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.
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 .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 . 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  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 —-> https://www.mdpi.com/2076-3425/10/9/655/htm
[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.
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[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.
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Written by: Arik Yates, PTA
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!
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.
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!
[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.
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[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
[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.
[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[…]
[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.
[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.
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.[…]