Posts Tagged VR

[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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[ARTICLE] Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study – Full Text

Abstract

Background

Virtual reality (VR)-based rehabilitation is considered a beneficial therapeutic option for stroke rehabilitation. This pilot study assessed the clinical feasibility of a newly developed VR-based planar motion exercise apparatus (Rapael Smart Board™ [SB]; Neofect Inc., Yong-in, Korea) for the upper extremities as an intervention and assessment tool.

Methods

This single-blinded, randomized, controlled trial included 26 stroke survivors. Patients were randomized to the intervention group (SB group) or control (CON) group. During one session, patients in the SB group completed 30 min of intervention using the SB and an additional 30 min of standard occupational therapy; however, those in the CON group completed the same amount of conventional occupational therapy. The primary outcome was the change in the Fugl–Meyer assessment (FMA) score, and the secondary outcomes were changes in the Wolf motor function test (WMFT) score, active range of motion (AROM) of the proximal upper extremities, modified Barthel index (MBI), and Stroke Impact Scale (SIS) score. A within-group analysis was performed using the Wilcoxon signed-rank test, and a between-group analysis was performed using a repeated measures analysis of covariance. Additionally, correlations between SB assessment data and clinical scale scores were analyzed by repeated measures correlation. Assessments were performed three times (baseline, immediately after intervention, and 1 month after intervention).

Results

All functional outcome measures (FMA, WMFT, and MBI) showed significant improvements (p < 0.05) in the SB and CON groups. AROM showed greater improvements in the SB group, especially regarding shoulder abduction and internal rotation. There was a significant effect of time × group interactions for the SIS overall score (p = 0.038). Some parameters of the SB assessment, such as the explored area ratio, mean reaching distance, and smoothness, were significantly associated with clinical upper limb functional measurements with moderate correlation coefficients.

Conclusions

The SB was available for improving upper limb function and health-related quality of life and useful for assessing upper limb ability in stroke survivors.

Background

Virtual reality (VR)-based rehabilitation is being increasingly used for post-stroke rehabilitation []. A recent systematic review mentioned that VR is an emerging treatment option for upper limb rehabilitation among stroke patients []. The benefits of VR include real-time feedback, easy adaptability, and the provision of safe environments that mimic the real world []. The gaming property of VR allows patients to experience fun, active participation, positive emotions, and engagement []. Therefore, rehabilitation with VR enables more intense and repetitive training, which is important for rehabilitation and the promotion of neural plasticity [].

VR systems commonly used in the entertainment industry, such as Wii and Kinect, could be used for rehabilitation. However, these game-like systems are only applicable to patients with muscle strength above a certain value, thus limiting their use by more affected patients. Therefore, adjunct therapies, such as functional electrical stimulation and robotics, have been combined with these systems []. However, those adjunct therapies are costly and require continuous monitoring by healthcare professionals because of safety concerns []. Therefore, their use is restricted to clinical settings, and they are not actively used for telerehabilitation or home-based rehabilitation. A non-motorized or non-assisted device is required for more active use of VR for rehabilitation.

We developed the Rapael Smart Board™ (SB; Neofect Inc., Yong-in, Korea), which is a VR-based rehabilitation device incorporating planar motion exercise that does not require additional gravity compensation. This two-dimensional planar movement with full gravitational support, which lessens the need for antigravity muscle facilitation, allows for much easier participation than three-dimensional movement under gravity. Additionally, it is known to be safe and easy to learn, and it has been shown to improve motor ability with less aggravation of shoulder pain and spasticity; therefore, it is useful to patients with reduced motor ability []. Planar motion exercises provoke less maladaptive compensatory movements. Additionally, the nearly zero friction of the linear guides enable a wide range of repetitive active range of motion (AROM) exercises. Furthermore, the SB adopted Rapael Clinic software that was originally developed for patients with disabilities and has proven efficacy for stroke rehabilitation []. Therefore, the SB, which has multiple advantages because of its hardware and software, might be beneficial for the functional improvement of the upper extremities. Moreover, the SB could have a role as an assessment tool because VR has been reported to be useful for objective kinematic measurements of the upper extremities [].

The present pilot study aimed to assess the availability of this newly developed VR-based rehabilitation device incorporating planar exercises for the upper extremities as an intervention and assessment tool among stroke patients in the chronic phase of recovery. To assess the availability in terms of clinical effectiveness, we compared the effects of an intervention involving the SB and that involving dose-matched occupational therapy (OT) on upper extremity function and health-related quality of life (HRQoL). We also investigated the correlations between kinematic data from the SB and data from clinical scales regarding upper extremity function.

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Continue —>  Effects of virtual reality-based planar motion exercises on upper extremity function, range of motion, and health-related quality of life: a multicenter, single-blinded, randomized, controlled pilot study | SpringerLink

Fig. 1Hardware of the Smart Board. The board and forearm-supported controller. Three linear guides with an H-shape configuration enable two-dimensional planar motion of the handlebar, which is attached to the horizontal linear guide

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[WEB PAGE] Restoring Veterans’ Health Through Virtual Reality

POST WRITTEN BY Eran Orr. Eran Orr is the founder of XRHealth, the leader in extended reality and therapeutic applications.

 

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Veterans returning home from war zones after serving in combat face a myriad of health concerns. Most of these concerns have to do with pain. A 2016 survey by the NIH found that 65.5% of U.S. military veterans said they have pain, and the pain is severe for 9.1% of the group surveyed. Whether it is reported in a vet’s back, neck, knees or shoulders, the pain usually persists. Chronic pain (pain that lasts for more than 12 weeks) affects many of the 20 million U.S. veterans.

And on too many occasions, it isn’t properly treated.

All of these difficult issues, including nonspecific physical complaints, such as fatigue, cognitive disturbances, memory or concentration problems, are tied together. Far too often, you’ll see these problems getting lumped into what’s known as post-traumatic stress disorder (PTSD). This is a serious psychological issue that garners its fair share of attention and sometimes unhelpful distortion from the news and entertainment media.

The question for far too many years has been: What can be done about it? How do we provide veterans with meaningful healthcare and rehabilitation that can help ease them back to their normal lives again? We’re learning that virtual reality (VR), delivered through technologically advanced headsets, can have an impact on the treatment of chronic pain and could become a powerful alternative to opioid interventions. Years ago, this was something that couldn’t have been imagined, but the same gear associated with video gaming and entertainment is indeed helping veterans with pain management, physical rehabilitation and the cognitive disorders associated with PTSD.

I am a cofounder and CEO of a company that in the last four years has sought to elevate the use of extended reality and therapeutic applications for healthcare. But it goes much deeper than that. As a military man in the Israeli Air Force, I toiled in the field of physical therapy with specific expertise in spinal cord damage prevention. I myself also experienced a long but successful injury rehabilitation process, which included VR as a means to heal. That experience convinced me that the use of virtual reality could change healthcare for the better.

What VR can provide and the reason it can be so effective for the patient is that it creates an immersive 360-degree world. Patients are guided through this virtual world with sophisticated software on virtual reality headsets, which provides a smooth and relaxing environment. The patient’s focus is redirected while being guided through a virtual world that provides a distraction from the pain or anxiety they are being treated for. Many patients get to the point where they are tricked into really believing they are in another reality.

2019 study with 120 participants looked at on-demand VR therapy compared to specialized “health and wellness” television programming for pain reduction in hospitalized patients. The results showed that VR was “significantly” better at reducing pain and was “most effective” as a remedy for severe pain. Today, VR is also being used as a vehicle for a treatment technique called exposure therapy. For example, one such program called Virtual Iraq immerses veterans from the Iraq war suffering from chronic PTSD in an environment that, according to Veterans Families United, produces “visuals of a war zone and … the other senses, sound, smell, touch that is experienced in a war zone.” The hope is that the everyday things that can trigger fear and panic become insignificant through virtual repetition and the reactions to the memory become disconnected from the memory itself.

An additional benefit of virtual reality is that when it is incorporated with artificial intelligence, it can be the basis of gaining comprehensive real-time data from the vet’s work with the headset. The data provides an opportunity for a therapist to adjust the program immediately if need be. The data can also be made available instantly to the patient and shared with other veterans. Despite recent advances, more attention and research will need to be applied to the treatment of veterans utilizing virtual reality. Market education is the toughest challenge right now. AR/VR platforms for therapeutic purposes are aimed at providing clinicians with an option to better manage their patients’ care via specialized extended reality technology solutions and data analysis. It is our job to educate the marketplace and continue to provide clinical evidence to the United States Food and Drug Administration (FDA) that the platform is worthy of designation as a medical device.

In the meantime, wider adoption of this tech by more healthcare organization leaders would help position VR as a routine treatment option. There are many companies out there, such as AppliedVR and BehaVR, that are also working toward the same health-related, therapeutic goals, especially in pain management. As an industry, we understand and can demonstrate how VR/AR therapy supports rehabilitation services, cognitive assessment and training, and pain management. Conversations with healthcare leaders about how it works and its enormous potential will need to continue so they can see this tech in operation.

Perhaps the tipping point for the adoption of VR therapy platforms will occur once it becomes designated as a medical device. When it happens, I believe you could eventually see VR headsets in every hospital, every nursing home and every healthcare facility in the next couple of years. More than any other subset of the population, military personnel are familiar with VR as used as a digital training tool for war exercises and other training. This familiarity is an ideal rationale for continued strategic advances in VR healthcare therapy and the development of VR medical devices, incorporating hardware and software that can be widely used to provide a significant variety of post-deployment treatment for veterans.

 

via Council Post: Restoring Veterans’ Health Through Virtual Reality

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[ARTICLE] Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review – Full Text

Abstract

Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers.

Introduction

Virtual reality and active video games (VR/AVG) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice [,]. A steady increase in the number of peer-reviewed articles evaluating the effects of VR/AVG interventions in many rehabilitation populations has been observed over the past 20 years. This increase reflects a growing interest in VR/AVG from the rehabilitation research and development sectors. Ideally, newly developed and empirically evaluated products and interventions that are found to be safe and effective would be quickly integrated into clinical practice. Yet what we are observing in patient care follows a more typical pattern for the adoption of evidence-based treatment techniques or tools: one of slow and variable progress [].

Collaboration between engineers and product end-users can inform the development of useful VR/AVG technologies that meet the needs of clients and therapists. Moving VR/AVG technology into the hands of therapists allows clients to benefit from its therapeutic potential. Systematically examining the factors that impact VR/AVG adoption in rehabilitation, and the effect of knowledge translation (KT) strategies on behaviors related to their use, is critical for guiding the successful implementation of these technologies. A clear understanding of how VR/AVG is being used by clinicians, the limitations clinicians face in integrating the technologies into their daily treatment routines, and the most effective strategies for supporting clinicians in technology adoption are paramount to informing these implementation approaches.

Recent surveys of occupational and physical therapists in Canada [], the United States (Levac et al., in preparation), and Scotland [] on their use of VR/AVG and their learning needs related to future use of these technologies provides a foundational knowledge base about current clinical use. Nearly half of the 1071 respondents in Canada [] and 76% of the 491 U.S. respondents (Levac et al., in preparation) had used VR/AVG clinically. However, only 12% of respondents in Canada [], 31% in the United States (Levac et al., in preparation), and 18% of the 112 respondents in Scotland [] reported current use. This discrepancy indicates the need for additional efforts to identify and to address existing barriers to VR/AVG use. Commercially available AVG systems were the most common systems in use in all 3 countries [,] (Levac et al., in preparation); the use of rehabilitation-specific VR systems by Canadian [] and U.S. therapists (Levac et al., in preparation) was much lower (<3% of respondents for any given system).

Despite low reported daily use, VR/AVG systems were perceived by therapists to be widely relevant to rehabilitation for a number of different client populations, functional recovery goals and practice settings []. Sixty-one percent of respondents in Scotland reported that they would use gaming if it were available to them []. The majority of respondents in both Canada [] (76.3%) and the United States (69.9%) (Levac et al., in preparation) reported low self-efficacy in using VR/AVG clinically, but were interested in learning more. Commonly reported learning needs included knowledge and skills in selecting appropriate systems and games for individual clients, grading activities, evaluating outcomes, and integrating theoretical approaches to treatment [,,]. These findings suggest a strong need for educational resources and knowledge translation (KT) supports to facilitate evidence-based technology adoption [,]. KT is the process of moving evidence into practice []. KT interventions have the potential to support adoption by targeting known barriers to change, including a lack of knowledge and skills [].

Strong insights into the factors influencing therapists’ adoption of VR/AVG have emerged only in the past 5 years. A decomposed Theory of Planned Behavior, which integrates constructs from the Technology Adoption Model and the Diffusion of Innovation theory forms the theoretical basis for the majority of this research [,]. The Theoretical Domains Framework (TDF) is another approach that can be used to conceptualize the evaluation of barriers and facilitators of change, including technology adoption []. The TDF is an implementation framework that integrates 128 theoretical constructs drawn from 33 behavior change theories into 14 barrier/facilitator domains []. Although the framework has not been applied yet to this body of literature, it offers a more comprehensive approach to the identification and classification of barriers and facilitators of change than a single theory or framework alone. Drawn from the KT literature, the framework can be used to structure the assessment of barriers and facilitators of change across a range of contexts, as well as the selection of interventions to target these barriers and facilitators [].

The purpose of this scoping review was to apply the TDF to examine the extent, range, and nature of studies assessing VR/AVG barriers and facilitators and/or recommending or evaluating KT interventions to promote VR/AVG adoption in rehabilitation since 2005. Our objectives were to

  1. present an overview of factors known to limit or support VR/AVG adoption for rehabilitation;

  2. describe the KT strategies that have been recommended or evaluated to address these factors and to report on their effectiveness, where possible; and

  3. provide recommendations for technology development, research, and clinical implementation based on these findings.

[…]

Continue —>  Barriers, Facilitators and Interventions to Support Virtual Reality Implementation in Rehabilitation: A Scoping Review

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[ARTICLE] The Effect of Virtual Reality on Rehabilitation Post Stroke Patients: An Integrative Review – Full Text PDF

Abstract

Background:Post stroke patients need to be rehabilitated to improve their body functions to performed daily activity. Mostly conventional rehabilitative therapies were monotonous which may decrease patient’s motivation due to repetitive and simple movements. Virtual reality intervention as technology based therapy showing a promises approach that could be applied in stroke rehabilitation.

Objective:This literature review aimed to identify various virtual reality interventions and its effectiveness for rehabilitation stroke patients.

Methods: An integrative literature review was conducted to search the publication in the data base of Cumulative Index to Nursing and Allied Health Literature (CINAHL and Pubmed in period during 2009 to 2019. The inclusion criteria were randomized control trial, studies that used virtual reality in rehabilitation patients with stroke; free full text articles, and used English language. The exclusion criteria was pilot study. Finally a total of 13 relevant studies included in analysis.

Results: All of the articles were randomized control trials published in 2018 or later. The sample size were adults or elderly varied from 20-80 years old with stroke. The sample size varied from 20 to 121 respondents. Nintendo Wii was the most common used as VR intervention.

Conclusions:This review shows evidences that suggested the effectiveness of virtual reality intervention in rehabilitation patients with stroke. Most studies support the beneficial effects of VR on upper limb motor recovery. Other studies reported the improvement in balance, walking, lower extremity muscle activation, visual perception, brain activity and activity daily living in stroke patients.

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[22] Santisteban,L.,Térémetz,M.,Bleton,J.P.,Baron,J.C.,Maier,M.A.,&Lindberg,P.G.(2016).Upper limb outcome measures use dinstrok erehabilitation studies:Asystematic literature review.PloSOne,11(5), e0154792.
[23] Sullivan,K.J.,Tilson,J.K.,Cen,S.Y.,Rose,D.K.,Hershberg,J.,Correa,A.,…&Duncan,P.W.(2011).FuglMeyer assessment of sensorimotor function after stroke: standardized training procedure for clinical practice and clinical trials. Stroke, 42(2), 427-432.

 

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via The Effect of Virtual Reality on Rehabilitation Post Stroke Patients: An Integrative Review | KnE Life Sciences

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[Abstract] Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review

Abstract

BACKGROUND:

Virtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy.

METHODS:

This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed.

RESULTS:

Ninety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended.

CONCLUSION:

Our results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments.

 

via Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. – PubMed – NCBI

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[WEB PAGE] Stroke Therapy At Home with VR Games

Rutgers virtual reality tools show promise for at-home stroke recovery

Screenshot of Rutgers VR stroke recovery airplane game.

A small propeller plane operated by Allen DeNiear climbs into the sky. With a stark desert valley, seemingly inhabited by nothing more than cacti, visible on the red earth below, DeNiear makes a small motion with his hand. The plane pitches downward and dives.

DeNiear is not a pilot.

Nevertheless, his eyes focus on his targets, a series of orbs floating in the sky at various altitudes. His goal is simple enough: collect the orbs without crashing.

His reality, for the moment, is virtual.

Ready, player one.

Sitting in a lab at the Rutgers School of Health Professions in Newark, DeNiear moves his hand again. In his lap, a small infrared camera linked to the computer running the virtual reality (VR) flight simulator registers his hand movement. The plane ascends, and he collects another orb.

Both the motion and the game seem deceptively easy, but for DeNiear, who is recovering from a stroke and has limited mobility in his right hand, arm, and shoulder, the move is more than meets the eye, and the game, which can be played from anywhere you can fit a laptop, could wind up revolutionizing physical therapy treatments for stroke victims.

Today, DeNiear is with his Rutgers recovery team. But tomorrow, when he needs to do therapeutic work on his hand and arm, he’ll do it from home. No appointment is needed, the trek to a rehab center is eliminated, and—because the games are a lot more fun than monotonous rehab programs—he is more likely to actually do his exercises, thanks to the at-home approach to rehabilitation being tested and refined by Rutgers researchers.

Improving at-home therapy’s low score.

Standard at-home physical therapy regimens for stroke recovery are both boring and frustrating for patients. “The adherence to home exercise programs is incredibly low,” said Gerry Fluet, an associate professor in the rehabilitation and movement sciences department. A physical therapist by trade, Fluet’s research is focused on using VR games to increase patient participation in at-home therapy programs.

“We’re trying to create something that’s more pleasurable and interesting than opening your hand 50 times while you watch it and wish it would move more,” he said. “We set out to develop simulations that people would stop in the middle of their day to play, and tomorrow, pick them up and play them again, and then again the day after that.”

Why games?

By building the physical rehabilitation regimen into a game, Fluet and his team are able to turn the monotony of stroke rehabilitation into something that is a lot more fun than it used to be. This is important, he said, because after a stroke, a person must put in a lot of work to regain control of the hand.

Without gaming therapy, people are exercising at home two or three times a week, for about five to 10 minutes, if they even bother doing it at all, Fluet said. Meanwhile, people in the lab’s study using the VR games at home are averaging anywhere from 60 to 90 minutes of exercise therapy in a week, with no additional reminders or encouragement. In the real world, this could translate into a much more cost effective and impactful form of stroke rehabilitation.

“We’re seeing tangible, measurable results,” he said.

Rutgers professors Qinyin Qiu (left) and Gerry Fluet (right) work with patient Allen DeNiear (center).

At-home arcade.

The game library developed so far has a dozen titles. In addition to piloting a plane, players can drive a car, run through a maze, hit the keys of a piano, and more—all from a Windows-based application developed by Fluet’s long-time collaborator Qinyin Qiu, an assistant professor in the Department of Rehabilitation and Movement Sciences at Rutgers, and Amanda Cronce, a digital designer in the Department of Biomedical Engineering at New Jersey Institute of Technology (NJIT), as part of a collaboration between Rutgers Biomedical and Health Sciences and the Motor Control and Rehabilitation Lab led by Sergei Adamovich at NJIT.

The study has patients play the VR games at home for at least 15 minutes a day, every day for three months. The gaming application collects the patient data and transfers it to a remote data server so Qiu and Fluet can monitor the at-home progress. They can even use the application real-time chat with the patient.

“We’re really trying to turn this into tele-rehab,” said Qiu, adding that the team is exploring go-to-market strategies and commercialization opportunities for their project through an I-Corps grant.

Leveling up.

DeNiear is, self-admittedly, “not a video game person,” but he embraces gaming as a method for recovering from his stroke. “As you’re playing the game, it breaks the monotony of what you’re supposed to be doing. If I didn’t have the games, it would be a lot slower,” he said of his recovery. “It helped speed the process up, I think.”

Today, DeNiear has regained enough mobility to be able to drive again, and write with his right hand. He is still not 100 percent recovered, and he acknowledges that he may never be totally back to his old self. But he is committed to making the most of his situation by taking advantage of opportunities to participate in studies like Fluet and Qiu’s at-home VR physical therapy program.

“You gotta work at it,” he said. “You gotta do it.”

via Stroke Therapy At Home with VR Games | Rutgers University

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[BOOK Chapter] Assessment and Rehabilitation Using Virtual Reality after Stroke: A Literature Review – Abstract + References

Abstract

This chapter presents the studies that have used virtual reality as an assessment or rehabilitation tool of cognitive functions following a stroke. To be part of this review, publications must have made a collection of data from individuals who have suffered a stroke and must have been published between 1980 and 2017. A total of 50 publications were selected out of a possible 143 that were identified in the following databases: Academic Search Complete, CINAHL, MEDLINE, PsychINFO, Psychological and Behavioural Sciences Collection. Overall, we find that most of the studies that have used virtual reality with stroke patients focused on attention, spatial neglect, and executive functions/multitasking. Some studies have focused on route representation, episodic memory, and prospective memory. Virtual reality has been used for training of cognitive functions with stroke patients, but also for their assessment. Overall, the studies support the value and relevance of virtual reality as an assessment and rehabilitation tool with people who have suffered a stroke. Virtual reality seems indeed an interesting way to better describe the functioning of the person in everyday life. Virtual reality also sometimes seems to be more sensitive than traditional approaches for detecting deficits in stroke people. However, it is important to pursue work in this emergent field in clinical neuropsychology.

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