Abstract

Post-stroke neurorehabilitation based on virtual therapies are performed completing repetitive exercises shown in visual electronic devices, whose content represents imaginary or daily life tasks. Currently, there are two ways of visualization of these task. 3D virtual environments are used to get a three dimensional space that represents the real world with a high level of detail, whose realism is determinated by the resolucion and fidelity of the objects of the task. Furthermore, 2D virtual environments are used to represent the tasks with a low degree of realism using techniques of bidimensional graphics. However, the type of visualization can influence the quality of perception of the task, affecting the patient's sensorimotor performance. The purpose of this paper was to evaluate if there were differences in patterns of kinematic movements when post-stroke patients performed a reach task viewing a virtual therapeutic game with two different type of visualization of virtual environment: 2D and 3D. Nine post-stroke patients have participated in the study receiving a virtual therapy assisted by PUPArm rehabilitation robot. Horizontal movements of the upper limb were performed to complete the aim of the tasks, which consist in reaching peripheral or perspective targets depending on the virtual environment shown. Various parameter types such as the maximum speed, reaction time, path length, or initial movement are analyzed from the data acquired objectively by the robotic device to evaluate the influence of the task visualization. At the end of the study, a usability survey was provided to each patient to analysis his/her satisfaction level. For all patients, the movement trajectories were enhanced when they completed the therapy. This fact suggests that patient's motor recovery was increased. Despite of the similarity in majority of the kinematic parameters, differences in reaction time and path length were higher using the 3D task. Regarding the success rates were very similar. In conclusion, the using of 2D environments in virtual therapy may be a more appropriate and comfortable way to perform tasks for upper limb rehabilitation of post-stroke patients, in terms of accuracy in order to effectuate optimal kinematic trajectories.

Highlights

  • Virtual Reality (VR) is a technology platform that allows developing computer generated environments which the subjects can explore and interact with any type of object or events to perform perspectives and motor tasks

  • There are some clinical studies about the development of VR systems to deliver rehabilitation therapies for motor recovery of hand function (Jack et al, 2001) or to improve the performance of activities of daily living in post-stroke patients (Laver et al, 2012; Turolla et al, 2013)

  • The influence of applying 2D or 3D therapeutic games in the performance of upper limb rehabilitation in post-stroke patients has been presented in this study

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Summary

Introduction

Virtual Reality (VR) is a technology platform that allows developing computer generated environments which the subjects can explore and interact with any type of object or events to perform perspectives and motor tasks. The main feature that the VR provides is the possibility of repeating the same task in any moment, modifying factors such as level of complexity, time and intensity of the practice In this way, the virtual therapy may be used to promote motor learning and rehabilitation due to the VR can be adjusted to generate environment, scenario, or activity that allows for the user practice motor skills to improve the experience-dependent neural plasticity (Doyon and Benali, 2005). Repetitive movements guiaded by robotic devices and directed by virtual reality improve the motor control in patients with upper limb injuries (Merians et al, 2006). In Fluet and Deutsch (2013), an overview of virtual reality studies for sensorimotor rehabilitation post-stroke has been performed to evaluate a comparative efficacy between VR and standard of care and/or differences in VR delivery methods, using different categories

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