Posts Tagged virtual reality

[ARTICLE] Non-Immersive Virtual Reality for Post-Stroke Upper Extremity Rehabilitation: A Small Cohort Randomized Trial – Full Text


Immersive and non-immersive virtual reality (NIVR) technology can supplement and improve standard physiotherapy and neurorehabilitation in post-stroke patients. We aimed to use MIRA software to investigate the efficiency of specific NIVR therapy as a standalone intervention, versus standardized physiotherapy for upper extremity rehabilitation in patients post-stroke. Fifty-five inpatients were randomized to control groups (applying standard physiotherapy and dexterity exercises) and experimental groups (applying NIVR and dexterity exercises). The two groups were subdivided into subacute (<six months post-stroke) and chronic (>six months to four years post-stroke survival patients). The following standardized tests were applied at baseline and after two weeks post-therapy: Fugl–Meyer Assessment for Upper Extremity (FMUE), the Modified Rankin Scale (MRS), Functional Independence Measure (FIM), Active Range of Motion (AROM), Manual Muscle Testing (MMT), Modified Ashworth Scale (MAS), and Functional Reach Test (FRT). The Kruskal–Wallis test was used to determine if there were significant differences between the groups, followed with pairwise comparisons. The Wilcoxon Signed-Rank test was used to determine the significance of pre to post-therapy changes. The Wilcoxon Signed-Rank test showed significant differences in all four groups regarding MMT, FMUE, and FIM assessments pre- and post-therapy, while for AROM, only experimental groups registered significant differences. Independent Kruskal–Wallis results showed that the subacute experimental group outcomes were statistically significant regarding the assessments, especially in comparison with the control groups. The results suggest that NIVR rehabilitation is efficient to be administered to post-stroke patients, and the study design can be used for a further trial, in the perspective that NIVR therapy can be more efficient than standard physiotherapy within the first six months post-stroke.

1. Introduction

Stroke Alliance for Europe states that “every 20 s, someone in Europe has a stroke”, while in the United States, “someone has a stroke every 40 s” a leading cause of significant long-term disabilities [1,2]. According to a European Union (EU) report, Romania has the lowest annual healthcare expenditure per capita (€1029 in 2015, compared to the EU average of €2884). The highest risk factors of a stroke are smoking and alcohol drinking, with males accounting for more than 50% of those impacted. Additionally, the level of education influences both lifestyle and life expectancy, with the Romanian life expectancy being among the lowest in the EU (75.3 years in Romania versus 80.9 years in the EU, in 2015). Moreover, there were 61,552 stroke cases in Romania in 2015 and forecasts state that this number will increase by 24% until 2035 [3,4].Worldwide, the population faces high incidence rates of stroke and post-stroke sequelae with an increased need for neurorehabilitation services. In Europe, it is estimated that the number of annual stroke events will increase from 613,148 registered in 2015 to 819,771 in 2035, an increase of 34%. Considering that post-stroke survival rates have improved; estimations predict that the number of people living with strokes in Europe will grow from 3,718,785 in 2015 to 4,631,050 in 2035 [1].Stroke complications can be long-lasting; thus, at 15-years post-stroke, two-thirds of survivors live with a disability, nearly two of five suffer from depression, and more than a quarter have cognitive impairment [5]. Post-stroke disability significantly contributes to the increasing use of long-term medical care resources, thus highlighting that efficient rehabilitation can cut costs in the healthcare system [6] whereas telerehabilitation is still in the early phase of utilization in developing countries.Furthermore, international guidelines for stroke rehabilitation include physiotherapy techniques and methods for the recovery of the swallowing function and the urinary and bowel continence. These techniques and methods are also recommended for the improvement/prevention of shoulder pain, joint misalignments, and limb deviations caused by post-stroke spasticity, also used for secondary prevention of falling, as well as for enhancing the ability to perform self-care and daily living activities. Recovery from post-stroke impairments is facilitated, on the one hand, by increasing the motor function and, on the other hand, by improving the functionality of the limbs and body as a whole functional unit. In order to retrieve functional capacity, the existing guidelines recommend the use of intensive, repetitive training, improvement of functional mobility, use of orthoses, performing specific activities of daily living (ADLs) practiced repeatedly, progressive and bilateral training of the upper limb, the use of virtual reality and assisted robotic therapy, and the use of strength training exercises [7,8,9].The use of virtual reality technology as an adjunct or substitute for traditional physiotherapy has been studied and proved to be effective in improving patients’ functional rehabilitation. However, as regards strokes, some systematic reviews suggest that virtual reality (VR) has not brought more benefits to patients compared to standard physiotherapy alone, while other research advocates for specific VR training as a therapy with a better outcome compared to conventional physiotherapy in the rehabilitation of stroke survivors [10,11,12,13,14].Research on neuroplasticity and learning or relearning abilities shows that there are several principles of motor learning, including multisensory stimulation, explicit feedback, knowledge of results, and motor imagery. These principles, notably explicit feedback and multisensory stimulation, are found in the VR technology used for neuromotor rehabilitation. Accordingly, VR therapy becomes an alternative to classical physiotherapy, as it develops neuroplasticity. So, novel enriched environments are preferred in the context of current rehabilitation methods since guidelines do not provide an accurate record of evidence inferred from the specialized literature about motor skill learning. This evidence is essential in identifying practical methods and applications that could shape future approaches to neuromotor relearning. Furthermore, in animal research, it has been shown that aerobic exercise and environmental enrichment have pleiotropic actions that influence the occurrence of molecular changes associated with stroke and subsequent spontaneous recovery. These aspects may argue in favor of the efficient use of VR in motor and functional recovery after a stroke, by stimulating neuroplasticity [15,16].Over the past ten years, research and literature reviews regarding the use of VR in post-stroke recovery have been homogeneous. Many approaches have focused on the use of VR as adjunct therapy alongside standard physiotherapy, and in some studies, non-dedicated VR technologies have been used, for medical purposes, in the motor rehabilitation of post-stroke patients [17,18]. Previous research on NIVR and immersive VR-based activities suggests that these interventions improve upper extremity rehabilitation after a stroke by providing motivating environments, stimulating extrinsic feedback, or simulating gameplay to facilitate recovery. Besides non-immersive VR therapy use in post-stroke patient’s rehabilitation, immersive VR therapy is used but requires more space and is more expensive, compared to NVIR. Robotic therapy is gaining more ground in neuro-motor rehabilitation, but the costs are very high, and in the case of exoskeletons, complex technology requires a long period of time for physiotherapists to acquire skills in the use of equipment. Currently, research has shown that VR positively influences the recovery of the upper extremity in post-stroke patients, as an adjunct therapy, by using dedicated and non-dedicated technologies [19,20]. The VR action on upper extremity post-stroke rehabilitation, using dedicated NVIR technology as a standalone therapy has not yet been determined at a staged level according to the post-stroke phases. The present study aims to investigate the efficiency of a dedicated NIVR system used in the rehabilitation of patients with subacute and chronic stroke, on upper extremity functionality and motor function. The research was done through specific VR training that incorporates real-time 3D motion capture and built-in visual feedback which provide functional exercises designed to train and regain the neuromotor functions of the upper extremity.Our main goal was to evaluate the efficiency of the proposed protocol, by using staged, specific, and customized NIVR therapy on three levels of difficulty and by using specific exergames according to patient’s capacity, and adjusted by the level of difficulty, compared to standard physiotherapy. Besides, we were looking for differences in post-stroke clinical and functional status in the use of VR that improve or negatively influence the functional outcomes of the upper extremity when exposed to VR-based therapy compared to standard physiotherapy. […]

Continue —->

, , , , , , , , , ,

Leave a comment

[Abstract + References] A Virtual Reality Serious Game for Hand Rehabilitation Therapy – IEEE Conference Publication


The human hand is the body part most frequently injured in occupational accidents, accounting for one out of five emergency cases and often requiring surgery with subsequently long periods of rehabilitation. This paper proposes a Virtual Reality game to improve conventional physiotherapy in hand rehabilitation, focusing on resolving recurring limitations reported in most technological solutions to the problem, namely the limited diversity support of movements and exercises, complicated calibrations and exclusion of patients with open wounds or other disfigurements of the hand. The system was assessed by seven able-bodied participants using a semistructured interview targeting three evaluation categories: hardware usability, software usability and suggestions for improvement. A System Usability Score (SUS) of 84.3 and participants’ disposition to play the game confirm the potential of both the conceptual and technological approaches taken for the improvement of hand rehabilitation therapy.


1. A. Elnaggar and D. Reichardt, “Digitizing the Hand Rehabilitation Using Serious Games Methodology with User-Centered Design Approach”, 2016 International Conference on Computational Science and Computational Intelligence (CSCI), pp. 13-22, 2016. Show Context View Article Full Text: PDF (1150KB) Google Scholar 

2. L. S. Robinson, M. Sarkies, T. Brown and L. O’Brien, “Direct indirect and intangible costs of acute hand and wrist injuries: A systematic review”, Injury, vol. 47, no. 12, pp. 2614-2626, Dec. 2016. Show Context CrossRef  Google Scholar 

3. D. Johnson, S. Deterding, K.-A. Kuhn, A. Staneva, S. Stoyanov and L. Hides, “Gamification for health and wellbeing: A systematic review of the literature”, Internet Interv., vol. 6, pp. 89-106, Nov. 2016. Show Context CrossRef  Google Scholar 

4. C. Prahm, “PlayBionic Interactive rehabilitation after amputation or nerve injury of the upper extremity”, Christian Doppler Laboratory for Restoration of Extremity Function and Rehabilitation, 2019. Show Context Google Scholar 

5. M. K. Holden, “Virtual Environments for Motor Rehabilitation: Review”, CyberPsychology Behav., vol. 8, no. 3, pp. 187-211, Jun. 2005. Show Context CrossRef  Google Scholar 

6. D. Ganjiwale, R. Pathak, A. Dwivedi, J. Ganjiwale and S. Parekh, “Occupational therapy rehabilitation of industrial setup hand injury cases for functional independence using modified joystick in interactive computer gaming in Anand Gujarat”, Natl. J. Physiol. Pharm. Pharmacol., vol. 9, pp. 1, 2018. Show Context CrossRef  Google Scholar 

7. H. A. Hernández, A. Khan, L. Fay, Je.-S. Roy and E. Biddiss, “Force Resistance Training in Hand Grasp and Arm Therapy: Feasibility of a Low-Cost Videogame Controller”, Games Health J., vol. 7, no. 4, pp. 277-287, Aug. 2018. Show Context CrossRef  Google Scholar 

8. J. Broeren, L. Claesson, D. Goude, M. Rydmark and K. S. Sunnerhagen, “Virtual Rehabilitation in an Activity Centre for Community-Dwelling Persons with Stroke”, Cerebrovasc. Dis., vol. 26, no. 3, pp. 289-296, 2008. Show Context CrossRef  Google Scholar 

9. J. Broeren, M. Rydmark and K. S. Sunnerhagen, “Virtual reality and haptics as a training device for movement rehabilitation after stroke: A single-case study”, Arch. Phys. Med. Rehabil., vol. 85, no. 8, pp. 1247-1250, Aug. 2004. Show Context CrossRef  Google Scholar 

10. C. N. Walifio-Paniagua et al., “Effects of a Game-Based Virtual Reality Video Capture Training Program Plus Occupational Therapy on Manual Dexterity in Patients with Multiple Sclerosis: A Randomized Controlled Trial”, J. Healthc. Eng., vol. 2019, pp. 1-7, Apr. 2019. Show Context CrossRef  Google Scholar 

11. M. E. Gabyzon, B. Engel-Yeger, S. Tresser and S. Springer, “Using a virtual reality game to assess goal-directed hand movements in children: A pilot feasibility study”, Technol. Heal. Care, vol. 24, no. 1, pp. 11-19, Jan. 2016. Show Context CrossRef  Google Scholar 

12. M. King, L. Hale, A. Pekkari, M. Persson, M. Gregorsson and M. Nilsson, “An affordable computerised table-based exercise system for stroke survivors”, Disabil. Rehabil. Assist. Technol., vol. 5, no. 4, pp. 288-293, Jul. 2010. Show Context CrossRef  Google Scholar 

13. J. Shin et al., “Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded randomized controlled trial”, J. Neuroeng. Rehabil., vol. 13, no. 1, pp. 17, Dec. 2016. Show Context CrossRef  Google Scholar 

14. R. Lipovsky and H. A. Ferreira, “Hand therapist: A rehabilitation approach based on wearable technology and video gaming”, 2015 IEEE 4th Portuguese Meeting on Bioengineering (ENBENG), pp. 1-2, February 2015. Show Context View Article Full Text: PDF (1901KB) Google Scholar 

15. C. Schuster-Amft et al., “Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial”, Trials, vol. 15, no. 1, pp. 350, Dec. 2014. Show Context CrossRef  Google Scholar 

16. Y. A. Rahman, M. M. Hoque, K. I. Zinnah and I. M. Bokhary, “Helping-Hand: A data glove technology for rehabilitation of monoplegia patients”, 2014 9th International Forum on Strategic Technology (IFOST), pp. 199-204, 2014. Show Context View Article Full Text: PDF (625KB) Google Scholar 

17. M. da Silva Cameirão, S. Bermúdez, I Badia, E. Duarte and P. F. M. J. Verschure, “Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: A randomized controlled pilot study in the acute phase of stroke using the Rehabilitation Gaming System”, Restor. Neurol. Neurosci., vol. 29, no. 5, pp. 287-298, 2011. Show Context CrossRef  Google Scholar 

18. M. R. Golomb et al., “In-Home Virtual Reality Videogame Telerehabilitation in Adolescents With Hemiplegic Cerebral Palsy”, Arch. Phys. Med. Rehabil., vol. 91, no. 1, pp. 1-8, Jan. 2010. Show Context CrossRef  Google Scholar 

19. R. Proffitt, M. Sevick, C.-Y. Chang and B. Lange, “User-Centered Design of a Controller-Free Game for Hand Rehabilitation”, Games Health J., vol. 4, no. 4, pp. 259-264, Aug. 2015. Show Context CrossRef  Google Scholar 

20. N. Arman, E. Tarakci, D. Tarakci and O. Kasapcopur, “Effects of Video Games-Based Task-Oriented Activity Training (Xbox 360 Kinect) on Activity Performance and Participation in Patients with Juvenile Idiopathic Arthritis: A Randomized Clinical Trial”, Am. J. Phys. Med. Rehabil., vol. 98, no. 3, pp. 174-181, 2019. Show Context CrossRef  Google Scholar 

21. S. Cho, W.-S. Kim, N.-J. Paik and H. Bang, “Upper-Limb Function Assessment Using VBBTs for Stroke Patients”, IEEE Comput. Graph. Appl., vol. 36, no. 1, pp. 70-78, Jan. 2016. Show Context View Article Full Text: PDF (4692KB) Google Scholar 

22. E. Tarakci, N. Arman, D. Tarakci and O. Kasapcopur, “Leap Motion Controller-based training for upper extremity rehabilitation in children and adolescents with physical disabilities: A randomized controlled trial”, J. Hand Ther., pp. 1-9, Apr. 2019. Show Context CrossRef  Google Scholar 

23. Y.-T. Wu, K.-H. Chen, S.-L. Ban, K.-Y. Tung and L.-R. Chen, “Evaluation of leap motion control for hand rehabilitation in burn patients: An experience in the dust explosion disaster in Formosa Fun Coast”, Burns, vol. 45, no. 1, pp. 157-164, Feb. 2019. Show Context CrossRef  Google Scholar 

24. T. Vanbellingen, S. J. Filius, T. Nyffeler and E. E. H. van Wegen, “Usability of Videogame- Based Dexterity Training in the Early Rehabilitation Phase of Stroke Patients: A Pilot Study”, Front. Neurol., vol. 8, no. DEC, pp. 1-9, Dec. 2017. Show Context CrossRef  Google Scholar 

25. M. Iosa et al., “Leap motion controlled videogame-based therapy for rehabilitation of elderly patients with subacute stroke: a feasibility pilot study”, Top. Stroke Rehabil., vol. 22, no. 4, pp. 306-316, Aug. 2015. Show Context CrossRef  Google Scholar 

26. A. M. D. C. Souza and S. R. Dos Santos, “Handcopter Game: A Video-Tracking Based Serious Game for the Treatment of Patients Suffering from Body Paralysis Caused by a Stroke”, 2012 14th Symposium on Virtual and Augmented Reality, pp. 201-209, 2012. Show Context View Article Full Text: PDF (795KB) Google Scholar 

27. A. L. Borstad et al., “In-Home Delivery of Constraint-Induced Movement Therapy via Virtual Reality Gaming”, J. Patient-Centered Res. Rev., vol. 5, no. 1, pp. 6-17, Jan. 2018. Show Context CrossRef  Google Scholar 

28. N. J. Seo, J. Arun Kumar, P. Hur, V. Crocher, B. Motawar and K. Lakshminarayanan, “Usability evaluation of low-cost virtual reality hand and arm rehabilitation games”, J. Rehabil. Res. Dev., vol. 53, no. 3, pp. 321-334, Jul. 2016. Show Context CrossRef  Google Scholar 

29. G. C. Burdea, A. Jain, B. Rabin, R. Pellosie and M. Golomb, “Long-term hand tele-rehabilitation on the playstation 3: Benefits and challenges”, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, pp. 1835-1838, 2011. Show Context View Article Full Text: PDF (479KB) Google Scholar 

30. M. R. Golomb, M. Barkat-Masih, B. Rabin, M. Abdelbaky, M. Huber and G. Burdea, “Eleven Months of home virtual reality telerehabilitation – Lessons learned”, 2009 Virtual Rehabilitation International Conference, pp. 23-28, 2009. Show Context View Article Full Text: PDF (1370KB) Google Scholar 

31. X. Huang, F. Naghdy, G. Naghdy and H. Du, “Clinical effectiveness of combined virtual reality and robot assisted fine hand motion rehabilitation in subacute stroke patients”, 2017 International Conference on Rehabilitation Robotics (ICORR), pp. 511-515, 2017. Show Context View Article Full Text: PDF (1865KB) Google Scholar 

32. G. Tieri, G. Morone, S. Paolucci and M. Iosa, “Virtual reality in cognitive and motor rehabilitation: facts fiction and fallacies”, Expert Rev. Med. Devices, vol. 15, no. 2, pp. 107-117, Feb. 2018. Show Context CrossRef  Google Scholar 

33. B. Garrett, T. Taverner, D. Gromala, G. Tao, E. Cordingley and C. Sun, “Virtual Reality Clinical Research: Promises and Challenges”, JMIR Serious Games, vol. 6, no. 4, pp. e10839, Oct. 2018. Show Context CrossRef  Google Scholar 

34. P. Lankoski, Game Research Methods: An Overview, 2015. Show Context Google Scholar 


, , , , , , , , , , , , , , ,

Leave a comment

[Abstract + References] Virtual and Augmented Reality Platform for Cognitive Tele-Rehabilitation Based System – Conference paper


Virtual and Augmented Reality systems have been increasingly studied, becoming an important complement to traditional therapy as they can provide high-intensity, repetitive and interactive treatments. Several systems have been developed in research projects and some of these have become products mainly for being used at hospitals and care centers. After the initial cognitive rehabilitation performed at rehabilitation centers, patients are obliged to go to the centers, with many consequences, as costs, loss of time, discomfort and demotivation. However, it has been demonstrated that patients recovering at home heal faster because surrounded by the love of their relatives and with the community support.


  1. 1.Aruanno, B., Garzotto, F., Rodriguez, M.C.: HoloLens-based mixed reality experiences for subjects with alzheimer’s disease. In: Proceedings of the 12th Biannual Conference on Italian SIGCHI Chapter (CHItaly 2017), Article 15, 9 p. (2017)Google Scholar
  2. 2.Bozgeyikli, L., Raij, A., Katkoori, S., Alqasemi, R.: A survey on virtual reality for individuals with autism spectrum disorder: design considerations. IEEE Trans. Learn. Technol. 11, 133–151 (2018)CrossRefGoogle Scholar
  3. 3.Cameron, C., et al.: Hand tracking and visualization in a virtual reality simulation, pp. 127–132, April 2011Google Scholar
  4. 4.American Psychiatric Association Diagnostic: Statistical manual of mental disorders. American psychiatric pub. (2013)Google Scholar
  5. 5.Gelsomini, M., Garzotto, F., Matarazzo, V., Messina, N., Occhiuto, D.: Creating social stories as wearable hyper-immersive virtual reality experiences for children with neurodevelopmental disorders. In: Proceedings of the 2017 Conference on Interaction Design and Children (IDC 2017), pp. 431–437 (2017)Google Scholar
  6. 6.Gelsomini, M., Garzotto, F., Montesano, D., Occhiuto, D.: Wildcard: a wearable virtual reality storytelling tool for children with intellectual developmental disability. In: 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) Orlando, FL, pp. 5188–5191 (2016)Google Scholar
  7. 7.Guna, J., Jakus, G., Pogacnik, M., Tomazic, S., Sodnik, J.: An analisis of the precision and reliability of the leap motion sensor and its suitability for static and diynamic tracking. Sensors 14, 3702–3720 (2014)CrossRefGoogle Scholar
  8. 8.Josman, N., Ben-Chaim, H.M., Friedrich, S., Weiss, P.L.: Effectiveness of virtual reality for teaching street-crossing skills to children and adolescents with autism. Int. J. Disabil. Hum. Dev. 49–56 (2011)Google Scholar
  9. 9.Aspoc Onlus (2020). Accessed 04 Apr 2020


, , , , , , , ,

Leave a comment

[BLOG POST] Advanced Integration of Virtual Reality in Physical Therapy

Written by: Arik Yates, PTA

Virtual Reality used in conjunction with the gait trainers (Pictured: Lokomat).
Virtual Reality used in conjunction with the gait trainers (Pictured: Lokomat).

In the previous blog post, we covered general integration of virtual reality into physical therapy, so let’s dig deeper today! One key thing I want to bring back up is just how simple the set up is for virtual reality. Most of Neuro Rehab VR’s exercises only require the VR headset and 2 controllers donned on the patient. Simple enough, right? For more complicated cases where integration seems more daunting, I have good news for you; applying VR continues to remain simple.

In fact, one might find that virtual reality compliments many functional positions and exercises you would normally perform within your sessions. From complex body weight support ambulation activities, to gait training, to sustaining balance in tall/half kneeling positions, and more; VR can be utilized. Below, I have compiled my experience integrating this wonderful immersive tool into patient goals from low functioning to high functioning; let’s get into it! 

First on our agenda is the standing frame. It comes in multiple forms and is even included in some electric wheelchairs. Standing frames offer a huge potential for VR utilization! Once the patient is safely up in their standing frame, knees aren’t hyper extended etc., apply the headset ensuring proper fit, and apply remotes to bilateral upper extremities with proper securing devices like active hands or ace bandages if needed. After verbal affirmation from the patient, select the Neuro Rehab VR exercise designed for their use case.

Neuro Rehab VR offers multiple therapeutic exercises that can be performed within a standing frame, but I am going to focus on Retail Therapy and Fowl Play. For Retail Therapy, despite being secured into a standing frame, focus can be put on reaching and grasping objects anterolateral with bilateral upper extremities i.e. for c5 and higher spinal cord injury patients. Doing this activity turns a static experience into a goal oriented weight bearing activity with bilateral upper-extremity and trunk usage. The same goes for Fowl Play, except no remotes are needed in the hand and all the focus is on the trunk due to having to dodge balls coming at you. Standing frames perfectly compliment the use of virtual reality. Lets move on to body weight support ambulation systems!

Virtual Reality used with the standing frame (Pictured: Omni Stand).
Virtual Reality used with the standing frame (Pictured: Omni Stand).
Virtual Reality used with the over-head body weight support system (Pictured: Zero G).
Virtual Reality used with the over-head body weight support system (Pictured: Zero G).

At first glance, body weight support ambulation systems had me scratching my head on how virtual reality could be properly integrated without taking away from the gait training aspects of these systems. With a VR headset donned, the patient is no longer paying attention to the individual intricate details of their gait, but rather focusing on the task presented in front of them within the virtual reality environment. Because of this, VR needs to be integrated at a specific time to ensure it does not inhibit the patient from working on improving gait mechanics. For instance, I have found focusing on fine tuned gait mechanics during the first portion of BWS (body weight supported) ambulation activities, then transition to focus on hammering out distance and carryover of practiced mechanics within the VR headset. When utilizing the Loko Sprint application from Neuro Rehab VR, traveling great distances is gamified by placing coins in front of the patient with slight deviations in positioning. Better yet, if their speed increases on the BWS ambulation system, so does their visible speed within the headset in real time without any modifications to settings required. Alright, onto higher functioning integration, while working on walking and static balance using VR and a BWS systems.

Patient kneels up against box in real life / a table in the VR environment.
Patient kneels up against box in real life / a table in the VR environment.

Working to improve balance with higher functioning patients within the VR space has been one of the most rewarding experiences of my career. Don’t get me wrong, working with VR in general has been incredibly rewarding no matter the level of function. By being able to challenge the patients balance by coupling balance disks, blue foam pads, bosu balls, and more, provides a level of challenge and engagement unlike anything I have seen. For example, virtual reality in a tall kneeling position adds an extra layer of challenge not found elsewhere. Due to their exercise and instruction predominantly being within the headset, the therapist gets to solely focus on the patient’s position and movement without environmental distractions, or the utilization of a technician. Lets say we have a patient requiring glute/trunk strength, so we couple tall kneeling with Fowl Play, challenging the patient to not only stabilize in that position, but also dodge balls coming at them. When working on standing balance, once a patient is stabilized on a bosu ball, blue foam pad, incline wedge, etc., don the headset on your patient and let the “magic” begin!

To reiterate, utilizing VR can seem daunting when first dipping your toes in these unfamiliar waters of new technology, but I hope your worries are lessened and your excitement for virtual reality is growing. We are just scratching the surface of the therapeutic benefits of this technological modality. Be sure to reach out for more information regarding Neuro Rehab VR’s XR Therapy System for purchase or comment your questions that can be answered in future blog posts!


, , , , ,

Leave a comment

[Abstract + References] Move-IT: A Virtual Reality Game for Upper Limb Stroke Rehabilitation Patients – Conference paper


Stroke rehabilitation plays an important role in recovering the lifestyle of stroke survivors. Although existing research proved the effectiveness and engagement of Non-immersive Virtual Reality (VR) based rehabilitation systems, however, limited research is available on the applicability of fully immersive VR-based rehabilitation systems. In this paper, we present the development and evaluation of “Move-IT” game designed for domestic upper limb stroke patients. The game incorporates the use of Oculus Rift Head Mounted Display (HMD) and the Leap Motion hand tracker. A user study of five upper limb stroke patients was performed to evaluate the application. The results showed that the participants were pleased with the system, enjoyed the game and found it was exciting and easy to play. Moreover, all the participants agreed that the game was very motivating to perform rehabilitation exercises.


  1. 1.“What is stroke?”, 16 July 2014. Accessed 20 May 2020
  2. 2.Burke, J.: Games For Upper-limb Stroke Rehabilitation (Seminar). University of Ulster, Northern Ireland, 29 March 2010Google Scholar
  3. 3.A stroke occurs when the brain is damaged due to lack of blood supply. Accessed 20 May 2020
  4. 4.Khujah, A.: Stroke Rehabilitation, 17 February 2012. Accessed 20 May 2020
  5. 5.WHO|The world health report 2002 – Reducing Risks, Promoting Healthy Life, WHO. Accessed 20 May 2020
  6. 6.Alhazani, 100 stroke cases accure in SA daily, 13 September 2013.السعودية-تسجل-100-اصابة-بالسكتة-الدماغية-يوميا.html. Accessed 20 May 2020
  7. 7.Alsinani, F.: 6000 of stroke cases accure in Kingdom of Saudi Arabia yearly, Riyad newspaper, 14 Apr 2005. Accessed 23 May 2020
  8. 8.Gunasekera, W., Bendall, J.: Rehabilitation of neurologically injured patients. In: Moore, A.J., Newell, D.W. (eds.) Neurosurgery. Springer Specialist Surgery Series, pp. 407–421. Springer, London (2005).
  9. 9.Burke, J.W., McNeill, M., Charles, D., Morrow, P., Crosbie, J., McDonough, S.: Serious games for upper limb rehabilitation following stroke. In: Proceedings of the 2009 Conference in Games and Virtual Worlds for Serious Applications, Washington, DC, USA, 2009, pp. 103–110 (2009)Google Scholar
  10. 10.Rego, P.A., Moreira, P., Reis, L.: Serious games for rehabilitation: a survey and a classification towards a taxonomy. In: 5th Iberian Conference on Information Systems and Technologies (CISTI), pp. 1–6 (2010)Google Scholar
  11. 11.Laver, K.E., George, S., Thomas, S., Deutsch, J.E., Crotty, M.: Virtual reality for stroke rehabilitation. Cochrane Database Syst. Rev. no. 9, p. CD008349, September 2011Google Scholar
  12. 12.AlMousa, M., Al-Khalifa, H.S., AlSobayel, H.: Requirements elicitation and prototyping of a fully immersive virtual reality gaming system for upper limb stroke rehabilitation in Saudi Arabia. Mobile Information Systems (2017). Accessed 23 May 2020
  13. 13.Grimm, F., Gharabaghi, A.: Closed-loop neuroprosthesis for reach-to-grasp assistance: combining adaptive multi-channel neuromuscular stimulation with a multi-joint arm exoskeleton. Front. Neurosci. 10, 284 (2016)Google Scholar
  14. 14.Dörner, R., Göbel, S., Effelsberg, W., Wiemeyer, J. (eds.): Serious Games, Foundations, Concepts and Practice. Springer, Cham (2016). Scholar
  15. 15.Yagv, B.: Overview of virtual reality technologies. In: Presented at the Interactive Multimedia Conference, University of Southampton, United Kingdom (2013)Google Scholar


, , , , , , ,

Leave a comment

[VIDEO] Virtual Reality in Physical Therapy by Neuro Rehab VR – Clip from the show Information Matrix TV – YouTube

Information Matrix TV Reviews Virtual Reality in Physical Therapy at Neuro Rehab VR with Host Laurence Fishburne

, , ,

Leave a comment

[Abstract] Impact of virtual reality game therapy and task-specific neurodevelopmental treatment on motor recovery in survivors of stroke



This study aimed to compare the impact of virtual reality game therapy and task-specific neurodevelopmental training on the motor recovery of upper limb and trunk control, as well as physical function, in people who have had a stroke.


This randomised, assessor-blinded clinical trial was conducted with 34 patients with post-stroke duration of 135 ± 23 days. Patients with first-onset cortical stroke aged 40–60 years, Mini-Mental State Examination score >20, ability to complete a nine-hole peg test within 120 seconds, ability to lift the affected arm at shoulder level and independent standing were included. Patients were excluded if they had unilateral neglect and musculoskeletal injuries of the affected limb in the past 2 months. Outcome measures used were the Fugl-Meyer Upper Extremity Scale, Action Research Arm Test, Trunk Impairment Scale and Stroke Impact Scale-16. The virtual reality game therapy group performed interactive table tennis, boxing and discus throwing games. The neurodevelopmental treatment group underwent task-specific movements of the upper limb in sitting and standing. All patients performed 45 minutes of treatment, 5 days a week for 4 weeks.


Both groups showed improvements in all measures after training (P<0.05). There was a between-group difference of 3.47 points in Fugl-Meyer Upper Extremity Scale in favour of the virtual reality game therapy.


Both treatment regimens resulted in equal improvements in hand dexterity and trunk control after stroke. Virtual reality game therapy improved the upper limb motor recovery of stroke survivors to a greater extent than neurodevelopmental treatment.


, , , , , , , ,

Leave a comment

[ARTICLE] Development of the Home based Virtual Rehabilitation System (HoVRS) to Remotely Deliver an Intense and Customized Upper Extremity Training – Full Text PDF


Background: After stroke, sustained hand rehabilitation training is required for continuous improvement
and maintenance of distal function.
Methods: In this paper, we present a system designed and implemented in our lab: the Home based
Virtual Rehabilitation System (HoVRS). Fifteen subjects with chronic stroke were recruited to test the
feasibility of the system as well as to rene the design and training protocol to prepare for a future
ecacy study. HoVRS was placed in subjects’ homes, and subjects were asked to use the system at least
15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical
Results: All patients completed the study without any adverse events. Subjects on average spent 13.5
hours using the system. Clinical and kinematic data were collected pre and post study. The whole group
improved on the Fugl-Meyer (FM) assessment and on six kinematic measurements. In addition, a
combination of these kinematic measures was able to predict a substantial portion of subjects’ FM
Conclusion: The outcomes of this pilot study warrant further investigation of the system’s ability to
promote recovery of hand function in subacute and chronic stroke[…]

Full Text PDF

Figure 1
Figure 1
HoVRS sub-systems diagram and types of arm positioning. A: HoVRS sub-systems diagram: The clientbased platform provides hand and arm training. A cloud-based data server provides secure data
streaming, analysis and presenting. Therapists can access patients’ progress through web portal. Two
different types of arm positioning above LMC: B: Passive arm support. C: Hip wedge

, , , , , , , , ,

Leave a comment

[Abstract] Combining brain–computer interface and virtual reality for rehabilitation in neurological diseases: A narrative review



The traditional rehabilitation for neurological diseases lacks the active participation of patients, its process is monotonous and tedious, and the effects need to be improved. Therefore, a new type of rehabilitation technology with more active participation combining brain–computer interface (BCI) with virtual reality (VR) has developed rapidly in recent years and has been used in rehabilitation in neurological diseases.


This narrative review analyzed and characterized the development and application of the new training system (BCI-VR) in rehabilitation of neurological diseases from the perspective of the BCI paradigm, to provide a pathway for future research in this field.


The review involved a search of the Web of Science-Science Citation Index/Social Sciences Citation Index and the China National Knowledge Infrastructure databases; 39 papers were selected. Advantages and challenges of BCI-VR – based neurological rehabilitation were analyzed in detail.


Most BCI-VR studies included could be classified by 3 major BCI paradigms: motor imagery, P300, and steady-state visual-evoked potential. Integrating VR scenes into BCI systems could effectively promote the recovery process from nervous system injuries as compared with traditional methods.


As compared with rehabilitation based on traditional BCI, rehabilitation based on BCI-VR can provide better feedback information for patients and promote the recovery of brain function. By solving the challenges and continual development, the BCI-VR system can be broadly applied to the clinical treatment of various neurological diseases.


, , , , ,

Leave a comment

[ARTICLE] Virtual reality art-making for stroke rehabilitation: Field study and technology probe – Full Text


In a three-week field study of traditional art-making by 14 stroke survivors with disabilities, we found that these artists utilized the physical and temporally unfolding properties of the materials to create beauty without excessive fine motor precision, used a social, situated and reflective process of tool selection, and created work that blended inspirations and accomplishments from their previous and current identity.

We contrasted themes derived from the field study and experiential virtual reality interviews using state of the art 3D tools as a technology probe. We found that the affordances of VR as a medium shifted making away from meditative, physicallysupported fine motor activity to free form mid-air gesture. The experience was immersive, physical and out of control and creations were at times abstract, intentional or emergent.

Implications for the design of VR art-making identified from two types of research inquiry. The contrast of the social, reflective and unhurried nature for traditional artmaking and the unfolding of traditional materials, with the speed, proximity and finality of 3D paint lead us to recommend social, situated, reflective, physical and meaningmaking considerations for VR art interaction.


How can we better understand the process of therapeutic art-making for stroke rehabilitation, and what are design opportunities for virtual reality art-making for people with stroke-related impairments? We investigated this question in a two-part study with 14 amateur artists with disabilities resulting from stroke: a three-week field study and a technology probe consisting of experiential virtual reality interviews. We uncovered what participants made, the aesthetics of the materials and the process of making. The field study revealed inspirations around identity, situatedness of choices for tools in the social and physical environment, and a breadth of application techniques (e.g., dripping paint or use of tape) that varied in need for fine motor control. The experiential virtual reality interviews highlighted the need for control, the affordances of the medium, and the challenges in viewing and reflecting on work. Emergent art reflected qualities of the 3D paint and free-form gesture. Virtual reality and traditional art-making contrasted in the speed and finality of application, opportunities for iteration and reflection, and in the need for dexterity. We discuss strengths, weaknesses and implications for design of virtual reality art-making for those with stroke-related impairments.

1. Introduction

Art is immersive and virtual reality art may be especially so. Virtual reality (VR) provides a sense of presence fostered by a head-mounted display that situates the user in an immersive environment. VR has been lauded as a promising form of rehabilitation because of its ability to provide rich visual experiences and transferable skills Wilson et al. (1997), control over dynamic environments and measurements of responses Schultheis and Rizzo (2001), and the ability to present greater risks than would be possible in real life Standen and Brown (2005). While VR is heralded as a way to transcend social and physical boundaries, accessibility barriers continue to exist as basic assistive features such as auto-reading are absent Tefilo et al. (2016). Our work focuses on artists with disabilities from stroke as power users Kara et al. (1997) and lead users Von Hippel (1986) for VR art-making.

A stroke occurs when the blood supply to the brain is disrupted, resulting in brain damage and loss of ability. Stroke is the most common cause of adult disability worldwide What is stroke? (2017). Recovering from stroke requires sustained adherence to physical therapy that consists of dozens of repetitions of basic movements and tasks of daily life, such as reach and grasp, and which are perceived as tedious Bassett (2003). Lack of motivation for and adherence to therapy worsens therapeutic outcomes Maclean et al. (2000). Rehabilitation in VR meets some of these challenges because patients can perform their physical exercise while the immersion draws attention away from discomfort and pain Lohse et al. (2014)Thomson et al. (2014). VR can also be done at home and gesture activity and progress can be tracked. To be fully successful, a rehabilitation program for stroke must not only be effective and draw attention away from pain, but also be engaging and draw patients out of a state of grief Hackett et al. (2005). Immersive gaming is a burgeoning area which can engage patients in cognitive flow and continuous physical movement exploration Burke et al. (2010). VR game-based stroke interventions tend to focus on improving physical function or cognitive aspects. Depression and anxiety are common psychological disorders post-stroke, but these are neglected in current treatments Ali et al. (2014). We aim to begin to address this gap by better understanding current practices for therapeutic art-making and investigating design opportunities for VR art-based stroke rehabilitation.

Art therapy is an effective treatment for stroke Kongkasuwan et al. (2016). Art-therapists work with clients in art-making directed by therapeutic goals. Art therapy supports physical, cognitive and emotional healing through the creation of art including painting, drawing, sculpting, mixed media or other methods. The malleability and interaction possibilities of the materials are critical. Art-therapists’ expertise in materiality enables them to work with clients through the art-making process to transcend disabilities. Art-therapists overcome communication impairments by using “making” as expression  Lazar et al. (2018). Art-therapists also offer unobtrusive physical assistance to empower clients Lazar et al. (2016). To understand current therapeutic art-making practices and design opportunities for virtual art-making for stroke rehabilitation, we study the context of post-stroke art-making. We used VR art as a technology probe Hutchinson et al. (2003) within the context of an institution that offers art classes, open studio time and art therapy. Our work makes three contributions:1.

Empirical results from a field study of traditional art-making by 14 stroke survivors with disabilities. We found that these artists i) utilized the physical and temporally unfolding properties of the materials to create beauty without excessive fine motor precision, ii) used a social, situated and reflective process of tool selection, and iii) created work that blended inspirations and accomplishments from their previous and current identity.2.

Themes derived from experiential VR interviews using a state of the art 3D tool as a technology probe. We found that the affordances of VR as a medium shifted making away from meditative, physically-supported fine motor activity to free-form mid-air gesture. The experience was immersive, physical and sometimes out of control. Creations were abstract, intentional or emergent.3.

Implications for the design of VR art-making which have been identified from two types of research inquiry. The contrasts of the social, reflective and unhurried nature of traditional art-making and the unfolding of traditional materials, with the speed, proximity and finality of 3D paint lead us to recommend social, situated, reflective, physical and meaning-making considerations for VR art interaction.[…]

Continue —> Virtual reality art-making for stroke rehabilitation: Field study and technology probe – ScienceDirect

Fig. 3
Fig. 3. Participants’ artworks. From first row left: 3a. Example of mixing inspirations: a painting with overlayed poetry; 3b. Example of alternative methods: a painting from a dripping and rotating method. Second row: 3c. Example of alternative tools: texture from sponges; 3d. Example of social inspiration: a painting of a peer. Third row: 3e. Example of a personal artistic style, abstract in this case, carried on in VR art; 3f. Second example of a personal artistic style, exploration of color and shape in this case, carried on in VR art.

, , , , , ,

Leave a comment

%d bloggers like this: