Posts Tagged VR

[Abstract] Upper Limb Movement Modelling for Adaptive and Personalised Physical Rehabilitation in Virtual Reality – Thesis

Abstract

Stroke is one of the leading causes of disability with over three-quarters of patients experiencing an upper limb impairment varying in severity. Early, intense, and frequent physical rehabilitation is important for quicker recovery of the upper limbs and the prevention of further deterioration of their upper limb impairment. Rehabilitation begins almost immediately at the hospital. Once released from the hospital it is intended that patients continue their rehabilitation program at home supported by a community stroke team. However, there are two main barriers to rehabilitation continuing effectively at this stage. The first is limited contact with a physiotherapist or occupational therapist to guide and support an intensive rehabilitation programme. The second is that conventional rehabilitation is tough to maintain immediately after stroke due to fatigue, lack of concentration, depression and other effects. Stroke patients can find exercises monotonous and tiring, and a lack of motivation can result in patients failing to engage fully with their treatment. Lack of participation in prescribed rehabilitation exercises may affect recovery or cause deterioration of mobility.

This thesis examines the hypothesis that upper limb stroke rehabilitation can be made more accessible and enjoyable through the use of modern commercial virtual reality (VR) hardware, with personalised models of user hand motion adapted to user capability over time, and VR games with tasks that utilise natural hand gestures as input controls to execute personalised physical rehabilitation exercises. To support the investigation of this hypothesis a novel adaptive, gamebased, virtual reality (VR) rehabilitation system has been designed and developed for self-managed rehabilitation. Hands are tracked using a Leap Motion Controller, with hand movements and gestures used as in input controller for VR tasks. A user-centred design methodology was adopted, and the final version of the system was evolved through several versions and iterative testing and feedback through trials with able-bodied testers, stroke survivor volunteers, and practising clinicians.

A key finding of the research was that an adapted form of Fitts’s law, that models difficulty of reaching and touching objects in 3D interaction spaces, could be used to profile movement capability for able-bodied people and stroke patients vii in upper arm VR stroke rehabilitation. It was also found that even when Fitts’s law was less effective, that the statistics of the regression quality were still informative in profiling users. Fitts law regression statistics along with information on task performance (such as percentage of hits) could be used to adapt task difficulty or advising rest. Further, it was found that multiple regression could provide better movement capability profiles with a modified form of Fitts law to account for varying degrees of difficulty due to the angles of motion in 3D space. In addition, a novel approach was developed which profiled sectors of the 3D VR interaction space separately, rather than treat movement through the whole space as being equally difficult. This approach accounts for some stroke patients having more difficulty moving in some directions than others, e.g. up and left. Results demonstrate that this has potential but may need to be investigated further with stroke patients and with larger numbers of people.

The VR system that utilised the movement capability model was evolved over time with a user-centred design methodology, with input from able-bodied people, stroke patients, and clinicians. A final longitudinal study investigated the suitability of three bespoke games, the usability of the system over a longer time, and the effectiveness of the movement profiler and adaptive system. Throughout this experiment, the system provided informative user movement profile variations that could identify unique movement behaviour traits in individuals. Results showed that user performance varied over time and the adaptive system proved effective in changing the difficulty of the tasks for individuals over multiple sessions. The VR rehabilitation games incorporated enhanced gameplay and feedback, and users expressed enjoyment with the interactive experience. Throughout all of the experiments, users enjoyed wearing a VR headset, preferring it over a standard PC monitor. Most users subjectively felt that they were more effective in completing tasks within VR, and results from experiments provided empirical evidence to support this view. Results within this thesis support the proposal that an appropriately designed, adaptive gamebased VR system can provide an accessible, personalised and enjoyable rehabilitation system that can motivate more regular rehabilitation participation and promote improved motor function.

via Upper Limb Movement Modelling for Adaptive and Personalised Physical Rehabilitation in Virtual Reality — Ulster University

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[Abstract + References] Game Design Principles Influencing Stroke Survivor Engagement for VR-Based Upper Limb Rehabilitation: A User Experience Case Study – Proceedings

ABSTRACT

Engagement with one’s rehabilitation is crucial for stroke survivors. Serious games utilising desktop Virtual Reality could be used in rehabilitation to increase stroke survivors’ engagement. This paper discusses the results of a user experience case study that was conducted with six stroke survivors to determine which game design principles are or would be important for engaging them with a desktop VR serious games designed for the upper limb rehabilitation. The results of our study showed the game design principles that warrant further investigation are awareness, feedback, interactivity, flow and challenge; and also important to a great extent are attention, involvement, motivation, effort, clear instructions, usability, interest, psychological absorption, purpose and a first-person view.

References

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via Game Design Principles Influencing Stroke Survivor Engagement for VR-Based Upper Limb Rehabilitation | Proceedings of the 31st Australian Conference on Human-Computer-Interaction

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[Abstract] Examining the potential of virtual reality to deliver remote rehabilitation

Abstract

Remote workers are particularly prone to mental health problems (Bowers et al., 2018). Unfortunately, it is often difficult for them to access the quality psychological help that they need. As a result, psychological treatment is increasingly being delivered to remote workers via telehealth (videoconferencing and telephone calls). However, the perceived remoteness of the therapist during such treatments can greatly hinder progress. This project examined the potential of virtual reality (VR) to deliver psychotherapy to workers located in remote locations (since it can make people separated by great distances feel that they are “present” in the same virtual space). The study compared the experiences of 30 ‘clients’ who participated in both VR and Skype-based mock counselling sessions (delivered by trained psychotherapists). Overall, VR was found to outperform Skype:

1) as a therapeutic tool,

2) in terms of the perceived realism of the session; and

3), in terms of the degree of presence it generated in the clients and the therapists.

Clients did not report feeling sick or stressed when using VR and found it as easy to use as Skype. These study findings (based on formal questionnaire data) were also confirmed by interviews with both the therapists and clients.

Highlights

  • This project examined the potential of virtual reality to deliver psychotherapy to workers located in remote locations.
  • The study compares the experiences of 30 ‘clients’ who participated in both VR and Skype-based mock counselling.
  • VR was found to outperform Skype: as a therapeutic tool, perceived realism of the session; and the degree of presence.
  • Clients did not report feeling sick or stressed when using VR and found it as easy to use as Skype.

via Examining the potential of virtual reality to deliver remote rehabilitation – ScienceDirect

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[ARTICLE] Mechanisms Of Functional Adaptation Of Post Stroke Patients During Upper Limb Rehabilitation – Full Text

INTRODUCTION

Task oriented approach training of the patient with the arm weight unloading with feedback through the mirror.

Figure 1. Arm weight support training

Stroke is a leading cause of disability of the adult population worldwide. Successful recovery of upper limb motor function occurs only in 20% of cases [1]. Upper limb motor recovery is a most challenging goal, due to lack of patient’s motivation, training intensity and pathological synergy which is very difficult to correct using traditional methods. Poststroke upper limb paresis, spasticity and caused by them pathological synergies is the main problem on the way to daily living activities recovery. The problem of pathological synergies correction and transformation in rehabilitation practice are linked with the complexity of the required motor training approach [2]. A combination of cost-efficient, task-oriented, isolated and complex movement training with biofeedback is required to make synergy a compensatory mechanism for daily activities instead of pathological synkinesia.A promising but insufficiently studied method is virtual reality (VR), as well as its combination with other techniques like arm weight support training. Motor training in virtual reality (VR) with arm weight support creates the necessary facilitated environment for motor skills relearning [3].

MATERIALS AND METHODS.

45 patients (27 males and 18 females) with medium age 55 [45;65] years were enrolled in this study. All patients had one supratentorial lesion due to ischemic or hemorrhagic stroke (confirmed by MRI). Medium stroke age was 7 [4;12] months. All patients had moderate to severe upper limb paresis measured by Medical Research Council Scale for Muscle Strength and Fugl-Meyer assessment of physical performance (FMAS) upper extremity subscore 45 [35;55]. All patients received 2 weeks of a rehabilitation course, 5 days per week, 45 minutes daily.

Upper limb exoskeleton with weight support system and functional tasks in virtual environment.

Figure 2. Virtual reality with arm weight support training

Main group (n=25)  received 10 training sessions 45  minutes each on Armeo Spring system with separately adjusted weight support for shoulder and forearm and VR imitation of daily living activities such as reaching and grasping. The session includes 10 games like exercises and consistent increase of degrees of freedom from shoulder to the wrist. This condition allows teaching the patient voluntarily prevent pathologic synergy while performing a motor task.

The control group (n=20) received conventional therapy sessions with arm weight support (a system of pulleys), visual feedback (via mirror) and comparable set of tasks – reaching, grasping, manipulating objects.

The reaching test paradigm for motion analysis.

Figure 3. The reaching test.

For primary outcome assessment was used Fugl-Meyer assessment scale for upper limb, Action Research Arm Test (ARAT), Ashworth scale and Frenchay arm test. For motion analysis was used Russian Motion Capture System (Biosoft 3D). The paradigm for biomechanical analysis was presented with the functional reaching test. The reaching test was performed before and after the training course. Sitting at the table patient had to reach and grasp an empty glass located in front of him on the distance of extended healthy arm. For primary outcome were chosen reaching trajectory and arm kinematics, but patients were instructed to focus on the grasping movement to keep reaching movement more automatic. Normal reaching pattern was investigated on 10 healthy volunteers.

RESULTS.

FM and ARAT results on the main and control group before and after rehabilitation course.FM and ARAT results on the main and control group before and after rehabilitation course.
Figure 4. FM and ARAT scales before and after rehabilitation.
Table 1. Time of reaching test.
  Before rehabilitation After rehabilitation p-level
Moderate paresis, Ме [25%;75%] 1,5 [1,24; 1,71] 1,26 [0,9; 1,62] p=0,045
Severe paresis, Ме [25%;75%] 2,25 [1,65; 3,76] 2,66 [1,11; 3,05] p=0,043
Normal, Ме [25%;75%] 0,96 [0,87; 1,16]

In our study, the clinical assessment (FM and ARAT scales) showed that paretic hand recovery was found more in patients with moderate and severe paresis. Statistically significant improvements in the arm motor function (FMAS) were found in both groups. However, subsection analysis revealed that the patients of the main group compared to the control group had a more significant improvement in wrist movements. In ARAT was found that in patients with moderate paresis significant improvements occur in both main and control groups. In patients with severe paresis, improvements were observed only in the main group.

However, after motion analysis, a different stereotype of movement recovery was found in different groups of patients. In patients with severe paresis, an increase in the deviation of the movement pattern from the physiological movement was observed. At the same time, the normalization of the motor pattern was noted in patients with moderate paresis.

Table 2. Kinematics parameters in sever hand paresis.
Movement Before rehabilitation, Ме [25%;75%] After rehabilitation, Ме [25%;75%] p-level
Elbow extension 124 [116;126] 112 [109; 125] 0,01
Shoulder  flexion 36 [27; 41] 21 [20; 32] 0,02
Shoulder abduction 10 [10; 17] 19 [18; 22] 0,04
Velocity shoulder abduction 17 [13; 20] 48 [39; 65] 0,02
Velocity elbow extension 39 [26; 69] 29 [18,39] 0,02

The time of reaching test execution in patients with severe paresis after rehabilitation was longer than before and exceeded the normal time more than twice. Curiously,  these changes in patients with severe paresis were associated with an increase in functionality in the paretic arm (p>0,05).

The kinematic parameters such as elbow extension, shoulder abduction and angular velocity in shoulder and elbow joints after rehabilitation were worsened. After a rehabilitation course was founded decreasing of the angular velocity of the elbow joint extension, increasing of the angular velocity of the shoulder joint, decreasing of the flexion in the shoulder joint and angular speed of the elbow joint extension.

The analysis of trunk movements in severe paresis patients was shown that after rehabilitation course the trunk compensatory strategy was increased (trunk was mowed forward when patient reach the glass). These changes were associated with an increase in functionality in the paretic arm (p>0,05).

CONCLUSIONS.

Table 3. Body displacement in reaching test.
Shoulder displacement Before rehabilitation, Ме [25%;75%] After rehabilitation, Ме [25%;75%]
Healthy shoulder 23 [19,8; 57,44] 66 [49;81]
Paretic shoulder 169 [88; 178] 215 [162; 229]

If we summarized data of clinical and biomechanical parameters we see, that patients with severe paresis formed the new compensatory strategy of motion. Because of the significant changes in functional recovery are combined with worsened of biomechanical parameters.

It is believed that it is the resistance to pathological synergies and the forced training in physiological movement is the most effective method. However, correction of pathological synergies allows developing the most energy-efficient stereotype of movements for patients with regard to their individual capabilities. Combined VR and weight support training can be more effective to restore the impaired motor function after stroke than conventional weight support training. This approach contributes to the motor pattern reorganization through biomechanical and visual feedback, projected into the virtual space.

REFERENCES

[1] Beebe J.A., Lang C.E. Active range of motion predicts upper extremity function 3 months after stroke. Stroke. 2009 40 (5): 1772–1779.

[2] Cirstea M.C., Levin M.F. Compensatory strategies for reaching in stroke. Brain. 2000 123 (5): 940–953.

[3] Laver K.E., George S.,J.E. Thomas, M. Deutsch. Crotty Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev.  2015 12 (2): 83.

via Mechanisms Of Functional Adaptation Of Post Stroke Patients During Upper Limb Rehabilitation.

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[NEWS] Virtual Reality is a Cool Rehab Tool, But Ensure it is ‘Thoughtfully Applied’ to Each Patient

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VirtualReality

 

Virtual reality can help patients with movement issues, but only if it is done correctly and tailored to individual patients, says Robert Ferguson, a neurorehabilitation clinical specialist who focuses on such therapy.

Clinicians “are reading the research and they are applying it wrong,” he explains, in Medscape Medical News. “The evidence suggests that it’s not about the virtual reality, it’s about how you use the research. You need to know how the equipment and programs work so you know how to modify them for your individual patient.”

A more methodological approach to virtual reality therapy is needed.

“It shouldn’t be that we just throw someone into a virtual reality environment,” states Nancy Baker, ScD, an occupational therapist at Tufts University in Medford, Mass. “If you want it to be therapeutic, it has to be thoughtfully applied.”

Ferguson, who manages the stroke rehabilitation program at the University of Michigan Health System in Ann Arbor, presented a number of cases during his talk on virtual reality and occupational therapy recently at the American College of Rheumatology 2019 Annual Meeting.

He described asking a stroke survivor who appeared to be unable to handle problems on the left side of her body to “climb” a virtual reality rock wall. Ferguson watched as the patient sat in a chair and moved her arms in a climbing motion in response to the computer-generated field in front of her.

At first, the woman only seemed to climb to her right. But as she learned the rules of the game, Ferguson manipulated the rock wall she was seeing, ultimately encouraging her to explore the wall to her left. By the end of the session, her brain — which until then had ignored problems on the left side of her body — had led her to “climb” the wall to her left, per Medscape.

Another patient, an avid bowhunter, was trying to regain balance after a leg amputation. Ferguson constructed a virtual reality game in which the patient had to defend a castle using a bow and arrows.

“He told me, ‘it’s the hardest therapy I’ve ever done, but it’s also the most fun’,” Ferguson shares.

“The thing about immersive virtual reality environments is that we need to connect it to a goal,” he told the audience. “The virtual reality is not the treatment; it’s an adjunct treatment to what you’re doing. You need to know what your goal is and how you are going to get the patient to that goal.”

“When we use immersive virtual reality — the kind of virtual reality that makes people feel as though they are in the virtual world — meta-analyses and systemic reviews suggest that people are more engaged and more motivated,” Ferguson tells Medscape Medical News.

“We are seeing some immediate and longer-term improvements in both cognitive performance and motor function, but we are not sure how long-lasting those effects are,” he adds.

Baker, who focuses on musculoskeletal disorders and chronic pain, shares that she has been working to launch research programs looking at the effect virtual reality can have in therapy.

“The thing about chronic pain is that people lose the ability to do the things they love to do, and it can be hard to motivate them in occupational therapy,” she continues. “In a virtual reality environment, you can put them in a real-seeming space, so they can do the things they like to do.”

Research to this point indicates that virtual reality is a reasonable addition to a comprehensive rehabilitation program, as long as therapists take into account a patient’s goals, abilities, and preferences, Ferguson concludes.

“The problem is that significant heterogeneity and small study sizes limit the power of the conclusions,” he adds. “That’s why we need more research.”

[Source: Medscape Medical News]

 

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[ARTICLE] Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis – Full Text

Abstract

Background. Despite the rise of virtual reality (VR)-based interventions in stroke rehabilitation over the past decade, no consensus has been reached on its efficacy. This ostensibly puzzling outcome might not be that surprising given that VR is intrinsically neutral to its use—that is, an intervention is effective because of its ability to mobilize recovery mechanisms, not its technology. As VR systems specifically built for rehabilitation might capitalize better on the advantages of technology to implement neuroscientifically grounded protocols, they might be more effective than those designed for recreational gaming.

Objective. We evaluate the efficacy of specific VR (SVR) and nonspecific VR (NSVR) systems for rehabilitating upper-limb function and activity after stroke. Methods. We conducted a systematic search for randomized controlled trials with adult stroke patients to analyze the effect of SVR or NSVR systems versus conventional therapy (CT).

Results. We identified 30 studies including 1473 patients. SVR showed a significant impact on body function (standardized mean difference [SMD] = 0.23; 95% CI = 0.10 to 0.36; P = .0007) versus CT, whereas NSVR did not (SMD = 0.16; 95% CI = −0.14 to 0.47; P = .30). This result was replicated in activity measures.

Conclusions. Our results suggest that SVR systems are more beneficial than CT for upper-limb recovery, whereas NSVR systems are not. Additionally, we identified 6 principles of neurorehabilitation that are shared across SVR systems and are possibly responsible for their positive effect. These findings may disambiguate the contradictory results found in the current literature.

Introduction

Better medical treatments in the acute phase after stroke have increased survival and with that the number of patients needing rehabilitation with an associated increased burden on the health care system. Novel technologies have sought to meet this increased rehabilitation demand and to potentially allow patients to continue rehabilitation at home after they leave the hospital. Also, technology has the potential to gather massive and detailed data (eg, kinematic and performance data) that might be useful in understanding recovery after stroke better, improving the quality of diagnostic tools and developing more successful treatment approaches. Given these promises, several studies and meta-analyses have evaluated the effectiveness of technologies that use virtual reality (VR) in stroke rehabilitation. In a first review, Crosbie et al analyzed 6 studies that used VR to provide upper-limb rehabilitation. Although they found a positive effect, they concluded that the evidence was only weak to moderate given the low quality of the research. A later meta-analysis analyzing 5 randomized controlled trials (RCTs) and 7 observational studies suggested a positive effect on a patient’s upper-limb function after training. Another meta-analysis of 26 studies by Lohse et al, which compared specific VR (SVR) systems with commercial VR games, found a significant benefit for SVR systems as compared with conventional therapy (CT) in both body function and activity but not between the 2 types of systems. This study, however, included a variety of systems that would treat upper-limb, lower-limb, and cognitive deficits. Saywell et al analyzed 30 “play-based” interventions, such as VR systems including commercial gaming consoles, rehabilitation tools, and robot-assisted systems. They found a significant effect of play-based versus control interventions in dose-matched studies in the Fugl-Meyer Assessment of the Upper Extremity (FM-UE). In contrast, a more recent large-scale analysis of a study with Nintendo Wii–based video games, including 121 patients concluded that recreational activities are as effective as VR. A later review evaluated 22 randomized and quasi–randomized controlled studies and concluded that there is no evidence that the use of VR and interactive video gaming is more beneficial in improving arm function than CT. In all, 31% of the included studies tested nonspecific VR (NSVR) systems (Nintendo Wii, Microsoft Xbox Kinect, Sony PlayStation EyeToy). Hence, although VR-based interventions have been in use for almost 2 decades, their benefit for functional recovery, especially for the upper limb, remains unknown. Possibly, these contradictory results indicate that, at present, studies are too few or too small and/or the recruited participants too variable to be conclusive. However, alternative conclusions can be drawn. First, VR is an umbrella term. Studies comparing its impact often include heterogeneous systems or technologies, customized or noncustomized for stroke treatment, addressing a broad range of disabilities. However, effectiveness can only be investigated if similar systems that rehabilitate the same impairment are contrasted. This has been achieved by meta-analyses that investigated VR-based interventions for the lower limb, concluding that VR systems are more effective in improving balance or gait than CT. Second, a clear understanding of the “active ingredients” that should make VR interventions effective in promoting recovery is missing. Therapeutic advantages of VR identified in current meta-analyses are that it might apply principles relevant to neuroplasticity,, such as providing goal-oriented tasks,, increasing repetition and dosage,, providing therapists and patients with additional feedback,,, and allowing to adjust task difficulty. In addition, it has been suggested that the use of VR increases patient motivation, enjoyment,, and engagement; makes intensive task-relevant training more interesting,; and offers enriched environments. Although motivational aspects are important in the rehabilitation process because they possibly increase adherence, their contribution to recovery is difficult to quantify because it relies on patients’ subjective evaluation., Rehabilitation methods, whether VR or not, however, need to be objectively beneficial in increasing the patient’s functional ability. Hence, an enormous effort has been expended to identify principles of neurorehabilitation that enhance motor learning and recovery. Consequently, an effective VR system should besides be motivating, also augment CT by applying these principles in the design. Following this argument, we advance the hypothesis that custom-made VR rehabilitation systems might have incorporated these principles, unlike off-the-shelf VR tools, because they were created for recreational purposes. Combining the effects of both approaches in one analysis might, thus, mask their real impact on recovery. Again, in the rehabilitation of the lower limb, this effect has been observed. Two meta-analyses investigating the effect of using commercial VR systems for gait and balance training did not find a superior effect, which contradicts the conclusions of the other systematic reviews. In upper-limb rehabilitation, this question has not been properly addressed until the most recent review by Aminov et al. However, there are several flaws in the method applied that could invalidate the results they found. Specifically, studies were included regardless of their quality, and it is not clear which outcome measurements were taken for the analysis according to the World Health Organization’s International Classification of Function, Disability, and Health (ICF-WHO). In addition, a specifically designed rehabilitation system (Interactive Rehabilitation Exercise [IREX]) was misclassified as an off-the-shelf VR tool. Because their search concluded in June 2017, the more recent evidence is missing. We decided to address these issues by conducting a well-controlled meta-analysis that focuses only on RCTs that use VR technologies for the recovery of the upper limb after stroke. We analyze the effect of VR systems specifically built for rehabilitation (ie, SVR systems) and off-the-shelf systems (ie, NSVR commercial systems) against CT according to the ICF-WHO categories. Also, we extracted 11 principles of motor learning and recovery from established literature that could act as “active ingredients” in the protocols of effective VR systems. Through a content analysis, we identified which principles are present in the included studies and compared their presence between SVR and NSVR systems. We hypothesized, first, that SVR systems might be more effective than NSVR systems as compared with CT in the recovery of upper-limb movement and, second, that this superior effect might be a result of the specific principles included in SVR systems.[…]

 

Continue —->  Effect of Specific Over Nonspecific VR-Based Rehabilitation on Poststroke Motor Recovery: A Systematic Meta-analysis

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[Abstract] Wearable Hand Exoskeleton Systems for Virtual Reality and Rehabilitation

Abstract

The aim is to overcome the limitations of conventional systems in terms of both wearability and portability. As the hand receives diverse physical information and manipulates different type of objects, conventional systems contain many sensors and actuators, and are both large and heavy. Thus, hand exoskeleton systems exhibiting high wearability and portability while measuring finger motions and delivering forces would be highly valuable. For VR hand exoskeleton systems, a wearable hand exoskeleton system with force-controllable actuator modules was developed to ensure free finger motion and force mode control. The linkage structure ensures motion with three degrees of freedom (DOF) and provides a large fingertip workspace; the finger postures assumed when interacting with objects are appropriate. A series elastic actuator (SEA) with an actuator and an elastic element was used to fabricate compact actuator modules. Actuator friction was eliminated using a friction compensation algorithm. A proportional differential (PD) controller, optimized by a linear quadratic (LQ) method featuring a disturbance observer (DOB), was used to ensure accurate force mode control even during motion. The force control performance of the actuator module was verified in force generation experiments including stationary and arbitrary end-effector motions. The forces applied to the fingertips, which are the principal parts of the hand that interact with objects, were kinematically analyzed via both simulations and experiments. To overcome the weak point of previous system, a wearable hand exoskeleton system featuring finger motion measurement and force feedback was developed and evaluated in terms of user experience (UX). The finger structures for the thumb, index, and middle fingers, which play important roles when grasping objects, satisfy full range of motion (ROM). The system estimates all joint angles of these three digits using a dedicated algorithm; measurement accuracy was experimentally evaluated to verify system performance. The UX performance was evaluated by 15 undergraduate students who completed questionnaires assessing usability and utilitarian value following trials conducted in the laboratory. All subjects were highly satisfied with both usability and the utilitarian nature of the system, not only because control and feedback were intuitive but also because performance was accurate. For rehabilitation, a highly portable exoskeleton featuring flexion/extension finger exercises was developed. The exoskeleton features two four-bar linkages reflecting the natural metacarpophalangeal (MCP) and proximal phalangeal (PIP) joint angles. During optimization, the design parameters were adjusted to reflect normal finger trajectories, which vary by finger length and finger joint ROM. To allow for passive physical impedance, a spring was installed to generate the forces that guided the fingers. The moments transmitted to the MCP and PIP joints were estimated via finite element method (FEM) analysis and the cross-sectional areas of the links were manually designed by reference to the expected joint moments. Finger motion and force distribution experiments verified that the system guided the fingers effectively, allowed for the desired finger motions, and distributed the required moments to the joints (as revealed by FEM analysis).; This thesis reports the development of hand exoskeleton systems, for use in virtual reality (VR) environments and for hand rehabilitation

via ScholarWorks: Wearable Hand Exoskeleton Systems for Virtual Reality and Rehabilitation

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[Abstract] The influence of virtual reality on rehabilitation of upper limbs and gait after stroke: a systematic review – Full Text PDF

Abstract

Stroke is the leading cause of functional disability in adults. Its neurovascular origin and injury location indicates the possible functional consequences. Virtual rehabilitation (VR) using patient’s motion control is a new technological tool for conventional rehabilitation, allowing patterns of movements in varied environments, involving the patient in therapy through the playful components offered by VR applications. The objective of this systematic review is to collect data regarding the influence promoted by VR in upper limb and hemiparetic gait. Full articles published between 2009 and 2015 in english were searched and selected in PubMed, Cochrane and Pedro databases. Eleven articles included (5 for VR and upper limbs; 4 for VR, gait and balance; and 2 for VR and neural mechanisms). The articles included demonstrate efficacy in VR treatment in hemiparetic patients in the variables analyzed.

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via The influence of virtual reality on rehabilitation of upper limbs and gait after stroke: a systematic review | Journal of Innovation and Healthcare Management

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[Abstract] A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors

Abstract

BACKGROUND:

Stroke is a leading cause of death and disability in the Western world, and leads to impaired balance and mobility.

OBJECTIVE:

To investigate the feasibility of using a Virtual Reality-based dual task of an upper extremity while treadmill walking, to improve gait and functional balance performance of chronic poststroke survivors.

METHODS:

Twenty-two individuals chronic poststroke participated in the study, and were divided into 2 groups (each group performing an 8-session exercise program): 11 participated in dual-task walking (DTW), and the other 11 participated in single-task treadmill walking (TMW). The study was a randomized controlled trial, with assessors blinded to the participants’ allocated group. Measurements were conducted at pretest, post-test, and follow-up. Outcome measures included: the 10-m walking test (10 mW), Timed Up and Go (TUG), the Functional Reach Test (FRT), the Lateral Reach Test Left/Right (LRT-L/R); the Activities-specific Balance Confidence (ABC) scale, and the Berg Balance Scale(BBS).

RESULTS:

Improvements were observed in balance variables: BBS, FRT, LRT-L/R, (P < .01) favoring the DTW group; in gait variables: 10 mW time, also favoring the DTW group (P < .05); and the ABC scale (P < .01). No changes for interaction were observed in the TUG.

CONCLUSIONS:

The results of this study demonstrate the potential of VR-based DTW to improve walking and balance in people after stroke; thus, it is suggested to combine training sessions that require the performance of multiple tasks at the same time.

 

via A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors. – PubMed – NCBI

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[Editorial] Virtual reality in stroke rehabilitation: virtual results or real values?

1Laboratory for the Study of Mind and Action in Rehabilitation Technologies, IRCCS Fondazione Santa Lucia, Rome, Italy.

Seven Capital Devices for the Future of Stroke Rehabilitation was the title of a review published seven years ago by our group, in which we analyzed the most promising technologies for neurorehabilitation1. They were: robots, virtual reality, brain computer interfaces, wearable devices for human movement analysis, noninvasive brain stimulators (such as transcranial direct current stimulation and transcranial magnetic stimulation), neuroprostheses, and computers/tablets for electronic clinical records and planning1.

Seven years later, we can now take stock of the situation. We must be honest: on one hand, we can surely affirm that the above-proposed technologies have really been the most developed and applied in these last years, but on the other hand, we should say that questions about their efficacy are still open, as reported by Cochrane reviews highlighting the need of further studies2,3.

However, every month, new studies claiming the efficacy of technological rehabilitation are published, and this continuously-growing amount of literature reveals the lack of definitive proof; otherwise all these studies would have been unnecessary. This “efficacy paradox” could potentially give us many more years of research without any conclusive results, especially because the more technology is adaptable to the needs of the patients (as clinicians want), the less the protocol to test the efficacy of that technology is standardizable (as researchers want)4.

Furthermore, the pressure on researchers to publish, the optimism about the use of technologies of some clinicians, the hopes of patients and their caregivers about new miraculous approaches, and the commercial interests of technology companies, may lead to some misleading claims in the mass media. For example, in many scientific and journalistic papers, some electromechanical devices without any intelligence on board are improperly called “robots”, nonimmersive video games are called “virtual reality”, the expressions “mind power” or “force of thought” are associated with brain computer interfaces1. Market analysts expect that the greatest developing field for robots in the next five years will be rehabilitation, compared with other fields5. Conversely, computers, the Internet and smartphones have changed our lives and were not directly developed for rehabilitation, but this clinical field may benefit from all the developed know-how. Virtual reality should be differentiated by video games, referring to a high-end user-computer interface involving real-time stimulation based on the three “I’s”: immersive experience, interaction, and imagination6.

In this scenario, the recent study by Ogun and colleagues clearly shows all the potentials of using a Leap Motion controller interfaced with 3D immersive virtual reality to improve the upper extremity functions in patients with ischemic stroke7. The Leap Motion controller is an optical tracking system including three infrared light emitters and two infrared cameras for tracking hand and finger kinematics, interfacing them with a virtual environment developed as a human-computer interface. In 2014, our group published the first feasibility pilot study proposing the use of Leap Motion in neurorehabilitation, noting its advantageous features: it is precise, markerless, low-cost, small, and easy to use8.

Ogun and colleagues have confirmed our intuition: they found that virtual reality rehabilitation guided by a Leap Motion controller appeared to be effective in improving upper extremity function and self-care skills (but not functional independence), more than conventional therapy, in a wide sample of patients7.

Many studies have reported that the sense of presence, of body ownership and agency elicited by virtual reality are similar to those in the real environment, and daily life activities have been replicated in virtual environments for training patients. But what is the real value of virtual reality in rehabilitation if it is just a replication of a real environment? Virtual reality can also elicit amusement, arousal and valence, even more than in the real environment, as happens in virtual reality-based video games. Amusement can improve participation, arousal can improve brain activities, valence can improve learning9. It seems to be time for a generation of amusing and immersive virtual reality for improving real outcomes in neurorehabilitation.

REFERENCES

1. Iosa M, Morone G, Fusco A, Bragoni M, Coiro P, Multari M, et al. Seven capital devices for the future of stroke rehabilitation. Stroke Res Treat. 2012;2012:187965. https://doi.org/10.1155/2012/187965 [ Links ]

2. Mehrholz J, Pohl M, Platz T, Kugler J, Elsner B. Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database Syst Rev. 2018 Sep;9:CD006876. https://doi.org/10.1002/14651858.CD006876.pub5 [ Links ]

3. Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017 Nov;11:CD008349. https://doi.org/10.1002/14651858.CD008349.pub4 [ Links ]

4. Iosa M, Morone G, Cherubini A, Paolucci S. The Three laws of neurorobotics: a review on what neurorehabilitation robots should do for patients and clinicians. J Med Biol Eng. 2016;36(1):1–11. https://doi.org/10.1007/s40846-016-0115-2 [ Links ]

5. Ugalmugale S, Mupid S. Healthcare assistive robot market size by product. City: Global Market Insights, 2017. [ Links ]

6. Burdea GC, Coiffet P. Virtual reality technology. 2nd ed. Hoboken, NJ: John Wiley & Sons; 2003. [ Links ]

7. Ögün1 MN, Kurul R, Yaşar MF, Turkoglu SA, Avcı S, Yildiz N. Effect of leap motion-based 3D immersive virtual reality usage on upper extremity function in ischemic stroke patients. Arq Neuropsiquiatr 2019;77(10):681-88. https://doi.org/10.1590/0004-282X20190129 [ Links ]

8. Iosa M, Morone G, Fusco A, Castagnoli M, Fusco FR, Pratesi L, et al. Leap motion controlled videogame-based therapy for rehabilitation of elderly patients with subacute stroke: a feasibility pilot study. Top Stroke Rehabil. 2015 Aug;22(4):306–16. https://doi.org/10.1179/1074935714Z.0000000036 [ Links ]

9. Tieri G, Morone G, Paolucci S, Iosa M. Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies. Expert Rev Med Devices. 2018 Feb;15(2):107–17. https://doi.org/10.1080/17434440.2018.1425613 [ Links ]

 

via Virtual reality in stroke rehabilitation: virtual results or real values?

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