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[ARTICLE] Efficacy and Brain Imaging Correlates of an Immersive Motor Imagery BCI-Driven VR System for Upper Limb Motor Rehabilitation: A Clinical Case Report – Full Text

To maximize brain plasticity after stroke, a plethora of rehabilitation strategies have been explored. These include the use of intensive motor training, motor-imagery (MI), and action-observation (AO). Growing evidence of the positive impact of virtual reality (VR) techniques on recovery following stroke has been shown. However, most VR tools are designed to exploit active movement, and hence patients with low level of motor control cannot fully benefit from them. Consequently, the idea of directly training the central nervous system has been promoted by utilizing MI with electroencephalography (EEG)-based brain-computer interfaces (BCIs). To date, detailed information on which VR strategies lead to successful functional recovery is still largely missing and very little is known on how to optimally integrate EEG-based BCIs and VR paradigms for stroke rehabilitation. The purpose of this study was to examine the efficacy of an EEG-based BCI-VR system using a MI paradigm for post-stroke upper limb rehabilitation on functional assessments, and related changes in MI ability and brain imaging. To achieve this, a 60 years old male chronic stroke patient was recruited. The patient underwent a 3-week intervention in a clinical environment, resulting in 10 BCI-VR training sessions. The patient was assessed before and after intervention, as well as on a one-month follow-up, in terms of clinical scales and brain imaging using functional MRI (fMRI). Consistent with prior research, we found important improvements in upper extremity scores (Fugl-Meyer) and identified increases in brain activation measured by fMRI that suggest neuroplastic changes in brain motor networks. This study expands on the current body of evidence, as more data are needed on the effect of this type of interventions not only on functional improvement but also on the effect of the intervention on plasticity through brain imaging.

Introduction

Worldwide, stroke is a leading cause of adult long-term disability (Mozaffarian et al., 2015). From those who survive, an increased number is suffering with severe cognitive and motor impairments, resulting in loss of independence in their daily life such as self-care tasks and participation in social activities (Miller et al., 2010). Rehabilitation following stroke is a multidisciplinary approach to disability which focuses on recovery of independence. There is increasing evidence that chronic stoke patients maintain brain plasticity, meaning that there is still potential for additional recovery (Page et al., 2004). Traditional motor rehabilitation is applied through physical therapy and/or occupational therapy. Current approaches of motor rehabilitation include functional training, strengthening exercises, and range of movement exercises. In addition, techniques based on postural control, stages of motor learning, and movement patterns have been proposed such as in the Bobath concept and Bunnstrom approach (amongst others) (Bobath, 1990). After patients complete subacute rehabilitation programs, many still show significant upper limb motor impairment. This has important functional implications that ultimately reduce their quality of life. Therefore, alternative methods to maximize brain plasticity after stroke need to be developed.

So far, there is growing evidence that action observation (AO) (Celnik et al., 2008) and motor imagery (MI) improve motor function (Mizuguchi and Kanosue, 2017) but techniques based on this paradigm are not widespread in clinical settings. As motor recovery is a learning process, the potential of MI as a training paradigm relies on the availability of an efficient feedback system. To date, a number of studies have demonstrated the positive impact of virtual-reality (VR) based on neuroscientific grounds on recovery, with proven effectiveness in the stroke population (Bermúdez i Badia et al., 2016). However, patients with no active movement cannot benefit from current VR tools due to low range of motion, pain, fatigue, etc. (Trompetto et al., 2014). Consequently, the idea of directly training the central nervous system was promoted by establishing an alternative pathway between the user’s brain and a computer system.

This is possible by using electroencephalography (EEG)-based Brain-Computer Interfaces (BCIs), since they can provide an alternative non-muscular channel for communication and control to the external world (Wolpaw et al., 2002), while they could also provide a cost-effective solution for training (Vourvopoulos and Bermúdez, 2016b). In rehabilitation, BCIs could offer a unique tool for rehabilitation since they can stimulate neural networks through the activation of mirror neurons (Rizzolatti and Craighero, 2004) by means of action-observation (Kim et al., 2016), motor-intent and motor-imagery (Neuper et al., 2009), that could potentially lead to post-stroke motor recovery. Thus, BCIs could provide a backdoor to the activation of motor neural circuits that are not stimulated through traditional rehabilitation techniques.

In EEG-based BCI systems for motor rehabilitation, Alpha (8–12 Hz) and Beta (12–30 Hz) EEG rhythms are utilized since they are related to motor planning and execution (McFarland et al., 2000). During a motor attempt or motor imagery, the temporal pattern of the Alpha rhythms desynchronizes. This rhythm is also named Rolandic Mu-rhythm or the sensorimotor rhythm (SMR) because of its localization over the sensorimotor cortices. Mu-rhythms are considered indirect indications of functioning of the mirror neuron system and general sensorimotor activity (Kropotov, 2016). These are often detected together with Beta rhythm changes in the form of an event-related desynchronization (ERD) when a motor action is executed (Pfurtscheller and Lopes da Silva, 1999). These EEG patterns are primarily detected during task-based EEG (e.g., when the participant is actively moving or imagining movement) and they are of high importance in MI-BCIs for motor rehabilitation.

A meta-analysis of nine studies (combined N = 235, sample size variation 14 to 47) evaluated the clinical effectiveness of BCI-based rehabilitation of patients with post-stroke hemiparesis/hemiplegia and concluded that BCI technology could be effective compared to conventional treatment (Cervera et al., 2018). This included ischemic and hemorrhagic stroke in both subacute and chronic stages of stoke, between 2 to 8 weeks. Moreover, there is evidence that BCI-based rehabilitation promotes long-lasting improvements in motor function of chronic stroke patients with severe paresis (Ramos-Murguialday et al., 2019), while overall BCI’s are starting to prove their efficacy as rehabilitative technologies in patients with severe motor impairments (Chaudhary et al., 2016).

The feedback modalities used for BCI motor rehabilitation include: non-embodied simple two-dimensional tariffs on a screen (Prasad et al., 2010Mihara et al., 2013), embodied avatar representation of the patient on a screen or with augmented reality (Holper et al., 2010Pichiorri et al., 2015), neuromuscular electrical stimulation (NMES) (Kim et al., 2016Biasiucci et al., 2018). and robotic exoskeletal orthotic movement facilitation (Ramos-Murguialday et al., 2013Várkuti et al., 2013Ang et al., 2015). In addition, it has been shown that multimodal feedback lead to a significantly better performance in motor-imagery (Sollfrank et al., 2016) but also multimodal feedback combined with motor-priming, (Vourvopoulos and Bermúdez, 2016a). However, there is no evidence which modalities are more efficient in stroke rehabilitation are.

Taking into account all previous findings in the effects of multimodal feedback in MI training, the purpose of this case study is to examine the effect of the MI paradigm as a treatment for post-stroke upper limb motor dysfunction using the NeuRow BCI-VR system. This is achieved through the acquisition of clinical scales, dynamics of EEG during the BCI treatment, and brain activation as measured by functional MRI (fMRI). NeuRow is an immersive VR environment for MI-BCI training that uses an embodied avatar representation of the patient arms and haptic feedback. The combination of MI-BCIs with VR can reinforce activation of motor brain areas, by promoting the illusion of physical movement and the sense of embodiment in VR (Slater, 2017), and hence further engaging specific neural networks and mobilizing the desired neuroplastic changes. Virtual representation of body parts paves the way to include action observation during treatment. Moreover, haptic feedback is added since a combination of feedback modalities could prove to be more effective in terms of motor-learning (Sigrist et al., 2013). Therefore, the target of this system is to be used by patients with low or no levels of motor control. With this integrated BCI-VR approach, severe cases of stroke survivors may be admitted to a VR rehabilitation program, complementing traditional treatment.

Methodology

Patient Profile

In this pilot study we recruited a 60 years old male patient with left hemiparesis following cerebral infarct in the right temporoparietal region 10 months before. The participant had corrected vision through eyewear, he had 4 years of schooling and his experience with computers was reported as low. Moreover, the patient was on a low dose of diazepam (5 mg at night to help sleep), dual antiplatelet therapy, anti-hypertensive drug and metformin. Hemiparesis was associated with reduced dexterity and fine motor function; however, sensitivity was not affected. Other sequelae of the stroke included hemiparetic gait and dysarthria. Moreover, a mild cognitive impairment was identified which did not interfere with his ability to perform the BCI-VR training. The patient had no other relevant comorbidities. Finally, the patient was undergoing physiotherapy and occupational therapy at the time of recruitment and had been treated with botulinum toxin infiltration 2 months before due to focal spasticity of the biceps brachii.

Intervention Protocol

The patient underwent a 3-weeks intervention with NeuRow, resulting in 10 BCI sessions of a 15 min of exposure in VR training per session. Clinical scales, motor imagery capability assessment, and functional -together with structural- MRI data had been gathered in three time-periods: (1) before (serving as baseline), (2) shortly after the intervention and (3) one-month after the intervention (to assess the presence of long-term changes). Finally, electroencephalographic (EEG) data had been gathered during all sessions, resulting in more than 20 datasets of brain electrical activity.

The experimental protocol was designed in collaboration with the local healthcare system of Madeira, Portugal (SESARAM) and approved by the scientific and ethic committees of the Central Hospital of Funchal. Finally, written informed consent was obtained from the participant upon recruitment for participating to the study but also for the publication of the case report in accordance with the 1964 Declaration of Helsinki.

Assessment Tools

A set of clinical scales were acquired including the following:

1. Montreal Cognitive Assessment (MoCA). MoCA is a cognitive screening tool, with a score range between 0 and 30 (a score greater than 26 is considered to be normal) validated also for the Portuguese population, (Nasreddine et al., 2005).

2. Modified Ashworth scale (MAS). MAS is a 6-point rating scale for measuring spasticity. The score range is 0, 1, 1+, 2, 3, and 4 (Ansari et al., 2008).

3. Fugl-Meyer Assessment (FMA). FMA is a stroke specific scale that assesses motor function, sensation, balance, joint range of motion and joint pain. The motor domain for the upper limb has a maximum score of 66 (Fugl-Meyer et al., 1975).

4. Stroke Impact Scale (SIS). SIS is a subjective scale of the perceived stroke impact and recovery as reported by the patient, validated for the Portuguese population. The score of each domain of the questionnaire ranges from 0 to 100 (Duncan et al., 1999).

5. Vividness of Movement Imagery Questionnaire (VMIQ2). VMIQ2 is an instrument that assess the capability of the participant to perform imagined movements from external perspective (EVI), internal perspective imagined movements (IVI) and finally, kinesthetic imagery (KI) (Roberts et al., 2008).

NeuRow BCI-VR System

EEG Acquisition

For EEG data acquisition, the Enobio 8 (Neuroelectrics, Barcelona, Spain) system was used. Enobio is a wearable wireless EEG sensor with 8 EEG channels for the recording and visualization of 24-bit EEG data at 500 Hz and a triaxial accelerometer. The spatial distribution of the electrodes followed the 10–20 system configuration (Klem et al., 1999) with the following electrodes over the somatosensory and motor areas: Frontal-Central (FC5, FC6), Central (C1, C2, C3, C4), and Central-Parietal (CP5, CP6) (Figure 1A). The EEG system was connected via Bluetooth to a dedicated desktop computer, responsible for the EEG signal processing and classification, streaming the data via UDP through the Reh@Panel (RehabNet Control Panel) for controlling the virtual environment. The Reh@Panel is a free tool that acts as a middleware between multiple interfaces and virtual environments (Vourvopoulos et al., 2013).

FIGURE 1

Figure 1. Experimental setup, including: (A) the wireless EEG system; (B) the Oculus HMD, together with headphones reproducing the ambient sound from the virtual environment; (C) the vibrotactile modules supported by a custom-made table-tray, similar to the wheelchair trays used for support; (D) the visual feedback with NeuRow game. A written informed consent was obtained for the publication of this image.

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[NEWS] New Gaming Platform Aims to Use Virtual Rehab to Help Stroke Survivors

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Researchers at UK-based University of East Anglia (UEA), in collaboration with Evolv Rehabilitation Technologies, have created a new virtual reality (VR) gaming platform designed to help improve the lives of stroke patients suffering from complex neurological syndromes caused by their stroke.

The new technology, which has been funded by the National Institute for Health Research (NIHR), was recently unveiled at RehabWeek in Toronto.

Around 30% to 50% of stroke survivors experience Œhemispatial neglect, which leaves people unaware of things located on one side of their body and greatly reduces their ability to live independently.

“A stroke can damage the brain, so that it no longer receives information about the space around one side of the world,” lead researcher Dr Stephanie Rossit, from UEA’s school of Psychology, explains in a media release from UEA.

“If this happens, people may not be aware of anything on one side, usually the same side they also lost their movement. This is called hemispatial neglect.

“These people tend to have very poor recovery and are left with long-term disability. Patients with this condition tell us that it is terrifying. They bump into things, they’re scared to use a wheelchair, so it really is very severe and life-changing.”

Current rehabilitation treatments involve different types of visual and physical coordination tasks (visuomotor) and cognitive exercises, ­ many of which are Œpaper and pen-based.

The new non-immersive VR technology being showcased updates these paper and pen tasks for the digital age – using videogame technology instead, per the release.

“We know that adherence is key to recovery – so we wanted to create something that makes it fun to stick to a rehabilitation task,” Roissit adds.

In one such game, the patient sees a random series of apples, some complete and some with a piece bitten off. The apples vibrate and move to provide greater stimulation to the patient.

“The aim for the patient is to choose the maximum number of complete apples that they see in the quickest time possible,” states David Fried, CEO of Evolv.

“A person with visual neglect would quite often only see a small number of correct targets to the right-hand side of the screen. Therapists can control the complexity of the game by increasing or reducing the number of apples on screen.”

As well as aiding diagnosis, the new game aims to improve rehabilitation by including elements such as scoring and rewards to engage the patient and improve adherence to their treatment.

Fried said: “Traditional rehabilitation treatment is quite monotonous and boring, so this gamification aspect is really important to help people stick with their treatment,” Fried adds.

“Our goal is to use technology to make rehabilitation fun and engaging, and we have applied this to our Spatial Neglect therapy solution. The great thing about it is that it can be used not only in clinics but also in patients’ homes, thereby giving them access to personalized rehabilitation without leaving their living room.”

The team has previously worked with stroke survivors, carers, and clinicians to assess the feasibility, usability, and acceptability of new gaming technology, per the release.

Dr Rossit said: ³This technology has the potential to improve both independence and quality of life of stroke survivors,” Rossit shares.

“This innovative therapy could also improve long-term care after stroke by providing a low-cost, enjoyable therapy that can be self-administered anywhere and anytime, without the need for a therapist to be present on every occasion.”

[Source: University of East Anglia]

 

via New Gaming Platform Aims to Use Virtual Rehab to Help Stroke Survivors – Rehab Managment

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[Abstract] Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games with a Head Mount Display: A Feasibility Study

Abstract

Background

Rehabilitation therapy using virtual reality (VR) system for stroke patients has gained attention. However, only few studies have investigated fully immersive VR using a head‐mount display (HMD) for upper extremity rehabilitation in stroke patients.

Objective

To investigate the feasibility, preliminary efficacy, and usability of a fully immersive VR rehabilitation program using a commercially available HMD for upper‐limb rehabilitation in stroke patients.

Design

A feasibility study

Setting

Two rehabilitation centers

Participants

Twelve stroke patients with upper extremity weakness

Interventions

Five upper extremity rehabilitation tasks were implemented in a virtual environment, and the participants wore an HMD (HTC Vive) and trained with appropriate tasks. Participants received a total of 10 sessions two to three times a week, consisting of 30 minutes per session.

Main Outcome Measures

Both patients’ participation and adverse effects of VR training and were monitored. Primary efficacy was assessed using functional outcomes (action arm reach test, box and block test, and modified Barthel index), before and after the intervention. Usability was assessed using a self‐reported questionnaire.

Results

Three patients discontinued VR training, and nine patients completed the entire training sessions and there were no adverse effects due to motion sickness. The patients who received all sessions showed significant functional improvement in all outcome measures after training (P < .05 for all measures). The overall satisfaction was 6.3 ± 0.8 on a 7‐point Likert scale in all participants.

Conclusions

A fully immersive VR rehabilitation program using an HMD for rehabilitation of the upper extremities following stroke is feasible and, in this small study, no serious adverse effects were identified.

 

via Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games with a Head Mount Display: A Feasibility Study – Lee – – PM&amp;R – Wiley Online Library

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[ARTICLE] Tracking the evolution of virtual reality applications to rehabilitation as a field of study – Full Text

Abstract

Background

Application of virtual reality (VR) to rehabilitation is relatively recent with clinical implementation very rapidly following technological advancement and scientific discovery. Implementation is often so rapid that demonstrating intervention efficacy and establishing research priorities is more reactive than proactive. This study used analytical tools from information science to examine whether application of VR to rehabilitation has evolved as a distinct field of research or is primarily a methodology in core disciplines such as biomedical engineering, medicine and psychology.

Methods

The analysis was performed in three-stages: 1) a bibliographic search in the ISI Web of Science database created an initial corpus of publications, 2) the corpus was refined through topic modeling, and 3) themes dominating the corpus from the refined search results were identified by topic modeling and network analytics. This was applied separately to each of three time periods: 1996 to 2005 (418 publications), 2006 to 2014 (1454 publications), and 2015 to mid-2018 (1269 publications).

Results

Publication rates have continuously increased across time periods with principal topics shifting from an emphasis on computer science and psychology to rehabilitation and public health. No terminology specific to the field of VR-based rehabilitation emerged; rather a range of central concepts including “virtual reality”, “virtual gaming”, “virtual environments”, “simulated environments” continue to be used. Communities engaged in research or clinical application of VR form assemblages distinguished by a focus on physical or psychological rehabilitation; these appear to be weakly linked through tele-rehabilitation.

Conclusions

Varying terms exemplify the main corpus of VR-based rehabilitation and terms are not consistent across the many scientific domains. Numerous distinguishable areas of research and clinical foci (e.g., Tele-rehabilitation, Gait & Balance, Cognitive Rehabilitation, Gaming) define the agenda. We conclude that VR-based rehabilitation consists of a network of scientific communities with a shared interest in the methodology rather than a directed and focused research field. An interlinked team approach is important to maintain scientific rigor and technological validity within this diverse group. Future studies should examine how these interdisciplinary communities individually define themselves with the goals of gathering knowledge and working collectively toward disseminating information essential to associated research communities.

Background

Virtual Reality (VR) in general, and the application of VR to rehabilitation in particular, is a relatively young, interdisciplinary field where clinical implementation very rapidly follows scientific discovery and technological advancement. Indeed, implementation is often so rapid that demonstration of intervention efficacy by investigators, and establishment of research and development priorities by funding bodies, tends to be more reactive than proactive.

Rapid growth in the number and type of applications of VR to rehabilitation has occurred over the past 15 years, suggesting that the research in this area may be demonstrative of a new scientific field. Reviews of the research in this area (see e.g., Rizzo and Kim [], Sveistrup [], and Levin et al. []), however, focus principally on applications of VR technology to specific disability or impairment. If VR-based rehabilitation is chiefly one more tool in the field of rehabilitation science, then cross-disciplinary communication could consist primarily of reporting methodological approaches. If, however, VR-based rehabilitation has emerged as a distinctive scientific domain, then it becomes the responsibility of the scientists and clinicians engaged in this work to disseminate both research insights and future directions across engaged disciplines. Our aim in the current study is to use tools of analysis from the domain of information science to examine whether application of VR to rehabilitation has evolved as a distinct field of research or is primarily a methodology in core disciplines such as biomedical engineering, medicine and psychology.

We initiated our search in 1996 because only one moderately relevant review article alluding to virtual reality being applied to medicine was found prior to that time []. Thus Period 1 (1996–2005) is defined as the period in which key technological developments emerged that influenced the use of VR technology for rehabilitation (Fig. 1). The most characteristic features of the early technologies in Period 1 were their large size, high cost and limited accuracy. These systems led to several pioneering motor rehabilitation applications [] whose clinical relevance was still uncertain since their high cost, technical complexity, and encumbrance severely limited access to both hardware or software []. Although there was limited recognition of its growing clinical potential, no significant grassroots perception of the need for VR-based interventions took hold during this period.

Continue —->  Tracking the evolution of virtual reality applications to rehabilitation as a field of study | SpringerLink

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[ARTICLE] Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response – Full Text

ABSTRACT

Background:

Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT.

Methods:

Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function.

Results:

Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery.

Conclusion:

VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.

 

Stroke can be defined as a neurological deficit resulting from focal and acute central nervous system injury. It is considered a major cause of mortality and disability worldwide1. Stroke is the second leading cause of death in Brazil and the leading cause of chronic disability in adults, resulting in socioeconomic consequences and reduced quality of life. Therefore, it is an important public health problem, particularly because of long-term dependence on public health services2,3.

Cerebrovascular injury may damage the cells of the cortex and emerging axons, generating dysfunction of the upper motor neurons. Motor function can be impaired, reducing functional capacity, particularly that of the upper limbs4. Approximately 85% of individuals experience hemiparesis immediately after the stroke, particularly in an upper limb, and 55%–75% of these individuals have persistence of motor deficits, making it difficult to return to work and leisure, consequently worsening their quality of life5.

Epidemiological clinical studies have suggested that 33%–66% of stroke patients had no motor recovery after six months. Several techniques aiming to improve upper limb function are still being developed. However, the implementation of these techniques requires great team work, a high degree of specialization, and requires more time5,6. Currently, there are new approaches to rehabilitation, and virtual reality is still developing, with the objective of restoring the functional capacity of individuals after stroke as an easy, interactive, and low-cost intervention7,8.

The objective of stroke rehabilitation is to provide maximal physical, functional, and psychosocial recovery for the patients9. Comprehensive rehabilitation initiated early after stroke (within the first 24 hours) is generally accepted as being associated with better motor outcomes for these patients9. Strength training is an important part of the therapeutic process for upper-limb motor impairment after stroke10.

Virtual reality is defined as any hardware or software system that provides a simulated environment with real or imagined conditions that allow participating individuals to interact with the environment. The interaction is made by body movements using motion capture technology or by manipulating a device11. This interaction generates information necessary for proper understanding of the movement with particular emphasis on the upper limbs12. The technique consists of an avatar (graphic representation of the person) generated by the video game, where the individual manages a wireless control, directing the movement during the practice of different activities5. This is a good option for rehabilitation for individuals with stroke due to the variety of nonimmersive video game systems developed by the entertainment industry for home use.

This wide availability makes virtual reality an accessible and inexpensive rehabilitation method for rehabilitation centers13. Despite the ease of application, virtual reality therapy (VRT), added to conventional physical therapy has not been associated with a better outcome than recreational activity13. Adverse events usually are mild and the main effects described are transient dizziness and headache, pain and numbness13,14. Time since the onset of stroke, severity of impairment, and the type of device (commercial or customized) usually do not influence the outcome14. However, the variable methodology is an important bias for these investigations14. Therefore, virtual reality is still a promising tool. Some authors have reported that VRT can be combined with conventional rehabilitation to improve upper limb function after stroke15,16. The clinical situations wherein VRT may best be used have not yet been established in the literature. Also, the exact mechanism of action of this treatment modality is not yet fully understood.

The objectives of this study were to evaluate the effects of VRT combined with conventional rehabilitation for upper limb function in the recovery of individuals after stroke. Neuroimaging characteristics that could be used as predictors of a better response to VRT were also investigated.[…]

Continue —>  Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response

Figure Brain areas affected in nine patients with stroke and upper limb impairment underwent virtual reality therapy (A). Findings are overlaid in a template of axial magnetic resonance image slices and in a three-dimensional model of the brain (B). The color code bar in the inferior portion of the figure indicates the number of patients with the area injured. 

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[Case Report] Improving neuropsychiatric symptoms following stroke using virtual reality – Full Text

Abstract

Rationale: Post-stroke cognitive impairment occurs frequently in patients with stroke, with a 20% to 80% prevalence. Anxiety is common after stroke, and is associated with a poorer quality of life. The use of standard relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects, whereas virtual reality seems to have a role in the treatment of anxiety disorders, especially when associated to neurological damage.

Patients concerns: A 50-year-old woman, smokers, affected by hypertension and right ischemic stroke in the chronic phase (i.e., after 12 months by cerebrovascular event), came to our observation for a severe anxiety state and a mild cognitive deficit, mainly involving attention and visuo-executive processes, besides a mild left hemiparesis.

Diagnosis: Anxiety in a patient with ischemic stroke.

Interventions: Standard relaxation techniques alone in a common clinical setting or the same psychological approach in an immersive virtual environment (i.e., Computer Assisted Rehabilitation Environment – CAREN).

Outcomes: The patient’s cognitive and psychological profile, with regard to attention processes, mood, anxiety, and coping strategies, were evaluated before and after the 2 different trainings. A significant improvement in the functional and behavioral outcomes were observed only at the end of the combined approach.

Lessons: The immersive virtual reality environment CAREN might be useful to improve cognitive and psychological status, with regard to anxiety symptoms, in post-stroke individuals.

1 Introduction

Stroke is a neurological syndrome caused by a focal disruption in the cerebral blood flow due to occlusion (ischemic stroke) or rupture of a blood vessel (hemorrhagic stroke). Stroke is the leading cause of disability worldwide and the third cause of death in the western countries.[1]Following stroke, especially in right hemisphere lesions, several psychological changes may arise, being depression and anxiety the most common.[2] The right hemisphere plays an important role in verbal communication, as it is mostly responsible for speech prosody and its emotional aspects.[3] Moreover, previous studies indicate that post-stroke anxiety is also common and persistent,[4,5] and this is attributable to a feeling of impotence and uncertainty about the future. Some personality factors, as coping strategies, can contribute to reduce or increase the anxiety’s level. The prevalence of post-stroke cognitive dysfunctions varies from 23% to 55% within three months from the stroke onset, and declines to a percentage between 11% and 31% after 1 year.[6,7] It has been found that after stroke most of the patients may have enduring difficulties in specific cognitive domains, such as attention process and concentration, memory abilities, spatial awareness, perception, praxis and executive functioning.[8,9] Thus, a proper psychometric evaluation should be the mainstay of post-stroke patient’s treatment. Limited evidences showed the relationship between cognition processes, emotions and anxiety. Anxiety disorders frequently coexist with depression, and may be more common in women and younger stroke survivors.[10]

Patients with a ‘probable anxiety disorder’ at 3-months had a poorer quality of life at 1, 3, and 5-years post-stroke after adjusting for age, gender, and stroke severity. Moreover, anxiety symptoms persisted for up to 10 years.[11]

Relaxation techniques can be considered a useful tool, determining a positive emotional and psychological well-being.[12,13] Among the different relaxation techniques, diaphragmatic breathing (DB), progressive muscle relaxation,[12,13] and autogenic relaxing training[14] are characterized by a significant positive association between physical and cognitive dimensions. The use of these techniques in treating anxiety in patients undergoing post-stroke rehabilitation have shown some positive effects.[15]

In the last years, virtual reality (VR) and interactive video gaming are emerging as promising treatment approaches in stroke rehabilitation, both for cognitive rehabilitation and mood/anxiety disorder treatment.[16] VR can provide exposure to nature for those living in isolated confined environments, and it has been demonstrated to reduce stress and improving mood.[17] Virtual Reality Therapy with an Interactive Semi-Immersive Program (i.e., Bts-Nirvana System) can be considered a useful complementary treatment to potentiate functional recovery, with regard to attention, visual-spatial deficits, and motor function in patients affected by stroke.[18] Moreover, relaxation and respiratory techniques in a semi-immersive virtual reality environment, using Bts-Nirvana, may be a promising tool in improving attention process, coping strategies, and anxiety in individuals with neurological disorders, including stroke.[19]

Aim of this case study is to evaluate the effects of a combined rehabilitative approach, using conventional relaxation and respiratory techniques in a virtual immersive rehabilitative environment, that is, Computer Assisted Rehabilitation ENvironment (CAREN), in a patient with chronic stroke.[…]

 

Continue —>  Improving neuropsychiatric symptoms following stroke using v… : Medicine

Figure 1 It shows the combined rehabilitative approach with the CAREN System. CAREN = Computer Assisted Rehabilitation ENvironment.
Source
Improving neuropsychiatric symptoms following stroke using virtual reality: A case report
Medicine98(19):e15236, May 2019.

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[WEB SITE] Virtual Reality: New Therapy for Neurological Disorders

Virtual Reality: New Therapy for Neurological Disorders

Emerging technology in the form of virtual reality (VR) may provide a new tool to aid treatment for neurological disorders such as autism, schizophrenia and Parkinson’s disease. A recent study suggests that playing games in VR could help individuals with these neurological conditions shift their perceptions of time, which their conditions lead them to perceive differently.

Researchers from the University of Waterloo discovered VR can help improve an individual’s perception of time. “The ability to estimate the passage of time with precision is fundamental to our ability to interact with the world,” says co-author Séamas Weech, a post-doctoral fellow in Kinesiology.

“For some individuals, however, the internal clock is maladjusted, causing timing deficiencies that affect perception and action. Studies like ours help us to understand how these deficiencies might be acquired, and how to recalibrate time perception in the brain.”

Researchers tested 18 females and 13 males with normal vision and no sensory, musculoskeletal or neurological disorders. The researchers used a virtual reality game, Robo Recall, to create a natural setting in which to encourage re-calibration of time perception.

The key manipulation of the study was that the researchers coupled the speed and duration of visual events to the participant’s body movements.

The researchers measured participants’ time perception abilities before and after they were exposed to the dynamic VR task. Some participants also completed non-VR time-perception tasks, such as throwing a ball, to use as a control comparison.

Investigators measured the actual and perceived durations of a moving probe in the time perception tasks. They discovered that the virtual reality manipulation was associated with significant reductions in the participants’ estimates of time, by around 15 percent.

“This study adds valuable proof that the perception of time is flexible, and that VR offers a potentially valuable tool for recalibrating time in the brain,” says Weech. “It offers a compelling application for rehabilitation initiatives that focus on how time perception breaks down in certain populations.”

Weech adds, however, that while the effects were strong during the current study, more research is needed to find out how long the effects last, and whether these signals are observable in the brain.

“For developing clinical applications, we need to know whether these effects are stable for minutes, days, or weeks afterward. A longitudinal study would provide the answer to this question.”

“Virtual reality technology has matured dramatically,” says Michael Barnett-Cowan, neuroscience professor and senior author of the paper.

“VR now convincingly changes our experience of space and time, enabling basic research in perception to inform our understanding of how the brains of normal, injured, aged and diseased populations work and how they can be treated to perform optimally.”

Source: University of Waterloo

 

via Virtual Reality: New Therapy for Neurological Disorders

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[VIDEO] Robot Arm Platform for VR, Rehabilitation, and More – YouTube

Δημοσιεύτηκε στις 6 Δεκ 2018

LinkDyn’s robot arm, and the actuator technology it’s built on, has the potential to fundamentally change the way we interact with robots. This technology which features seamless, safe, and smooth interaction with humans and changing physical environments, will drive the next big push in robotics toward humans and robots interacting closely and safely. The robotic arm provides just one example of how this ability to interact easily and safely with robots can empower the human workforce by exploiting the radical benefits of VR training while losing no drawbacks compared to conventional training. This same technology, with slight adjustments to the VR contents and software, can also serve to help patients suffering from physical or neurological injuries to rehabilitate more effectively than ever. The device was built on LinkDyn’s patent-pending actuator platform, which takes cues from human muscle design and cutting edge human-robot research to deliver the highest performing force control in a compact form factor. This fundamental technology is designed from the ground up for seamless human-machine interaction, and enables a massive leap forward in wearable exoskeletons, interactive robots, haptic feedback, and more compared to conventional robotic technology. https://linkdyn.com

 

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[Abstract] Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview.

OBJECTIVE:This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals.
METHODS:Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms “VR,” “rehabilitation,” and “stroke.”
RESULTS:Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training.
CONCLUSIONS:Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.

via Virtual Reality and Cognitive Rehabilitation in People With Stroke: An Overview. – Abstract – Europe PMC

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[NEWS] From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds

 Jan. 15, 2019, 07:52 AM

IRVINE, Calif.Jan. 15, 2019 /PRNewswire/ — Since the beginning, virtual reality paired with an omnidirectional treadmill that allows users to move through the virtual world in any direction has been relegated to realms of fiction…until now. A new company, OmniPad, (OmniPad.com), is looking to change the world of virtual reality with its sleek and innovative game-changing VR treadmill that allows for fully immersive natural 360-degree movement through virtual space.

The OmniPad utilizes a ball-bearing encrusted omnidirectional platform that supports a flattened spherical, revolving treadmill track. The OmniPad platform enables the locomotion surface to freely revolve endlessly, in any direction, creating a unique omnidirectional treadmill. With the OmniPad, gamers, first responders, architects, virtual tourists, and even the military, can freely walk and run around in real time virtual environments, experiencing the most comprehensive and fully immersive VR experience available.

“Being a professional 3D animator for over 25 years, and having worked on very high-end virtual reality projects, the challenge of ‘how to enable 360-degree locomotion on a stationary surface‘ is a question that burned in my mind since the late 1990’s. I contemplated this obstacle to freedom of VR locomotion for months and years. Then, I was lying in bed one night further toiling with the omnidirectional locomotion surface question, and it dawned on me . . . a water balloon!” said Neil Epstein, OmniPad’s CEO and president. “I realized that when you take a small water balloon, press it firmly between your palms so that the top and bottom surfaces are completely flat, and then motion your hands in opposing circular directions, the flattened water balloon freely revolves in all directions while still remaining completely flat on both sides. Hence, the core mechanics of the OmniPad were born.”

The benefits and features of the OmniPad will include:

  • A Unique Omnidirectional Treadmill Design: The circular moving omnidirectional platform sets the company apart in the VR industry.
  • Unmatched Virtual Reality Immersion: The OmniPad lets virtual reality users experience the most immersive VR experience available by letting users freely and naturally walk, jog and run around in the virtual reality world.
  • Patented Treadmill Design and Construction: The dynamic, never before implemented design mechanics that grant the OmniPad its unique immersive locomotion abilities make it the only VR accessory of its type available in the industry.
  • A Multitude Of Uses Possible Uses: With the appropriate Virtual Reality environments, the OmniPad offers a comprehensive gaming experience, as well as highly-effective training of training first responders and soldiers, and allows architects, engineers, and home buyers to visualize buildings and real estate, and even has significant applications in sports training, eSports competitions, and rehabilitation, among so many other applications.

OmniPad has launched a SEC regulation crowdfunding equity campaign, (https://wefunder.com/omnipad.company ), to share awareness and the potential capabilities of this awe-inspiring product. You can check out the company’s YouTube channel, (https://www.youtube.com/channel/UCsR1sCPunIZs2G28DFmmn9A), to see the OmniPad in action.

ABOUT OmniPad

OmniPad is a startup company comprised of some of the brightest and creative minds available. The company’s team includes the world’s foremost expert on omnidirectional locomotion surface technology and Stanford Engineering graduate, David Carmein, the EMMY award-winning 3-D artist and conceptual mind behind OmniPad, Neil Epstein, J.D., and the marketing specialties of Jordan Robinson, Orentheal Williams, and Kenneth Dunn.

Media Contact:
George Pappas
Conservaco/The Ignite Agency
949-339-2002
207740@email4pr.com
https://ignitecfp.com

View original content to download multimedia:https://www.prnewswire.com/news-releases/from-fiction-to-virtual-reality-omnipad-launches-an-innovative-circular-revolving-tread-omnidirectional-treadmill-that-lets-users-naturally-walk-jog-or-run-in-any-direction-through-vr-worlds-300778419.html

SOURCE OmniPad

 

via From Fiction to Virtual Reality: OmniPad Launches an Innovative Circular Revolving-Tread Omnidirectional Treadmill That Lets Users Naturally Walk, Jog or Run in any Direction Through VR Worlds | Markets Insider

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