1
|
Hernan G, Ingale N, Somayaji S, Veerubhotla A. Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review. Brain Sci 2024; 14:429. [PMID: 38790408 PMCID: PMC11119161 DOI: 10.3390/brainsci14050429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury. METHODS Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait". RESULTS A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair. DISCUSSION Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.
Collapse
Affiliation(s)
| | | | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, Grossman School of Medicine, New York University, New York, NY 10016, USA; (G.H.); (N.I.); (S.S.)
| |
Collapse
|
2
|
Bateni H, Carruthers J, Mohan R, Pishva S. Use of Virtual Reality in Physical Therapy as an Intervention and Diagnostic Tool. Rehabil Res Pract 2024; 2024:1122286. [PMID: 38304610 PMCID: PMC10834096 DOI: 10.1155/2024/1122286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/27/2023] [Accepted: 11/30/2023] [Indexed: 02/03/2024] Open
Abstract
Within the past decade, the integration of computer-generated virtual realities (VRs) has witnessed a significant rise in the field of healthcare, particularly in diagnosis and treatment applications. These VR systems have found extensive use in physical therapy, rehabilitation, research, and assessment. This narrative review article is aimed at providing a comprehensive overview of the literature regarding the implementation of VR in the physical therapy profession. The primary objective of this review is to provide information to clinicians about the diverse applications of VR and its potential advantages in intervening across various patient populations and diagnoses during rehabilitation therapy. Through in-depth discussions with experts and a thorough review of pertinent literature, several significant aspects of the topic were identified. Subsequently, we carried out an online search to investigate the prevalent utilization of VR systems within healthcare, both as assessment tools and for therapeutic interventions. Our examination encompassed a total of 56 articles, with supplementary references incorporated as required.
Collapse
Affiliation(s)
- Hamid Bateni
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Jenna Carruthers
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Rebecca Mohan
- Physical Therapy Program, School of Allied Health and Communicative Disorders, Northern Illinois University, 1425 W. Lincoln Hwy., DeKalb, IL 60115, USA
| | - Seyedamirhossein Pishva
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO 64106, USA
| |
Collapse
|
3
|
Corrigan F, Wee IC, Collins-Praino LE. Chronic motor performance following different traumatic brain injury severity-A systematic review. Front Neurol 2023; 14:1180353. [PMID: 37288069 PMCID: PMC10243142 DOI: 10.3389/fneur.2023.1180353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models. Methods PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included. Results A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined. Conclusion Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.
Collapse
Affiliation(s)
- Frances Corrigan
- Head Injury Lab, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Ing Chee Wee
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| | - Lyndsey E. Collins-Praino
- Cognition, Ageing and Neurodegenerative Disease Laboratory, School of Biomedicine, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
4
|
Bruschetta R, Maggio MG, Naro A, Ciancarelli I, Morone G, Arcuri F, Tonin P, Tartarisco G, Pioggia G, Cerasa A, Calabrò RS. Gender Influences Virtual Reality-Based Recovery of Cognitive Functions in Patients with Traumatic Brain Injury: A Secondary Analysis of a Randomized Clinical Trial. Brain Sci 2022; 12:brainsci12040491. [PMID: 35448022 PMCID: PMC9024763 DOI: 10.3390/brainsci12040491] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/07/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
The rehabilitation of cognitive deficits in individuals with traumatic brain injury is essential for promoting patients’ recovery and autonomy. Virtual reality (VR) training is a powerful tool for reaching this target, although the effectiveness of this intervention could be interfered with by several factors. In this study, we evaluated if demographical and clinical variables could be related to the recovery of cognitive function in TBI patients after a well-validated VR training. One hundred patients with TBI were enrolled in this study and equally randomized into the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received standard cognitive treatment. All the patients were evaluated by a complete neuropsychological battery before (T0) and after the end of the training (T1). We found that the VR-related improvement in mood, as well as cognitive flexibility, and selective attention were influenced by gender. Indeed, females who underwent VR training were those showing better cognitive recovery. This study highlights the importance of evaluating gender effects in planning cognitive rehabilitation programs. The inclusion of different repetitions and modalities of VR training should be considered for TBI male patients.
Collapse
Affiliation(s)
- Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Maria Grazia Maggio
- Department of Biomedical and Biotechnological Science, University of Catania, 95123 Catania, Italy;
| | - Antonino Naro
- Stroke Unit, Azienda Ospedaliera Universitaria Gaetano Martino, 98123 Messina, Italy;
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (G.M.)
| | | | - Paolo Tonin
- S’Anna Institute, 88900 Crotone, Italy; (F.A.); (P.T.)
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
| | - Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy; (R.B.); (G.T.); (G.P.)
- S’Anna Institute, 88900 Crotone, Italy; (F.A.); (P.T.)
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
- Correspondence:
| | | |
Collapse
|
5
|
Wright WG, Handy JD, Haskell A, Servatius L, Servatius R. History of Mild Traumatic Brain Injury Affects Static Balance Under Complex Multisensory Manipulations. J Neurotrauma 2022; 39:821-828. [PMID: 35229645 DOI: 10.1089/neu.2020.7600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A recent study in active duty military in the Coast Guard suggested lifetime experience with mTBI was associated with subtle deficits in postural control when exposed to multisensory discordance (i.e. rotating visual stimulation). The present study extended postural assessments to veterans recruited from the community. Service veterans completed the Defense Veteran Brain Injury Center (DVBIC) TBI Screening Tool, PTSD Checklist (PCL-5), and neurobehavioral symptom inventory (NSI). Postural control was assessed using a custom designed virtual reality based device, which assessed center of pressure (COP) sway in response to six conditions designed to test sensory integration by systematically combining three visual conditions (eyes open, eyes closed, and rotating scene) with two somatosensory conditions (firm or foam surface). Veterans screening positive for lifetime experience of mTBI (mTBI+) displayed similar postural sway to veterans without lifetime experience of mTBI (mTBI-) on basic assessment of eyes open or closed on firm and foam surface. mTBI+ veterans displayed greater sway than mTBI- veterans in response to the rotating visual stimuli while on a foam surface. Similar to previous research the degree of sway was affected by the number of lifetime experiences of mTBI. Increased postural sway was not related to PTSD, NSI, or, balance-specific symptom expression. In summary, veterans who experienced mTBI over their lifetime exhibited dysfunction in balance control as revealed by challenging conditions with multisensory discordance. These balance-related signs were independent of self-reported balance-related symptoms or other symptom domains measured by the NSI, which can provide a method for exposing otherwise covert dysfunction long after experience of mTBI.
Collapse
Affiliation(s)
- W Geoffrey Wright
- Temple University College of Public Health, 16043, Health and Rehabilitation Sciences, Philadelphia, Pennsylvania, United States;
| | - Justin D Handy
- Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Amanda Haskell
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Labeeby Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,Central New York Research Corporation, Research and Development, Syracuse, New York, United States;
| | - Richard Servatius
- Syracuse VAMC, 20078, Research, Syracuse, New York, United States.,SUNY Upstate Medical University, 12302, Psychiatry, Syracuse, New York, United States;
| |
Collapse
|
6
|
Potential Mechanisms of Acute Standing Balance Deficits After Concussions and Subconcussive Head Impacts: A Review. Ann Biomed Eng 2021; 49:2693-2715. [PMID: 34258718 DOI: 10.1007/s10439-021-02831-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/29/2021] [Indexed: 01/04/2023]
Abstract
Standing balance deficits are prevalent after concussions and have also been reported after subconcussive head impacts. However, the mechanisms underlying such deficits are not fully understood. The objective of this review is to consolidate evidence linking head impact biomechanics to standing balance deficits. Mechanical energy transferred to the head during impacts may deform neural and sensory components involved in the control of standing balance. From our review of acute balance-related changes, concussions frequently resulted in increased magnitude but reduced complexity of postural sway, while subconcussive studies showed inconsistent outcomes. Although vestibular and visual symptoms are common, potential injury to these sensors and their neural pathways are often neglected in biomechanics analyses. While current evidence implies a link between tissue deformations in deep brain regions including the brainstem and common post-concussion balance-related deficits, this link has not been adequately investigated. Key limitations in current studies include inadequate balance sampling duration, varying test time points, and lack of head impact biomechanics measurements. Future investigations should also employ targeted quantitative methods to probe the sensorimotor and neural components underlying balance control. A deeper understanding of the specific injury mechanisms will inform diagnosis and management of balance deficits after concussions and subconcussive head impact exposure.
Collapse
|
7
|
Technology and concussion: A scoping review. JOURNAL OF CONCUSSION 2021. [DOI: 10.1177/2059700221992952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Technology for concussion identification and management is rapidly expanding across the continuum of care. Although many technologies offer a range of services around concussion, there is an absence of a non-commercial online location for medical providers to access regarding the functionality of the various technologies used in concussion identification and management. Objective The purpose of this review is to present research findings on technology for concussion identification and management. Methods Searches for eligible studies were conducted using the PubMed, EMBASE, and Scopus databases with specific search criteria. Through a stepwise process, full-text articles were selected for inclusion if they described clinically useful electronic technologies (i.e. electronics able to be used in standard clinical environments including telehealth) by healthcare providers or end users (i.e. parents or athletes). Results A total of 29 articles were included in this review and described technology used to measure symptoms (3), neurocognitive performance (7), the visual system (4), and balance or dual task performance (18). Within the results, various technologies demonstrated increased utility for concussion identification, often detecting subtle deficits not possible with current low-tech clinical methods, differentiating those with concussion from those without concussion, with strong reliability and validity. Conclusion Innovative technologies included in this review demonstrate enhanced ability to identify and manage symptoms of concussion, neurocognitive deficits, visual deficits, and balance and dual-task deficits.
Collapse
|
8
|
Wittstein MW, Crider A, Mastrocola S, Guerena Gonzalez M. Use of Virtual Reality to Assess Dynamic Posturography and Sensory Organization: Instrument Validation Study. JMIR Serious Games 2020; 8:e19580. [PMID: 33325830 PMCID: PMC7773518 DOI: 10.2196/19580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/10/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
Background The Equitest system (Neurocom) is a computerized dynamic posturography device used by health care providers and clinical researchers to safely test an individual’s postural control. While the Equitest system has evaluative and rehabilitative value, it may be limited owing to its cost, lack of portability, and reliance on only sagittal plane movements. Virtual reality (VR) provides an opportunity to reduce these limitations by providing more mobile and cost-effective tools while also observing a wider array of postural characteristics. Objective This study aimed to test the plausibility of using VR as a feasible alternative to the Equitest system for conducting a sensory organization test. Methods A convenience sample of 20 college-aged healthy individuals participated in the study. Participants completed the sensory organization test using the Equitest system as well as using a VR environment while standing atop a force plate (Bertec Inc). The Equitest system measures the equilibrium index. During VR trials, the estimated equilibrium index, 95% ellipse area, path length, and anterior-posterior detrended fluctuation analysis scaling exponent alpha were calculated from center of pressure data. Pearson correlation coefficients were used to assess the relationship between the equilibrium index and center of pressure–derived balance measures. Intraclass correlations for absolute agreement and consistency were calculated to compare the equilibrium index and estimated equilibrium index. Results Intraclass correlations demonstrated moderate consistency and absolute agreement (0.5 < intraclass correlation coefficient < 0.75) between the equilibrium index and estimated equilibrium index from the Equitest and VR sensory organization test (SOT), respectively, in four of six tested conditions. Additionally, weak to moderate correlations between force plate measurements and the equilibrium index were noted in several of the conditions. Conclusions This research demonstrated the plausibility of using VR as an alternative method to conduct the SOT. Ongoing development and testing of virtual environments are necessary before employing the technology as a replacement to current clinical tests.
Collapse
Affiliation(s)
| | - Anthony Crider
- Department of Physics, Elon University, Elon, NC, United States
| | | | | |
Collapse
|
9
|
|
10
|
Marchetto J, Wright WG. The Validity of an Oculus Rift to Assess Postural Changes During Balance Tasks. HUMAN FACTORS 2019; 61:1340-1352. [PMID: 30917062 DOI: 10.1177/0018720819835088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate whether shifts in head position, measured via an Oculus Rift head-mounted display (HMD), is a valid measure of whole-body postural stability. BACKGROUND The inverted single-link pendulum model of balance suggests shifts in whole-body center of mass can be estimated from individual body segments. However, whether head position describes postural stability such as center-of-pressure (COP) remains unclear. METHOD Participants (N = 10) performed six conditions while wearing an HMD and performing a previously validated virtual reality (VR)-based balance assessment. COP was recorded with a Wii Balance Board force plate (WBB), while an HMD recorded linear and angular head displacement. Visual input was presented in the HMD (stable scene, dark scene, or dynamic scene) and somatosensory information (with or without foam) was varied across each condition. The HMD time series data were compared with the criterion-measure WBB. RESULTS Significant correlations were found between COP measures (standard deviation, range, sway area, velocity) and head-centered angular and linear displacements (roll, pitch, mediolateral and anteroposterior directions). CONCLUSIONS The Oculus Rift HMD shows promise as a measure of postural stability without additional posturography equipment. These findings support the application of VR HMD technology for assessment of postural stability across a variety of challenging conditions. APPLICATION The human factors and ergonomic benefit of such an approach is in its portability, low cost, and widespread availability for clinic and home-based investigation of postural disturbances. Fall injury affects millions of people annually, so assessment of fall risk and treatment of the underlying causes has enormous public health benefit.
Collapse
|
11
|
Kaewkaen K, Uthama S, Ruengsirarak W, Puntumetakul R. Validity and Reliability of the Wii Balance Board for Static Balance Assessment in Healthy Young Adults. Malays J Med Sci 2019; 26:114-121. [PMID: 31447614 PMCID: PMC6687213 DOI: 10.21315/mjms2019.26.2.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/17/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction The Wii Balance Board (WBB) is a commonly used tool for balance assessment, however the inconsistency in the reported validity for the WBB when used for the assessment of healthy young adults needs to be clarified. Aim To investigate the concurrent validity and reliability of the WBB for balance assessment in healthy young adults. Methods Thirty-two young adults participated in this study. Their ability to balance was tested while standing on a WBB and a laboratory-grade force platform, under three conditions: feet together with eyes open, feet together with eyes closed and semi-tandem standing with eyes open. They had 10 min resting period between tests. The agreement between the WBB and the laboratory-grade force platform was investigated, and the reliability of the WBB was determined. Results A poor agreement between the WBB and the laboratory-grade force platform was found for all standing conditions [intraclass correlation coefficient (ICC) = 0.03 to 0.07]. A moderate to high reliability was found for the WBB for balance assessment in healthy young adults (ICC = 0.66 to 0.76). Conclusion The WBB was found to be a reliable tool for static balance assessment in healthy young adults. However, it had poor validity compared to the laboratory-grade force platform.
Collapse
Affiliation(s)
- Kitchana Kaewkaen
- Department of Physical Therapy, School of Health Science, Mae Fah Luang University, Chiang Rai, Thailand.,Research center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH) Khon Kaen University, Thailand
| | - Suraphong Uthama
- School of Information Technology, Mae Fah Luang University, Chiang Rai, Thailand
| | - Worasak Ruengsirarak
- School of Information Technology, Mae Fah Luang University, Chiang Rai, Thailand
| | - Rungthip Puntumetakul
- Department of Physical Therapy, Faculty of Associated Medical Science, Khon Kaen University, Thailand.,Research center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH) Khon Kaen University, Thailand
| |
Collapse
|
12
|
Cognitive rehabilitation in patients with traumatic brain injury: A narrative review on the emerging use of virtual reality. J Clin Neurosci 2019; 61:1-4. [DOI: 10.1016/j.jocn.2018.12.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/22/2018] [Indexed: 12/13/2022]
|
13
|
Oagaz H, Schoun B, Pooji M, Choi MH. Neurocognitive Assessment in Virtual Reality Through Behavioral Response Analysis. IEEE J Biomed Health Inform 2018; 23:1899-1910. [PMID: 30442624 DOI: 10.1109/jbhi.2018.2881455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability to detect and diagnose neurocognitive disorders at the earliest possible moment is key to a better prognosis for the patient. Two of the earliest indicators of potential neurocognitive problems are motor and visual dysfunction. Motor disorders and problems in visual cognition can be seen in many neurocognitive disorders, resulting in abnormal physical reactions to visual stimuli. Analyzing physical behaviors when presented with such stimuli can provide insights into the visual perception and motor abilities of an individual, yet there is currently no unbiased, objective, general-purpose tool that analyzes attention and motor behavior to assess neurocognitive function. We propose a novel method of neurocognitive function assessment that tests the patient's cognition using virtual reality with eye tracking and motion analysis. By placing the patient in a controlled virtual environment and analyzing their movements, we can evoke certain physical responses from subjects for neurocognitive assessment. We have developed a prototype system that places the subject in a virtual baseball field and captures their full body motion as they try to catch baseballs. This scenario tests the subject's ability to determine the landing time and position of the ball, as well as the test subject's balance, motor skills, attention, and memory. Preliminary tests with 20 healthy normal individuals demonstrate the ability of this tool to assess the test subject's balance, memory, attention, and reaction to visual stimuli. This platform has a twofold contribution: it is used to assess several neurocognitive constructs that affect visual and motor capability neutrally and objectively based on controlled stimuli, and it enables objective comparison between different neurocognitive disorders research in this field.
Collapse
|
14
|
Zanier ER, Zoerle T, Di Lernia D, Riva G. Virtual Reality for Traumatic Brain Injury. Front Neurol 2018; 9:345. [PMID: 29867748 PMCID: PMC5964310 DOI: 10.3389/fneur.2018.00345] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/30/2018] [Indexed: 01/19/2023] Open
Abstract
In this perspective, we discuss the potential of virtual reality (VR) in the assessment and rehabilitation of traumatic brain injury, a silent epidemic of extremely high burden and no pharmacological therapy available. VR, endorsed by the mobile and gaming industries, is now available in more usable and cheaper tools allowing its therapeutic engagement both at the bedside and during the daily life at chronic stages after injury with terrific potential for a longitudinal disease modifying effect.
Collapse
Affiliation(s)
- Elisa R Zanier
- Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Tommaso Zoerle
- Neuroscience ICU, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Di Lernia
- Dipartimento di Psicologia, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Centro Studi e Ricerche di Psicologia della Comunicazione, Università Cattolica del Sacro Cuore, Milan, Italy
| |
Collapse
|
15
|
Servatius RJ, Spiegler KM, Handy JD, Pang KC, Tsao JW, Mazzola CA. Neurocognitive and Fine Motor Deficits in Asymptomatic Adolescents during the Subacute Period after Concussion. J Neurotrauma 2018; 35:1008-1014. [DOI: 10.1089/neu.2017.5314] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Richard J. Servatius
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
- State University of New York Upstate Medical University, Syracuse, New York
| | - Kevin M. Spiegler
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
| | - Justin D. Handy
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Central New York Research Corporation, Syracuse, New York
| | - Kevin C.H. Pang
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Graduate School of Biomedical Sciences, Rutgers University, Newark, New Jersey
| | - Jack W. Tsao
- University of Tennessee Health Science Center, Memphis, Tennessee
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Catherine A. Mazzola
- Rutgers Biomedical Health Sciences, Pharmacology, Physiology, and Neuroscience, Rutgers University, Newark, New Jersey
- Morristown Medical Center, Morristown, New Jersey
| |
Collapse
|
16
|
Wright WG, Handy JD, Avcu P, Ortiz A, Haran FJ, Doria M, Servatius RJ. Healthy Active Duty Military with Lifetime Experience of Mild Traumatic Brain Injury Exhibits Subtle Deficits in Sensory Reactivity and Sensory Integration During Static Balance. Mil Med 2018; 183:313-320. [DOI: 10.1093/milmed/usx182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- W Geoffrey Wright
- Neuromotor Sciences Program, College of Public Health, Temple University, 1800 N. Broad St., Philadelphia, PA
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Justin D Handy
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - Pelin Avcu
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
| | - Alejandro Ortiz
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
| | - F Jay Haran
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD
| | - Michael Doria
- U.S. Coast Guard Headquarters, 2701 Martin Luther King Jr Ave SE, Washington DC
| | - Richard J Servatius
- Department of Veterans Affairs, Syracuse Veterans Affairs Medical Center, 800 Irving Ave., Syracuse, NY
- Rutgers Biomedical Health Sciences, Stress and Motivated Behavior Institute, Rutgers University, 65 Bergen St., Newark, NJ
| |
Collapse
|
17
|
Salisbury JP, Keshav NU, Sossong AD, Sahin NT. Concussion Assessment With Smartglasses: Validation Study of Balance Measurement Toward a Lightweight, Multimodal, Field-Ready Platform. JMIR Mhealth Uhealth 2018; 6:e15. [PMID: 29362210 PMCID: PMC5801523 DOI: 10.2196/mhealth.8478] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/14/2017] [Accepted: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background Lightweight and portable devices that objectively measure concussion-related impairments could improve injury detection and critical decision-making in contact sports and the military, where brain injuries commonly occur but remain underreported. Current standard assessments often rely heavily on subjective methods such as symptom self-reporting. Head-mounted wearables, such as smartglasses, provide an emerging platform for consideration that could deliver the range of assessments necessary to develop a rapid and objective screen for brain injury. Standing balance assessment, one parameter that may inform a concussion diagnosis, could theoretically be performed quantitatively using current off-the-shelf smartglasses with an internal accelerometer. However, the validity of balance measurement using smartglasses has not been investigated. Objective This study aimed to perform preliminary validation of a smartglasses-based balance accelerometer measure (BAM) compared with the well-described and characterized waist-based BAM. Methods Forty-two healthy individuals (26 male, 16 female; mean age 23.8 [SD 5.2] years) participated in the study. Following the BAM protocol, each subject performed 2 trials of 6 balance stances while accelerometer and gyroscope data were recorded from smartglasses (Glass Explorer Edition). Test-retest reliability and correlation were determined relative to waist-based BAM as used in the National Institutes of Health’s Standing Balance Toolbox. Results Balance measurements obtained using a head-mounted wearable were highly correlated with those obtained through a waist-mounted accelerometer (Spearman rho, ρ=.85). Test-retest reliability was high (intraclass correlation coefficient, ICC2,1=0.85, 95% CI 0.81-0.88) and in good agreement with waist balance measurements (ICC2,1=0.84, 95% CI 0.80-0.88). Considering the normalized path length magnitude across all 3 axes improved interdevice correlation (ρ=.90) while maintaining test-retest reliability (ICC2,1=0.87, 95% CI 0.83-0.90). All subjects successfully completed the study, demonstrating the feasibility of using a head-mounted wearable to assess balance in a healthy population. Conclusions Balance measurements derived from the smartglasses-based accelerometer were consistent with those obtained using a waist-mounted accelerometer. Additional research is necessary to determine to what extent smartglasses-based accelerometry measures can detect balance dysfunction associated with concussion. However, given the potential for smartglasses to perform additional concussion-related assessments in an integrated, wearable platform, continued development and validation of a smartglasses-based balance assessment is warranted. This approach could lead to a wearable platform for real-time assessment of concussion-related impairments that could be further augmented with telemedicine capabilities to integrate professional clinical guidance. Smartglasses may be superior to fully immersive virtual reality headsets for this application, given their lighter weight and reduced likelihood of potential safety concerns.
Collapse
Affiliation(s)
- Joseph P Salisbury
- Neural Sensing and Biometrics Division, TIAX LLC, Lexington, MA, United States.,Empowerment Lab, Brain Power, LLC, Cambridge, MA, United States
| | - Neha U Keshav
- Empowerment Lab, Brain Power, LLC, Cambridge, MA, United States
| | - Anthony D Sossong
- Neural Sensing and Biometrics Division, TIAX LLC, Lexington, MA, United States.,Empowerment Lab, Brain Power, LLC, Cambridge, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Ned T Sahin
- Neural Sensing and Biometrics Division, TIAX LLC, Lexington, MA, United States.,Empowerment Lab, Brain Power, LLC, Cambridge, MA, United States.,Department of Psychology, Harvard University, Cambridge, MA, United States
| |
Collapse
|