper limb function [9]. Nevertheless, most studies on VR-based rehabilitation for the upper extremity reported on the proximal upper extremity, with limited information on the distal upper extremity. Although 2 previous studies showed promising results regarding VR-based rehabilitation for the distal upper extremity, these studies did not include a control group [10, 11]. Randomized control trials have been performed using a VR system with different types of gloves; however, a definite conclusion about the treatment effect could not be obtained owing to the low number of participants [12, 13]. Furthermore, the effects of VR-based rehabilitation on health related quality of life (HRQoL) have not been appropriately assessed, although the QoL of stroke survivors is crucial for comprehensive rehabilitation.

Therefore, the objective of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy (OT) on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.

Continue —> Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Effect of Virtual Reality on Cognitive Dysfunction in Patients With Brain Tumor – Full Text HTML/PDF

Abstract

Objective: To investigate whether virtual reality (VR) training will help the recovery of cognitive function in brain tumor patients.

Methods: Thirty-eight brain tumor patients (19 men and 19 women) with cognitive impairment recruited for this study were assigned to either VR group (n=19, IREX system) or control group (n=19). Both VR training (30 minutes a day for 3 times a week) and computer-based cognitive rehabilitation program (30 minutes a day for 2 times) for 4 weeks were given to the VR group. The control group was given only the computer-based cognitive rehabilitation program (30 minutes a day for 5 days a week) for 4 weeks. Computerized neuropsychological tests (CNTs), Korean version of Mini-Mental Status Examination (K-MMSE), and Korean version of Modified Barthel Index (K-MBI) were used to evaluate cognitive function and functional status.

Results: The VR group showed improvements in the K-MMSE, visual and auditory continuous performance tests (CPTs), forward and backward digit span tests (DSTs), forward and backward visual span test (VSTs), visual and verbal learning tests, Trail Making Test type A (TMT-A), and K-MBI. The VR group showed significantly (p<0.05) better improvements than the control group in visual and auditory CPTs, backward DST and VST, and TMT-A after treatment.

Conclusion: VR training can have beneficial effects on cognitive improvement when it is combined with computer-assisted cognitive rehabilitation. Further randomized controlled studies with large samples according to brain tumor type and location are needed to investigate how VR training improves cognitive impairment.

via KoreaMed Synapse.

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[REVIEW] Virtual reality using games for improving physical functioning in older adults. – Full Text PDF

Abstract

The use of virtual reality through exergames or active video game, i.e. a new form of interactive gaming, as a complementary tool in rehabilitation has been a frequent focus in research and clinical practice in the last few years. However, evidence of their effectiveness is scarce in the older population.

This review aim to provide a summary of the effects of exergames in improving physical functioning in older adults. A search for randomized controlled trials was performed in the databases EMBASE, MEDLINE, PsyInfo, Cochrane data base, PEDro and ISI Web of Knowledge. Results from the included studies were analyzed through a critical review and methodological quality by the PEDro scale. Thirteen studies were included in the review.

The most common apparatus for exergames intervention was the Nintendo Wii gaming console (8 studies), followed by computers games, Dance video game with pad (two studies each) and only one study with the Balance Rehabilitation Unit. The Timed Up and Go was the most frequently used instrument to assess physical functioning (7 studies). According to the PEDro scale, most of the studies presented methodological problems, with a high proportion of scores below 5 points (8 studies). The exergames protocols and their duration varied widely, and the benefits for physical function in older people remain inconclusive. However, a consensus between studies is the positive motivational aspect that the use of exergames provides. Further studies are needed in order to achieve better methodological quality, external validity and provide stronger scientific evidence.

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[ARTICLE] Serious Games for Stroke Rehabilitation Employing Immersive User Interfaces in 3D Virtual Environment – Full Text PDF

ABSTRACT

Stroke is a disease with very high socio-economic impact. In average, the healthcare expenditure cost for Strokes across different countries in Europe and USA exceeds 3% of their entire healthcare expenditure, including inpatient treatments, outpatient hospital visits and long-term rehabilitation and care. Therefore, there is an urgent need for devising an effective long-term care and rehabilitation strategy for stroke patients, which would actively involve patients in the rehabilitation process while minimizing costly human support. This paper reports on the ongoing developments of the serious gaming approach to an integrated rehabilitation training for post-stroke patients employing the Unity3D virtual reality environment combined with a hybrid of advanced media technologies and immersive user interfaces. The proposed approach empowers the patients and their caretakers for effective application of rehabilitation protocols in their home settings, while leading physicians are enabled to supervise the progress of the rehabilitation (and intervene if needed) through the use of Personal Health Record (PHR) system. The increased rehabilitation speed and ability to perform training at home directly improves quality of life of patients. The work described herein has been performed in the “StrokeBack” project co-funded by the European Commission under the Framework 7 Program in the ICT domain.

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[ARTICLE] Dose Response of Virtual Reality Therapy on Function and Quality of Life after Stroke

…Objective

To determine the most effective doses of virtual reality therapy (VRT), required to obtain positive effects on upper limb (UL) function and quality of life, after stroke…

via Dose Response of Virtual Reality Therapy on Function and Quality of Life after Stroke – Archives of Physical Medicine and Rehabilitation.

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