Posts Tagged virtual reality

[ARTICLE] Virtual Reality for Stroke Rehabilitation – Full Text

The use of virtual reality programs specifically designed for stroke rehabilitation is increasing as is the use of commercial video game devices in clinical settings. This review is an update of our review published first in 2011 and then in 2015.1


The primary objective of this review was to examine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. Our secondary objective was to examine the efficacy on gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.


We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and 7 additional databases as well as trials registries. We included randomized and quasi-randomized trials of virtual reality in adults after stroke. The primary outcome of interest was upper limb function and activity. Two review authors independently selected trials, extracted data, and assessed risk of bias with input from a third author to moderate disagreements when required.

Main Results

A total of 72 trials (with 2470 participants) were included in the review. This review includes 35 new studies in addition to the studies included in the previous version of this review (published in 2015). Most studies involved small sample sizes and interventions varied in terms of both the goals of treatment and the virtual reality program or device used. Although there are a relatively large number of randomized controlled trials, the evidence remains mostly low quality when rated using the GRADE system because of the risk of bias in the studies and inconsistent findings between studies. Control groups in the included studies usually received either no therapy or conventional therapy which was provided by an occupational therapist or physiotherapist. Primary outcome: when virtual reality was compared with the same dose of conventional therapy the results were not statistically significant for upper limb function (standardized mean difference, 0.07; 95% confidence interval, −0.05–0.20; 22 studies, 1038 participants, low-quality evidence). However, when virtual reality was used to supplement usual care (thereby providing participants in the intervention group with a higher dose of therapy), there was a statistically significant difference between groups (standardized mean difference, 0.49; 95% confidence interval, 0.21–0.77, 10 studies, 210 participants, low-quality evidence). Secondary outcomes: when compared with conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living outcome (standardized mean difference, 0.25; 95% confidence interval, 0.06–0.43; 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. There were few adverse events experienced in the 23 studies which reported on this and adverse events were relatively mild. There was a trend suggesting that customized virtual reality programs were preferable to commercial game products, however, these findings were not statistically significant (Figure).


Figure. Virtual reality versus conventional therapy: upper limb function: subgroup analyses, specialized, or gaming program. CI indicates confidence interval.

Implications for Practice

We found that virtual reality therapy may not be more effective than conventional therapy for upper limb outcomes, but there is low-quality evidence that virtual reality may be used to improve outcomes in the absence of other therapy interventions after stroke. Clinicians who currently have access to virtual reality programs should be reassured that their use as part of a comprehensive rehabilitation program seems reasonable, taking into account the patient’s goals, abilities, and preferences.

Sources of Funding

Dr Laver is supported by a National Health and Medical Research Council-Australian Research Council fellowship. Dr Saposnik is supported by the 2017 to 2021 Heart and Stroke Foundation of Canada Career Award following an open and peer-reviewed competition. He also served as the Topic Editor for the Emerging Therapies Section (Stroke Journal).




  • This paper is based on a Cochrane Review published in The Cochrane Library 2017, Issue 11 (see for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.

  • Received December 13, 2017.
  • Revision received December 13, 2017.
  • Accepted December 21, 2017.


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[Conference paper] The Role of Virtual Reality and Biomechanical Technologies in Stroke Rehabilitation


The aim of this paper is to present a spectrum of virtual reality and biomechanical technologies that can be potentially used in supporting the rehabilitation of people after stroke, in both clinical and home conditions. The methodology was based on a systematic review of up-to-date, published research works available in Elsevier Science Direct database including peer-reviewed journal articles. As a result, trends, possible promising solutions and gaps in the area of innovative rehabilitation tools for post-stroke patients were recognized and discussed. Particularly, the new knowledge and good practices focused on the applicability of biomechanical systems and Virtual Reality (VR) technologies in stroke treatment were searched, which is the subject of an educational and international Erasmus+ project entitled “Development of innovative training contents based on the applicability of virtual reality in the field of stroke rehabilitation- Brain4Train”. The training content, which is one of the project outcomes, will be provided to all interested professionals engaged in post-stroke patients’ rehabilitation, in order to make them capable to develop customized rehabilitation programs based on techno-innovative rehabilitation models.




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[Abstract] Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke.



Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.


To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.


In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.


Statistically significant improvements in game scores (p < 0.05) were observed in group A. In within-group analysis, there were statistically significant improvements in all clinical outcome measures except for the BRS-hand, MAS-distal, and MAS-hand in group A; MAS-(proximal, distal, hand) and BRS-(UE, hand) in group B compared with baseline values. Differences from baseline of FMA, MI, and AROM (except adduction of shoulder and extension of elbow) were greater in group A (p < 0.05).


To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.


via Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke. – PubMed – NCBI

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[ARTICLE] A multisession evaluation of an adaptive competitive arm rehabilitation game – Full Text


People with neurological injuries such as stroke should exercise frequently and intensely to regain their motor abilities, but are generally hindered by lack of motivation. One way to increase motivation in rehabilitation is through competitive exercises, but such exercises have only been tested in single brief sessions and usually did not adapt difficulty to the patient’s abilities.


We designed a competitive arm rehabilitation game for two players that dynamically adapts its difficulty to both players’ abilities. This game was evaluated by two participant groups: 15 participants with chronic arm impairment who exercised at home with an unimpaired friend or relative, and 20 participants in the acute or subacute phase of stroke who exercised in pairs (10 pairs) at a rehabilitation clinic. All participants first played the game against their human opponent for 3 sessions, then played alone (against a computer opponent) in the final, fourth session. In all sessions, participants’ subjective experiences were assessed with the Intrinsic Motivation Inventory questionnaire while exercise intensity was measured using inertial sensors built into the rehabilitation device. After the fourth session, a final brief questionnaire was used to compare competition and exercising alone.


Participants who played against an unimpaired friend or relative at home tended to prefer competition (only 1 preferred exercising alone), and exhibited higher enjoyment and exercise intensity when competing (first three sessions) than when exercising alone (last session).

Participants who played against each other in the clinic, however, did not exhibit significant differences between competition and exercising alone. For both groups, there was no difference in enjoyment or exercise intensity between the first three sessions, indicating no negative effects of habituation or novelty.


Competitive exercises have high potential for unsupervised home rehabilitation, as they improve enjoyment and exercise intensity compared to exercising alone. Such exercises could thus improve rehabilitation outcome, but this needs to be tested in long-term clinical trials. It is not clear why participants who competed against each other at the clinic did not exhibit any advantages of competition, and further studies are needed to determine how different factors (environment, nature of opponent etc.) influence patients’ experiences with competitive exercises.

Trial registration

The study is not a clinical trial. While human subjects are involved, they do not participate in a full rehabilitation intervention, and no health outcomes are examined.

Electronic supplementary material

The online version of this article (10.1186/s12984-017-0336-9) contains supplementary material, which is available to authorized users.


Rehabilitation games

Stroke is a leading cause of disability, with 795,000 new or recurrent strokes per year in the United States alone [1]. 88% of survivors experience motor function impairment and thus require rehabilitation to regain their movement abilities [2]. However, even top hospitals devote only an hour per day to motor rehabilitation [3], and exercise intensity is usually too low for optimal rehabilitation outcome [4]. Patients are thus expected to exercise independently at home after leaving the clinic to fully regain their abilities, but frequently do not exercise frequently or intensely enough. For example, one study found that only 30% of unsupervised patients comply with prescribed home rehabilitation regimens [5]. Another home rehabilitation study found that patients average around 1.5 h of exercise per week [6], while clinical studies involve at least 3 h of exercise per week [78]. To improve home rehabilitation, it is therefore critical to increase the frequency and intensity of exercise.

One key reason for poor compliance in home rehabilitation is lack of motivation, which is an important predictor of rehabilitation outcome [910]. While the definition of motivation in rehabilitation is blurry, it is generally agreed to involve a willingness to actively engage in exercise [1112]. To improve engagement, researchers have thus developed numerous rehabilitation games that try to both ensure high enjoyment (using, e.g., meaningful goals, in-game rewards and entertaining graphics [1215]) and provide an appropriate exercise intensity via automated difficulty adaptation [121416]. The games are controlled using motion tracking hardware such as the Microsoft Kinect or even with rehabilitation robots that provide limb support in addition to motion tracking. However, recent reviews have emphasized that such games are not yet sufficiently engaging for all patients [1718]. Therefore, additional rehabilitation game development and validation is necessary to improve patient engagement.[…]


Continue —> A multisession evaluation of an adaptive competitive arm rehabilitation game

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Fig. 1
The Bimeo arm rehabilitation system in the wrist and forearm training configuration. Inertial sensors are attached to the upper arm, attached to the forearm, and integrated in the sphere that supports the hand

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[ARTICLE] Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – Full Text HTML



Objective: To investigate the efficacy of Nintendo Wii Fit®-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.

Methods: During the study period, 70 stroke patients were evaluated. Of these, 23 who met the study criteria were randomly assigned to either the experimental group (n = 12) or the control group (n = 11) by block randomization. Primary outcome measures were Berg Balance Scale, Functional Reach Test, Postural Assessment Scale for Stroke Patients, Timed Up and Go Test and Static Balance Index. Secondary outcome measures were postural sway, as assessed with Emed-X, Functional Independence Measure Transfer and Ambulation Scores. An evaluator who was blinded to the groups made assessments immediately before (baseline), immediately after (post-treatment), and 4 weeks after completion of the study (follow-up).

Results: Group-time interaction was significant in the Berg Balance Scale, Functional Reach Test, anteroposterior and mediolateral centre of pressure displacement with eyes open, anteroposterior centre of pressure displacement with eyes closed, centre of pressure displacement during weight shifting to affected side, to unaffected side and total centre of pressure displacement during weight shifting. Demonstrating significant group-time interaction in those parameters suggests that, while both groups exhibited significant improvement, the experimental group showed greater improvement than the control group.

Conclusion: Virtual reality exercises with the Nintendo Wii system could represent a useful adjunctive therapy to traditional treatment to improve static and dynamic balance in stroke patients.


Stroke is one of the leading causes of disability (1). In stroke patients, balance can be affected by various factors, such as muscular weakness, abnormal muscle tone, deficits in visual and sensory function or disturbances in vestibular mechanisms (2). Since balance dysfunction is associated with increased risk of falling, balance exercises are a critical component of the rehabilitation of stroke patients.

Recent years have seen growing interest in the use of new technologies, such as virtual reality (VR), in stroke rehabilitation. Clinical results indicate that the use of VR technologies improves motor functioning (3–5). VR can be used to improve upper limb function, gait and balance, global motor function and cognitive function in stroke patients (6). However, VR equipment is usually complex and expensive, and may be available only in specialist centres with the help of experienced therapists. As a consequence, there has been an increase in the number of studies on the efficacy of commercial gaming programs in stroke rehabilitation. PlayStation, Wii, and Xbox, along with Kinect, are the game consoles most commonly used in stroke rehabilitation. Wii (Nintendo, Kyoto, Japan) is a game console used to improve balance, strength, flexibility and fitness. It provides a relatively simple and inexpensive opportunity for VR treatment (7).

Several randomized controlled studies have evaluated the effect of Wii-based balance rehabilitation programmes in stroke patients. Cho et al. (8) investigated the effects of VR balance training using Wii in chronic stroke patients. They reported that Wii-based VR exercises resulted in a significant improvement in dynamic balance (8). In another study, chronic stroke patients were randomly assigned to 2 groups. In the first group patients played console games for 5 weeks, and in the control group patients maintained their usual daily activities. A slight improvement was measured in the first group (9).

There are conflicting results in the literature about the efficacy of Wii-based balance exercises compared with other balance rehabilitation programmes, such as progressive balance training and task-specific programmes.

A number of studies have investigated whether the addition of Wii exercises or other exercise options to balance rehabilitation programmes makes a difference in stroke patients. The results are controversial. Lee et al. (10) reported better results in the Wii group. In contrast, Yatar et al. (11) indicated that there were no differences between Wii Fit balance training and progressive balance exercises.

Adequate postural control and good balance performance are prerequisites for independence in daily activities; therefore, these should be important goals of stroke rehabilitation (8). The aim of this study was to investigate the efficacy of Wii Fit-based balance rehabilitation as an adjunctive therapy to conventional rehabilitation in stroke patients.[…]

Continue —>  Journal of Rehabilitation Medicine – Effectiveness of Wii-based rehabilitation in stroke: A randomized controlled study – HTML

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[Abstract] The application of virtual reality in neuro-rehabilitation: motor re-learning supported by innovative technologies


The motor function impairment resulting from a stroke injury has a negative impact on autonomy, the activities of daily living thus the individuals affected by a stroke need long-term rehabilitation. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. Innovative technologies used in rehabilitation allow one the possibility to enhance training throughout generated feedback. It seems advantageous to combine traditional motor rehabilitation with innovative technology in order to promote motor re-learning and skill re-acquisition by means of enhanced training. An environment enriched by feedback involves multiple sensory modalities and could promote active patient participation. Exercises in a virtual environment contain elements necessary to maximize motor learning, such as repetitive and diffe-rentiated task practice and feedback on the performance and results. The recovery of the limbs motor function in post-stroke subjects is one of the main therapeutic aims for patients and physiotherapist alike. Virtual reality as well as robotic devices allow one to provide specific treatment based on the reinforced feedback in a virtual environment (RFVE), artificially augmenting the sensory information coherent with the real-world objects and events. Motor training based on RFVE is emerging as an effective motor learning based techniques for the treatment of the extremities.


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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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[ARTICLE] The Immersive Virtual Reality Lab: Possibilities for Remote Experimental Manipulations of Autonomic Activity on a Large Scale – Full Text

There is a need for large-scale remote data collection in a controlled environment, and the in-home availability of virtual reality (VR) and the commercial availability of eye tracking for VR present unique and exciting opportunities for researchers. We propose and provide a proof-of-concept assessment of a robust system for large-scale in-home testing using consumer products that combines psychophysiological measures and VR, here referred to as a Virtual Lab. For the first time, this method is validated by correlating autonomic responses, skin conductance response (SCR), and pupillary dilation, in response to a spider, a beetle, and a ball using commercially available VR. Participants demonstrated greater SCR and pupillary responses to the spider, and the effect was dependent on the proximity of the stimuli to the participant, with a stronger response when the spider was close to the virtual self. We replicated these effects across two experiments and in separate physical room contexts to mimic variability in home environment. Together, these findings demonstrate the utility of pupil dilation as a marker of autonomic arousal and the feasibility to assess this in commercially available VR hardware and support a robust Virtual Lab tool for massive remote testing.


Virtual Reality (VR) is defined as “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” (Schultheis and Rizzo, 2001). Unlike lab scenarios, video stimuli, or even augmented reality, VR is unique in that it is at the furthest end of the reality continuum (Milgram and Kishino, 1994) replacing real-world environments with virtual contexts. This allows for levels of stimulus control that surpass lab testing, absolute control of colors, textures, and luminance (Riva et al., 2016). The addition of integrated eye tracking, which is currently available to control interfaces and guide avatars in games (e.g., FOVE Eye Tracking VR Headset), opens up for measuring psychophysiological responses remotely on a large scale. In their extensive review of the VR literature, Lindner et al. (2017) concluded that eye tracking is becoming an important new technology in commercially available VR. The widespread use of VR by the public, in research, and in therapy is creating a need for more high-quality empirical studies examining VR and its capability for naturalistic “Big Data.”

In this paper, we propose and provide a proof-of-concept assessment of a robust system for large-scale in-home testing using consumer products that combine psychophysiological measures and VR, here referred to as a Virtual Lab. Specifically, our first aim is to simultaneously test and correlate two autonomic measures: skin conductance response (SCR), a well-established autonomic measure that has been reliably used in previous VR studies, and pupil dilation, a measure which has been demonstrated as a reliable autonomic measure but has yet to be tested and validated in VR. Our second aim is to demonstrate that these measures can be reliably recorded independent of physical location, demonstrating possibilities for remote testing. For a Virtual Lab to be a feasible reality in scientific research, it is important to establish that: (a) there is a demand for remote data collection on a large scale, (b) there is a wide availability of VR equipment in homes, and (c) there is a way to measure autonomic responses in a reliable and robust manner through the VR device. Each of which will be discussed briefly in the following sections.[…}


Continue —> Frontiers | The Immersive Virtual Reality Lab: Possibilities for Remote Experimental Manipulations of Autonomic Activity on a Large Scale | Neuroscience

Figure 1. Side-by-side comparison of the real and virtual environment (a) and examples of the stimuli (b), spider and ball (Experiment 1) and beetle stimuli (Experiment 2). Note that the images do not accurately reflect the color, luminance, and dynamic animations in the actual experiment.

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[Abstract] Virtual Reality Interventions for Personal Development: A Meta-Analysis of Hardware and Software


Virtual reality (VR) has been repeatedly applied for personal development purposes, ranging from learning and training (cognitive outcomes), to psychological therapies (emotional outcomes), to physical rehabilitation (physical outcomes). Several factors lead to a successful VR intervention, most notably the hardware and software. In the current article, a meta-analysis is performed to test the effect of specialized input hardware (e.g motion sensors, floor pads, etc.), advanced output hardware (i.e., head-mounted displays, surround-screen displays, etc.), and game elements (i.e., score, competition, etc.) across and within the three noted applications of VR intervention. When analyzing the overall effects, only game elements had a significant impact on outcomes. When analyzing specific applications, input hardware did not have a notable impact on outcomes for any application; output hardware had a notable impact on cognitive and emotional outcomes but not physical; and game elements had a notable impact on cognitive outcomes but not emotional or physical. From these results, the current article provides direct suggestions for future research and practice. Particularly, certain mediating mechanisms are suggested to explain the impact of output hardware and game elements on VR intervention outcomes, sparking possible new directions for research and practice. Copyright © 2018 Taylor & Francis Group, LLC

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[ARTICLE] Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality – Full Text

Background: Kinematic analysis using virtual reality (VR) environment provides quantitative assessment of upper limb movements. This technique has rarely been used in evaluating motor function in stroke despite its availability in stroke rehabilitation.

Objective: To determine the discriminative validity of VR-based kinematics during target-to-target pointing task in individuals with mild or moderate arm impairment following stroke and in healthy controls.

Methods: Sixty-seven participants with moderate (32–57 points) or mild (58–65 points) stroke impairment as assessed with Fugl-Meyer Assessment for Upper Extremity were included from the Stroke Arm Longitudinal study at the University of Gothenburg—SALGOT cohort of non-selected individuals within the first year of stroke. The stroke groups and 43 healthy controls performed the target-to-target pointing task, where 32 circular targets appear one after the other and disappear when pointed at by the haptic handheld stylus in a three-dimensional VR environment. The kinematic parameters captured by the stylus included movement time, velocities, and smoothness of movement.

Results: The movement time, mean velocity, and peak velocity were discriminative between groups with moderate and mild stroke impairment and healthy controls. The movement time was longer and mean and peak velocity were lower for individuals with stroke. The number of velocity peaks, representing smoothness, was also discriminative and significantly higher in both stroke groups (mild, moderate) compared to controls. Movement trajectories in stroke more frequently showed clustering (spider’s web) close to the target indicating deficits in movement precision.

Conclusion: The target-to-target pointing task can provide valuable and specific information about sensorimotor impairment of the upper limb following stroke that might not be captured using traditional clinical scale.


In stroke, the prevalence of upper limb impairment is approximately 50–80% in the acute phase (13) and 40–50% in the chronic phase (24). The frequently observed upper limb impairments after stroke are paresis, abnormal muscle tone, decreased somatosensation, and coordination. As a consequence of these impairments, individuals with stroke may experience reduced ability to perform everyday activities such as opening a door, handling a key, or working with a computer. Therefore, assessment of upper limb motor function is critical for determining the prognosis and evaluating the treatment effects following stroke (56).

The assessment of motor functions in stroke is usually performed using standardized clinical scales. Some of the most frequently used clinical instruments for assessing upper extremity impairment and activity capacity in stroke are Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) (79). These scales are reliable (1012) and responsive to change (1314) for measuring gross changes in motor function. They have also been recommended as core measures to be included in every stroke recovery trial (6). However, observer-based ordinal instruments like FMA-UE and ARAT lack the sensitivity to assess subtle, yet, potentially important changes in movement performance (15). These clinical scales tend to have ceiling effect since they rely on scoring criteria rather than a continuous measurement construct (16).

Kinematic assessment is one solution for the need for a more objective, accurate, and sensitive measurement method (6). Kinematic assessment is being increasingly used in upper limb evaluation after stroke, out of which motion capture systems (17), robotic devices, and virtual reality (VR) systems with haptic devices (18) have become popular in the last decade. Kinematic assessment has revealed that the arm movements in subjects with stroke are slower, less accurate, less smooth, and more segmented than healthy subjects (1926).

Kinematic assessment involving the use of VR with haptic device has shown to be a promising tool for upper limb stroke rehabilitation (2728). Despite the availability of the VR system for stroke rehabilitation, it has been rarely used in assessment of upper limb movements after stroke. Individuals with stroke use similar strategies for reaching objects in both real and virtual environments (29). Previous studies using the target-to-target pointing task have shown that the movement time, velocity, and trajectory straightness were improved after a 5-week computer gaming practice in individuals with stroke (30). Movement time, mean velocity, and trajectory straightness were also stable in a test–retest study in healthy subjects (31). A clear advantage with VR systems as a measurement tool is its standardized instructions, adaptation of tasks according to patients’ functioning level, and availability of quick feedback (32). The VR assessment and training are often described as enjoyable and challenging by the users (3334).

The target-to-target pointing task is similar to routinely used tasks in everyday life, such as interacting with touch screens, using electrical switches, and pushing buttons on various devices. The choice of a regularly performed, purposeful task for this study increases its ecological validity. With VR technologies becoming more available, it opens up an opportunity to use the VR interface to acquire accurate and detailed kinematic data of upper limb movements after stroke (35). The novelty of this study is in evaluating a compact and easy-to-use haptic device coupled with VR in 3D space in order to measure movement performance during a common upper limb task.

The aim of this study was to identify the end-point kinematic variables obtained during the VR-based target-to-target pointing task that discriminate among individuals with mild and moderate upper limb impairment after stroke and healthy controls.[…]


Continue —>  Frontiers | Upper Limb Kinematics in Stroke and Healthy Controls Using Target-to-Target Task in Virtual Reality | Neurology

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