Virtual Reality Rehabilitation Research Articles

VR rehabilitation system evaluator: A fNIRS-based and LLM-enabled evaluation paradigm for Mild Cognitive Impairment

Virtual Reality (VR) has significant potential for Mild Cognitive Impairment (MCI) rehabilitation by offering dynamic and engaging tasks designed to stimulate various cognitive domains. However, how efficiently evaluating the VR tasks is always challenging. The current effectiveness evaluation methods for task evaluation and optimisation typically rely on post-training metrics like game performance or subjective questionnaires, which cannot directly reflect the comprehensiveness and intensity of cognitive stimulation. To bridge these gaps, we propose a novel approach integrating functional near-infrared spectroscopy (fNIRS) data and a Large Language Model (LLM) for VR rehabilitation task evaluation and optimisation. Firstly, we leverage fundamental cognitive theories to propose a systematic evaluation paradigm for assessing the scope of the cognitive domains stimulated by VR tasks. Secondly, we propose fNIRS-derived graph parameters to objectively evaluate the cognitive stimulation with high-time resolution. Finally, we develop a prompt-generating strategy to facilitate Large Language Model (LLM)-based analysis, which transforms fNIRS-derived metrics combined with the scope of stimulated cognitive domains into easy-to-understand evaluation reports and actionable recommendations for task optimisation. We demonstrate this approach with two VR rehabilitation tasks. Several experts evaluated the LLM-based task evaluation results and task optimisation recommendation and agreed that the LLM-generated results are meaningful and applicable. This approach offers a rapid, objective method to evaluate VR task effectiveness and improves their design, marking a significant step in developing more effective MCI interventions.

The Effectiveness of Virtual Reality in Rehabilitation of Athletes: A Systematic Review and Meta-Analysis

The Effectiveness of Virtual Reality in Rehabilitation of Athletes: A Systematic Review and Meta-Analysis

Personalized rehabilitation approach for reaching movement using reinforcement learning

Musculoskeletal disorders challenge significantly the performance of many daily life activities, thus impacting the quality of life. The efficiency of the traditional physical therapy programs is limited by ecological parameters such as intervention duration and frequency, number of caregivers, geographic accessibility, as well as by subjective factors such as patient’s motivation and perseverance in training. The implementation of VR rehabilitation systems may address these limitations, but the technology still needs to be improved and clinically validated. Furthermore, current applications generally lack flexibility and personalization. A VR rehabilitation game simulation is developed, which focuses on the upper-limb movement of reaching, an essential movement involved in numerous daily life activities. Its novelty consists in the integration of a machine learning algorithm, enabling highly adaptive and patient-customized therapeutic intervention. An immersive VR system for the rehabilitation of reaching movement using a bubble popping game is proposed. In the virtual space, the patient is presented with bubbles appearing at different locations and is asked to reach the bubble with the injured limb and pop it. The implementation of a Q-learning algorithm enables the game to adjust the location of the next bubble according to the performance of the patient, represented by his kinematic characteristics. Two test cases simulate the performance of the patient during a training program of 10 days/sessions, in order to validate the effectiveness of the algorithm, demonstrated by the spatial and temporal distribution of the bubbles in each evolving scenario. The results show that the algorithm learns the patient’s capabilities and successfully adapts to them, following the reward policy dictated by the therapist; moreover, the algorithm is highly responsive to kinematic features’ variation, while demanding a reasonable number of iterations. A novel approach for upper limb rehabilitation is presented, making use of immersive VR and reinforcement learning. The simulation suggests that the algorithm offers adaptive capabilities and high flexibility, needed in the comprehensive personalization of a rehabilitation process. Future work will demonstrate the concept in clinical trials.

TABLET TOSCANA to Develop Innovative Organizational Models for Tele-Rehabilitation in Subjects with Congenital and Acquired Developmental Disabilities: A Wait-List Control Group Trial Protocol.

Background/Objectives: In recent years, the advent of new technologies has fostered their application in neuro-psychomotor and language rehabilitation, particularly since the COVID-19 pandemic. Tele-rehabilitation has emerged as an innovative and timely solution, enabling personalized interventions monitored by clinicians. TABLET TOSCANA project aims to develop innovative tele-rehabilitation organizational models in children, adolescents and young adults with congenital and acquired developmental disabilities, using the Virtual Reality Rehabilitation System (VRRS) Home Kit and the MedicoAmico APP. Methods: The trial is designed according to the CONSORT statement guidelines. The project encompasses three phases: adapting the technologies for pediatric use, validating them through a wait-list study, and analyzing feasibility and effectiveness data to define new organizational models. A randomized wait-list-control study with 100 subjects aged 6 to 30 years will compare tele-rehabilitation versus prosecution of standard care. Discussion: Although literature highlights tele-rehabilitation benefits such as improved access, cost savings, and enhanced treatment adherence, practical implementation remains limited (i.e., the definition of standardized procedures). TABLET TOSCANA project seeks to address these gaps by focusing on multi-domain treatments for neurodevelopmental disabilities and emphasizing the integration of tele-rehabilitation into local health services. Conclusion: The project aims to improve the continuity and intensity of care through innovative models that integrate tele-rehabilitation into local health services. The results could inform healthcare policies and promote the development of innovative and collaborative models of care, paving the way for more effective and widespread tele-rehabilitation solutions and fostering collaborative networks among professionals.

Geodesic restricted aruco-based positioning for VR rehabilitation robotics

Geodesic restricted aruco-based positioning for VR rehabilitation robotics

Cognitive Outcomes following Virtual Reality Rehabilitation in Patient with Traumatic Brain Injury: A Prospective Randomized Comparative Study

Cognitive Outcomes following Virtual Reality Rehabilitation in Patient with Traumatic Brain Injury: A Prospective Randomized Comparative Study

Effectiveness of the Use of Virtual Reality Rehabilitation in Children with Dyslexia: Follow-Up after One Year.

Dyslexia is a common learning disorder that hinders reading fluency and comprehension. Traditional treatments can be tedious for children, limiting their effectiveness. This study investigated the one-year effects of rehabilitation treatment with a virtual reality rehabilitation system (VRRS) on children with dyslexia. Twenty-four children were divided into control (CG) and experimental (EG) groups. The CG underwent conventional neuropsychological treatment (CNT), while the EG underwent VR neurorehabilitation training (VRNT) using the VRRS. Neuropsychological evaluation was conducted before treatment, after six months, and again after one year for both groups. Compared to the control group, children who received VR training showed significant improvement in reading skills, especially in non-word reading and reading speed, even after one year without further VR intervention. VRRS can improve treatment adherence and minimize symptoms by offering engaging activities for children. These findings suggest VRRS may be a valuable tool for dyslexia rehabilitation with long-lasting effects.

Long-lasting improvements in episodic memory among subjects with mild cognitive impairment who received transcranial direct current stimulation combined with cognitive treatment and telerehabilitation: a multicentre, randomized, active-controlled study.

In recent years, an increasing number of studies have examined the potential efficacy of cognitive training procedures in individuals with normal ageing and mild cognitive impairment (MCI). The aims of this study were to (i) evaluate the efficacy of the cognitive Virtual Reality Rehabilitation System (VRRS) combined with anodal transcranial direct current stimulation (tDCS) applied to the left dorsolateral prefrontal cortex compared to placebo tDCS stimulation combined with VRRS and (ii) to determine how to prolong the beneficial effects of the treatment. A total of 109 subjects with MCI were assigned to 1 of 5 study groups in a randomized controlled trial design: (a) face-to-face (FTF) VRRS during anodal tDCS followed by cognitive telerehabilitation (TR) (clinic-atDCS-VRRS+Tele@H-VRRS); (b) FTF VRRS during placebo tDCS followed by TR (clinic-ptDCS-VRRS+Tele@H-VRRS); (c) FTF VRRS followed by cognitive TR (clinic-VRRS+Tele@H-VRRS); (d) FTF VRRS followed by at-home unstructured cognitive stimulation (clinic-VRRS+@H-UCS); and (e) FTF cognitive treatment as usual (clinic-TAU). An improvement in episodic memory was observed after the end of clinic-atDCS-VRRS (p < 0.001). We found no enhancement in episodic memory after clinic-ptDCS-VRRS or after clinic-TAU.Moreover, the combined treatment led to prolonged beneficial effects (clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-ptDCS-VRRS+Tele@H-VRRS: p = 0.047; clinic-atDCS-VRRS+Tele@H-VRRS vs. clinic-VRRS+Tele@H-VRRS: p = 0.06). The present study provides preliminary evidence supporting the use of individualized VRRS combined with anodal tDCS and cognitive telerehabilitation for cognitive rehabilitation. https://clinicaltrials.gov/study/NCT03486704?term=NCT03486704&rank=1, NCT03486704.

Sensory-motor training with virtual reality as a complementary intervention to manual therapy for persistent non-specific neck pain: a randomized controlled trial.

Persistent non-specific neck pain (NP) is a widespread condition described as a complex biopsychosocial disorder, characterized by physical and psychological symptoms. Virtual reality (VR) shows promise in NP treatment, potentially reducing pain, kinesiophobia, and improving range of motion (ROM) and motor control. The primary aim of the study was to assess the effectiveness of VR sensorimotor training, combined with manual therapy, in reducing the level of disability in persistent non-specific NP individuals. The secondary aim was to determine if this VR-enhanced approach also contributes to improvement in overall function, pain perception and kinesiophobia. Monocentric, single-blind, randomized controlled trial. We conducted this trial at San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy. Forty NP participants were enrolled in the study and randomly allocated into two groups. The study involved a 6-week rehabilitation program, comprising 12 sessions of 45 minutes each, twice weekly. Both intervention groups underwent manual therapy as a consistent component of their treatment. The Experimental Group (VRT) was additionally engaged in sensorimotor rehabilitation exercises using Virtual Reality, whereas the Control Group (CT) performed the same exercises without VR. We assessed subjects at baseline (T0) and after six weeks of rehabilitation (T1). The primary outcome was the disability (Neck Disability Index) while the secondary outcomes were: pain perception (Numeric Rating Scale, NP and Disability Scale, Central Sensitization Inventory) function (Cervical Kinematics) and kinesiophobia (Tampa Scale of Kinesiophobia). Both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia. Significant advancements in kinematics were observed: VRT group showed enhanced ROM during craniocervical rotation (P=0.039), lateral bending (P=0.001), flexion-extension (P=0.009), and mean velocity across movements (P<0.001), whereas CT group improved in maximal ROM during lateral bending rotation (P=0.001). Between-group analysis, after Bonferroni's correction for multiple comparisons, revealed that VRT group had significantly better outcomes in ROM during rotation (P=0.040), ratio of the primary over the secondary movement while performing rotation (P=0.021), and mean velocity during lateral bending (P=0.031). Sensorimotor training, combined with manual therapy, could enhance kinematic outcomes for NP patients, supporting the potential of VR in rehabilitation. This study highlighted that both groups demonstrated significant reduction in level of disability, pain perception, and kinesiophobia after sensorimotor training combined with manual therapy. It is important to underscore that in terms of reducing the level of neck disability, both interventions proved to be equally effective. This parity in efficacy is a critical finding, reaffirming the robustness of our therapeutic approaches for this specific outcome.

Interacting with virtual characters, objects and environments: investigating immersive virtual reality in rehabilitation

Purpose This pilot study aimed to (a) investigate opportunities for immersive Virtual Reality (VR) technology in communication, physical, and visual rehabilitation by examining the interaction of people without disabilities in a range of structured virtual environments; and (b) validate research protocols that might be used to evaluate the physical, visual, and verbal interaction of users in virtual worlds, and their safety while using the technology. Methods Thirteen adults identifying as people without disability were exposed to VR via a head-mounted display. A video-review method was used to qualitatively code and analyse each participant’s communication, movement, orientation, and support needs. Results All participants oriented to their virtual environments sufficiently to use applications. Their spoken language was effective for interaction, although unconventional social behaviours were also observed. Two participants reported minor adverse reactions consistent with mild cybersickness. Conclusion The results provide insight into the types of environments and characters that support the greatest communicative, physical, and visual interaction in immersive VR. The tested protocols are useful to assess safety when using VR, and to observe communicative, physical, and visual interaction with virtual environments and characters. Implications for future research and use of VR with people with communication, physical and visual disability are discussed.

Updated research trend and clustering algorithm on virtual reality and pulmonary rehabilitation: Scopus-based bibliometric and visual analysis

Background: Virtual reality (VR) is a new innovative technology that can enhance intervention and should promote the effectiveness of rehabilitation, but there is a lack of scientific evidence on the clustering and topic research trend, especially on VR and pulmonary rehabilitation (PR). More evidence about network clusters and trends will encourage the research in the future. Objective: This study aimed to explore, identify, cluster, and forecast analysis for the research trend of VR and PR from the research articles on the SCOPUS database. Materials and methods: In this study, the search terms “virtual reality” AND “pulmonary rehabilitation” were extracted from specific English research articles published on the SCOPUS database between 2013-2023. RStudio software was used to perform bibliometric and visual analysis. During the analysis in the bibliometric tool, the normalization process with Salton’s Cosine and network clustering via trend topic with the Walktrap algorithm was analyzed before specific visualization with the network clustering mapping, Treemap, and trend topic line by KamadaKawai layout algorithm. Results: From the 1,396 articles on “VR” published between 2010 and 2023, there were 13 research articles on “VR AND PR” published between 2013 and 2023. The bibliometric result from 13 articles showed total of 36 subdisciplines correlated networks among virtual reality (20, 7%), male (16, 6%), female (15, 5%), aged (12, 4%), chronic obstructive lung disease (12, 4%), exercise (11, 4%), human (10, 4%), humans (10, 4%), middle-aged (10, 4%), quality of life (10, 4%), article (9, 3%), pulmonary rehabilitation (9, 3%), controlled study (8, 3%), adult (6, 2%), chronic obstructive (6, 2%), clinical article (6, 2%), forced expiratory volume (6, 2%), pulmonary disease (6, 2%), randomized controlled trial (6, 2%), and forced vital capacity (5, 2%), etc., respectively. Three network clusters were reported after the normalization process and clustering evaluation by factorial analysis. The first cluster was composed of virtual reality, male, female, aged, chronic obstructive lung disease, exercise, human, humans, middle-aged, quality of life, article, pulmonary rehabilitation, controlled study, adult, chronic obstructive, clinical article, forced expiratory volume, randomized controlled trial, forced vital capacity, six-minute walk test, depression, technology, telerehabilitation, breathing exercise, Covid-19, dyspnea, functional status, hospital patient, and physical activity, respectively. The second cluster consisted of procedure and exercise therapy, and the last cluster consisted of exercise tolerance, lung, treatment outcome, health program, and convalescence. Finally, trend research topics were presented in virtual reality, male, female, aged, chronic obstructive lung disease, human, exercise, quality of life, and middle-aged, respectively, in 2023. Conclusion: Therefore, the contribution from data analysis in this article can identify the clustering and trend topics of VR, chronic obstructive lung disease, aging participants, exercise, and quality of life in future research.

Views of Specialist Clinicians and People With Multiple Sclerosis on Upper Limb Impairment and the Potential Role of Virtual Reality in the Rehabilitation of the Upper Limb in Multiple Sclerosis: Focus Group Study.

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Using virtual reality (VR) could be a solution to this challenge; however, there is a lack of reporting on the views of people with MS and clinicians on VR-based approaches and recommendations for games for rehabilitation. This study aims to identify common UL problems and their related current therapeutic approaches for people with MS, and to explore the opinions of people with MS and specialist clinicians on VR and obtain suggestions for the development and design of VR games. Separate focus groups were conducted with people with MS, recruited through the MS Society UK's research network, and clinicians, recruited through the MS Trust Therapists in MS network. A total of 10 people with MS (2 focus groups) and 8 clinicians (5 physiotherapists, 2 occupational therapists, and 1 MS nurse in 2 focus groups) were involved. The focus groups were recorded and transcriptions were analyzed using theme-based content analysis. People with MS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many people with MS neglected UL exercise and found strategies for adapting to the UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a solution, as it was convenient for people with MS to access and it could provide a more engaging and disguised approach to exercise. There were shared concerns with cybersickness and disengagement with using VR approaches. Both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and people with MS suggesting more abstract activities. VR was well received by both people with MS and clinicians for UL rehabilitation. Recommendations were made for the development of VR rehabilitation games which are personalized and customizable for the varying abilities of people with MS.

Study of the Possibility of Using Virtual Reality Application in Rehabilitation among Elderly Post-Stroke Patients.

Thanks to medical advances, life expectancy is increasing. With it comes an increased incidence of diseases, of which age is a risk factor. Stroke is among these diseases, and is one of the causes of long-term disability. The opportunity to treat these patients is via rehabilitation. A promising new technology that can enhance rehabilitation is virtual reality (VR). However, this technology is not widely used by elderly patients, and, moreover, the elderly often do not use modern technology at all. It therefore becomes a legitimate question whether elderly people will be able to use virtual reality in rehabilitation. This article presents a rehabilitation application dedicated to patients with upper limb paresis and unilateral spatial neglect (USN). The application was tested on a group of 60 individuals including 30 post-stroke patients with an average age of 72.83 years. The results of the conducted study include a self-assessment by the patients, the physiotherapist's evaluation, as well as the patients' performance of the exercise in VR. The study showed that elderly post-stroke patients are able to use virtual reality applications, but the ability to correctly and fully perform an exercise in VR depends on several factors. One of them is the ability to make logical contact (p = 0.0001 < 0.05). However, the study presented here shows that the ability to use VR applications does not depend on age but on mental and physical condition, which gives hope that virtual reality applications can be used in post-stroke rehabilitation among patients of all ages.

Effects of Virtual Reality Therapy Combined With Conventional Rehabilitation on Pain, Kinematic Function, and Disability in Patients With Chronic Neck Pain: Randomized Controlled Trial.

Neck pain is a common condition that leads to neck motor dysfunction and subsequent disability, with a significant global health care burden. As a newly emerging tool, virtual reality (VR) technology has been employed to address pain and reduce disability among patients with neck pain. However, there is still a lack of high-quality studies evaluating the efficacy of VR therapy combined with conventional rehabilitation for patients with chronic neck pain, particularly in terms of kinematic function. This study aims to investigate the effect of VR therapy combined with conventional rehabilitation on pain, kinematic function, and disability in patients with chronic neck pain. We conducted an assessor-blinded, allocation-concealed randomized controlled trial. Sixty-four participants experiencing chronic neck pain were randomly allocated into the experimental group that underwent VR rehabilitation plus conventional rehabilitation or the control group receiving the same amount of conventional rehabilitation alone for 10 sessions over 4 weeks. Pain intensity, disability, kinematic function (cervical range of motion, proprioception, and mean and peak velocity), degree of satisfaction, and relief of symptoms were evaluated at 3 timepoints (baseline, postintervention, and at 3 months follow-up). A 2*3 mixed repeated measures analysis of variance was utilized for analyzing the difference across indicators, with a significant difference level of .05. Both groups demonstrated significant improvements in pain, disability, and kinematic functions (P<.05) at postintervention and at 3-month follow-up. The experimental group showed superior therapeutic outcomes compared to the control group in pain reduction (mean difference from the baseline: 5.50 vs 1.81 at posttreatment; 5.21 vs 1.91 at the 3-month follow-up, respectively; P<.001), disability improvement (mean difference from baseline: 3.04 vs 0.50 at posttreatment; 3.20 vs 0.85 at the 3-month follow-up, respectively; P<.001), and enhanced kinematic functions (P<.05). Moreover, participants in the experimental group reported better satisfaction and relief of symptoms than the control group (P<.05), with better initiative for exercising during the follow-up period. However, there was no between-group difference of improvement in proprioception. No adverse events were reported or observed in our research. The findings of our study support the efficacy of combining VR therapy with conventional rehabilitation in alleviating pain, enhancing kinematic function, and reducing disability of patients with chronic neck pain. Future research should focus on refining the therapeutic protocols and dosages for VR therapy as well as on optimizing its application in clinical settings for improved convenience and effectiveness. Chinese Clinical Trial Registry ChiCTR2000040132; http://www.chictr.org.cn/showproj.aspx?proj=64346.

The Application of Virtual Reality in Shoulder Surgery Rehabilitation.

To achieve a positive functional prognosis in orthopedic surgery, particularly in shoulder surgeries, effective rehabilitation is essential. Recently, there has been growing interest in the use of virtual reality (VR) in the field of orthopedics, particularly for preoperative education and training, as well as clinical and home-based rehabilitation. This report describes the process of developing an application utilizing Meta Quest 2 VR technology (Meta, CA, USA) for rehabilitation after shoulder surgery. This application assists patients in performing postoperative exercises at home by wearing VR equipment tailored to their postoperative weeks. The advantages of VR rehabilitation lie in overcoming the limitations of traditional rehabilitation methods and providing patients with a better rehabilitation experience. Moreover, automating the rehabilitation process and reducing patients' visits to clinics can lead to cost savings. This report raises expectations for the potential and scalability of VR utilization, extending beyond orthopedics to other fields. In addition, it anticipates that with better feedback and motivation, the rehabilitation effects for patients can be further enhanced.

Evaluating the Accuracy of a Novel Motion Tracking Sensor Technology as part of a Full-Body Immersive VR Rehabilitation System

Evaluating the Accuracy of a Novel Motion Tracking Sensor Technology as part of a Full-Body Immersive VR Rehabilitation System

Non-immersive virtual reality based treatment for children with unilateral cerebral palsy: Preliminary results.

Unilateral cerebral palsy (UCP) represents about 30-40% of overall cerebral palsy diagnoses. Upper limb impairment has a significant negative impact on activities of daily living (ADL), and recent studies have shown that the use of virtual reality (VR) can increase motivation and promote an improvement in ADL. This preliminary study was aimed at exploring the acceptability and usability of a VR rehabilitation treatment, using the VITAMIN Platform, for children with UCP. A secondary goal of the study was to compare the results of usual standardized clinical scales and questionnaires with kinematic results as well as with the quantitative measures acquired by the VITAMIN platform in each exercise of the rehabilitation sessions. Six children with UCP (aged 7-15) were recruited for a preliminary investigation in using a non-immersive VR system. The treatment was composed of 10 weekly sessions of 45 minutes. Each child played five types of exergames, using the impaired upper limb to hit virtual objects projected on a wide screen. Standardized clinical scales, kinematic analysis, and questionnaires were used to extensively assess upper limb function before and at the end of treatment. Five typically-developing children provided a reference for the instrumented kinematic assessment. At the end of the treatment, Melbourne Assessment 2 (MA2) scores increased for all the participants (mean increase in range of movement (ROM) + 19.1%, accuracy + 4.6%, dexterity + 13.1%, fluency + 10.3%). Shoulder flexion-extension ROM also improved (mean increase + 10.5°), and according to the kinematic analysis, shoulder movements became more similar to reference profiles. These results were confirmed by a general improvement in performing ADL, assessed by the ABILHAND-Kids questionnaire. Finally, a general agreement among the different measures and indexes emerged from the acquired data. The results show that VR treatment with the VITAMIN platform could be engaging and functional for rehabilitation of children with UCP. The good agreement among the qualitative and quantitative measures and indexes confirms the potential of such novel treatment. However, due to the limited sample size and small number of sessions, further and larger investigations are required to evaluate the effectiveness and to generalize the results.

O216: RECOVER REALITY - Recover after injury or surgery to the brain and spine with virtual Reality: Feasibility Trial Results and Effectiveness Trial Protocol

Abstract Aim Neurorehabilitation is fundamental to improve outcomes for patients recovering from injury or surgery to the central nervous system. Access to neurorehabilitation is limited by resource shortages, the consequences of which are unfulfilled therapy needs, longer hospital stays and detrimental effects on quality of life. Virtual reality (VR) could be used to augment neurorehabilitation in a self-directed, safe, virtual environment. The aim of this study is to investigate the feasibility of a VR rehabilitation programme in an acute neurosurgical inpatient environment to improve neurorehabilitation. Method A single group, feasibility study was conducted in a tertiary UK neurosurgical department. Patients aged 16 and over who had undergone a neurosurgical intervention for brain tumours were eligible. Participants were offered a VR session at least once per day for the first 14 days post-surgery/injury or until discharge, whichever comes first, with reasons for non-engagement collected. Primary outcomes were feasibility outcomes, and secondary outcomes included rehabilitation engagement and length of stay. Results Thirty-five participants were recruited. One withdrew due to headaches. None of the VR applications failed but connectivity to accompanying tablet was latent in 50% of cases. Majority of patients were able to use VR from day 2 post-op or injury. The Hopkins Rehabilitation Engagement scale and Simulation Sickness Questionnaires were feasible instruments to measure outcomes. Conclusions Feasibility was confirmed in this study. A multi-centre, prospective, randomised, controlled, unblinded, parallel-group trial of virtual reality enhanced neurorehabilitation versus standard neurorehabilitation for improving recovery after neurotrauma or neurosurgery has now been designed.

Impact of Virtual Rehabilitation in Adjunct to Conventional Physical Therapy on Proximal Humerus Fracture: A Randomized Controlled Trial.

Introduction Humerusfractures are fairly prevalent in the general population, and their incidence increases with age. The majority of minimally displaced fractures may be treated with prompt rehabilitation. An interdisciplinary team strategy involving experienced musculoskeletal specialists, geriatricians, and skilled physiotherapists should be employed for optimal therapy. Rehabilitation is essential in coping with the consequences of the fracture. The greatest current information for shoulder rehabilitation comprises the use of counseling, exercises, and mobility of restricted joints to regain upperlimbfunction. Virtual reality (VR) based therapies are among the most effective since they may give visual, aural, and somatosensory cues to help patients. In fact, VR-based treatments have been shown to enhance motor function, neuropathic pain, balance, and aerobic performance in individuals with neurological disorders. However, there is limited evidence on the use of VR's therapeutic efficacy on individuals with musculoskeletal disorders. This study applied oculus-guided VR rehabilitation in addition to conventional physical therapy for the rehabilitation of patients with proximal humerus fractures. This study aims to assess the impact of virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture. Methods This study is a randomized controlled trial in which 50 patients were divided randomly into two groups: 25 patients in group A and 25 patients in group B. Group A was an experimental group that received VR plus conventional therapy. At the same time, group B was a control group that received only conventional therapy. Shoulder range of motion (ROM), manual muscle testing (MMT), numerical pain rating scale (NPRS), disabilities of arm, shoulder, and hand (DASH), and Shoulder pain and disability index (SPADI) were used as outcome measures of this study. Results There is an increase in flexion (t=7.58, P=0.0001), extension (t=6.90, P=0.0001), abduction (t = 9.57, P=0.0001), internal rotation (t=6.31, P=0.0001), and external rotation (t=3.41, P=0.001) in group A is statistically more significant than group B. The improvement in MMT scores in group B (t=1.71, P=0.10) is not significant, whereas improvements in group A are statistically significant (t=13.86, P=0.0001). The SPADI and DASH scores improved more significantly in group A (t=62.46, P=0.0001, and t=57.48, P=0.0001, respectively) than in group B (t=39.14, P=0.0001 and 46.58, P=0.0001, respectively). There is no significant difference in pain outcomes between the two groups. Conclusion The findings of this study reveal that virtual rehabilitation in adjunct to conventional physical therapy on proximal humerus fracture is more effective in improving shoulder ROM, muscle strength, and upper limb function than conventional therapy alone.However, no intervention can be considered superior to others in terms of the management of pain associated with proximal humerus fracture.

Non-photorealistic rendering as a feedback strategy in virtual reality for rehabilitation

Virtual reality (VR) rehabilitation has been proven to be a very promising method to increase the focus and attention of patients by immersing them in a virtual world, and through that, improve the effectiveness of the rehabilitation. One of the biggest challenges in designing VR Rehabilitation exercises is in choosing feedback strategies that guide the patient and give the appropriate success/failure indicators, without breaking their sense of immersion. A new strategy for feedback is proposed, using non-photorealistic rendering (NPR) to highlight important parts of the exercise the patient needs to focus on and fade out parts of the scene that are not relevant. This strategy is implemented into an authoring tool that allows rehabilitators specifying feedback strategies while creating exercise profiles. The NPR feedback can be configured in many ways, using different NPR schemes for different layers of the exercise environment such as the background environment, the non-interactive exercise objects, and the interactive exercise objects. The main features of the system including the support for universal render pipeline, camera stacking, and stereoscopic rendering are evaluated in a testing scenario. Performance tests regarding memory usage and supported frames per second are also considered. In addition, a group of rehabilitators evaluated the system usability. The proposed system meets all the requirements to apply NPR effect in VR scenarios and solves all the limitations with regard to technical function and image quality. In addition, the system performance has been shown to meet the targets for low-cost hardware. Regarding authoring tool usability rehabilitators agree that is easy to use and a valuable tool for rehabilitation scenarios. NPR schemes can be integrated into VR rehabilitation scenarios achieving the same image quality as non-VR visualizations with only a small impact on the frame rate. NPR schemes are a good visual feedback alternative.