Posts Tagged Virtual Reality

[Abstract] Gamification of Hand Rehabilitation Process Using Virtual Reality Tools: Using Leap Motion for Hand Rehabilitation

Abstract:

Nowadays virtual reality (VR) technology give us the considerable opportunities to develop new methods to supplement traditional physiotherapy with sustain beneficial quantity and quality of rehabilitation. VR tools, like Leap motion have received great attention in the recent few years because of their immeasurable applications, whish include gaming, robotics, education, medicine etc. In this paper we present a game for hand rehabilitation using the Leap Motion controller. The main idea of gamification of hand rehabilitation is to help develop the muscle tonus and increase precision in gestures using the opportunities that VR offer by making the rehabilitation process more effective and motivating for patients.

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Source: Gamification of Hand Rehabilitation Process Using Virtual Reality Tools: Using Leap Motion for Hand Rehabilitation – IEEE Xplore Document

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[Abstract] Interactive design of patient-oriented video-games for rehabilitation: concept and application

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Purpose: Serious video-games are innovative tools used to train the motor skills of subjects affected by neurological disorders. They are often developed to train a specific type of patients and the rules of the game are standardly defined. A system that allows the therapist to design highly patient-oriented video-games, without specific informatics skills, is proposed.

Method: The system consists of one personal computer, two screens, a Kinect™ sensor and a specific software developed here for the design of the video-games. It was tested with the collaboration of three therapists and six patients, and two questionnaires were filled in by each patient to evaluate the appreciation of the rehabilitative sessions.

Results: The therapists learned easily how to use the system, and no serious difficulties were encountered by the patients. The questionnaires showed an overall good satisfaction by the patients and highlighted the key-role of the therapist in involving the patients during the rehabilitative session.

Conclusions: It was found that the proposed system is effective for developing patient-oriented video-games for rehabilitation. The two main advantages are that the therapist is allowed to (i) develop personalized video-games without informatics skills and (ii) adapt the game settings to patients affected by different pathologies.

Implications for rehabilitation

Virtual reality and serious video games offer the opportunity to transform the traditional therapy into a more pleasant experience, allowing patients to train their motor and cognitive skills.

Both the therapists and the patients should be involved in the development of rehabilitative solutions to be highly patient-oriented.

A system for the design of rehabilitative games by the therapist is described and the feedback of three therapists and six patients is reported.

Virtual reality and serious video games offer the opportunity to transform the traditional therapy into a more pleasant experience, allowing patients to train their motor and cognitive skills.

Both the therapists and the patients should be involved in the development of rehabilitative solutions to be highly patient-oriented.

A system for the design of rehabilitative games by the therapist is described and the feedback of three therapists and six patients is reported.

Source: Interactive design of patient-oriented video-games for rehabilitation: concept and application

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[ARTICLE] Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review – Full Text

Abstract

Background

Virtual reality (VR) based applications play an increasing role in motor rehabilitation. They provide an interactive and individualized environment in addition to increased motivation during motor tasks as well as facilitating motor learning through multimodal sensory information. Several previous studies have shown positive effect of VR-based treatments for lower extremity motor rehabilitation in neurological conditions, but the characteristics of these VR applications have not been systematically investigated. The visual information on the user’s movement in the virtual environment, also called movement visualisation (MV), is a key element of VR-based rehabilitation interventions. The present review proposes categorization of Movement Visualisations of VR-based rehabilitation therapy for neurological conditions and also summarises current research in lower limb application.

Methods

A systematic search of literature on VR-based intervention for gait and balance rehabilitation in neurological conditions was performed in the databases namely; MEDLINE (Ovid), AMED, EMBASE, CINAHL, and PsycInfo. Studies using non-virtual environments or applications to improve cognitive function, activities of daily living, or psychotherapy were excluded. The VR interventions of the included studies were analysed on their MV.

Results

In total 43 publications were selected based on the inclusion criteria. Seven distinct MV groups could be differentiated: indirect MV (N = 13), abstract MV (N = 11), augmented reality MV (N = 9), avatar MV (N = 5), tracking MV (N = 4), combined MV (N = 1), and no MV (N = 2). In two included articles the visualisation conditions included different MV groups within the same study. Additionally, differences in motor performance could not be analysed because of the differences in the study design. Three studies investigated different visualisations within the same MV group and hence limited information can be extracted from one study.

Conclusions

The review demonstrates that individuals’ movements during VR-based motor training can be displayed in different ways. Future studies are necessary to fundamentally explore the nature of this VR information and its effect on motor outcome.

Background

Virtual reality (VR) in neurorehabilitation has emerged as a fairly recent approach that shows great promise to enhance the integration of virtual limbs in one`s body scheme [1] and motor learning in general [2]. Virtual Rehabilitation is a “group [of] all forms of clinical intervention (physical, occupational, cognitive, or psychological) that are based on, or augmented by, the use of Virtual Reality, augmented reality and computing technology. The term applies equally to interventions done locally, or at a distance (tele-rehabilitation)” [3]. The main objectives of intervention for facilitating motor learning within this definition are to (1) provide repetitive and customized high intensity training, (2) relay back information on patients’ performance via multimodal feedback, and (3) improve motivation [24]. VR therapies or interventions are based on real-time motion tracking and computer graphic technologies displaying the patients’ behaviour during a task in a virtual environment.

The interaction of the user and Virtual environment can be described as a perception and action loop [5]. This motor performance is displayed in the virtual environment and subsequently, the system provides multimodal feedback related to movement execution. Through external (e.g. vision) and internal (proprioception) senses the on-line sensory feedback is integrated into the patient’s mental representation. If necessary, the motor plan is corrected in order to achieve the given goal [5].

A previous Cochrane Review from Laver, George, Thomas, Deutsch, and Crotty [2] on Virtual Reality for stroke rehabilitation showed positive effects of VR intervention for motor rehabilitation in people post-stroke. However, grouped analysis from this review on recommendation for VR intervention provides inconclusive evidence. The author further comments that “[…] virtual reality interventions may vary greatly […], it is unclear what characteristics of the intervention are most important” ([2], p. 14).

Virtual rehabilitation system provides three different types of information to the patient: movement visualisation, performance feedback and context information [6]. During a motor task the patient’s movements are captured and represented in the virtual environment (movement visualisation). According to the task success, information about the accomplished goal or a required movement alteration is transmitted through one or several sensory modalities (performance feedback). Finally, these two VR features are embedded in a virtual world (context information) that can vary from a very realistic to an abstract, unrealistic or reduced, technical environment.

Performance feedback often relies on theories of motor learning and is probably the most studied information type within VR-based motor rehabilitation. Moreover, context information is primarily not designed with a therapeutic purpose. Movement observation, however, plays an important role for central sensory stimulation therapies, such as mirror therapy or mental training. The observation or imagination of body movements facilitates motor recovery [789] and provides new possibilities for cortical reorganization and enhancement of functional mobility. Thus, it appears that movement visualisation may also play an important role in motor rehabilitation [101112], although this aspect is yet to be systematically investigated [13].

The main goal of the present review is to identify various movement visualisation groups in VR-based motor interventions for lower extremities, by means of a systematic literature search. Secondarily, the included studies are further analysed for their effect on motor learning. This will help guide future research in rehabilitation using VR.

An interim analysis of the review published in 2013 showed six MV groups for upper and lower extremity training and additional two MV groups directed only towards lower extremity training. In this paper, we analysed only studies involving lower limb training, leading to a revision and expansion of the previously published MV groups findings [131415].

Continue —> Movement visualisation in virtual reality rehabilitation of the lower limb: a systematic review | BioMedical Engineering OnLine | Full Text

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[Conference paper] Usage of VR Headsets for Rehabilitation Exergames – Abstract+References

Abstract

The work presented here is part of a large project aimed at finding new ways to tackle exergames used for physical rehabilitation. The preferred user group consists of physically impaired who normally cannot use commercially available games; our approach wants to fill a niche and allow them to get the same playing experience like healthy. Four exercises were implemented with the Blender Game engine and connected to a motion capture device (Kinect) via a modular middleware. The games incorporate special features that enhance weak user movements, such that the avatar reacts in the same way as for persons without physical restrictions. Additionally, virtual reality glasses have been integrated to achieve a more immersive feeling during play. In this work, we compare the results of preliminary user tests, performed with and without VR glasses. Test outcomes are good for motion amplification in some of the games but do not present generally better results when using the VR glasses.

Source: Usage of VR Headsets for Rehabilitation Exergames | SpringerLink

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[WEB SITE] The Rehabilitation Gaming System

slideshow 1RGS is a highly innovative Virtual Reality (VR) tool for the rehabilitation of deficits that occur after brain lesions and has been successfully used for the rehabilitation of the upper extremities after stroke.
The RGS is based on the neurobiological considerations that plasticity of the brain remains  throughout life and therefore can be utilized to achieve functional reorganization of the brain areas affected by stroke. This can be realized by means of activation of secondary motor areas such as the so called mirror neurons system.

RGS deploys a deficit oriented training approach. Specifically, while training with RGS the patient is playing individualized games where movement execution is combined with the observation of correlated actions performed by a virtual body. The system optimizes the user’s training by analyzing the qualitative and quantitative aspects of the user’s performance. This warranties a detailed assessment of the deficits of the patient and their recovery dynamics.

Key articles and Recent publications

also see specs.upf.edu

Source: The Rehabilitation Gaming System | Rehabilitation Gaming System

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[ARTICLE] Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity – Full Text

Abstract

Background

People with chronic arm impairment should exercise intensely to regain their abilities, but frequently lack motivation, leading to poor rehabilitation outcome. One promising way to increase motivation is through interpersonal rehabilitation games, which allow patients to compete or cooperate together with other people. However, such games have mainly been evaluated with unimpaired subjects, and little is known about how they affect motivation and exercise intensity in people with chronic arm impairment.

Methods

We designed four different arm rehabilitation games that are played by a person with arm impairment and their unimpaired friend, relative or occupational therapist. One is a competitive game (both people compete against each other), two are cooperative games (both people work together against the computer) and one is a single-player game (played only by the impaired person against the computer). The games were played by 29 participants with chronic arm impairment, of which 19 were accompanied by their friend or relative and 10 were accompanied by their occupational therapist. Each participant played all four games within a single session. Participants’ subjective experience was quantified using the Intrinsic Motivation Inventory questionnaire after each game, as well as a final questionnaire about game preferences. Their exercise intensity was quantified using wearable inertial sensors that measured hand velocity in each game.

Results

Of the 29 impaired participants, 12 chose the competitive game as their favorite, 12 chose a cooperative game, and 5 preferred to exercise alone. Participants who chose the competitive game as their favorite showed increased motivation and exercise intensity in that game compared to other games. Participants who chose a cooperative game as their favorite also showed increased motivation in cooperative games, but not increased exercise intensity.

Conclusions

Since both motivation and intensity are positively correlated with rehabilitation outcome, competitive games have high potential to lead to functional improvement and increased quality of life for patients compared to conventional rehabilitation exercises. Cooperative games do not increase exercise intensity, but could still increase motivation of patients who do not enjoy competition. However, such games need to be tested in longer, multisession studies to determine whether the observed increases in motivation and exercise intensity persist over a longer period of time and whether they positively affect rehabilitation outcome.

Trial registration

The study is not a clinical trial. While human subjects are involved, they participate in a single-session evaluation of a rehabilitation game rather than a full rehabilitation intervention, and no health outcomes are examined.

Keywords

Rehabilitation ,Virtual reality ,Multiplayer games, Interpersonal rehabilitation games ,Social interaction ,Motivation ,Exercise intensity

Background

Home rehabilitation technology

Diseases such as stroke have a massively debilitating effect on people’s lives. It is estimated that one in six people will experience a stroke in their lifetime [1], and 88% of survivors report some impairment of their limb function [2]. In the United States, approximately 795,000 individuals suffer a new or recurrent stroke every year, leading to an estimated combined direct and indirect cost of $68.9 billion [3]. Intensive training delivered by a therapist soon after the injury can effectively restore motor functions needed for independent life. However, even top hospitals only devote a limited amount of time to rehabilitation of motor functions [4]. The situation is even worse in most other hospitals and health centers, where patients are idle for most of the day due to a shortage of qualified medical staff [4]. After leaving the hospital, patients thus need to exercise at home without therapist supervision in order to fully regain their abilities.

Several technologies, ranging from consumer devices such as the Microsoft Kinect [5] to complex exoskeletons [6], have been deployed for motor rehabilitation at home. These technologies usually combine limb tracking with virtual environments presented on a personal computer, which allow patients to perform a variety of simulated activities of daily living [7]. Furthermore, they incorporate game-like elements such as automated difficulty adaptation, score displays and cognitive challenges [8, 9, 10, 11]. However, despite promising technical achievements, the effectiveness of home rehabilitation technology remains limited. A recent study showed that, even if a therapist prescribes a technology-supported exercise, only about 30% of unsupervised patients will comply with the rehabilitation regimen [12].

This lack of compliance is due to lack of motivation for rehabilitation, which is known to be a key determinant of rehabilitation outcome: patients who are unmotivated will not exercise frequently or intensely enough [13, 14]. Studies outside rehabilitation have already shown that motivational interventions improve compliance with the therapy regimen [15], and recent home rehabilitation studies have emphasized the importance of motivational elements that would increase the duration and intensity of exercise [16, 17]…

Continue —> Competitive and cooperative arm rehabilitation games played by a patient and unimpaired person: effects on motivation and exercise intensity | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 The BiMeo used unimanually without support (top left), unimanually on a table (top right), bimanually without support (bottom left), and bimanually on a table (bottom right)

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[Abstract] Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study

Abstract

Objectives

The YouGrabber (YG) is a new virtual reality training system that focuses on unilateral and bimanual activities. This nested study was part of a larger multicentre randomised controlled trial and explored experiences of people with chronic stroke during a 4 week intensive upper limb training with YG.

Design

A qualitative design using semi-structured, face-to-face interviews. A phenomenological descriptive approach was used, with data coded, categorized and summarized using a thematic analysis. Topics investigated included: the experience of YG training, perceived impact of YG training on arm function, and the role of the treating therapist.

Results

Five people were interviewed (1 female, age range 55-75yrs, 1-6yrs post-stroke). Seven main themes were identified: (1) general experience, (2) expectations, (3) feedback, (4) arm function, (5) physiotherapist’s role, (6) fatigue, (7) motivation. Key experiences reported included feelings of motivation and satisfaction, with positive factors identified as challenge, competition, fun and effort. The YG training appeared to trigger greater effort, however fatigue was experienced at the end of the training. Overall, patients described positive changes in upper limb motor function and activity level, e.g. automatic arm use. While the opportunity for self-practice was appreciated, input from the therapist at the start of the intervention was deemed important for safety and confidence.

Conclusions

Reported experiences were mostly positive and the participants were motivated to practice intensively. They enjoyed the challenging component of the games.

Source: Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study – Physiotherapy

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[ARTICLE] The application of virtual reality in neurorehabilitation: motor re-learning supported by innovative technologies – Full Text

Abstract
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.

Continue —> The application of virtual reality in neurorehabilitation: motor re-learning supported by innovative technologies (PDF Download Available)

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[Abstract] Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial.

Abstract
OBJECTIVES: To study whether the reinforced feedback in virtual environment (RFVE) is more effective than traditional rehabilitation (TR) for the treatment of upper limb motor function after stroke, regardless of stroke etiology (i.e., ischemic, hemorrhagic).
DESIGN: Randomized controlled trial. Participants. Forty-four patients affected by stroke. Intervention. The patients were randomized into two groups: RFVE (N = 23) and TR (N = 21), and stratified according to stroke etiology. The RFVE treatment consisted of multidirectional exercises providing augmented feedback provided by virtual reality, while in the TR treatment the same exercises were provided without augmented feedbacks. Outcome Measures. Fugl-Meyer upper extremity scale (F-M UE), Functional Independence Measure scale (FIM), and kinematics parameters (speed, time, and peak).
RESULTS: The F-M UE (P = 0.030), FIM (P = 0.021), time (P = 0.008), and peak (P = 0.018), were significantly higher in the RFVE group after treatment, but not speed (P = 0.140). The patients affected by hemorrhagic stroke significantly improved FIM (P = 0.031), time (P = 0.011), and peak (P = 0.020) after treatment, whereas the patients affected by ischemic stroke improved significantly only speed (P = 0.005) when treated by RFVE.
CONCLUSION: These results indicated that some poststroke patients may benefit from RFVE program for the recovery of upper limb motor function. This trial is registered with NCT01955291.

Source: Reinforced feedback in virtual environment for rehabilitation of upper extremity dysfunction after stroke: preliminary data from a randomized controlled trial.

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[Abstract] Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

Abstract
Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”.
Objectives: To identify support of a virtual reality system in the kinematic assessment and physiotherapy approach to gait disorders in individuals with stroke.
Methods: We adapt Virtual Reality Rehabilitation System (VRRS), software widely used in the functional recovery of the upper limb, for its use on the lower limb of hemiplegic patients. Clinical scales have been used to relate them with the kinematic assessment provided by the system. A description of the use of reinforced feedback provided by the system on the recovery of deficits in several real cases in the field of physiotherapy is performed. Specific examples of functional tasks have been detailed, to be considered in creating intelligent health technologies to improve post-stroke gait.
Results: Both participants improved scores on the clinical scales, the kinematic parameters in leg stance on plegic lower extremity and walking speed > Minimally Clinically Important Difference (MCID).
Conclusion: The use of the VRRS software attached to a motion tracking capture system showed their practical utility and safety in enriching physiotherapeutic assessment and treatment in post-stroke gait disorders.

Source: Virtual Reality to Assess and Treat Lower Extremity Disorders in Post-stroke Patients

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