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Thuilier E, Carey J, Dempsey M, Dingliana J, Whelan B, Brennan A. Virtual rehabilitation for patients with osteoporosis or other musculoskeletal disorders: a systematic review. VIRTUAL REALITY 2024; 28:93. [PMID: 38595908 PMCID: PMC10999384 DOI: 10.1007/s10055-024-00980-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 02/25/2024] [Indexed: 04/11/2024]
Abstract
This study aims to identify effective ways to design virtual rehabilitation to obtain physical improvement (e.g. balance and gait) and support engagement (i.e. motivation) for people with osteoporosis or other musculoskeletal disorders. Osteoporosis is a systemic skeletal disorder and is among the most prevalent diseases globally, affecting 0.5 billion adults. Despite the fact that the number of people with osteoporosis is similar to, or greater than those diagnosed with cardiovascular disease and dementia, osteoporosis does not receive the same recognition. Worldwide, osteoporosis causes 8.9 million fractures annually; it is associated with substantial pain, suffering, disability and increased mortality. The importance of physical therapy as a rehabilitation strategy to avoid osteoporosis fracture cannot be over-emphasised. However, the main rehabilitation challenges relate to engagement and participation. The use of virtual rehabilitation to address such challenges in the delivery of physical improvement is gaining in popularity. As there currently is a paucity of literature applying virtual rehabilitation to patients with osteoporosis, the authors broadened the search parameters to include articles relating to the virtual rehabilitation of other skeletal disorders (e.g. Ankylosing spondylitis, spinal cord injury, motor rehabilitation, etc.). This systematic review initially identified 130 titles, from which 23 articles (involving 539 participants) met all eligibility and selection criteria. Four groups of devices supporting virtual rehabilitation were identified: a head-mounted display, a balance board, a camera and more specific devices. Each device supported physical improvement (i.e. balance, muscle strength and gait) post-training. This review has shown that: (a) each device allowed improvement with different degrees of immersion, (b) the technology choice is dependent on the care need and (c) virtual rehabilitation can be equivalent to and enhance conventional therapy and potentially increase the patient's engagement with physical therapy.
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Affiliation(s)
- Eléa Thuilier
- School of Computer Science, University of Galway, Galway, Ireland
| | - John Carey
- School of Medicine, University of Galway, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, University of Galway, Galway, Ireland
| | - John Dingliana
- School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Bryan Whelan
- School of Medicine, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, University of Galway, Galway, Ireland
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2
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Özlü A, Üstündağ S, Bulut Özkaya D, Menekşeoğlu AK. Effect of Exergame on Pain, Function, and Quality of Life in Shoulder Impingement Syndrome: A Prospective Randomized Controlled Study. Games Health J 2024; 13:109-119. [PMID: 38394299 DOI: 10.1089/g4h.2023.0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Objective: This study aimed to investigate the effect of a virtual reality (VR)-mediated gamified rehabilitation program added to a home exercise program on pain, functionality, and quality of life in shoulder impingement syndrome. Methods: Forty-eight participants with shoulder impingement syndrome were included in this prospective, randomized, single-blind study between January and July 2022. The participants were randomized into two groups: the VR group (n = 24) and the control group (n = 24). All participants were given a home exercise program for 3 weeks, with five sessions per week. The participants in the VR group received 15 sessions (45 minutes each session) of a gamified shoulder exercise program with an immersive VR headset, while those in the control group received 15 sessions (45 minutes each session) of supervised therapeutic exercises. The participants were evaluated and compared before and after treatment using the 36-item Short Form Survey (SF-36), range-of-motion (ROM) measurements, the Visual Analog Scale (VAS), and the Shoulder Pain and Disability Scale (SPADI). Results: At the baseline assessment, the two groups were homogenous regarding demographic and clinical parameters. The post-treatment shoulder extension and adduction ROM was significantly greater in the VR group and the post-treatment pain subscales for SPADI and SF-36 were significantly lower in the VR group. Conclusion: In individuals with shoulder impingement syndrome, a VR-mediated gamified exercise program added to a home exercise program increased shoulder ROM and reduced pain scores. Further clinical studies are needed to prove the long-term efficacy of the addition of VR-mediated gamified exercises to the treatment of this condition in clinical settings.
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Affiliation(s)
- Aysun Özlü
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Sema Üstündağ
- Department of Internal Medicine, Faculty of Nursing, Kutahya Health Sciences University, Kutahya, Turkey
| | - Dilan Bulut Özkaya
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ahmet Kıvanç Menekşeoğlu
- Department of Physical Medicine and Rehabilitation, Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
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De Miguel-Rubio A, Gallego-Aguayo I, De Miguel-Rubio MD, Arias-Avila M, Lucena-Anton D, Alba-Rueda A. Effectiveness of the Combined Use of a Brain-Machine Interface System and Virtual Reality as a Therapeutic Approach in Patients with Spinal Cord Injury: A Systematic Review. Healthcare (Basel) 2023; 11:3189. [PMID: 38132079 PMCID: PMC10742447 DOI: 10.3390/healthcare11243189] [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: 10/26/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain-machine interface and virtual reality offers a therapeutic alternative to be considered in the treatment of this pathology. This systematic review aimed to evaluate the effectiveness of the combined use of virtual reality and the brain-machine interface in the treatment of spinal cord injuries. A search was performed in PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Medline, including articles published from the beginning of each database until January 2023. Articles were selected based on strict inclusion and exclusion criteria. The Cochrane Collaboration's tool was used to assess the risk of bias and the PEDro scale and SCIRE systems were used to evaluate the methodological quality of the studies. Eleven articles were selected from a total of eighty-two. Statistically significant changes were found in the upper limb, involving improvements in shoulder and upper arm mobility, and weaker muscles were strengthened. In conclusion, most of the articles analyzed used the electroencephalogram as a measurement instrument for the assessment of various parameters, and most studies have shown improvements. Nonetheless, further research is needed with a larger sample size and long-term follow-up to establish conclusive results regarding the effect size of these interventions.
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Affiliation(s)
- Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
| | - Ignacio Gallego-Aguayo
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
| | | | - Mariana Arias-Avila
- Physical Therapy Department, Universidade Federal de São Carlos, São Paulo 13565-905, Brazil;
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain;
| | - Alvaro Alba-Rueda
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (I.G.-A.); (A.A.-R.)
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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Jovanovic LI, Jervis Rademeyer H, Pakosh M, Musselman KE, Popovic MR, Marquez-Chin C. Scoping Review on Brain-Computer Interface-Controlled Electrical Stimulation Interventions for Upper Limb Rehabilitation in Adults: A Look at Participants, Interventions, and Technology. Physiother Can 2023; 75:276-290. [PMID: 37736411 PMCID: PMC10510539 DOI: 10.3138/ptc-2021-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/07/2021] [Accepted: 12/07/2021] [Indexed: 09/23/2023]
Abstract
Purpose While current rehabilitation practice for improving arm and hand function relies on physical/occupational therapy, a growing body of research evaluates the effects of technology-enhanced rehabilitation. We review interventions that combine a brain-computer interface (BCI) with electrical stimulation (ES) for upper limb movement rehabilitation to summarize the evidence on (1) populations of study participants, (2) BCI-ES interventions, and (3) the BCI-ES systems. Method After searching seven databases, two reviewers identified 23 eligible studies. We consolidated information on the study participants, interventions, and approaches used to develop integrated BCI-ES systems. The included studies investigated the use of BCI-ES interventions with stroke and spinal cord injury (SCI) populations. All studies used electroencephalography to collect brain signals for the BCI, and functional electrical stimulation was the most common type of ES. The BCI-ES interventions were typically conducted without a therapist, with sessions varying in both frequency and duration. Results Of the 23 eligible studies, only 3 studies involved the SCI population, compared to 20 involving individuals with stroke. Conclusions Future BCI-ES interventional studies could address this gap. Additionally, standardization of device and rehabilitation modalities, and study-appropriate involvement with therapists, can be considered to advance this intervention towards clinical implementation.
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Affiliation(s)
- Lazar I. Jovanovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | - Hope Jervis Rademeyer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Kristin E. Musselman
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
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Bates M, Sunderam S. Hand-worn devices for assessment and rehabilitation of motor function and their potential use in BCI protocols: a review. Front Hum Neurosci 2023; 17:1121481. [PMID: 37484920 PMCID: PMC10357516 DOI: 10.3389/fnhum.2023.1121481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/01/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Various neurological conditions can impair hand function. Affected individuals cannot fully participate in activities of daily living due to the lack of fine motor control. Neurorehabilitation emphasizes repetitive movement and subjective clinical assessments that require clinical experience to administer. Methods Here, we perform a review of literature focused on the use of hand-worn devices for rehabilitation and assessment of hand function. We paid particular attention to protocols that involve brain-computer interfaces (BCIs) since BCIs are gaining ground as a means for detecting volitional signals as the basis for interactive motor training protocols to augment recovery. All devices reviewed either monitor, assist, stimulate, or support hand and finger movement. Results A majority of studies reviewed here test or validate devices through clinical trials, especially for stroke. Even though sensor gloves are the most commonly employed type of device in this domain, they have certain limitations. Many such gloves use bend or inertial sensors to monitor the movement of individual digits, but few monitor both movement and applied pressure. The use of such devices in BCI protocols is also uncommon. Discussion We conclude that hand-worn devices that monitor both flexion and grip will benefit both clinical diagnostic assessment of function during treatment and closed-loop BCI protocols aimed at rehabilitation.
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Bressi F, Cricenti L, Bravi M, Pannunzio F, Cordella F, Lapresa M, Miccinilli S, Santacaterina F, Zollo L, Sterzi S, Campagnola B. Treatment of the Paretic Hand with a Robotic Glove Combined with Physiotherapy in a Patient Suffering from Traumatic Tetraparesis: A Case Report. SENSORS (BASEL, SWITZERLAND) 2023; 23:3484. [PMID: 37050544 PMCID: PMC10099243 DOI: 10.3390/s23073484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND cervical spinal cord injury leads to loss of upper limb functionality, which causes a decrease in autonomy to perform activities of daily living. The use of robotic technologies in rehabilitation could contribute to improving upper limb functionality and treatment quality. This case report aims to describe the potential of robotic hand treatment with Gloreha Sinfonia, in combination with conventional rehabilitation, in a tetraparetic patient. MATERIAL fifteen rehabilitative sessions were performed. Evaluations were conducted pre-treatment (T0), post-treatment (T1), and at two-months follow-up (T2) based on: the upper-limb range of motion and force assessment, the FMA-UE, the 9-Hole Peg Test (9HPT), and the DASH questionnaire. A virtual reality game-based rating system was used to evaluate the force control and modulation ability. RESULTS the patient reported greater ability to use hands with less compensation at T1 and T2 assessments. Improvements in clinical scales were reported in both hands at T1, however, at T2 only did the dominant hand show further improvement. Improved grip strength control and modulation ability were reported for T1. However a worsening was found in both hands at T2, significant only for the non-dominant hand. The maximum force exerted increased from T0 to T2 in both hands. CONCLUSION hand treatment combining physical therapy and Gloreha Sinfonia seems to have benefits in functionality and dexterity in tetraparetic patient in the short term. Further studies are needed to confirm these findings, to verify long-term results, and to identify the most appropriate modalities of robotic rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Fabiana Pannunzio
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Francesca Cordella
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Martina Lapresa
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
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Juan MC, Elexpuru J, Dias P, Santos BS, Amorim P. Immersive virtual reality for upper limb rehabilitation: comparing hand and controller interaction. VIRTUAL REALITY 2022; 27:1157-1171. [PMID: 36475065 PMCID: PMC9715412 DOI: 10.1007/s10055-022-00722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/15/2022] [Indexed: 06/05/2023]
Abstract
Virtual reality shows great potential as an alternative to traditional therapies for motor rehabilitation given its ability to immerse the user in engaging scenarios that abstract them from medical facilities and tedious rehabilitation exercises. This paper presents a virtual reality application that includes three serious games and that was developed for motor rehabilitation. It uses a standalone headset and the user's hands without the need for any controller for interaction. Interacting with an immersive virtual reality environment using only natural hand gestures involves an interaction that is similar to that of real life, which would be especially desirable for patients with motor problems. A study involving 28 participants (4 with motor problems) was carried out to compare two types of interaction (hands vs. controllers). All of the participants completed the exercises. No significant differences were found in the number of attempts necessary to complete the games using the two types of interaction. The group that used controllers required less time to complete the exercise. The performance outcomes were independent of the gender and age of the participants. The subjective assessment of the participants with motor problems was not significantly different from the rest of the participants. With regard to the interaction type, the participants mostly preferred the interaction using their hands (78.5%). All four participants with motor problems preferred the hand interaction. These results suggest that the interaction with the user's hands together with standalone headsets could improve motivation, be well accepted by motor rehabilitation patients, and help to complete exercise therapy at home.
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Affiliation(s)
- M.-Carmen Juan
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camino de Vera, S/N, 46022 Valencia, Spain
| | - Julen Elexpuru
- Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, C/Camino de Vera, S/N, 46022 Valencia, Spain
| | - Paulo Dias
- Department of Electronics Telecommunications and Informatics (DETI), University of Aveiro, Aveiro, Portugal
| | - Beatriz Sousa Santos
- Department of Electronics Telecommunications and Informatics (DETI), University of Aveiro, Aveiro, Portugal
| | - Paula Amorim
- Centre Region Rehabilitation Medicine Centre Rovisco Pais (CMRRC-RP), Tocha, Portugal
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Reichert C, Klemm L, Mushunuri RV, Kalyani A, Schreiber S, Kuehn E, Azañón E. Discriminating Free Hand Movements Using Support Vector Machine and Recurrent Neural Network Algorithms. SENSORS (BASEL, SWITZERLAND) 2022; 22:6101. [PMID: 36015862 PMCID: PMC9412700 DOI: 10.3390/s22166101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Decoding natural hand movements is of interest for human-computer interaction and may constitute a helpful tool in the diagnosis of motor diseases and rehabilitation monitoring. However, the accurate measurement of complex hand movements and the decoding of dynamic movement data remains challenging. Here, we introduce two algorithms, one based on support vector machine (SVM) classification combined with dynamic time warping, and the other based on a long short-term memory (LSTM) neural network, which were designed to discriminate small differences in defined sequences of hand movements. We recorded hand movement data from 17 younger and 17 older adults using an exoskeletal data glove while they were performing six different movement tasks. Accuracy rates in decoding the different movement types were similarly high for SVM and LSTM in across-subject classification, but, for within-subject classification, SVM outperformed LSTM. The SVM-based approach, therefore, appears particularly promising for the development of movement decoding tools, in particular if the goal is to generalize across age groups, for example for detecting specific motor disorders or tracking their progress over time.
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Affiliation(s)
- Christoph Reichert
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Universitaetsplatz 2, 39106 Magdeburg, Germany
- Forschungscampus STIMULATE, Otto-Hahn-Str. 2, 39106 Magdeburg, Germany
| | - Lisa Klemm
- Department of Neurology, University Medical Center, Leipziger Str. 44, 39120 Magdeburg, Germany
| | | | - Avinash Kalyani
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Stefanie Schreiber
- Center for Behavioral Brain Sciences (CBBS), Universitaetsplatz 2, 39106 Magdeburg, Germany
- Department of Neurology, University Medical Center, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Esther Kuehn
- Center for Behavioral Brain Sciences (CBBS), Universitaetsplatz 2, 39106 Magdeburg, Germany
- Institute for Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany
- Hertie Institute for Clinical Brain Research (HIH), Otfried Mueller-Str. 27, 72076 Tuebingen, Germany
| | - Elena Azañón
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Brenneckestr. 6, 39118 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Universitaetsplatz 2, 39106 Magdeburg, Germany
- Department of Neurology, University Medical Center, Leipziger Str. 44, 39120 Magdeburg, Germany
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De Miguel-Rubio A, Muñoz-Pérez L, Alba-Rueda A, Arias-Avila M, Rodrigues-de-Souza DP. A Therapeutic Approach Using the Combined Application of Virtual Reality with Robotics for the Treatment of Patients with Spinal Cord Injury: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148772. [PMID: 35886624 PMCID: PMC9322038 DOI: 10.3390/ijerph19148772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 02/04/2023]
Abstract
Spinal cord injury (SCI) has been associated with high mortality rates. Thanks to the multidisciplinary vision and approach of SCI, including the application of new technologies in the field of neurorehabilitation, people with SCI can survive and prosper after injury. The main aim of this systematic review was to analyze the effectiveness of the combined use of VR and robotics in the treatment of patients with SCI. The literature search was performed between May and July 2021 in the Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, and Web of Science. The methodological quality of each study was assessed using the SCIRE system and the PEDro scale, whereas the risk of bias was analyzed using the Cochrane Collaboration’s tool. A total of six studies, involving 63 participants, were included in this systematic review. Relevant changes were found in the upper limbs, with improvements of shoulder and upper arm mobility, as well as the strengthening of weaker muscles. Combined rehabilitation may be a valuable approach to improve motor function in SCI patients. Nonetheless, further research is necessary, with a larger patient sample and a longer duration.
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Affiliation(s)
- Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (L.M.-P.); (A.A.-R.)
- Correspondence: ; Tel.: +34-957-218-220
| | - Lorena Muñoz-Pérez
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (L.M.-P.); (A.A.-R.)
| | - Alvaro Alba-Rueda
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain; (L.M.-P.); (A.A.-R.)
| | - Mariana Arias-Avila
- Physical Therapy Department, Universidade Federal de São Carlos, São Carlos, São Paulo 13565-905, Brazil;
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FarmDay: A Gamified Virtual Reality Neurorehabilitation Application for Upper Limb Based on Activities of Daily Living. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12147068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with upper limb disorders are limited in their activities of daily living and impose an important healthcare burden due to the repetitive rehabilitation they require. A way to reduce this burden is through home-based therapy using virtual reality solutions, since they are readily available, provide immersion, and enable accurate motion tracking, and custom applications can be developed for them. However, there is lack of guidelines for the design of effective VR rehabilitation applications in the literature, particularly for bimanual training. This work introduces a VR telerehabilitation system that uses off-the-shelf hardware, a real-time remote setup, and a bimanual training application that aims to improve upper extremity motor function. It is made of six activities and was evaluated by five physiotherapists specialised in (1) neuromotor disorders and (2) functional rehabilitation and (3) occupational therapy. A descriptive analysis of the results obtained from the System Usability Scale test of the application and a collection of qualitative assessments of each game have been carried out. The application obtained a mean score of 86.25 (±8.96 SD) in the System Usability Scale, and the experts concluded that it accurately reproduces activities of daily living movements except for wrist and finger movements. They also offer a set of design guidelines.
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12
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de Los Reyes-Guzmán A, Fernández García L, Alvarez-Rodríguez M, Lozano-Berrio V, Domingo-García AM, Ceruelo-Abajo S. [Low-cost virtual reality. A new application for upper extremity motor rehabilitation in neurological pathology: Pilot study]. Rehabilitacion (Madr) 2022; 56:173-181. [PMID: 34511255 DOI: 10.1016/j.rh.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study is to present a new virtual reality (VR) low cost application based on Leap Motion Controller (LMC) device for upper extremity motor rehabilitation after neurological pathology and to demonstrate its clinical feasibility by carrying out a pilot experience. MATERIAL AND METHODS The LMC allows the interaction with virtual applications by capturing the patient's hand movements. A pilot study was carried out with 4 patients with upper limb impairment reflected with Upper Extremity Motor Score (UEMS) greater than 10. They were assessed using the Box and Block (BBT) and the writing task within the Jebsen-Taylor Hand Function (JTHF) before and after the intervention. RESULTS All patients completed the 9-session, 30-min protocol divided into 3 sessions per week. They went from an average result of 38 (SD 20) blocks in BBT before the intervention to 44 (SD 21.72) after it. They went from 28.25 s (SD 8.61) to 26.75 s (SD 21.72) in the JTHF. Statistically significant differences were no found. The device usability was assessed by the QUEST scale, being the security, effectiveness and ease to use the aspects that patients considered to be a priority. CONCLUSIóN: A new VR development based on the LMC device is presented and the clinical feasibility of its application in neurological patients with upper limb involvement has been proven. A clinical study with a large sample size is needed to assess its potential clinical effectiveness as a treatment element.
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Affiliation(s)
| | - L Fernández García
- Servicio de Rehabilitación. Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M Alvarez-Rodríguez
- Unidad de Biomecánica. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - V Lozano-Berrio
- Unidad de Biomecánica. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - A M Domingo-García
- Unidad de Terapia Ocupacional. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
| | - S Ceruelo-Abajo
- Servicio de Rehabilitación. Hospital Nacional de Parapléjicos de Toledo, Toledo, España
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Abstract
This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.
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Affiliation(s)
- Stuart Stokes
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Martin Drozda
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Christopher Lee
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
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Koryakina OV, Moskvina EY, Kovtun OP, Kazaeva AV, Safronov AA. [Evaluation the effectiveness of immersive VR-assisted rehabilitation in a child with chemotherapy-induced neurological complication in acute lymphoblastic leukemia]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:85-89. [PMID: 36170105 DOI: 10.17116/jnevro202212209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Rehabilitation therapy is considered as an actual and complex system of knowledge, in which the main task is the development and implementation of new methods of rehabilitation. In present time, the most perspective rehabilitation program is utilizing virtual reality. A report was made with the utilization of rehabilitation therapy with virtual reality in a child with chemotherapy-induced neurological disorders in acute lymphoblastic leukemia. The child performed a set of exercises using fully immersive virtual reality. Over the course of rehabilitation positive dynamics was observed, namely increased muscle strength in the injured limb from 3 to 5 scores according to the Medical Research Council Weakness Scale. There was improved balance on the Berg Balance Scale from 35 to 42. In addition, there were increased range of active movements, partly restored biomechanics of gait with increased velocity by 2 times. According to the results of testing the psycho-emotional state using the Luscher color test and the graphic technique «Cactus» by M.A. Panfilova, self-esteem, the desire to succeed and independence were improved, the level of auto-aggression was decreased. The results show that rehabilitation using fully immersive virtual reality is probably a perspective tool in addition to traditional rehabilitation. It improves the neurological and psycho-emotional state, raises motivation of patients, which, in turn, helps to increase the effectiveness of rehabilitation therapy and speeds up the rehabilitation process.
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Affiliation(s)
- O V Koryakina
- Ural State Medical University, Yekaterinburg, Russia
- Regional Children Clinical Hospital, Yekaterinburg, Russia
| | - E Yu Moskvina
- Ural State Medical University, Yekaterinburg, Russia
| | - O P Kovtun
- Ural State Medical University, Yekaterinburg, Russia
| | - A V Kazaeva
- The Sverdlovsk Charity Organization Helping Patients with Cancer «Together for life», Yekaterinburg, Russia
| | - A A Safronov
- Regional Children Clinical Hospital, Yekaterinburg, Russia
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Leemhuis E, Giuffrida V, Giannini AM, Pazzaglia M. A Therapeutic Matrix: Virtual Reality as a Clinical Tool for Spinal Cord Injury-Induced Neuropathic Pain. Brain Sci 2021; 11:1201. [PMID: 34573221 PMCID: PMC8472645 DOI: 10.3390/brainsci11091201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022] Open
Abstract
Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the transversal role embodiment and how multisensory and environmental or artificial stimuli modulate illusory sensations of bodily presence and ownership. Then, we present a brief overview of the use of VR in healthcare and pain management. Finally, we discus research experiences which used VR in patients with SCI to treating NP, including the most recent combinations of VR with further stimulation techniques.
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Affiliation(s)
- Erik Leemhuis
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Valentina Giuffrida
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
| | - Anna Maria Giannini
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
| | - Mariella Pazzaglia
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185 Rome, Italy
- Body and Action Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy
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Handelzalts S, Ballardini G, Avraham C, Pagano M, Casadio M, Nisky I. Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic. Front Neurorobot 2021; 15:617636. [PMID: 33679364 PMCID: PMC7925397 DOI: 10.3389/fnbot.2021.617636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/07/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
| | - Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Chen Avraham
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Mattia Pagano
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Ilana Nisky
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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A Knitted Sensing Glove for Human Hand Postures Pattern Recognition. SENSORS 2021; 21:s21041364. [PMID: 33671966 PMCID: PMC7919032 DOI: 10.3390/s21041364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022]
Abstract
In recent years, flexible sensors for data gloves have been developed that aim to achieve excellent wearability, but they are associated with difficulties due to the complicated manufacturing and embedding into the glove. This study proposes a knitted glove integrated with strain sensors for pattern recognition of hand postures. The proposed sensing glove is fabricated at all once by a knitting technique without sewing and bonding, which is composed of strain sensors knitted with conductive yarn and a glove body with non-conductive yarn. To verify the performance of the developed glove, electrical resistance variations were measured according to the flexed angle and speed. These data showed different values depending on the speed or angle of movements. We carried out experiments on hand postures pattern recognition for the practicability verification of the knitted sensing glove. For this purpose, 10 able-bodied subjects participated in the recognition experiments on 10 target hand postures. The average classification accuracy of 10 subjects reached 94.17% when their own data were used. The accuracy of up to 97.1% was achieved in the case of grasp posture among 10 target postures. When all mixed data from 10 subjects were utilized for pattern recognition, the average classification expressed by the confusion matrix arrived at 89.5%. Therefore, the comprehensive experimental results demonstrated the effectiveness of the knitted sensing gloves. In addition, it is expected to reduce the cost through a simple manufacturing process of the knitted sensing glove.
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Go Virtual to Get Real: Virtual Reality as a Resource for Spinal Cord Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041819. [PMID: 33668438 PMCID: PMC7918193 DOI: 10.3390/ijerph18041819] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people's multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, motor rehabilitation, and psychological well-being.
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De Miguel-Rubio A, Rubio MD, Alba-Rueda A, Salazar A, Moral-Munoz JA, Lucena-Anton D. Virtual Reality Systems for Upper Limb Motor Function Recovery in Patients With Spinal Cord Injury: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e22537. [PMID: 33270040 PMCID: PMC7746495 DOI: 10.2196/22537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patients with spinal cord injury (SCI) usually present with different motor impairments, including a deterioration of upper limb motor function (ULMF), that limit their performance of activities of daily living and reduce their quality of life. Virtual reality (VR) is being used in neurological rehabilitation for the assessment and treatment of the physical impairments of this condition. OBJECTIVE A systematic review and meta-analysis was conducted to evaluate the effectiveness of VR on ULMF in patients with SCI compared with conventional physical therapy. METHODS The search was performed from October to December 2019 in Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and Cochrane Central Register of Controlled Trials. The inclusion criteria of selected studies were as follows: (1) comprised adults with SCI, (2) included an intervention with VR, (3) compared VR intervention with conventional physical therapy, (4) reported outcomes related to ULMF, and (5) was a controlled clinical trial. The Cochrane Collaboration's tool was used to evaluate the risk of bias. The RevMan 5.3 statistical software was used to obtain the meta-analysis according to the standardized mean difference (SMD) and 95% CIs. RESULTS Six articles were included in this systematic review. Four of them contributed information to the meta-analysis. A total of 105 subjects were analyzed. All of the studies used semi-immersive or nonimmersive VR systems. The statistical analysis showed nonsignificant results for the Nine-Hole Peg Test (SMD -0.93, 95% CI -1.95 to 0.09), muscle balance test (SMD -0.27, 95% CI -0.82 to 0.27), Motricity Index (SMD 0.16, 95% CI -0.37 to 0.68), Jebsen-Taylor Hand Function Test (JTHFT) subtests (writing, SMD -0.10, 95% CI -4.01 to 3.82; simulated page turning, SMD -0.99, 95% CI -2.01 to 0.02; simulated feeding, SMD -0.64, 95% CI -1.61 to 0.32; stacking checkers, SMD 0.99, 95% CI -0.02 to 2.00; picking up large light objects, SMD -0.42, 95% CI -1.37 to 0.54; and picking up large heavy objects, SMD 0.52, 95% CI -0.44 to 1.49), range of motion of shoulder abduction/adduction (SMD -0.23, 95% CI -1.48 to 1.03), shoulder flexion/extension (SMD 0.56, 95% CI -1.24 to 2.36), elbow flexion (SMD -0.36, 95% CI -1.14 to 0.42), elbow extension (SMD -0.21, 95% CI -0.99 to 0.57), wrist extension (SMD 1.44, 95% CI -2.19 to 5.06), and elbow supination (SMD -0.18, 95% CI -1.80 to 1.44). Favorable results were found for the JTHFT subtest picking up small common objects (SMD -1.33, 95% CI -2.42 to -0.24). CONCLUSIONS The current evidence for VR interventions to improve ULMF in patients with SCI is limited. Future studies employing immersive systems to identify the key aspects that increase the clinical impact of VR interventions are needed, as well as research to prove the benefits of the use of VR in the rehabilitation of patients with SCI in the clinical setting.
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Affiliation(s)
| | - M Dolores Rubio
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Cordoba, Spain
| | - Alvaro Alba-Rueda
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, Cordoba, Spain
| | - Alejandro Salazar
- Department of Statistics and Operational Research, University of Cadiz, Cadiz, Spain.,Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, Cadiz, Spain.,The Observatory of Pain, University of Cadiz, Cadiz, Spain
| | - Jose A Moral-Munoz
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, Cadiz, Spain.,The Observatory of Pain, University of Cadiz, Cadiz, Spain.,Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence. J Clin Med 2020; 9:jcm9103369. [PMID: 33096678 PMCID: PMC7590210 DOI: 10.3390/jcm9103369] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
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Is Virtual Reality Effective for Balance Recovery in Patients with Spinal Cord Injury? A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9092861. [PMID: 32899665 PMCID: PMC7564926 DOI: 10.3390/jcm9092861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022] Open
Abstract
Virtual reality (VR) is an emerging tool used in the neurological rehabilitation of patients with spinal cord injury (SCI), focused on recovering balance, mobility, and motor function, among other functional outcomes. The main objective of this study was to analyze the effectiveness of VR systems to recover balance in patients with SCI. The literature search was performed between October and December 2019 in the following databases: Embase, Web of Science, CINAHL, Scopus, Medline, Physiotherapy Evidence Database (PEDro), PubMed, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Spinal Cord Injury Rehabilitation Evidence (SCIRE) system and the PEDro scale, while the risk of bias was analyzed by the Cochrane Collaboration’s tool. A total of 12 studies, involving 188 participants, were included in the systematic review, of which two were included in the meta-analysis. Statistical analysis showed favorable results for balance measured by the modified Functional Reach Test (standardized mean difference (SMD) = 3.42; 95% confidence interval: 2.54 to 4.29) and by the t-shirt test (SMD= −2.29; 95% confidence interval: −3.00 to −1.59). The results showed that VR interventions provided potential benefits, in addition to conventional physical therapy, to recover balance in patients with SCI.
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De Miguel-Rubio A, Rubio MD, Salazar A, Camacho R, Lucena-Anton D. Effectiveness of Virtual Reality on Functional Performance after Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 9:jcm9072065. [PMID: 32630234 PMCID: PMC7408779 DOI: 10.3390/jcm9072065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
Abstract
A spinal cord injury (SCI) usually results in a significant limitation in the functional outcomes, implying a challenge to the performance of activities of daily living. The main aim of this study is to analyze the effectiveness of virtual reality to improve functional performance in patients with SCI. The search was performed between October and December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, Web of Science, and Embase. The methodological quality of the studies was evaluated through the PEDro scale, and the risk of bias was evaluated with the Cochrane collaboration’s tool. Seven articles were included in this systematic review, and five of them in the meta-analysis. Statistical analysis showed favorable results for functional performance in control group performing conventional therapy, measured by the functional independence measure (standardized mean difference (SMD)= −0.70; 95% confidence interval: −1.25 to −0.15). Results were inconclusive for other outcomes. Most studies have not shown beneficial effects on functional performance compared with conventional physical therapy. The results obtained showed that virtual reality may not be more effective than conventional physical therapy in improving functional performance in patients with SCI.
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Affiliation(s)
- Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain;
| | - M. Dolores Rubio
- Department of Cell Biology, Physiology, and Immunology, University of Cordoba, 14007 Cordoba, Spain; (M.D.R.); (R.C.)
| | - Alejandro Salazar
- Department of Statistics and Operational Research, University of Cadiz, 11009 Cadiz, Spain
- Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz (INiBICA), University of Cadiz, 11009 Cadiz, Spain
- The Observatory of Pain, University of Cadiz, 11009 Cadiz, Spain
- Correspondence:
| | - Rocio Camacho
- Department of Cell Biology, Physiology, and Immunology, University of Cordoba, 14007 Cordoba, Spain; (M.D.R.); (R.C.)
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cadiz, 11009 Cadiz, Spain;
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Byrom B, Breedon P, Tulkki-Wilke R, Platko JV. Meaningful change: Defining the interpretability of changes in endpoints derived from interactive and mHealth technologies in healthcare and clinical research. J Rehabil Assist Technol Eng 2020; 7:2055668319892778. [PMID: 32206336 PMCID: PMC7079306 DOI: 10.1177/2055668319892778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/01/2019] [Indexed: 12/28/2022] Open
Abstract
Immersive, interactive and mHealth technologies are increasingly being used in clinical research, healthcare and rehabilitation solutions. Leveraging technology solutions to derive new and novel clinical outcome measures is important to the ongoing assessment of clinical interventions. While demonstrating statistically significant changes is an important element of intervention assessment, understanding whether changes detected reflect changes of a magnitude that are considered meaningful to patients is equally important. We describe methodologies used to determine meaningful change and recommend that these techniques are routinely included in the development and testing of clinical assessment and rehabilitation technology solutions.
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Affiliation(s)
- B Byrom
- Product Management, Signant Health, London, UK
| | - P Breedon
- Medical Design Research Group, Nottingham Trent University, Nottingham, UK
| | | | - J V Platko
- ECOA Science, Signant Health, Plymouth Meeting, USA
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Efficacy of Virtual Reality Rehabilitation after Spinal Cord Injury: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7106951. [PMID: 31828120 PMCID: PMC6885151 DOI: 10.1155/2019/7106951] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 01/01/2023]
Abstract
Background Spinal cord injury (SCI) is often associated with long-term impairments related to functional limitations in the sensorimotor system. The use of virtual reality (VR) technology may lead to increased motivation and engagement, besides allowing a wide range of possible tasks/exercises to be implemented in rehabilitation programs. The present review aims to investigate the possible benefits and efficacy of VR-based rehabilitation in individuals with SCI. Methods An electronically systematic search was performed in multiple databases (PubMed, BVS, Web of Science, Cochrane Central, and Scielo) up to May 2019. MESH terms and keywords were combined in a search strategy. Two reviewers independently selected the studies in accordance with eligibility criteria. The PEDro scale was used to score the methodological quality and risk of bias of the selected studies. Results Twenty-five studies (including 482 participants, 47.6 ± 9.5 years, 73% male) were selected and discussed. Overall, the studies used VR devices in different rehabilitation protocols to improve motor function, driving skills, balance, aerobic function, and pain level, as well as psychological and motivational aspects. A large amount of heterogeneity was observed as to the study design, VR protocols, and outcome measures used. Only seven studies (28%) had an excellent/good quality of evidence. However, substantial evidence for significant positive effects associated with VR therapy was found in most of the studies (88%), with no adverse events (88%) being reported. Conclusion Although the current evidence is limited, the findings suggest that VR-based rehabilitation in subjects with SCI may lead to positive effects on aerobic function, balance, pain level, and motor function recovery besides improving psychological/motivational aspects. Further high-quality studies are needed to provide a guideline to clinical practice and to draw robust conclusions about the potential benefits of VR therapy for SCI patients. Protocol details are registered on PROSPERO (registration number: CRD42016052629).
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van der Veen SM, Bordeleau M, Pidcoe PE, France CR, Thomas JS. Agreement Analysis between Vive and Vicon Systems to Monitor Lumbar Postural Changes. SENSORS 2019; 19:s19173632. [PMID: 31438520 PMCID: PMC6749183 DOI: 10.3390/s19173632] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/14/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022]
Abstract
Immersive virtual reality has recently developed into a readily available system that allows for full-body tracking. Can this affordable system be used for component tracking to advance or replace expensive kinematic systems for motion analysis in the clinic? The aim of this study was to assess the accuracy of position and orientation measures from Vive wireless body trackers when compared to Vicon optoelectronic tracked markers attached to (1) a robot simulating trunk flexion and rotation by repeatedly moving to know locations, and (2) healthy adults playing virtual reality games necessitating significant trunk displacements. The comparison of both systems showed component tracking with Vive trackers is accurate within 0.68 ± 0.32 cm translationally and 1.64 ± 0.18° rotationally when compared with a three-dimensional motion capture system. No significant differences between Vive trackers and Vicon systems were found suggesting the Vive wireless sensors can be used to accurately track joint motion for clinical and research data.
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Affiliation(s)
- Susanne M van der Veen
- Department of Physical TherapyVirginia Commonwealth University, MCV Campus, Richmond, VA 23220, USA.
| | - Martine Bordeleau
- Department of Neuroscience, Université Laval, Québec, QC G1V 4G2, Canada
| | - Peter E Pidcoe
- Department of Physical TherapyVirginia Commonwealth University, MCV Campus, Richmond, VA 23220, USA
| | - Chris R France
- Department of Psychology, Ohio University, College of Arts & Sciences, Athens, OH 45701, USA
| | - James S Thomas
- Department of Physical TherapyVirginia Commonwealth University, MCV Campus, Richmond, VA 23220, USA
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Massetti T, da Silva TD, Crocetta TB, Guarnieri R, de Freitas BL, Bianchi Lopes P, Watson S, Tonks J, de Mello Monteiro CB. The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review. J Cent Nerv Syst Dis 2018; 10:1179573518813541. [PMID: 30515028 PMCID: PMC6262495 DOI: 10.1177/1179573518813541] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/19/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Virtual reality (VR) experiences (through games and virtual environments) are increasingly being used in physical, cognitive, and psychological interventions. However, the impact of VR as an approach to rehabilitation is not fully understood, and its advantages over traditional rehabilitation techniques are yet to be established. Method: We present a systematic review which was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). During February and March of 2018, we conducted searches on PubMed (Medline), Virtual Health Library Search Portal databases (BVS), Web of Science (WOS), and Embase for all VR-related publications in the past 4 years (2015, 2016, 2017, and 2018). The keywords used in the search were “neurorehabilitation” AND “Virtual Reality” AND “devices.” Results: We summarize the literature which highlights that a range of effective VR approaches are available. Studies identified were conducted with poststroke patients, patients with cerebral palsy, spinal cord injuries, and other pathologies. Healthy populations have been used in the development and testing of VR approaches meant to be used in the future by people with neurological disorders. A range of benefits were associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. Conclusions: The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery.
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Affiliation(s)
- Thais Massetti
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Talita Dias da Silva
- School of Arts, Sciences and Humanities (EACH), University of São Paulo (USP), São Paulo, Brazil
| | | | | | - Bruna Leal de Freitas
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Israelite Hospital Albert Einstein, São Paulo, Brazil
| | | | - Suzanna Watson
- The Cambridge Centre for Paediatric Neurorehabilitation, Cambridge, UK
| | - James Tonks
- Medical School, University of Exeter, Exeter, UK.,Haven Clinical Psychology Practice, Cornwall, UK
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Schuster-Amft C, Eng K, Suica Z, Thaler I, Signer S, Lehmann I, Schmid L, McCaskey MA, Hawkins M, Verra ML, Kiper D. Effect of a four-week virtual reality-based training versus conventional therapy on upper limb motor function after stroke: A multicenter parallel group randomized trial. PLoS One 2018; 13:e0204455. [PMID: 30356229 PMCID: PMC6200191 DOI: 10.1371/journal.pone.0204455] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Virtual reality-based training has found increasing use in neurorehabilitation to improve upper limb training and facilitate motor recovery. OBJECTIVE The aim of this study was to directly compare virtual reality-based training with conventional therapy. METHODS In a multi-center, parallel-group randomized controlled trial, patients at least 6 months after stroke onset were allocated either to an experimental group (virtual reality-based training) or a control group receiving conventional therapy (16x45 minutes within 4 weeks). The virtual reality-based training system replicated patients´ upper limb movements in real-time to manipulate virtual objects. Blinded assessors tested patients twice before, once during, and twice after the intervention up to 2-month follow-up for dexterity (primary outcome: Box and Block Test), bimanual upper limb function (Chedoke-McMaster Arm and Hand Activity Inventory), and subjective perceived changes (Stroke Impact Scale). RESULTS 54 eligible patients (70 screened) participated (15 females, mean age 61.3 years, range 20-81 years, time since stroke 3.0±SD 3 years). 22 patients were allocated to the experimental group and 32 to the control group (3 drop-outs). Patients in the experimental and control group improved: Box and Block Test mean 21.5±SD 16 baseline to mean 24.1±SD 17 follow-up; Chedoke-McMaster Arm and Hand Activity Inventory mean 66.0±SD 21 baseline to mean 70.2±SD 19 follow-up. An intention-to-treat analysis found no between-group differences. CONCLUSIONS Patients in the experimental and control group showed similar effects, with most improvements occurring in the first two weeks and persisting until the end of the two-month follow-up period. The study population had moderate to severely impaired motor function at entry (Box and Block Test mean 21.5±SD 16). Patients, who were less impaired (Box and Block Test range 18 to 72) showed higher improvements in favor of the experimental group. This result could suggest that virtual reality-based training might be more applicable for such patients than for more severely impaired patients. TRIAL REGISTRATION ClinicalTrials.gov NCT01774669.
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Affiliation(s)
- Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute for Rehabilitation and Performance Technology, Bern University of Applied Sciences, Burgdorf, Switzerland
| | - Kynan Eng
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Zorica Suica
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Irene Thaler
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Sandra Signer
- Physiotherapy Department, Buergerspital Solothurn, Solothurn, Switzerland
| | - Isabelle Lehmann
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Ludwig Schmid
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Physiotherapy Department, Zurcher RehaZentrum Lengg, Zurich, Switzerland
| | - Michael A. McCaskey
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute of Human Movement Sciences, ETH Zurich, Zurich, Switzerland
| | - Miura Hawkins
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Martin L. Verra
- Department of Physiotherapy, Insel Group, Bern University Hospital, Berne, Switzerland
| | - Daniel Kiper
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Zurich, Switzerland
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Iamsakul K, Pavlovcik AV, Calderon JI, Sanderson LM. PROJECT HEAVEN: Preoperative Training in Virtual Reality. Surg Neurol Int 2017; 8:59. [PMID: 28540125 PMCID: PMC5421260 DOI: 10.4103/sni.sni_371_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/10/2017] [Indexed: 01/05/2023] Open
Abstract
A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure.
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Affiliation(s)
- Kiratipath Iamsakul
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Alexander V Pavlovcik
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Jesus I Calderon
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
| | - Lance M Sanderson
- Department of Biomedical Engineering, Inventum Bioengineering Technologies, LLC, Chicago, Illinois, USA
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