Posts Tagged Virtual rehabilitation

[BOOK] Emerging Therapies in Neurorehabilitation II – [Chapter] Virtual Rehabilitation – Request PDF


This chapter addresses the current state of the art of virtual rehabilitation by summarizing recent research results that focus on the assessment and remediation of motor impairments using virtual rehabilitation technology. Moreover, strengths and weaknesses of the virtual rehabilitation approach and its technical and clinical implications will be discussed. This overview is an update and extension of a previous virtual rehabilitation chapter with a similar focus. Despite tremendous advancements in virtual reality hardware in the past few years, clinical evidence for the efficacy of virtual rehabilitation methods is still sparse. All recent meta-analyses agree that the potential of virtual reality systems for motor rehabilitation in stroke and traumatic brain injury populations is evident, but that larger clinical trials are needed that address the contribution of individual aspects of virtual rehabilitation systems on different patient populations in acute and chronic stages of neurorehabilitation.

Virtual Rehabilitation | Request PDF. Available from:

via Virtual Rehabilitation | Request PDF


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[BLOG POST] Tyromotion Introduces Virtual Reality to Robotic Therapy to Facilitate Stroke Recovery

Rehabilitation technology leader Tyromotion has developed a rehabilitation device that combines virtual reality with robotic therapy to make stroke rehabilitation faster and more efficient.

Tyromotion has created a rehabilitation device that uses a bilateral 3D arm robot and virtual reality glasses to fully immerse stroke patients in virtual worlds where both the visual and physical environments can be shaped. The device is designed to help patients with limited arm function perform daily tasks by challenging and encouraging them to increase their range of motion and the number of repetitions during their therapy sessions. Both these elements are vital to motor learning.

The introduction of virtual reality into therapy delivers a 3D training environment that can be adapted to each individual patient’s abilities. The virtual setting has a gaming element to it, which helps motivate patients to keep repeating their exercises.

Tyromotion’s device is currently being tested by leading rehabilitation facilities in Europe and the United States. The initial reports from therapists and doctors have been very positive, indicating that the new approach to therapy has a strong potential to transform it by increasing patient motivation and making therapy programs more cost effective across the board.

Diego, the robot-assisted arm rehabilitation device used to deliver VR therapy, is the world’s most versatile arm-shoulder rehabilitation device, one that combines robotics with intelligent gravity compensation (IGC) and virtual reality to help patients regain lost arm function. The device offers passive, active and assistive, uni- and bilateral applications that are easily adapted to meet the needs of each patient.

The gravity compensation feature makes heavy arms lighter, allowing physiological movement of the arms in every phase of rehabilitation. The device gives patients more room and more freedom to move and is particularly well suited for task-oriented training with real objects.

Diego offers a versatile range of therapy options with interactive therapy modules that provide haptic and audiovisual feedback, immersing patients in motion in the virtual environment. The therapy modules have different levels of difficulty, which motivates patients to keep making progress. Their progress is then recorded to make their achievements visible.

Diego is suitable for patients of all ages and can be used in all phases of arm rehabilitation. Watch the video below to learn more about its features and benefits.

Related news:

Tyrostation Offers Versatile Range of Therapy Options

Source: Tyromotion Introduces Virtual Reality to Robotic Therapy to Facilitate Stroke Recovery | Fitness Gaming

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[ARTICLE] USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems – Full Text HTML


New emerging technologies have proven their efficacy in aiding people in their rehabilitation. The tests that are usually used to evaluate usability (in general) or user satisfaction (in particular) of this technology are not specifically focused on virtual rehabilitation and patients. The objective of this contribution is to present and evaluate the USEQ (User Satisfaction Evaluation Questionnaire). The USEQ is a questionnaire that is designed to properly evaluate the satisfaction of the user (which constitutes part of usability) in virtual rehabilitation systems. Forty patients with balance disorders completed the USEQ after their first session with ABAR (Active Balance Rehabilitation), which is a virtual rehabilitation system that is designed for the rehabilitation of balance disorders. Internal consistency analysis and exploratory factor analysis were carried out to identify the factor structure of the USEQ. The six items of USEQ were significantly associated with each other, and the Cronbach alpha coefficient for the questionnaire was 0.716. In an analysis of the principal components, a one-factor solution was considered to be appropriate. The findings of the study suggest that the USEQ is a reliable questionnaire with adequate internal consistency. With regard to patient perception, the patients found the USEQ to be an easy-to-understand questionnaire with a convenient number of questions.

1. Introduction

1.1. Usability

Usability is an important quality attribute of a user’s experience when interacting with a system or tool, and it is also an important attribute in helping users to achieve the suggested goals [1]. With regard to HCI (Human–Computer Interface) and usability, Bevan states in [2] that standards related to usability can be categorized as being primarily concerned with the use of the product (effectiveness, efficiency, and satisfaction in a specific context of use).
The categorization of Bevan is coherent with the ISO 9241-11 standard [3,4,5], which describes a widely accepted definition of usability. This standard indicates the rules that are needed in terms of ergonomics, hardware, software, and environments in order to obtain good usability for a product or system. Section 8.1 describes the term usability as “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use”.

1.2. Usability in Virtual Rehabilitation

One of the promising and emerging fields within rehabilitation therapies for different pathologies is virtual rehabilitation (VRh) [6,7,8,9]. VRh systems are designed to assist clinical specialists and patients in the rehabilitation process [10]. The use of ground-breaking technologies together with the emergence of entertaining and playful virtual environments (VE) have demonstrated promising results in the rehabilitation process [11,12,13,14], improving the adherence to treatments [12]. However, these systems should be tested regarding important aspects such as usability.
Currently, there are different questionnaires that are designed to evaluate usability in general-purpose systems. The best-known usability questionnaire is the system usability scale (SUS) [15,16], which measures the feeling of usability of the users when using computer systems. It is composed of 10 questions with a five-point Likert attitude scale (from strongly disagree to strongly agree). This questionnaire has been used in different domains such as: security software [17], mobile phones [18,19], PDA [20], Social Network sites [21,22], wiki sites [23], serious games [24], or robotics [25]. Even though the SUS questionnaire is not specifically designed for VRh systems, it has also been used for rehabilitation purposes due to the lack of questionnaires that focus on VRh systems. Meldrum et al. [26] tested balance in patients with vestibular and other neurological diseases using VRh and quantified the usability of the Nintendo Wii Fit Plus®. Duvinage et al. [27] assessed the usability of a P300 system (using Brain–Computer interfaces) for lower-limb rehabilitation purposes. One considerable advantage of the SUS questionnaire is the reasonable number of questions that are to be answered at the end of the first session. However, the concepts of this questionnaire are too generic (computers, PDAs, Websites, etc.). The main drawback of the SUS questionnaire is that it does not include questions to obtain responses about specific items related to Virtual Rehabilitation.
Another well-known usability questionnaire is VRUSE [28]. Fitzgerald et al. [29] assessed the usability of the E-Yoga system using VRUSE, with the goal of improving postural control and biomechanical alignment of the subjects in a rehabilitation process. The VRUSE evaluates a wide range of concepts: functionality, user input, system output (display), user guidance and help, consistency, flexibility, simulation fidelity, error correction/handling and robustness, sense of immersion/presence, and overall system usability. The main drawback of this test is the large number of questions that the patients are required to answer [28]: the complete questionnaire has 100 questions. This drawback is especially important if the patients involved in a rehabilitation process have neurological and/or cognitive disorders. Other simplified usability questionnaires for VRh with reasonable outcomes are described in [30,31,32,33], but the drawback of these questionnaires is that the internal consistency has not yet been validated.
Kizony et al. [34] published the Short Feedback Questionnaire (SFQ), which is a questionnaire that is related to Witmer and Singer’s Presence Questionnaire [35]. It is composed of eight questions with a five-point Likert attitude scale, and it has been used in virtual reality environments [36,37,38]. The SFQ questionnaire evaluates the user’s sense of presence, perceived difficulty of the task, and any discomfort that users may have felt during the experience. This questionnaire does not focus on VRh systems.
To our knowledge, there are no validated questionnaires for testing usability or satisfaction of virtual rehabilitation systems. A questionnaire for this purpose must have a reasonable number of questions and internal consistency reliability.
Following the definitions of usability in [2,3,4,5], usability can be divided into three components: efficiency, effectiveness, and satisfaction. Focusing on VRh, efficiency and effectiveness can usually be measured through a clinical trial. With a classical clinical trial, we can compare an experimental group (using a VRh system) with a control group (following a traditional rehabilitation program) by evaluating efficacy and comparing the recovery level of the two groups. With regard to effectiveness, we can measure, for instance, the number of sessions that each group needs to reach a certain level. However, the third component of usability, satisfaction, cannot be evaluated in the same way as efficiency and effectiveness: a reliable and consistent questionnaire (with an adequate number of questions) is necessary to measure the satisfaction of the users.
The aim of the present study is to introduce the USEQ, a user satisfaction questionnaire that is specifically designed to evaluate satisfaction with virtual rehabilitation systems, and to validate their reliability by analyzing their internal consistency.

2. USEQ: The User Satisfaction Evaluation Questionnaire

2.1. SEQ: The Suitability Evaluation Questionnaire

In [39], the SEQ was introduced as a 14-question questionnaire that is designed to test items such as satisfaction, acceptance, and security of use in virtual rehabilitation systems. The SEQ was designed by a multidisciplinary team of clinical and technical experts. Factors such as the length of the questionnaire, the type of questions to be asked and what to ask were taken into account in the design of the questionnaire. For the length of the questionnaire, the clinical experts that collaborated in the design of the SEQ estimated that a maximum of 15 questions would be an acceptable length for patients.
For the type of questions, the designers of the SEQ considered 13 questions with a five-point Likert Scale, plus an open-ended question offering patients the possibility to add comments if necessary. The SEQ has a five-point Likert Scale questions (instead of other options such as seven-point Likert Scale questions) because the authors considered five options of answers to be good enough, and, also, it is coherent with the main usability questionnaires that are currently being used: SUS [15], VRUSE [28], and SFQ [34] also use five-point Likert Scale questions.
For what to ask about, the designers of the SEQ composed the questions taking into account the usability questionnaires available and their own experience, both in the technical and in the clinical field.
A previous study evaluating the suitability of virtual rehabilitation for the elderly was carried out using the SEQ [40]. The SEQ was used to evaluate the ABAR (Active Balance Rehabilitation) system, the VRh system that is used in this study. The study presented in [40] allowed the evaluation of the perceived length and difficulty of the SEQ. In [40], the patients completed the questionnaire without any problems. None of the patients considered the questionnaire to be too long. The main drawback of SEQ is that it is composed of different dimensions; therefore, it is not possible to evaluate their internal consistency.

Source: Sensors | Free Full-Text | USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems | HTML

Figure 1. Patient interacting with the ABAR system.


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[WEB SITE] ISVR Newsletter – International Society for Virtual Rehabilitation

ISVR Newsletter

Welcome to the newsletter of the International Society for Virtual Rehabilitation! The aim of this newsletter is to help fulfill the mission of the Society by providing regular information on activities and topics of interest in Virtual Rehabilitation relevant to current and potential future members.

The newsletter consists of four regular sections: a technological and a clinical profile of experienced virtual rehabilitation researchers, a feature article and the latest news from the society. We welcome your suggestions for future topics. Please let us know your feedback on, and join our mailing list!

Date Issue
April 2017 ISVR Newsletter Issue 10
December 2016 ISVR Newsletter Issue 9
September 2016 ISVR Newsletter Issue 8
April 2016 ISVR Newsletter Issue 7
November 2015 ISVR Newsletter Issue 6
August 2015 ISVR Newsletter Issue 5
April 2015 ISVR Newsletter Issue 4
December 2014 ISVR Newsletter Issue 3
August 2014 ISVR Newsletter Issue 2
March 2014 ISVR Newsletter Issue 1

Source: ISVR Newsletter | International Society for Virtual Rehabilitation

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[Thesis] Exploring In-Home Monitoring of Rehabilitation and Creating an Authoring Tool for Physical Therapists – Full Text PDF


Physiotherapy is a key part of treatment for neurological and musculoskeletal disorders, which affect millions in the U.S. each year. Physical therapy treatments typically consist of an initial diagnostic session during which patients’ impairments are assessed and exercises are prescribed to improve the impaired functions. As part of the treatment program, exercises are often assigned to be performed at home daily. Patients return to the clinic weekly or biweekly for check-up visits during which the physical therapist reassesses their condition and makes further treatment decisions, including readjusting the exercise prescriptions.

Most physical therapists work in clinics or hospitals. When patients perform their exercises at home, physical therapists cannot supervise them and lack quantitative exercise data reflecting the patients’ exercise compliance and performance. Without this information, it is difficult for physical therapists to make informed decisions or treatment adjustments. To make informed decisions, physical therapists need to know how often patients exercise, the duration and/or repetitions of each session, exercise metrics such as the average velocities and ranges of motion for each exercise, patients’ symptom levels (e.g. pain or dizziness) before and after exercise, and what mistakes patients make.

In this thesis, I evaluate and work towards a solution to this problem. The growing ubiquity of mobile and wearable technology makes possible the development of “virtual rehabilitation assistants.” Using motion sensors such as accelerometers and gyroscopes that are embedded in a wearable device, the “assistant” can mediate between patients at home and physical therapists in the clinic. Its functions are to:

  • use motion sensors to record home exercise metrics for compliance and performance and report these metrics to physical therapists in real-time or periodically;
  • allow physical therapists and patients to quantify and see progress on a fine-grain level;
  • record symptom levels to further help physical therapists gauge the effectiveness of exercise prescriptions;
  • offer real-time mistake recognition and feedback to the patients during exercises;

One contribution of this thesis is an evaluation of the feasibility of this idea in real home settings. Because there has been little research on wearable virtual assistants in patient homes, there are many unanswered questions regarding their use and usefulness:

  • Q1. What patient in-home data could wearable virtual assistants gather to support physical therapy treatments?
  • Q2. Can patient data gathered by virtual assistants be useful to physical therapists?
  • Q3. How is this wearable in-home technology received by patients?

I sought to answer these questions by implementing and deploying a prototype called “SenseCap.” SenseCap is a small mobile device worn on a ball cap that monitors patients’ exercise movements and queries them about their symptoms. A technology probe study showed that the virtual assistant could gather important compliance, performance, and symptom data to assist physical therapists’ decision-making, and that this technology would be feasible and acceptable for in-home use by patients.

Another contribution of this thesis is the development of a tool to allow physical therapists to create and customize virtual assistants. With current technology, virtual assistants require engineering and programming efforts to design, implement, configure and deploy them. Because most physical therapists do not have access to an engineering team they and their patients would be unable to benefit from this technology. With the goal of making virtual assistants accessible to any physical therapist, I explored the following research questions:

  • Q4. Would a user-friendly rule-specification interface make it easy for physical therapists to specify correct and incorrect exercise movements directly to a computer? What are the limitations of this method of specifying exercise rules?
  • Q5. Is it possible to create a CAD-type authoring tool, based on a usable interface, that physical therapists could use to create their own customized virtual assistant for monitoring and coaching patients? What are the implementation details of such a system and the resulting virtual assistant?
  • Q6. What preferences do PTs have regarding the delivery of coaching feedback for patients?
  • Q7. What is the recognition accuracy of a virtual rehabilitation assistant created by this tool?

This dissertation research aims to improve our understanding of the barriers to rehabilitation that occur because of the invisibility of home exercise behavior, to lower these barriers by making it possible for patients to use a widely-available and easily-used wearable device that coaches and monitors them while they perform their exercises, and improve the ability of physical therapists to create an exercise regime for their patients and to learn what patients have done to perform these exercises. In doing so, treatment should be better suited to each patient and more successful.

To Continue —> Download Full Text PDF


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[ARTICLE] Visualisation of two-dimensional kinematic data from bimanual control of a commercial gaming system used in post-stroke rehabilitation – Full Text PDF


Kinematic data from two stroke participants and a healthy control were collected using a novel bimanual rehabilitation system. The system employs two customized PlayStation Move Controllers and an Eye camera to track the participants’ hand movements.

In this study, the participants played a Facebook game by symmetrically moving both hands to control the computer’s mouse cursor. The collected data were recorded during one game session, and movement distribution analysis was performed to create density plots of each participant’s hand motion in the XY plane.

This type of kinematic information that can be gathered by rehabilitation systems with motion tracking capabilities has the potential to be used by therapists to monitor and guide home-based rehabilitation programs.

Full Text PDF

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[ARTICLE] Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients


Background: The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.

Objective: To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.

Methods: The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.

Results: After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients’ performance in a similar manner.

Conclusion: Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.

via Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients: Topics in Stroke Rehabilitation: Vol 0, No 0.

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[ARTICLE] Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial



First, to evaluate the clinical effectiveness of a virtual reality-based telerehabilitation program in the balance recovery of hemiparetic individuals post-stroke in comparison to an in-clinic program; second, to compare the subjective experiences; and finally, to contrast the costs.


Single-blind randomized controlled trial.


Neurorehabilitation unit.


Chronic outpatients with stroke (N=30) with residual hemiparesis.


Twenty 45-minute training sessions with the telerehabilitation system, administered three times a week, in the clinic or in home.

Main Outcome Measures

First, Berg Balance Scale for balance assessment. Balance and gait subscales of the Performance-Oriented Mobility Assessment, and the Brunel Balance Assessment were secondary outcomes. Clinical assessments were conducted at baseline, 8 weeks (post treatment), and 12 weeks (follow-up); Second, the System Usability Scale and the Intrinsic Motivation Inventory for subjective experiences; Finally, expenses in dollars for cost.


Significant improvement in both groups from the initial to the final assessment in the Berg Balance Scale (p=0.001, η2p =0.68), in the balance (p=0.006, η2p =0.24) and gait subscales (p=0.001, η2p =0.57) of the Tinetti Performance-Oriented Mobility Assessment, and in the Brunel Balance Assessment (x2=15.0′ p=0.002; x2=21.9 p=0.001). No significant differences between groups in any balance scale, nor in the feedback questionnaires. With regards to subjective experiences, both groups considered the VR system similarly usable and motivating. The in-clinic intervention resulted in more expenses than the telerehabilitation program (654.72 $ per person).


First, virtual reality-based telerehabilitation interventions can promote the reacquisition of locomotor skills associated with balance in a similar way that in-clinic interventions, both complemented with a conventional therapy program; second, the usability and the motivation of both interventions can be similar; and finally, the telerehabilitation interventions can involve savings that vary depending on each particular scenario.

via Effectiveness, usability, and cost-benefit of a virtual reality-based telerehabilitation program for balance recovery after stroke: a randomized controlled trial – Archives of Physical Medicine and Rehabilitation.

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[VIDEO] Virtual Rehabilitation – YouTube

Dr. Grigore Burdea of Rutgers University on the development of ways to provide virtual therapy at the patient’s home and the creation of the International Society for Virtual Rehabilitation. Preduced by the Academic Channel.
View this and other programs on the Academic Channel-
For More Info Vist:

via Virtual Rehabilitation – YouTube.


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