The Aerobic and Cognitive Exercise Study (ACES) for Community-Dwelling Older Adults With or At-Risk for Mild Cognitive Impairment (MCI): Neuropsychological, Neurobiological and Neuroimaging Outcomes of a Randomized Clinical Trial.
Frontiers in aging neuroscience
Prior research has found that cognitive benefits of physical exercise and brain health in older adults may be enhanced when mental exercise is interactive simultaneously, as in exergaming. It is unclear whether the cognitive benefit can be maximized by increasing the degree of mental challenge during exercise. This randomized clinical trial (RCT), the Aerobic and Cognitive Exercise Study (ACES) sought to replicate and extend prior findings of added cognitive benefit from exergaming to those with or at risk for mild cognitive impairment (MCI). ACES compares the effects of 6 months of an (virtual reality bike rides) with the effects of a more effortful (pedaling through a videogame to score points). Fourteen community-dwelling older adults meeting screening criteria for MCI (sMCI) were adherent to their assigned exercise for 6 months. The primary outcome was executive function, while secondary outcomes included memory and everyday cognitive function. Exer-tour and exer-score yielded significant moderate effects on executive function (Stroop A/C; 's = 0.51 and 0.47); there was no significant interaction effect. However, after 3 months the exer-tour revealed a significant and moderate effect, while exer-score showed little impact, as did a game-only condition. Both exer-tour and exer-score conditions also resulted in significant improvements in verbal memory. Effects appear to generalize to self-reported everyday cognitive function. Pilot data, including salivary biomarkers and structural MRI, were gathered at baseline and 6 months; exercise dose was associated with increased BDNF as well as increased gray matter volume in the PFC and ACC. Improvement in memory was associated with an increase in the DLPFC. Improved executive function was associated with increased expression of exosomal miRNA-9. Interactive physical and cognitive exercise (both high and low mental challenge) yielded similarly significant cognitive benefit for adherent sMCI exercisers over 6 months. A larger RCT is needed to confirm these findings. Further innovation and clinical trial data are needed to develop accessible, yet engaging and effective interventions to combat cognitive decline for the growing MCI population. ClinicalTrials.gov ID: NCT02237560.
10.3389/fnagi.2018.00076
Detection of Mild Cognitive Impairment in an At-Risk Group of Older Adults: Can a Novel Self-Administered Serious Game-Based Screening Test Improve Diagnostic Accuracy?
Zygouris Stelios,Iliadou Paraskevi,Lazarou Eftychia,Giakoumis Dimitrios,Votis Konstantinos,Alexiadis Anastasios,Triantafyllidis Andreas,Segkouli Sofia,Tzovaras Dimitrios,Tsiatsos Thrasyvoulos,Papagianopoulos Sotirios,Tsolaki Magda
Journal of Alzheimer's disease : JAD
BACKGROUND:Literature supports the use of serious games and virtual environments to assess cognitive functions and detect cognitive decline. This promising assessment method, however, has not yet been translated into self-administered screening instruments for pre-clinical dementia. OBJECTIVE:The aim of this study is to assess the performance of a novel self-administered serious game-based test, namely the Virtual Supermarket Test (VST), in detecting mild cognitive impairment (MCI) in a sample of older adults with subjective memory complaints (SMC), in comparison with two well-established screening instruments, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE). METHODS:Two groups, one of healthy older adults with SMC (N = 48) and one of MCI patients (N = 47) were recruited from day centers for cognitive disorders and administered the VST, the MoCA, the MMSE, and an extended pencil and paper neuropsychological test battery. RESULTS:The VST displayed a correct classification rate (CCR) of 81.91% when differentiating between MCI patients and older adults with SMC, while the MoCA displayed of CCR of 72.04% and the MMSE displayed a CCR of 64.89%. CONCLUSION:The three instruments assessed in this study displayed significantly different performances in differentiating between healthy older adults with SMC and MCI patients. The VST displayed a good CCR, while the MoCA displayed an average CCR and the MMSE displayed a poor CCR. The VST appears to be a robust tool for detecting MCI in a population of older adults with SMC.
10.3233/JAD-200880
Neural mechanisms of behavioral change in young adults with high-functioning autism receiving virtual reality social cognition training: A pilot study.
Yang Y J Daniel,Allen Tandra,Abdullahi Sebiha M,Pelphrey Kevin A,Volkmar Fred R,Chapman Sandra B
Autism research : official journal of the International Society for Autism Research
Measuring treatment efficacy in individuals with Autism Spectrum Disorder (ASD) relies primarily on behaviors, with limited evidence as to the neural mechanisms underlying these behavioral gains. This pilot study addresses this void by investigating neural and behavioral changes in a Phase I trial in young adults with high-functioning ASD who received an evidence-based behavioral intervention, Virtual Reality-Social Cognition Training over 5 weeks for a total of 10 hr. The participants were tested pre- and post-training with a validated biological/social versus scrambled/nonsocial motion neuroimaging task, previously shown to activate regions within the social brain networks. Three significant brain-behavior changes were identified. First, the right posterior superior temporal sulcus, a hub for socio-cognitive processing, showed increased brain activation to social versus nonsocial stimuli in individuals with greater gains on a theory-of-mind measure. Second, the left inferior frontal gyrus, a region for socio-emotional processing, tracked individual gains in emotion recognition with decreased activation to social versus nonsocial stimuli. Finally, the left superior parietal lobule, a region for visual attention, showed significantly decreased activation to nonsocial versus social stimuli across all participants, where heightened attention to nonsocial contingencies has been considered a disabling aspect of ASD. This study provides, albeit preliminary, some of the first evidence of the harnessable neuroplasticity in adults with ASD through an age-appropriate intervention in brain regions tightly linked to social abilities. This pilot trial motivates future efforts to develop and test social interventions to improve behaviors and supporting brain networks in adults with ASD. Autism Res 2018, 11: 713-725. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc. LAY SUMMARY:This study addresses how the behavioral changes after treatment for ASD reflect underlying brain changes. Before and after receiving VR-SCT, young adults with high-functioning ASD passively viewed biological motion stimuli in a MRI scanner, tapping changes in the social brain network. The results reveal neuroplasticity in this age population, extending the window of opportunity for interventions to impact social competency in adults with ASD.
10.1002/aur.1941
Extended Reality (XR) and telehealth interventions for children or adolescents with autism spectrum disorder: Systematic review of qualitative and quantitative studies.
Neuroscience and biobehavioral reviews
World Health Organization reported that almost one in 100 children is diagnosed with autism spectrum disorder (ASD) worldwide. Extended Reality (XR) and Telehealth interventions are evident to be effective for ASD treatments. While there is no comprehensive systematic review to summarize and evaluate the evidence for promoting the accessibility of different technology-based treatment regiments. This paper aims to verify the efficacy and validity of XR and Telehealth interventions for children and adolescents with ASD. We reviewed 112 studies from databases of PubMed, Web of Science and Cochrane Library, published in English between January 2010 to April 1st, 2022. We found that after interventions, positive improvements for ASD participants were observed in social interaction, acceptance, and engagement, communication and speech, emotion recognition and control, daily living skill, problem behavior reduction, attention, cost reduction, anxiety symptom reduction, pretend play, contextual processing, match to sample skill, and insomnia control. Our findings provide a solid and positive evidence of XR and Telehealth interventions in improving the treatment outcomes for children and adolescents with ASD. In the future, more research with RCTs and standardized outcome measurements are required to establish the therapeutic efficiency of the two interventions independently or combined.
10.1016/j.neubiorev.2022.104683
Extended Reality-Based Mobile App Solutions for the Therapy of Children With Autism Spectrum Disorders: Systematic Literature Review.
JMIR serious games
BACKGROUND:The increasing prevalence of autism spectrum disorder (ASD) has driven research interest on the therapy of individuals with autism, especially children, as early diagnosis and appropriate treatment can lead to improvement in the condition. With the widespread availability of virtual reality, augmented reality (AR), and mixed reality technologies to the public and the increasing popularity of mobile devices, the interest in the use of applications and technologies to provide support for the therapy of children with autism is growing. OBJECTIVE:This study aims to describe the literature on the potential of virtual reality, AR, and mixed reality technologies in the context of therapy for children with ASD. We propose to investigate and analyze the temporal distribution of relevant papers, identify the target audience for studies related to extended reality apps in ASD therapy, examine the technologies used in the development of these apps, assess the skills targeted for improvement in primary studies, explore the purposes of the proposed solutions, and summarize the results obtained from their application. METHODS:For the systematic literature review, 6 research questions were defined in the first phase, after which 5 international databases (Web of Science, Scopus, ScienceDirect, IEEE Xplore Digital Library, and ACM Digital Library) were searched using specific search strings. Results were centralized, filtered, and processed applying eligibility criteria and using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The results were refined using a technical and IT-oriented approach. The quality criteria assessed whether the research addressed ASDs, focused on children's therapy, involved targeted technologies, deployed solutions on mobile devices, and produced results relevant to our study. RESULTS:In the first step, 179 publications were identified in Zotero reference manager software (Corporation for Digital Scholarship). After excluding articles that did not meet the eligibility or quality assessment criteria, 28 publications were finalized. The analysis revealed an increase in publications related to apps for children with autism starting in 2015 and peaking in 2019. Most studies (22/28, 79%) focused on mobile AR solutions for Android devices, which were developed using the Unity 3D platform and the Vuforia engine. Although 68% (19/28) of these apps were tested with children, 32% (9/28) were tested exclusively by developers. More than half (15/28, 54%) of the studies used interviews as an evaluation method, yielding mostly favorable although preliminary results, indicating the need for more extensive testing. CONCLUSIONS:The findings reported in the studies highlight the fact that these technologies are appropriate for the therapy of children with ASD. Several studies showed a distinct trend toward the use of AR technology as an educational tool for people with ASD. This trend entails multidisciplinary cooperation and an integrated research approach, with an emphasis on comprehensive empirical evaluations and technology ethics.
10.2196/49906
Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson's disease.
Journal of neuroengineering and rehabilitation
BACKGROUND:Virtual reality (VR) has recently been explored as a tool for neurorehabilitation to enable individuals with Parkinson's disease (PD) to practice challenging skills in a safe environment. Current technological advances have enabled the use of affordable, fully immersive head-mounted displays (HMDs) for potential therapeutic applications. However, while previous studies have used HMDs in individuals with PD, these were only used for short bouts of walking. Clinical applications of VR for gait training would likely involve an extended exposure to the virtual environment, which has the potential to cause individuals with PD to experience simulator-related adverse effects due to their age or pathology. Thus, our objective was to evaluate the safety of using an HMD for longer bouts of walking in fully immersive VR for older adults and individuals with PD. METHODS:Thirty-three participants (11 healthy young, 11 healthy older adults, and 11 individuals with PD) were recruited for this study. Participants walked for 20 min while viewing a virtual city scene through an HMD (Oculus Rift DK2). Safety was evaluated using the mini-BESTest, measures of center of pressure (CoP) excursion, and questionnaires addressing symptoms of simulator sickness (SSQ) and measures of stress and arousal. RESULTS:Most participants successfully completed all trials without any discomfort. There were no significant changes for any of our groups in symptoms of simulator sickness or measures of static and dynamic balance after exposure to the virtual environment. Surprisingly, measures of stress decreased in all groups while the PD group also increased the level of arousal after exposure. CONCLUSIONS:Older adults and individuals with PD were able to successfully use immersive VR during walking without adverse effects. This provides systematic evidence supporting the safety of immersive VR for gait training in these populations.
10.1186/s12984-017-0225-2
Compensation or Restoration: Closed-Loop Feedback of Movement Quality for Assisted Reach-to-Grasp Exercises with a Multi-Joint Arm Exoskeleton.
Grimm Florian,Naros Georgios,Gharabaghi Alireza
Frontiers in neuroscience
Assistive technology allows for intensive practice and kinematic measurements during rehabilitation exercises. More recent approaches attach a gravity-compensating multi-joint exoskeleton to the upper extremity to facilitate task-oriented training in three-dimensional space with virtual reality feedback. The movement quality, however, is mostly captured through end-point measures that lack information on proximal inter-joint coordination. This limits the differentiation between compensation strategies and genuine restoration both during the exercise and in the course of rehabilitation. We extended in this proof-of-concept study a commercially available seven degree-of-freedom arm exoskeleton by using the real-time sensor data to display a three-dimensional multi-joint visualization of the user's arm. Ten healthy subjects and three severely affected chronic stroke patients performed reach-to-grasp exercises resembling activities of daily living assisted by the attached exoskeleton and received closed-loop online feedback of the three-dimensional movement in virtual reality. Patients in this pilot study differed significantly with regard to motor performance (accuracy, temporal efficiency, range of motion) and movement quality (proximal inter-joint coordination) from the healthy control group. In the course of 20 training and feedback sessions over 4 weeks, these pathological measures improved significantly toward the reference parameters of healthy participants. It was moreover feasible to capture the evolution of movement pattern kinematics of the shoulder and elbow and to quantify the individual degree of natural movement restoration for each patient. The virtual reality visualization and closed-loop feedback of joint-specific movement kinematics makes it possible to detect compensation strategies and may provide a tool to achieve the rehabilitation goals in accordance with the individual capacity for genuine functional restoration; a proposal that warrants further investigation in controlled studies with a larger cohort of stroke patients.
10.3389/fnins.2016.00280
Visuomotor gain distortion alters online motor performance and enhances primary motor cortex excitability in patients with stroke.
Bagce Hamid F,Saleh Soha,Adamovich Sergei V,Tunik Eugene
Neuromodulation : journal of the International Neuromodulation Society
OBJECTIVES:Determine if ipsilesional primary motor cortex (M1) in stroke patients processes online visuomotor discordance in gain between finger movement and observed feedback in virtual reality (VR). MATERIALS AND METHODS:Chronic stroke patients flexed (N= 7) or extended (N= 1) their finger with real-time feedback of a virtual hand presented in VR. Virtual finger excursion was scaled by applying a low-gain (G(0.25) ), high-gain (G(1.75) ), or veridical (G(1.00) ) scaling factor to real-time data streaming from a sensor glove. Effects of visuomotor discordance were assessed through analysis of movement kinematics (joint excursion, movement smoothness, and angular velocity) and amplitude of motor evoked potentials (MEPs) elicited with transcranial magnetic stimulation applied to ipsilesional M1. Data were analyzed with a repeated-measures analysis of variance (significance set at 0.05). RESULTS:G(0.25) discordance (relative to veridical) leads to significantly larger joint excursion, online visuomotor correction evidenced by decreased trajectory smoothness, and significantly facilitated agonist MEPs. This effect could not be explained by potential differences in motor drive (background electromyographic) or by possible differences related to joint angle or angular velocity, as these variables remained invariant across conditions at the time of MEP assessment. M1 was not significantly facilitated in the G(1.75) condition. MEPs recorded in an adjacent muscle that was not involved in the task were unaffected by visual feedback in either discordance condition. These data suggest that the neuromodulatory effects of visuomotor discordance on M1 were relatively selective. CONCLUSIONS: Visuomotor discordance may be used to alter movement performance and augment M1 excitability in patients following stroke. Our data illustrate that visual feedback may be a robust way to selectively modulate M1 activity. These data may have important clinical implications for the development of future VR training protocols.
10.1111/j.1525-1403.2012.00467.x
Learning real-life cognitive abilities in a novel 360°-virtual reality supermarket: a neuropsychological study of healthy participants and patients with epilepsy.
Grewe Philip,Kohsik Agnes,Flentge David,Dyck Eugen,Botsch Mario,Winter York,Markowitsch Hans J,Bien Christian G,Piefke Martina
Journal of neuroengineering and rehabilitation
BACKGROUND:To increase the ecological validity of neuropsychological instruments the use of virtual reality (VR) applications can be considered as an effective tool in the field of cognitive neurorehabilitation. Despite the growing use of VR programs, only few studies have considered the application of everyday activities like shopping or travelling in VR training devices. METHODS:We developed a novel 360°-VR supermarket, which is displayed on a circular arrangement of 8 touch-screens--the "OctaVis". In this setting, healthy human adults had to memorize an auditorily presented shopping list (list A) and subsequently buy all remembered products of this list in the VR supermarket. This procedure was accomplished on three consecutive days. On day four, a new shopping list (list B) was introduced and participants had to memorize and buy only products of this list. On day five, participants had to buy all remembered items of list A again, but without new presentation of list A. Additionally, we obtained measures of participants' presence, immersion and figural-spatial memory abilities. We also tested a sample of patients with focal epilepsy with an extended version of our shopping task, which consisted of eight days of training. RESULTS:We observed a comprehensive and stable effect of learning for the number of correct products, the required time for shopping, and the length of movement trajectories in the VR supermarket in the course of the training program. Task performance was significantly correlated with participants' figural-spatial memory abilities and subjective level of immersion into the VR. CONCLUSIONS:Learning effects in our paradigm extend beyond mere verbal learning of the shopping list as the data show evidence for multi-layered learning (at least visual-spatial, strategic, and verbal) on concordant measures. Importantly, learning also correlated with measures of figural-spatial memory and the degree of immersion into the VR. We propose that cognitive training with the VR supermarket program in the OctaVis will be efficient for the assessment and training of real-life cognitive abilities in healthy subjects and patients with epilepsy. It is most likely that our findings will also apply for patients with cognitive disabilities resulting from other neurological and psychiatric syndromes.
10.1186/1743-0003-10-42
Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson's Disease.
Maidan Inbal,Nieuwhof Freek,Bernad-Elazari Hagar,Bloem Bastiaan R,Giladi Nir,Hausdorff Jeffrey M,Claassen Jurgen A H R,Mirelman Anat
Neurorehabilitation and neural repair
BACKGROUND:In a randomized control trial conducted in patients with Parkinson's disease, a treadmill training program combined with virtual reality that targeted motor and cognitive aspects of safe ambulation led to fewer falls, compared with treadmill training alone. OBJECTIVE:To investigate if the 2 types of training differentially affected prefrontal activation and if this might explain differences in fall rates after the intervention. METHODS:Sixty-four patients with Parkinson's disease were randomized into the treadmill training arm (n = 34, mean age 73.1 ± 1.1 years, 64% men, disease duration 9.7 ± 1.0 years) or treadmill training with virtual reality arm (n = 30, mean age 70.1 ± 1.3 years, 71% men, disease duration 8.9 ± 1.1 years). Prefrontal activation during usual, dual-task, and obstacle negotiation walking was assessed before and after 6 weeks of training, using a functional near-infrared spectroscopy system. RESULTS:Treadmill training with and without virtual reality reduced prefrontal activation during walking ( P < .001), with specific interactions related to training arm ( P = .01), lateralization ( P = .05), and walking condition ( P = .001). For example, among the subjects who trained with treadmill training alone, prefrontal activation during dual-task walking and obstacle negotiation increased after training, while in the combined training arm, activation decreased. CONCLUSIONS:Prefrontal activation during usual and during more challenging walking conditions can be altered in response to 2 different types of training. The addition of a cognitive training component to a treadmill exercise program apparently modifies the effects of the training on the magnitude and lateralization of prefrontal activation and on falls, extending the understanding of the plasticity of the brain in PD.
10.1177/1545968318763750
EEG-Based Emotion Classification for Alzheimer's Disease Patients Using Conventional Machine Learning and Recurrent Neural Network Models.
Seo Jungryul,Laine Teemu H,Oh Gyuhwan,Sohn Kyung-Ah
Sensors (Basel, Switzerland)
As the number of patients with Alzheimer's disease (AD) increases, the effort needed to care for these patients increases as well. At the same time, advances in information and sensor technologies have reduced caring costs, providing a potential pathway for developing healthcare services for AD patients. For instance, if a virtual reality (VR) system can provide emotion-adaptive content, the time that AD patients spend interacting with VR content is expected to be extended, allowing caregivers to focus on other tasks. As the first step towards this goal, in this study, we develop a classification model that detects AD patients' emotions (e.g., happy, peaceful, or bored). We first collected electroencephalography (EEG) data from 30 Korean female AD patients who watched emotion-evoking videos at a medical rehabilitation center. We applied conventional machine learning algorithms, such as a multilayer perceptron (MLP) and support vector machine, along with deep learning models of recurrent neural network (RNN) architectures. The best performance was obtained from MLP, which achieved an average accuracy of 70.97%; the RNN model's accuracy reached only 48.18%. Our study results open a new stream of research in the field of EEG-based emotion detection for patients with neurological disorders.
10.3390/s20247212
Pavement patterns can be designed to improve gait in Parkinson's disease patients.
Gál Ota,Poláková Kamila,Hoskovcová Martina,Tomandl Jan,Čapek Václav,Berka Roman,Brožová Hana,Šestáková Irena,Růžička Evžen
Movement disorders : official journal of the Movement Disorder Society
BACKGROUND:Public spaces are usually designed with respect to various patient populations, but not Parkinson's disease. The objective of this study was to explore what type of easily applicable visual cueing might be used in public spaces and some interiors to improve gait in people with Parkinson's disease. METHODS:Thirty-two patients with freezing of gait walked an 8-meter track on 6 different floor patterns in single- and dual-task conditions in random sequence. The reference pattern was a virtual large transverse chessboard, and the other patterns differed either in size (small floor stones), orientation (diagonal), nature (real paving), regularity (irregular), or no pattern. Time, number of steps, velocity, step length, cadence, and dual-task effect were calculated. The number and total duration of freezing episodes were analyzed. RESULTS:Virtual, large, transverse floor stones improve time (P = 0.0101), velocity (P = 0.0029), number of steps (P = 0.0291), and step length (P = 0.0254) in Parkinson's disease patients compared with walking on no pattern. Virtual floor stones were superior in time and velocity to the real ones. Transverse floor stones were better than diagonal, whereas regular pattern stones were superior to irregular in some gait parameters. Subjectively, the reference pattern was preferred to the irregular one and to no pattern. No direct effect on freezing of gait was observed. CONCLUSIONS:Parkinson's disease patients may benefit from floor patterns incorporating transverse oriented large rectangular visual cues. Because public space can be regulated with respect to people with medical conditions, the relevant legislative documents should be extended to allow for parkinsonian gait disorder. © 2019 International Parkinson and Movement Disorder Society.
10.1002/mds.27831
Increase of frontal neuronal activity in chronic neglect after training in virtual reality.
Ekman U,Fordell H,Eriksson J,Lenfeldt N,Wåhlin A,Eklund A,Malm J
Acta neurologica Scandinavica
OBJECTIVES:A third of patients with stroke acquire spatial neglect associated with poor rehabilitation outcome. New effective rehabilitation interventions are needed. Scanning training combined with multisensory stimulation to enhance the rehabilitation effect is suggested. In accordance, we have designed a virtual-reality based scanning training that combines visual, audio and sensori-motor stimulation called RehAtt . Effects were shown in behavioural tests and activity of daily living. Here, we use fMRI to evaluate the change in brain activity during Posner's Cuing Task (attention task) after RehAtt intervention, in patients with chronic neglect. METHODS:Twelve patients (mean age = 72.7 years, SD = 6.1) with chronic neglect (persistent symptoms >6 months) performed the interventions 3 times/wk during 5 weeks, in total 15 hours. Training effects on brain activity were evaluated using fMRI task-evoked responses during the Posner's cuing task before and after the intervention. RESULTS:Patients improved their performance in the Posner fMRI task. In addition, patients increased their task-evoked brain activity after the VR interventions in an extended network including pre-frontal and temporal cortex during attentional cueing, but showed no training effects during target presentations. CONCLUSIONS:The current pilot study demonstrates that a novel multisensory VR intervention has the potential to benefit patients with chronic neglect in respect of behaviour and brain changes. Specifically, the fMRI results show that strategic processes (top-down control during attentional cuing) were enhanced by the intervention. The findings increase knowledge of the plasticity processes underlying positive rehabilitation effects from RehAtt in chronic neglect.
10.1111/ane.12955
Exploring perspectives from stroke survivors, carers and clinicians on virtual reality as a precursor to using telerehabilitation for spatial neglect post-stroke.
Neuropsychological rehabilitation
Spatial neglect is a common and severe cognitive consequence of stroke, yet there is currently no effective rehabilitation tool. Virtual Reality (VR) telerehabilitation tools have the potential to provide multisensory and enjoyable therapies and remotely monitor adherence without the presence of a therapist at all times. Researchers and industry need to better understand end-user perspectives about these technologies to ensure these are acceptable and, ultimately, optimize adherence and efficacy. This study aims to explore end-user perspectives on the use of self-administered VR for spatial neglect in a university environment to identify barriers and facilitators prior to extending its use remotely as a telerehabilitation tool. We used a mixed-method design including focus groups, self-administered questionnaires and interviews with stroke survivors ( = 7), their carers ( = 3) and stroke clinicians ( = 6). End-user perspectives identified clarity of instructions, equipment (cost, available resources) and for some, level of experience with technology as barriers of use. Perceived facilitators were performance feedback, engagement and enjoyment, and psychological benefits associated with self-administered VR telerehabilitation. Overall, end-users were positive and interested in using VR telerehabilitation for spatial neglect. These perspectives enabled us to produce practical recommendations to inform development, enhance engagement and uptake of VR telerehabilitation and inform future studies.
10.1080/09602011.2020.1819827
Using mixed methods to evaluate efficacy and user expectations of a virtual reality-based training system for upper-limb recovery in patients after stroke: a study protocol for a randomised controlled trial.
Schuster-Amft Corina,Eng Kynan,Lehmann Isabelle,Schmid Ludwig,Kobashi Nagisa,Thaler Irène,Verra Martin L,Henneke Andrea,Signer Sandra,McCaskey Michael,Kiper Daniel
Trials
BACKGROUND:In recent years, virtual reality has been introduced to neurorehabilitation, in particular with the intention of improving upper-limb training options and facilitating motor function recovery. METHODS/DESIGN:The proposed study incorporates a quantitative part and a qualitative part, termed a mixed-methods approach: (1) a quantitative investigation of the efficacy of virtual reality training compared to conventional therapy in upper-limb motor function are investigated, (2a) a qualitative investigation of patients' experiences and expectations of virtual reality training and (2b) a qualitative investigation of therapists' experiences using the virtual reality training system in the therapy setting. At three participating clinics, 60 patients at least 6 months after stroke onset will be randomly allocated to an experimental virtual reality group (EG) or to a control group that will receive conventional physiotherapy or occupational therapy (16 sessions, 45 minutes each, over the course of 4 weeks). Using custom data gloves, patients' finger and arm movements will be displayed in real time on a monitor, and they will move and manipulate objects in various virtual environments. A blinded assessor will test patients' motor and cognitive performance twice before, once during, and twice after the 4-week intervention. The primary outcome measure is the Box and Block Test. Secondary outcome measures are the Chedoke-McMaster Stroke Assessments (hand, arm and shoulder pain subscales), the Chedoke-McMaster Arm and Hand Activity Inventory, the Line Bisection Test, the Stroke Impact Scale, the MiniMentalState Examination and the Extended Barthel Index. Semistructured face-to-face interviews will be conducted with patients in the EG after intervention finalization with a focus on the patients' expectations and experiences regarding the virtual reality training. Therapists' perspectives on virtual reality training will be reviewed in three focus groups comprising four to six occupational therapists and physiotherapists. DISCUSSION:The interviews will help to gain a deeper understanding of the phenomena under investigation to provide sound recommendations for the implementation of the virtual reality training system for routine use in neurorehabilitation complementing the quantitative clinical assessments. TRIAL REGISTRATION:Cliniclatrials.gov Identifier: NCT01774669 (15 January 2013).
10.1186/1745-6215-15-350
Home-based Upper Extremity Stroke Therapy Using a Multiuser Virtual Reality Environment: A Randomized Trial.
Thielbar Kelly O,Triandafilou Kristen M,Barry Alexander J,Yuan Ning,Nishimoto Arthur,Johnson Joelle,Stoykov Mary Ellen,Tsoupikova Daria,Kamper Derek G
Archives of physical medicine and rehabilitation
OBJECTIVE:To compare participation and subjective experience of participants in both home-based multiuser virtual reality (VR) therapy and home-based single-user (SU) VR therapy. DESIGN:Crossover, randomized trial. SETTING:Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants' homes. PARTICIPANTS:Survivors of stroke with chronic upper extremity impairment (N=20). INTERVENTIONS:Four weeks of in-home treatment using a custom, multiuser virtual reality system (VERGE): 2 weeks of both multiuser (MU) and SU versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into 2 groups, First MU and First SU. MAIN OUTCOME MEASURES:We measured arm displacement during each session (m) as the primary outcome measure. Secondary outcome measures include time participants spent using each MU and SU VERGE and Intrinsic Motivation Inventory scores. Fugl-Meyer Assessment of Motor Recovery After Stroke Upper Extremity (FMA-UE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session. RESULTS:Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, P=.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (P=.04). FMA-UE score improved significantly across all participants (Δ3.2, P=.001). CONCLUSIONS:Multiuser VR exercises may provide an effective means of extending clinical therapy into the home.
10.1016/j.apmr.2019.10.182
Acceptance and Usability of Immersive Virtual Reality in Older Adults with Objective and Subjective Cognitive Decline.
Arlati Sara,Di Santo Simona Gabriella,Franchini Flaminia,Mondellini Marta,Filiputti Beatrice,Luchi Matilde,Ratto Federica,Ferrigno Giancarlo,Sacco Marco,Greci Luca
Journal of Alzheimer's disease : JAD
BACKGROUND:Virtual reality (VR) has recently emerged as a promising means for the administration of cognitive training of seniors at risk of dementia. Immersive VR could result in increased engagement and performances; however, its acceptance in older adults with cognitive deficits still has to be assessed. OBJECTIVE:To assess acceptance and usability of an immersive VR environment requiring real walking and active participants' interaction. METHODS:58 seniors with mild cognitive impairment (MCI, n = 24) or subjective cognitive decline (SCD, n = 31) performed a shopping task in a virtual supermarket displayed through a head-mounted display. Subjective and objective outcomes were evaluated. RESULTS:Immersive VR was well-accepted by all but one participant (TAM3 positive subscales > 5.33), irrespective of the extent of cognitive decline. Participants enjoyed the experience (spatial presence 3.51±0.50, engagement 3.85±0.68, naturalness 3.85±0.82) and reported negligible side-effects (SSQ: 3.74; q1-q3:0-16.83). The environment was considered extremely realistic, such as to induce potentially harmful behaviors: one participant fell while trying to lean on a virtual shelf. Older participants needed more time to conclude trials. Participants with MCI committed more errors in grocery items' selection and experienced less "perceived control" over the environment. CONCLUSION:Immersive VR was acceptable and enjoyable for older adults in both groups. Cognitive deficits could induce risky behaviors, and cause issues in the interactions with virtual items. Further studies are needed to confirm acceptance of immersive VR in individuals at risk of dementia, and to extend the results to people with more severe symptoms.
10.3233/JAD-201431
Utilizing multi-user virtual reality to bring clinical therapy into stroke survivors' homes.
Thielbar Kelly,Spencer Nicole,Tsoupikova Daria,Ghassemi Mohammad,Kamper Derek
Journal of hand therapy : official journal of the American Society of Hand Therapists
INTRODUCTION:Lifespans after the occurrence of a stroke have been lengthening, but most stroke survivors will experience chronic impairment. Directed, repetitive practice may reduce deficits, but clinical access is often limited by a variety of factors, such as transportation. PURPOSE OF THE STUDY:To introduce a multiuser virtual reality platform that can be used to promote therapist-client interactions when the client is at home. METHODS:The Virtual Environment for Rehabilitative Gaming Exercises encourages exploration of the hand workspace by enabling multiple participants, located remotely and colocated virtually, to interact with the same virtual objects in the shared virtual space. Each user controls an avatar by corresponding movement of his or her own body segments. System performance with stroke survivors was evaluated during longitudinal studies in a laboratory environment and in participants' homes. Active arm movement was tracked throughout therapy sessions for both studies. RESULTS:Stroke survivors achieved considerable arm movement while using the system. Mean voluntary hand displacement, after accounting for trunk displacement, was greater than 350 m per therapy session for the Virtual Environment for Rehabilitative Gaming Exercises system. Compliance for home-based therapy was quite high, with 94% of all scheduled sessions completed. Having multiple players led to longer sessions and more arm movement than when the stroke survivors were trained alone. CONCLUSIONS:Multiuser virtual reality offers a relatively inexpensive means of extending clinical therapy into home and enabling family and friends to support rehabilitation efforts, even when physically remote from each other.
10.1016/j.jht.2020.01.006
Virtual Reality-Based Cognitive Stimulation to Improve Cognitive Functioning in Community Elderly: A Controlled Study.
Gamito Pedro,Oliveira Jorge,Alves Catarina,Santos Nuno,Coelho Cátia,Brito Rodrigo
Cyberpsychology, behavior and social networking
The advantages of using naturalistic virtual reality (VR) environments based on everyday life tasks for cognitive intervention in the elderly are not yet well understood. The literature suggests that the similarity of such exercises with real life activities may improve generalizability by extending the transfer of gains of training to everyday living. This study aimed to investigate the gains associated with this ecologically-oriented virtual reality cognitive stimulation (VR-CS) versus standard cognitive stimulation in the elderly. Forty-three healthy older adults were divided into two groups: an experimental group underwent a VR-based cognitive stimulation and an active control group underwent a paper-and-pencil cognitive stimulation. The outcomes assessed at the pre-treatment and posttreatment assessment consisted in well-established tests for cognitive and executive functioning, depression, subjective well-being, and functionality. The results showed positive outcomes on dimensions of general cognition, executive functioning, attention, and visual memory in the group that underwent VR-CS. Improvements in executive functioning in this group was supported by consistent evidence of increases in attention abilities but little evidence of increases in memory abilities. Both effects may have contributed to improvements in general cognition. Further studies are needed to test whether these effects may extend to well-being and functionality in cognitively impaired older adults.
10.1089/cyber.2019.0271
Virtual Reality Meets Non-invasive Brain Stimulation: Integrating Two Methods for Cognitive Rehabilitation of Mild Cognitive Impairment.
Mancuso Valentina,Stramba-Badiale Chiara,Cavedoni Silvia,Pedroli Elisa,Cipresso Pietro,Riva Giuseppe
Frontiers in neurology
Mild cognitive impairment (MCI) refers to a subtle, general cognitive decline with a detrimental impact on elderlies' independent living and quality of life. Without a timely diagnosis, this condition can evolve into dementia over time, hence the crucial need for early detection, prevention, and rehabilitation. For this purpose, current neuropsychological interventions have been integrated with (i) virtual reality, which immerses the user in a controlled, ecological, and safe environment (so far, both virtual reality-based cognitive and motor rehabilitation have revealed promising positive outcomes); and (ii) non-invasive brain stimulation, i.e., transcranial magnetic or electric brain stimulation, which has emerged as a promising cognitive treatment for MCI and Alzheimer's dementia. To date, these two methods have been employed separately; only a few studies (limited to motor rehabilitation) have suggested their integration. The present paper suggests to extend this integration to cognitive rehabilitation as well as to provide a multimodal stimulation that could enhance cognitive training, resulting in a more efficient rehabilitation.
10.3389/fneur.2020.566731
Effects of Boundary-Based Assist-as-Needed Force Field on Lower Limb Muscle Synergies During Standing Posture Training.
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society
The boundary-based assist-as-needed (BAAN) force field is widely used in robotic rehabilitation and has shown promising results in improving trunk control and postural stability. However, the fundamental understanding of how the BAAN force field affects the neuromuscular control remains unclear. In this study, we investigate how the BAAN force field impacts muscle synergy in the lower limbs during standing posture training. We integrated virtual reality (VR) into a cable-driven Robotic Upright Stand Trainer (RobUST) to define a complex standing task that requires both reactive and voluntary dynamic postural control. Ten healthy subjects were randomly assigned to two groups. Each subject performed 100 trials of the standing task with or without assistance from the BAAN force field provided by RobUST. The BAAN force field significantly improved balance control and motor task performance. Our results also indicate that the BAAN force field reduced the total number of lower limb muscle synergies while concurrently increasing the synergy density (i.e., number of muscles recruited in each synergy) during both reactive and voluntary dynamic posture training. This pilot study provides fundamental insights into understanding the neuromuscular basis of the BAAN robotic rehabilitation strategy and its potential for clinical applications. In addition, we expanded the repertoire of training with RobUST that integrates both perturbation training and goal-oriented functional motor training within a single task. This approach can be extended to other rehabilitation robots and training approaches with them.
10.1109/TNSRE.2023.3273990
Influence of User Posture and Virtual Exercise on Impression of Locomotion During VR Observation.
IEEE transactions on visualization and computer graphics
A seated user watching his avatar walking in Virtual Reality (VR) may have an impression of walking. In this paper, we show that such an impression can be extended to other postures and other locomotion exercises. We present two user studies in which participants wore a VR headset and observed a first-person avatar performing virtual exercises. In the first experiment, the avatar walked and the participants (n=36) tested the simulation in 3 different postures (standing, sitting and Fowler's posture). In the second experiment, other participants (n=18) were sitting and observed the avatar walking, jogging or stepping over virtual obstacles. We evaluated the impression of locomotion by measuring the impression of walking (respectively jogging or stepping) and embodiment in both experiments. The results show that participants had the impression of locomotion in either sitting, standing and Fowler's posture. However, Fowler's posture significantly decreased both the level of embodiment and the impression of locomotion. The sitting posture seems to decrease the sense of agency compared to standing posture. Results also show that the majority of the participants experienced an impression of locomotion during the virtual walking, jogging, and stepping exercises. The embodiment was not influenced by the type of virtual exercise. Overall, our results suggest that an impression of locomotion can be elicited in different users' postures and during different virtual locomotion exercises. They provide valuable insight for numerous VR applications in which the user observes a self-avatar moving, such as video games, gait rehabilitation, training, etc.
10.1109/TVCG.2022.3161130
Effect of a Cognitive Function and Social Skills-Based Digital Exercise Therapy Using IoT on Motor Coordination in Children with Intellectual and Developmental Disability.
International journal of environmental research and public health
This study aimed to determine the effects of a virtual reality exercise program based on cognitive function and social skills on motor coordination in children with intellectual and developmental disabilities (IDD). Thirty-five children with IDD were randomly assigned to either the cognitive function and social skills-based virtual reality exercise system (CS-VR) group or the conventional virtual reality exercise system (C-VR) group. Before and after the intervention, each participant was tested for motor coordination (extended horizontal jump, hop, stationary dribble, overarm throw) and exercise performance (standing long jump, YMCA step test). Compared with the C-VR group, the CS-VR group showed significant improvements in motor coordination in terms of extended horizontal jump, hop, and overarm throw ( < 0.01, < 0.05, and < 0.01, respectively). In addition, compared with the C-VR group, the CS-VR group showed a significant increase in standing long jump ( < 0.01), although no significant between-group variation was found in stationary dribble and recovery heart rate (RHR) as part of the YMCA step test ( > 0.05, and > 0.05, respectively). These results suggest that for the development of motor skills in children with IDD, it is essential to develop an exercise program that reflects the levels of cognitive functions and social skills of these children.
10.3390/ijerph192416499
Virtual immersion for post-stroke hand rehabilitation therapy.
Tsoupikova Daria,Stoykov Nikolay S,Corrigan Molly,Thielbar Kelly,Vick Randy,Li Yu,Triandafilou Kristen,Preuss Fabian,Kamper Derek
Annals of biomedical engineering
Stroke is the leading cause of serious, long-term disability in the United States. Impairment of upper extremity function is a common outcome following stroke, often to the detriment of lifestyle and employment opportunities. While the upper extremity is a natural target for therapy, treatment may be hampered by limitations in baseline capability as lack of success may discourage arm and hand use. We developeda virtual reality (VR) system in order to encourage repetitive task practice. This system combined an assistive glove with a novel VR environment. A set of exercises for this system was developed to encourage specific movements. Six stroke survivors with chronic upper extremity hemiparesis volunteered to participate in a pilot study in which they completed 18 one-hour training sessions with the VR system. Performance with the system was recorded across the 18 training sessions. Clinical evaluations of motor control were conducted at three time points: prior to initiation of training, following the end of training, and 1 month later. Subjects displayed significant improvement on performance of the virtual tasks over the course of the training, although for the clinical outcome measures only lateral pinch showed significant improvement. Future expansion to multi-user virtual environments may extend the benefits of this system for stroke survivors with hemiparesis by furthering engagement in the rehabilitation exercises.
10.1007/s10439-014-1218-y
Construction and Application of Virtual Reality-Based Sports Rehabilitation Training Program.
Occupational therapy international
This paper adopts virtual reality technology to conduct in-depth research and analysis on sports rehabilitation training, designs a corresponding sports rehabilitation training program, and applies it to practice. An AR algorithm based on dynamic target tracking under VSLAM is proposed. The algorithm can effectively reject dynamic targets in static scenes while ensuring that the virtual objects registered based on dynamic template target tracking are still in the world coordinate system of VSLAM. To facilitate patients' hand function rehabilitation training, this paper uses OpenPose for 2D gesture pose recognition, combines camera pose information and depth information provided by VSLAM to map key points of the hand into the world coordinate system, and then completes the interaction by collision detection algorithm. The virtual interaction module is implemented in this paper to meet the demand for multiuser off-site interaction in virtual training. This paper uses the Unity3D software and Photon Server server to create a VR virtual scene and design a user interaction mechanism to realize a system that supports multiple users to train together online, which effectively extends the application scope of the VR training system. The module utilizes Unity3D's VR development capabilities to develop VR virtual basketball gym scenes and single-player offline interaction mechanisms such as virtual user single shooter and shooter; then, Photon Server is used to design and implement a multiuser remote login system and a multiuser interpass mechanism, thus achieving the effect of multiplayer remote online interaction in the same VR space. Finally, the proposed module was validated, and the results proved the effectiveness of the sports rehabilitation training program.
10.1155/2022/4364360
Therapeutic gardens as a design approach for optimising the healing environment of patients with Alzheimer's disease and other dementias: A narrative review.
Uwajeh Patrick Chukwuemeke,Iyendo Timothy Onosahwo,Polay Mukaddes
Explore (New York, N.Y.)
PURPOSE:The first half of this paper documents the role of nature in healthcare environments and its impact on wellness, with a particular focus on gardens. The second half presents a scientific evaluation of the role of gardens as a therapeutic intervention to optimise the clinical outcomes in patients with Alzheimer's disease (AD) and dementia, including a review of the innovative application of technologies alongside nature to promote cognitive rehabilitation in this particular patient population. METHODS:Using search engines such as the Institute for Scientific Information (ISI) Web of Science, PubMed, ProQuest Central, MEDLINE, Scopus and Google Scholar, a relevant literature search on the positive health implications of therapeutic gardens (TG) on AD and dementia patients in the healthcare milieu was conducted. RESULTS:The health implications of TG for AD and dementia patients span physical, social, psychological and cognitive effects. Virtual reality (VR) technologies that display natural environments also offer positive cognitive outcomes for AD and dementia patients. CONCLUSION:TG should be used to improve the health and wellbeing of AD and dementia patients, and its application should be extended to other patient populations to promote quicker recovery. Future directions in the design of TG, with a focus on patients with AD and other dementias, is also discussed.
10.1016/j.explore.2019.05.002
Virtual Reality Game Selection for Traumatic Brain Injury Rehabilitation: A Therapist's Wish List for Game Developers.
Games for health journal
This project explored the selection process of commercially available virtual reality (VR) games for traumatic brain injury rehabilitation. Occupational therapy practitioners (OTPs) developed a classification framework that they used to evaluate VR games. The classification framework focused on movements required to effectively play the game, cognitive demand, position for game play, ease in menu navigation, and perceived therapeutic applications. OTPs used the ratings to aid in game selection and identified relevant game examples that allowed customizable settings and basic navigation with a game focus on functional activities. The OTPs and the research team identified the need for further work on accessibility and adaptability of game features (e.g., difficulty and limb usage) allowing for more individualization to optimize outcomes of VR-enhanced rehabilitation. The classification framework was useful in evaluating the potential therapeutic benefit of commercially available VR games. However, trial of the game by clinicians prior to use was still warranted.
10.1089/g4h.2022.0174
Virtual Reality-Based Sensory Stimulation for Pediatric Disorders of Consciousness: A Pilot Study.
Frontiers in pediatrics
Objective:The purpose of this study was to determine whether virtual reality-based sensory stimulation has the ability to improve the level of consciousness in pediatric disorders of consciousness compared with general rehabilitation. Methods:Thirty subjects were divided into a virtual reality (VR) group ( = 15) and a control group ( = 15). Subjects in the VR group received both general rehabilitation and exposure to VR videos; the control group received only general rehabilitation. The Glasgow Coma Scale (GCS), Coma Recovery Scale-Revised (CRS-R), and amplitude-integrated electroencephalogram (EEG) (aEEG) were used to measure the clinical behavioral response and neuroelectrophysiology before and after the treatment. The Glasgow Outcome Scale Extended Pediatric Revised (GOS-E Peds) was used to measure the social and personal functional ability after 3 months. Results:After 2 weeks of treatment, the CRS-R and GCS improved in both groups. However, the VR group had better results than the control group in the CRS-R ( = 0.003) and GCS ( = 0.045). There were no significant differences on aEEG in the two groups after treatment. According to the GOS-E Peds, the improvement of social and personal functional ability had no significant differences in the two groups. Additionally, there were no obvious adverse reactions in the two group during the treatment. Conclusions:This pilot study indicates potential benefit from the addition of VR to standard rehabilitation in pediatric disorders of consciousness. To further explore the efficacy of VR, a large-sample randomized controlled trial is warranted.
10.3389/fped.2022.879422
Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation.
Perez-Marcos Daniel
Journal of neuroengineering and rehabilitation
BACKGROUND:In the context of stroke rehabilitation, new training approaches mediated by virtual reality and videogames are usually discussed and evaluated together in reviews and meta-analyses. This represents a serious confounding factor that is leading to misleading, inconclusive outcomes in the interest of validating these new solutions. MAIN BODY:Extending existing definitions of virtual reality, in this paper I put forward the concept of virtual reality experience (VRE), generated by virtual reality systems (VRS; i.e. a group of variable technologies employed to create a VRE). Then, I review the main components composing a VRE, and how they may purposely affect the mind and body of participants in the context of neurorehabilitation. In turn, VRS are not anymore exclusive from VREs but are currently used in videogames and other human-computer interaction applications in different domains. Often, these other applications receive the name of virtual reality applications as they use VRS. However, they do not necessarily create a VRE. I put emphasis on exposing fundamental similarities and differences between VREs and videogames for neurorehabilitation. I also recommend describing and evaluating the specific features encompassing the intervention rather than evaluating virtual reality or videogames as a whole. CONCLUSION:This disambiguation between VREs, VRS and videogames should help reduce confusion in the field. This is important for databases searches when looking for specific studies or building metareviews that aim at evaluating the efficacy of technology-mediated interventions.
10.1186/s12984-018-0461-0
Adjunctive Approaches to Aphasia Rehabilitation: A Review on Efficacy and Safety.
Picano Chiara,Quadrini Agnese,Pisano Francesca,Marangolo Paola
Brain sciences
Aphasia is one of the most socially disabling post-stroke deficits. Although traditional therapies have been shown to induce adequate clinical improvement, aphasic symptoms often persist. Therefore, unconventional rehabilitation techniques which act as a substitute or as an adjunct to traditional approaches are urgently needed. The present review provides an overview of the efficacy and safety of the principal approaches which have been proposed over the last twenty years. First, we examined the effectiveness of the pharmacological approach, principally used as an adjunct to language therapy, reporting the mechanism of action of each single drug for the recovery of aphasia. Results are conflicting but promising. Secondly, we discussed the application of Virtual Reality (VR) which has been proven to be useful since it potentiates the ecological validity of the language therapy by using virtual contexts which simulate real-life everyday contexts. Finally, we focused on the use of Transcranial Direct Current Stimulation (tDCS), both discussing its applications at the cortical level and highlighting a new perspective, which considers the possibility to extend the use of tDCS over the motor regions. Although the review reveals an extraordinary variability among the different studies, substantial agreement has been reached on some general principles, such as the necessity to consider tDCS only as an adjunct to traditional language therapy.
10.3390/brainsci11010041
Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals.
Journal of neuroengineering and rehabilitation
BACKGROUND:Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy-interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb-can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear. OBJECTIVE:Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability. MATERIALS AND METHODS:Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant's dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar's dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities. RESULTS:We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other. DISCUSSIONS:The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.
10.1186/s12984-024-01454-2
Enhancing cognitive flexibility and working memory in individuals with mild cognitive impairment: Exploring the impact of virtual reality on daily life activities.
Geriatric nursing (New York, N.Y.)
Mild Cognitive Impairment (MCI) serving as a transitional stage between normal aging and dementia. This study aimed to explore the impact of virtual reality (VR) on enhancing cognitive flexibility, working memory, and daily life activities. Forty participants diagnosed with MCI were randomly assigned to either an intervention group (N = 20) or a control group (N = 20). Evaluations were at baseline, post-training, and three months post-training using various cognitive assessment tools. Results showed that the VR-based cognitive rehabilitation significantly improved instrumental activities of daily living performance, visual and verbal working memory, and reduced anxiety and depression symptoms. While cognitive flexibility did not exhibit significant improvement, these findings highlight VR interventions as a potential avenue for improving cognitive and functional aspects, and alleviating psychological symptoms in individuals with MCI. Further research with larger sample sizes and extended follow-up periods is recommended to establish the long-term effectiveness of such interventions.
10.1016/j.gerinurse.2023.12.008
Virtual Reality as a Therapeutic Tool in Spinal Cord Injury Rehabilitation: A Comprehensive Evaluation and Systematic Review.
Journal of clinical medicine
: The spinal rehabilitation process plays a crucial role in SCI patients' lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. : The primary objective of this study is to assess a complete review of the extended impacts of VR-assisted training on spine rehabilitation in SCI patients. : This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a single database search in PubMed/Medline between the dates 1 January 2010 and 1 February 2024. MESH terms and keywords were combined in the following search strategy: (Augmented Reality OR VR OR Virtual Reality) AND (Spine OR Spinal) AND Rehabilitation. Included articles were written in English, involved adults with SCI, included an intervention with VR, AR, or any mixed reality system, and assessed changes in outcomes after the intervention. : The search produced 257 articles, and 46 of them were allocated for data extraction to evaluate 652 patients. Both when VR training was analyzed and reviewed separately, and when compared to traditional training, the findings exhibited predominantly promising outcomes, reflecting a favorable trend in the study. VR technologies were used in different settings and customizations, and the medium total time of VR training among the studies was 60.46 h per patient. : This auspicious outcome of the study further motivates the intervention of VR and AR in the rehabilitation of SCI patients along with ameliorating their overall holistic well-being.
10.3390/jcm13185429
The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis.
Bordeleau Martine,Stamenkovic Alexander,Tardif Pier-Alexandre,Thomas James
The journal of pain
This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function. PERSPECTIVE: Extended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.
10.1016/j.jpain.2021.08.001
Virtual, mixed, and augmented realities: A commentary on their significance in cognitive neuroscience and neuropsychology.
Applied neuropsychology. Adult
The integration of virtual, mixed, and augmented reality technologies in cognitive neuroscience and neuropsychology represents a transformative frontier. In this Commentary, we conducted a meta-analysis of studies that explored the impact of Virtual Reality (VR), Mixed Reality (MR), and Augmented Reality (AR) on cognitive neuroscience and neuropsychology. Our review highlights the versatile applications of VR, ranging from spatial cognition assessments to rehabilitation for Traumatic Brain Injury. We found that MR and AR offer innovative avenues for cognitive training, particularly in memory-related disorders. The applications extend to addressing social cognition disorders and serving as therapeutic interventions for mental health issues. Collaborative efforts between neuroscientists and technology developers are crucial, with reinforcement learning and neuroimaging studies enhancing the potential for improved outcomes. Ethical considerations, including informed consent, privacy, and accessibility, demand careful attention. Our review identified common aspects of the meta-analysis, including the potential of VR technologies in cognitive neuroscience and neuropsychology, the use of MR and AR in memory research, and the role of VR in neurorehabilitation and therapy.
10.1080/23279095.2024.2365870
Remote Extended Reality with Markerless Motion Tracking for Sitting Posture Training.
IEEE robotics and automation letters
Dynamic postural control during sitting is essential for functional mobility and daily activities. Extended reality (XR) presents a promising solution for posture training in addressing conventional training limitations related to patient accessibility and ecological validity. We developed a remote XR rehabilitation system with markerless motion tracking for sitting posture training. Forty-two healthy subjects participated in this proof-of-concept pilot study. Each subject completed 24 rounds of multi-directional reach tasks using the system and 24 rounds without it. Motion data were collected via online meetings using built-in camera in the user's laptop. Functional reach test scores were analyzed to assess the impact of the system on motor performance. Four standard questionnaires were used to assess the effects of this system on presence, simulator sickness, engagement, and enjoyment. Our results indicate that the remote XR training system significantly improved functional reach performance and proved highly effective for telerehabilitation. XR interaction also enhanced training engagement and enjoyment. By bridging the spatial gap between patients and therapists, this system enables personalized and engaging home-based intervention. Additionally, it facilitates more natural movements by eliminating body marker constraints and laboratory limitations. This study should serve as a stepping stone to advancing novel remote XR rehabilitation systems.
10.1109/lra.2024.3460412
The Effectiveness of Therapeutic Exercise Interventions With Virtual Reality on Balance and Walking Among Persons With Chronic Stroke: Systematic Review, Meta-Analysis, and Meta-Regression of Randomized Controlled Trials.
Journal of medical Internet research
BACKGROUND:Well-targeted balance, walking, and weight-shift training can improve balance capabilities in the chronic phase of stroke. There is an urgent need for a long-term approach to rehabilitation that extends beyond the acute and subacute phases, supporting participation without increasing the demand for health care staff. OBJECTIVE:This study aims to evaluate the effectiveness of therapeutic exercise interventions with virtual reality (VR) training on balance and walking at the activity and participation levels in individuals with chronic stroke, compared with control groups receiving no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without VR. METHODS:Studies were searched across 6 databases. The inclusion criteria were as follows: Adults aged 18 years or older with a stroke diagnosis for at least 6 months (population). Therapeutic exercises within a VR environment, using VR glasses or interactive games (intervention). Control groups without the use of VR (including no treatment, conventional physical therapy, specific training, similar treatment without VR, or identical treatment without the additional use of VR; comparison). We evaluated the Berg Balance Scale score, Functional Reach Test performance, Activities-specific Balance Confidence Scale score, Six-minute Walk Test, Two-minute Walk Test, 10-meter Walk Test results, and cadence (outcome measures). We investigated randomized controlled trials (study design). A meta-analysis and a meta-regression analysis were conducted to evaluate whether the content of VR interventions or control groups, as well as the level of VR immersion used, was related to balance or walking outcomes. RESULTS:A total of 43 randomized controlled trials involving 1136 participants were included in this review. The use of VR training in therapeutic exercise interventions had a large effect on balance (standardized mean difference 0.51, 95% CI 0.29-0.72; P<.001) and a moderate effect on walking (standardized mean difference 0.31, 95% CI 0.09-0.53; P=.006) in individuals with chronic stroke, compared with pooled control groups (no treatment, conventional physical therapy, specific training, similar treatment, or identical treatment without the use of VR). According to the meta-regression findings, the content of VR interventions (P=.52), the type of control groups (P=.79), and the level of VR immersion (P=.82) were not significantly related to the pooled balance or walking outcomes. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) was moderate for balance and low for walking. CONCLUSIONS:Therapeutic exercise training with VR had a positive, albeit moderate, effect on balance and a low impact on walking at the level of activity (capacity), even in the chronic phase of stroke, without serious side effects. The results are applicable to working-aged stroke rehabilitees who are able to walk without assistance. Further research is needed with defined VR methods and outcomes that assess performance at the level of real-life participation.
10.2196/59136
Environmental enrichment through virtual reality as multisensory stimulation to mitigate the negative effects of prolonged bed rest.
Frontiers in aging neuroscience
Prolonged bed rest causes a multitude of deleterious physiological changes in the human body that require interventions even during immobilization to prevent or minimize these negative effects. In addition to other interventions such as physical and nutritional therapy, non-physical interventions such as cognitive training, motor imagery, and action observation have demonstrated efficacy in mitigating or improving not only cognitive but also motor outcomes in bedridden patients. Recent technological advances have opened new opportunities to implement such non-physical interventions in semi- or fully-immersive environments to enable the development of bed rest countermeasures. Extended Reality (XR), which covers augmented reality (AR), mixed reality (MR), and virtual reality (VR), can enhance the training process by further engaging the kinesthetic, visual, and auditory senses. XR-based enriched environments offer a promising research avenue to investigate the effects of multisensory stimulation on motor rehabilitation and to counteract dysfunctional brain mechanisms that occur during prolonged bed rest. This review discussed the use of enriched environment applications in bedridden patients as a promising tool to improve patient rehabilitation outcomes and suggested their integration into existing treatment protocols to improve patient care. Finally, the neurobiological mechanisms associated with the positive cognitive and motor effects of an enriched environment are highlighted.
10.3389/fnagi.2023.1169683
Challenges and promises of mixed-reality interventions in acquired brain injury rehabilitation: A scoping review.
International journal of medical informatics
BACKGROUND:Acquired brain injury (ABI) can lead to significant impairments and difficulties in everyday life, necessitating the need for rehabilitation. Mixed-reality (MR) technologies have revolutionized the delivery of neurorehabilitation therapies. However, inconsistencies in research methodology, diverse study populations and designs, and exaggerated claims in the research, media, and private consumer sectors have impacted the knowledge base of the field, including within the context of ABI rehabilitation. OBJECTIVE:This scoping review aims to explore MR-systems in ABI rehabilitation, while assessing the evidence base and technology readiness levels of these systems. METHODS:Seven databases were searched for studies, which were screened and analyzed by two independent raters. The types of MR systems, levels of evidence, and technology readiness levels were extracted and analyzed using descriptive analyses. RESULTS:Twenty-six studies were included in the review, all of which focused on ABI etiologies stemming from strokes. Across studies, upper-limb motor rehabilitation was the most common rehabilitation target of MR interventions, followed by gait, cognition, and lower-extremity functioning. At present, overall results indicate low evidence for MR-applications in ABI rehabilitation, with a median technology readiness level of 6, corresponding to system prototypes being tested in relevant environments. CONCLUSION:Although challenges regarding system usability and design were reported, results appear promising with ongoing research. With variability across studies, technologies, and populations, determining the effectiveness of MR interventions in ABI remains a challenge, necessitating the need for ongoing innovation, research, and development of these systems.
10.1016/j.ijmedinf.2023.105235
The Use of Extended Reality in Rehabilitation for Patients with Acquired Brain Injury: A Scoping Review.
Studies in health technology and informatics
BACKGROUND:Extended reality (XR) seems promising for rehabilitation for people with acquired brain injury in terms of reducing professional supervision, faster recovery, shorter hospital stays, and reduced expenses. Since there is no overview this scoping review describes how XR can be utilized in rehabilitation, particularly for people with acquired brain injury (ABI). METHODS:The Arksey and O'Malley framework and PRISMA-ScR reporting guideline were followed. Studies between 2010 and May 2022 screened from healthcare as well as technical databases were imported in RAYYAN. Three researchers selected relevant articles in three rounds based on title, abstract and full text. RESULTS:75 articles were included in this scoping review. Most studies used VR as technology with therapy objectives in three main categories: cognitive, physical and diagnostic. The outcomes of the studies show potential and promising results of the use of XR, and enthusiasm with as well patients as professionals. A selection of four domains of the NASSS framework: condition, technology, value proposition and adopters were reported. Important lessons learned by the included studies are development of XR software, improvement of the hardware, improving feeling of safety and giving support to the patient, and support healthcare professionals for acceptance of XR. DISCUSSION:the use of XR for people with ABI has potential and is promising but not common practice yet. Future research should focus on implementation factors with a diverse and inclusive patient group using service modelling.
10.3233/SHTI230682
Metaverse Wearables for Immersive Digital Healthcare: A Review.
Advanced science (Weinheim, Baden-Wurttemberg, Germany)
The recent exponential growth of metaverse technology has been instrumental in reshaping a myriad of sectors, not least digital healthcare. This comprehensive review critically examines the landscape and future applications of metaverse wearables toward immersive digital healthcare. The key technologies and advancements that have spearheaded the metamorphosis of metaverse wearables are categorized, encapsulating all-encompassed extended reality, such as virtual reality, augmented reality, mixed reality, and other haptic feedback systems. Moreover, the fundamentals of their deployment in assistive healthcare (especially for rehabilitation), medical and nursing education, and remote patient management and treatment are investigated. The potential benefits of integrating metaverse wearables into healthcare paradigms are multifold, encompassing improved patient prognosis, enhanced accessibility to high-quality care, and high standards of practitioner instruction. Nevertheless, these technologies are not without their inherent challenges and untapped opportunities, which span privacy protection, data safeguarding, and innovation in artificial intelligence. In summary, future research trajectories and potential advancements to circumvent these hurdles are also discussed, further augmenting the incorporation of metaverse wearables within healthcare infrastructures in the post-pandemic era.
10.1002/advs.202303234
The effectiveness of extended reality on relieving pain after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.
Archives of orthopaedic and trauma surgery
PURPOSE:Patients with total knee arthroplasty (TKA) often suffer from severe postoperative pain, which seriously hinders postoperative rehabilitation. Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used to relieve pain after TKA. The purpose of this study was to evaluate the effectiveness of XR on relieving pain after TKA. METHODS:The electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to July 20, 2023. The outcomes were pain score, anxiety score, and physiological parameters related to pain. Meta-analysis was performed using the Review Manager 5.4 software. RESULTS:Overall, 11 randomized control trials (RCTs) with 887 patients were included. The pooled results showed XR had lower pain scores (SMD = - 0.31, 95% CI [- 0.46 to - 0.16], P < 0.0001) and anxiety scores (MD = - 3.95, 95% CI [- 7.76 to - 0.13], P = 0.04) than conventional methods. The subgroup analysis revealed XR had lower pain scores within 2 weeks postoperatively (SMD = - 0.49, 95% CI [- 0.76 to - 0.22], P = 0.0004) and XR had lower pain scores when applying XR combined with conventional methods (SMD = - 0.43, 95% CI [- 0.65 to - 0.20], P = 0.0002). CONCLUSION:This systematic review and meta-analysis found applying XR could significantly reduce postoperative pain and anxiety after TKA. When XR was combined with conventional methods, postoperative pain can be effectively relieved, especially within 2 weeks after the operation. XR is an effective non-pharmacological analgesia scheme.
10.1007/s00402-024-05440-0
Extended Reality "X-Reality" for Prosthesis Training of Upper-Limb Amputees: A Review on Current and Future Clinical Potential.
IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society
The rejection rates of upper-limb prosthetic devices in adults are high, currently averaging 26% and 23% for body-powered and electric devices, respectively. While many factors influence acceptance, prosthesis training methods relying on novel virtual reality systems have been cited as a critical factor capable of increasing the likelihood of long-term, full-time use. Despite that, these implementations have not yet garnered widespread traction in the clinical setting, and their use remains immaterial. This review aims to explore the reasons behind this situation by identifying trends in existing research that seek to advance Extended Reality "X-Reality" systems for the sake of upper-limb prosthesis rehabilitation and, secondly, analyzing barriers and presenting potential pathways to deployment for successful adoption in the future. The search yielded 42 research papers that were divided into two categories. The first category included articles that focused on the technical aspect of virtual prosthesis training. Articles in the second category utilize user evaluation procedures to ensure applicability in a clinical environment. The review showed that 75% of articles that conducted whole system testing experimented with non-immersive virtual systems. Furthermore, there is a shortage of experiments performed with amputee subjects. From the large-scale studies analyzed, 71% of those recruited solely non-disabled participants. This paper shows that X-Reality technologies for prosthesis rehabilitation of upper-limb amputees carry significant benefits. Nevertheless, much still must be done so that the technology reaches widespread clinical use.
10.1109/TNSRE.2022.3179327
The Extent of Evidence Supporting the Effectiveness of Extended Reality Telerehabilitation on Different Qualitative and Quantitative Outcomes in Stroke Survivors: A Systematic Review.
International journal of environmental research and public health
: To present the extent of evidence concerning the effectiveness of extended reality telerehabilitation and patients' experiences of using different types of virtual reality exercises at home. : We included studies on virtual reality and augmented reality telerehabilitation published in English. Systematic searches were undertaken in PubMed, Web of Sciences, Medline, Embase, CINAHL, and PEDro, with no date limitations. We included only RCTs and qualitative studies exploring patients' experiences. Methodological quality was assessed using the Cochrane Risk of Bias assessment tool for quantitative papers and the CASP scale for qualitative studies. All results are presented narratively. : Thirteen studies, nine quantitative and four qualitative, were included, with one qualitative and seven quantitative having a high risk of bias. All studies reported that extended reality-based telerehabilitation may be effective compared to conventional exercises or other extended reality exercises. Seven quantitative studies focused on upper limb function. Qualitative papers suggested that VR exercises were perceived as feasible by patients. : The literature suggests VR home exercises are feasible and potentially effective for patients after a stroke in the upper limb. Further high-quality studies are needed to examine the effectiveness of XR exercises early adoption on different qualitative and quantitative outcomes. Registration number: (CRD42022384356).
10.3390/ijerph20176630
Current status and clinical perspectives of extended reality for myoelectric prostheses: review.
Frontiers in bioengineering and biotechnology
Training with "Extended Reality" or X-Reality (XR) systems can undoubtedly enhance the control of the myoelectric prostheses. However, there is no consensus on which factors improve the efficiency of skill transfer from virtual training to actual prosthesis abilities. This review examines the current status and clinical applications of XR in the field of myoelectric prosthesis training and analyses possible influences on skill migration. We have conducted a thorough search on databases in the field of prostheses using keywords such as extended reality, virtual reality and serious gaming. Our scoping review encompassed relevant applications, control methods, performance evaluation and assessment metrics. Our findings indicate that the implementation of XR technology for myoelectric rehabilitative training on prostheses provides considerable benefits. Additionally, there are numerous standardised methods available for evaluating training effectiveness. Recently, there has been a surge in the number of XR-based training tools for myoelectric prostheses, with an emphasis on user engagement and virtual training evaluation. Insufficient attention has been paid to significant limitations in the behaviour, functionality, and usage patterns of XR and myoelectric prostheses, potentially obstructing the transfer of skills and prospects for clinical application. Improvements are recommended in four critical areas: activities of daily living, training strategies, feedback, and the alignment of the virtual environment with the physical devices.
10.3389/fbioe.2023.1334771
Extended reality to assess post-stroke manual dexterity: contrasts between the classic box and block test, immersive virtual reality with controllers, with hand-tracking, and mixed-reality tests.
Journal of neuroengineering and rehabilitation
BACKGROUND:Recent technological advancements present promising opportunities to enhance the frequency and objectivity of functional assessments, aligning with recent stroke rehabilitation guidelines. Within this framework, we designed and adapted different manual dexterity tests in extended reality (XR), using immersive virtual reality (VR) with controllers (BBT-VR-C), immersive VR with hand-tracking (BBT-VR-HT), and mixed-reality (MD-MR). OBJECTIVE:This study primarily aimed to assess and compare the validity of the BBT-VR-C, BBT-VR-HT and MD-MR to assess post-stroke manual dexterity. Secondary objectives were to evaluate reliability, usability and to define arm kinematics measures. METHODS:A sample of 21 healthy control participants (HCP) and 21 stroke individuals with hemiparesis (IHP) completed three trials of the traditional BBT, the BBT-VR-C, BBT-VR-HT and MD-MR. Content validity of the different tests were evaluated by asking five healthcare professionals to rate the difficulty of performing each test in comparison to the traditional BBT. Convergent validity was evaluated through correlations between the scores of the traditional BBT and the XR tests. Test-retest reliability was assessed through correlations between the second and third trial and usability was assessed using the System Usability Scale (SUS). Lastly, upper limb movement smoothness (SPARC) was compared between IHP and HCP for both BBT-VR test versions. RESULTS:For content validity, healthcare professionals rated the BBT-VR-HT (0[0-1]) and BBT-MR (0[0-1]) as equally difficult to the traditional BBT, whereas they rated BBT-VR-C as more difficult than the traditional BBT (1[0-2]). For IHP convergent validity, the Pearson tests demonstrated larger correlations between the scores of BBT and BBT-VR-HT (r = 0.94;p < 0.001), and BBT and MD-MR (r = 0.95;p < 0.001) than BBT and BBT-VR-C (r = 0.65;p = 0.001). BBT-VR-HT and MD-MR usability were both rated as excellent, with median SUS scores of 83[57.5-91.3] and 83[53.8-92.5] respectively. Excellent reliability was found for the BBT-VR-C (ICC = 0.96;p < 0.001), BBT-VR-HT (ICC = 0.96;p < 0.001) and BBT-MR (ICC = 0.99;p < 0.001). The usability of the BBT-VR-C was rated as good with a median SUS of 70[43.8-83.8]. Upper limb movements of HCP were significantly smoother than for IHP when completing either the BBT-VR-C (t = 2.05;p = 0.043) and the BBT-VR-HT (t = 5.21;p < 0.001). CONCLUSION:The different XR manual tests are valid, short-term reliable and usable tools to assess post-stroke manual dexterity. TRIAL REGISTRATION:https://clinicaltrials.gov/ct2/show/NCT04694833 ; Unique identifier: NCT04694833, Date of registration: 11/24/2020.
10.1186/s12984-024-01332-x
XR (Extended Reality: Virtual Reality, Augmented Reality, Mixed Reality) Technology in Spine Medicine: Status Quo and Quo Vadis.
Morimoto Tadatsugu,Kobayashi Takaomi,Hirata Hirohito,Otani Koji,Sugimoto Maki,Tsukamoto Masatsugu,Yoshihara Tomohito,Ueno Masaya,Mawatari Masaaki
Journal of clinical medicine
In recent years, with the rapid advancement and consumerization of virtual reality, augmented reality, mixed reality, and extended reality (XR) technology, the use of XR technology in spine medicine has also become increasingly popular. The rising use of XR technology in spine medicine has also been accelerated by the recent wave of digital transformation (i.e., case-specific three-dimensional medical images and holograms, wearable sensors, video cameras, fifth generation, artificial intelligence, and head-mounted displays), and further accelerated by the COVID-19 pandemic and the increase in minimally invasive spine surgery. The COVID-19 pandemic has a negative impact on society, but positive impacts can also be expected, including the continued spread and adoption of telemedicine services (i.e., tele-education, tele-surgery, tele-rehabilitation) that promote digital transformation. The purpose of this narrative review is to describe the accelerators of XR (VR, AR, MR) technology in spine medicine and then to provide a comprehensive review of the use of XR technology in spine medicine, including surgery, consultation, education, and rehabilitation, as well as to identify its limitations and future perspectives (status quo and quo vadis).
10.3390/jcm11020470
Efficacy of immersive extended reality (XR) interventions on different symptom domains of schizophrenia spectrum disorders. A systematic review.
Frontiers in psychiatry
Introduction:Extended reality (XR) is an umbrella term for virtual reality (VR) and augmented reality (AR), both novel vectors for therapeutic intervention modalities. In VR, head-mounted devices (HMD) allow interaction with three-dimensional virtual environments and simulated avatars, while AR overlaps virtual, simulated objects to observe physical reality. Treatment through immersive VR has been studied in psychiatry, including patients suffering from schizophrenia spectrum disorders, while there has not been much attention to AR technologies in psychiatry. Our systematic review aimed to examine the currently available literature regarding the treatment efficacy of immersive VR or AR technologies on different symptom domains of schizophrenia spectrum disorders, screen for potential adverse effects, and gather data on the technological and human resource requirements of such interventions to help guide future research. Methods:We conducted a systematic literature review with database searches carried out between 9/2021 and 8/2022 through PubMed, Scopus, EBSCOhost Academic Search Premier, and Web of Science. Results:We identified 2,157 records, 214 were assessed further for eligibility and 12 met inclusion criteria. All included articles studied immersive VR and none used AR technology. Included studies were heterogenous in nature, including AVATAR therapy (3) and CBT-based (5) VR interventions, as well as cognitive (2), social (1), and relaxation (1) training through VR. The comparison groups were either passive controls (waitlist and treatment as usual), therapeutic interventions (CBT and Integrated psychological treatment), passive VR environments, or traditional, comparable, non-virtual treatment modalities (social roleplay and progressive muscle relaxation training). Pooled together, the included studies on VR show positive treatment effects in all major symptom domains of schizophrenia spectrum disorders with hardly any adverse effects related to the intervention modalities. Conclusions:In this review, we have showcased how different symptom domains can be targeted through VR interventions, highlighting VR as a potential new vector for a diverse range of psychosocial therapeutic modalities that allow for completely new possibilities in the treatment of schizophrenia spectrum disorders. VR technology still requires more research and validation. Our review also shows that there are currently no studies examining AR technology in the treatment of schizophrenia spectrum disorders, indicating a distinctive research gap.
10.3389/fpsyt.2023.1208287
Extended reality in musculoskeletal rehabilitation and injury prevention - A systematic review.
Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine
OBJECTIVE:Unlike in neurological patient populations, the effects of Extended Reality within the context of sports medicine have rarely been studied. This systematic review was conducted to investigate the value of Extended Realty-assisted rehabilitation and injury prevention strategies on injury rehabilitation and prevention outcomes. METHODS:PubMed and Web of Science databases were consulted. The search strategy consisted of the terms Virtual Reality (Intervention), rehabilitation and injury prevention (Outcome) and healthy athletes or athletes with a musculoskeletal sports injury (Population). After eligibility and Risk of Bias screening, ten articles were included. Risk of Bias analysis resulted in a level of evidence varying between C (three articles), B (six articles) and A2 (one article) scores. RESULTS:Extended Reality was found to provide an added value for both sports injury prevention and rehabilitation outcomes. It particularly provides clinicians with the opportunity to address the underlying biomechanical risk profile for common sports injuries, allowing the athletes to train protective movement patterns more effectively. CONCLUSION:More large-scale high-quality prospective research is needed in order to determine whether Extended Reality-assisted therapy is superior to conventional therapy in sports rehabilitation and injury prevention circles with strong conclusive evidence.
10.1016/j.ptsp.2022.04.011
Extended Reality in Revolutionizing Neurological Disease: A New Era for Chronic Condition Treatment.
Cureus
Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR), provides promising advancements in managing chronic neurological disorders such as Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease, and stroke. This review examines the impact of XR technologies on neurological care, highlighting their ability to create immersive, interactive environments that enhance rehabilitation through tailored motor and cognitive exercises. XR supports neuroplasticity by providing engaging, contextually relevant exercises and real-time feedback, offering innovative alternatives to traditional methods. The technical issues, clinical validation, and accessibility must be addressed despite the potential benefits. Future developments should focus on refining XR applications, integrating them with complementary technologies, and establishing robust policies to guide their effective and ethical use. XR is poised to revolutionize neurological rehabilitation, promising improved patient outcomes and transforming medical training.
10.7759/cureus.67633
The Application of Extended Reality in Treating Children with Autism Spectrum Disorder.
Neuroscience bulletin
Autism Spectrum Disorder (ASD) is a common neurodevelopmental disorder in children, characterized by social interaction, communication difficulties, and repetitive and stereotyped behaviors. Existing intervention methods have limitations, such as requiring long treatment periods and needing to be more convenient to implement. Extended Reality (XR) technology offers a virtual environment to enhance children's social, communication, and self-regulation skills. This paper compares XR theoretical models, application examples, and intervention effects. The study reveals that XR intervention therapy is mainly based on cognitive rehabilitation, teaching, and social-emotional learning theories. It utilizes algorithms, models, artificial intelligence (AI), eye-tracking, and other technologies for interaction, achieving diverse intervention outcomes. Participants showed effective improvement in competency barriers using XR-based multimodal interactive platforms. However, Mixed Reality (MR) technology still requires further development. Future research should explore multimsodal interaction technologies combining XR and AI, optimize models, prioritize the development of MR intervention scenarios, and sustain an optimal intervention level.
10.1007/s12264-024-01190-6
Virtual reality for stroke rehabilitation.
The Cochrane database of systematic reviews
BACKGROUND:Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES:Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS:We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA:Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. DATA COLLECTION AND ANALYSIS:Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. MAIN RESULTS:We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME:results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES:when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS:We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
10.1002/14651858.CD008349.pub4