Abstract
BackgroundStroke is a frequent cause of adult disability that can lead to enduring impairments. However, given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Currently it is not clear how this reorganization can be mobilized. Novel technology based neurorehabilitation techniques hold promise to address this issue. Here we describe a Virtual Reality (VR) based system, the Rehabilitation Gaming System (RGS) that is based on a number of hypotheses on the neuronal mechanisms underlying recovery, the structure of training and the role of individualization. We investigate the psychometrics of the RGS in stroke patients and healthy controls.MethodsWe describe the key components of the RGS and the psychometrics of one rehabilitation scenario called Spheroids. We performed trials with 21 acute/subacute stroke patients and 20 healthy controls to study the effect of the training parameters on task performance. This allowed us to develop a Personalized Training Module (PTM) for online adjustment of task difficulty. In addition, we studied task transfer between physical and virtual environments. Finally, we assessed the usability and acceptance of the RGS as a rehabilitation tool.ResultsWe show that the PTM implemented in RGS allows us to effectively adjust the difficulty and the parameters of the task to the user by capturing specific features of the movements of the arms. The results reported here also show a consistent transfer of movement kinematics between physical and virtual tasks. Moreover, our usability assessment shows that the RGS is highly accepted by stroke patients as a rehabilitation tool.ConclusionsWe introduce a novel VR based paradigm for neurorehabilitation, RGS, which combines specific rehabilitative principles with a psychometric evaluation to provide a personalized and automated training. Our results show that the RGS effectively adjusts to the individual features of the user, allowing for an unsupervised deployment of individualized rehabilitation protocols.
Highlights
Stroke is a frequent cause of adult disability that can lead to enduring impairments
To address and investigate these aspects we have developed the Rehabilitation Gaming System (RGS), a Virtual Reality (VR) based neurorehabilitation paradigm for the treatment of motor deficits resulting from lesions to the central nervous system that exploits the cognitive processes that mediate between perception and action [20,21]
We first evaluated the basic properties of the RGS by a psychometric assessment of the performance of stroke patients and control subjects, leading to the development of the RGS’ Personalized Training Module (PTM)
Summary
Stroke is a frequent cause of adult disability that can lead to enduring impairments. Given the life-long plasticity of the brain one could assume that recovery could be facilitated by the harnessing of mechanisms underlying neuronal reorganization. Stroke is one of the main causes of adult disability [1] and of burden of disease in high- and middle-income countries with about 16 million first event stroke incidents per year [2,3,4] Both the economical and the psycho-social impact of stroke emphasize that we need to find effective diagnostics, treatment and rehabilitation approaches. Several methods and therapy concepts have been proposed and many of them aim at promoting functional changes within surviving motor networks [8,9,10,11,12,13,14,15] It is not always clear how effective these different approaches are and how they exactly influence recovery
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