Abstract
BackgroundAlthough numerous virtual reality applications have been developed for sensorimotor retraining in neurologically impaired individuals, it is unclear whether the virtual environment (VE) changes motor performance, especially in patients with brain injuries. To address this question, the movement characteristics of forward arm reaches during standing were compared in physical and virtual environments, presented at different viewing angles.MethodsFifteen patients with traumatic brain injuries (TBI) and 15 sex- and age-matched healthy individuals performed virtual reaches in a computer-generated courtyard with a flower-topped hedge. The hedge was projected on a flat screen and viewed in 3D format in 1 of 3 angles: 10° above horizon (resembling a real-world viewing angle), 50° above horizon, or 90° above horizon (directly overhead). Participants were instructed to reach with their dominant hand avatar and to touch the farthest flower possible without losing their balance or stepping. Virtual reaches were compared with reaches-to-point to a target in an equivalent physical environment. A set of kinematic parameters was used.ResultsReaches by patients with TBI were characterized by shorter distances, lower peak velocities, and smaller postural displacements than reaches by control individuals. All participants reached ~9% farther in the VE presented at a 50° angle than they did in the physical environment. Arm displacement in the more natural 10° angle VE was reduced by the same 9-10% compared to physical reaches. Virtual reaches had smaller velocity peaks and took longer than physical reaches.ConclusionThe results suggest that visual perception in the VE differs from real-world perception and the performance of functional tasks (e.g., reaching while standing) can be changed in TBI patients, depending on the viewing angle. Accordingly, the viewing angle is a critical parameter that should be adjusted carefully to achieve maximal therapeutic effect during practice in the VE.
Highlights
Virtual reality (VR)-based games and environments are recognized as an effective therapeutic approach in rehabilitation of individuals with acquired brain and spinal cord injuries
Reaches were done in the virtual environment (VE) and in the physical environment (PE) before and after virtual reaches
The VE reaches took longer and were characterized by multiple velocity peaks compared to PE reaches, which were performed faster and had a bell-shaped velocity profile with a single velocity peak
Summary
Virtual reality (VR)-based games and environments are recognized as an effective therapeutic approach in rehabilitation of individuals with acquired brain and spinal cord injuries. More than 50% of patients with severe brain injury have some form of visual perceptual deficiency [14,15], caused by impairment of visual discrimination, visual memory, visual spatial relations, or visual motor integration [16] These comorbidities complicate the implementation of VR technology in the rehabilitation of patients with TBI. Numerous virtual reality applications have been developed for sensorimotor retraining in neurologically impaired individuals, it is unclear whether the virtual environment (VE) changes motor performance, especially in patients with brain injuries To address this question, the movement characteristics of forward arm reaches during standing were compared in physical and virtual environments, presented at different viewing angles
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