Virtual Rehabilitation System Research Articles

Characterizing the Sensing Response of Carbon Nanocomposite-Based Wearable Sensors on Elbow Joint Using an End Point Robot and Virtual Reality

Physical therapy is often essential for complete recovery after injury. However, a significant population of patients fail to adhere to prescribed exercise regimens. Lack of motivation and inconsistent in-person visits to physical therapy are major contributing factors to suboptimal exercise adherence, slowing the recovery process. With the advancement of virtual reality (VR), researchers have developed remote virtual rehabilitation systems with sensors such as inertial measurement units. A functional garment with an integrated wearable sensor can also be used for real-time sensory feedback in VR-based therapeutic exercise and offers affordable remote rehabilitation to patients. Sensors integrated into wearable garments offer the potential for a quantitative range of motion measurements during VR rehabilitation. In this research, we developed and validated a carbon nanocomposite-coated knit fabric-based sensor worn on a compression sleeve that can be integrated with upper-extremity virtual rehabilitation systems. The sensor was created by coating a commercially available weft knitted fabric consisting of polyester, nylon, and elastane fibers. A thin carbon nanotube composite coating applied to the fibers makes the fabric electrically conductive and functions as a piezoresistive sensor. The nanocomposite sensor, which is soft to the touch and breathable, demonstrated high sensitivity to stretching deformations, with an average gauge factor of ~35 in the warp direction of the fabric sensor. Multiple tests are performed with a Kinarm end point robot to validate the sensor for repeatable response with a change in elbow joint angle. A task was also created in a VR environment and replicated by the Kinarm. The wearable sensor can measure the change in elbow angle with more than 90% accuracy while performing these tasks, and the sensor shows a proportional resistance change with varying joint angles while performing different exercises. The potential use of wearable sensors in at-home virtual therapy/exercise was demonstrated using a Meta Quest 2 VR system with a virtual exercise program to show the potential for at-home measurements.

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.

A Glove-Based Virtual Hand Rehabilitation System for Patients With Post-Traumatic Hand Injuries.

Recent studies have shown that virtual gamified therapy can be a potential adjunct to conventional orthopedic rehabilitation. However, the off-the-shelf gaming consoles used for virtual rehabilitation pose several practical challenges in deploying them in clinical settings. In this article, we present the design of a portable glove-based virtual hand rehabilitation system (RehabRelive Glove) that can be used at both clinics and homes for physiotherapy. We also evaluate the system's efficacy on patients with post-traumatic hand injuries. Thirty patients were randomly categorized into groups A (virtual rehabilitation) and B (conventional physiotherapy). Both groups received fifteen 25-minute sessions of respective therapy over three weeks. The wrist and finger joints' range of motion (ROM) and grip strength were measured every seven sessions to compare the efficacy. Group A showed about 1.5 times greater improvement in flexion/extension ROM of the wrist compared to Group B. While both groups improved finger ROM and grip strength with time, no significant difference was observed between the groups. The results suggest that the proposed virtual rehabilitation system effectively enables patients with hand injuries to recover ROM faster.

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.

The influence of scaffolding on intrinsic motivation and autonomous adherence to a game-based, unsupervised home rehabilitation program for people with upper extremity hemiparesis due to stroke. A randomized controlled trial.

This parallel, randomized controlled trial examines intrinsic motivation, adherence and motor function improvement demonstrated by two groups of subjects that performed a twelve-week, home-based upper extremity rehabilitation program. Seventeen subjects played games presenting eight to twelve discrete levels of increasing difficulty. Sixteen subjects performed the same activities controlled by success algorithms that modify game difficulty incrementally. 33 persons 20 to 80 years of age, at least six months post stroke with moderate to mild hemiparesis were randomized using a random number generator into the two groups. They were tested using the Action Research Arm Test, Upper Extremity Fugl Meyer Assessment, Stroke Impact Scale and Intrinsic Motivation Inventory pre and post training. Adherence was measured using timestamps generated by the system. Subjects had the Home Virtual Rehabilitation System [1]systems placed in their homes and were taught to perform rehabilitation games using it. Subjects were instructed to train twenty minutes per day but were allowed to train as much as they chose. Subjects trained for twelve weeks without appointments and received intermittent support from study staff. Group outcomes were compared using ANOVA. Correlations between subject demographics and adherence, as well as motor outcome, were evaluated using Pearson Correlation Coefficients. Classification and Regression Tree (CART) models were generated to predict responders using demographics and baseline measures. There were 5 dropouts and no adverse events. The main effect of time was statistically significant for four of the five clinical outcome measures. There were no significant training group by time interactions. Measures of adherence did not differ between groups. 21 subjects from both groups, demonstrated clinically important improvements in UEFMA score of at least 4.25 points. Subjects with pre training UEFMA scores below 53.5 averaged a seven-point UEFMA increase. IMI scores were stable pre to post training. Scaffolding did not have a meaningful impact on adherence or motor function improvement. A sparsely supervised program of game-based treatment in the home was sufficient to elicit meaningful improvements in motor function and activities of daily living. Common factors considered barriers to the utilization of telerehabilitation did not impact adherence or motor outcome. Clinical Trials.gov - NCT03985761, Registered June 14, 2019.

A Convergent Mixed Methods Design to Assess the Use of the Home Virtual Rehabilitation System By Persons with Chronic Stroke.

Purpose: Patients poststroke utilized the Home Virtual Rehabilitation System (HoVRS) to perform home-based, gamified upper extremity rehabilitation over 12 weeks. Outcomes related to adherence and clinical improvement were collected, and semistructured interviews were conducted to assess intrinsic and extrinsic motivators that impacted engagement with the system. Methods: Subjects performed between 299 and 2020 minutes of self-scheduled, sparsely supervised hand rehabilitation activities in their homes. Results: As a group, the subjects demonstrated statistically significant improvements at the structure/function, activity, and activities of daily living levels of function. Qualitative analysis generated seven themes that both positively and negatively influenced each subject's experience with HoVRS, including challenge as a primary intrinsic motivator and pursuing additional therapy and/or a return to higher functional status as a key extrinsic motivator. Subjects' ratings of the system using the Intrinsic Motivation Inventory before and after treatment were uniformly positive, but interview-based feedback was more balanced between positive and negative.

Assessment of Postural Control in Children with Movement Disorders by Means of a New Technological Tool: A Pilot Study.

Considering the variability and heterogeneity of motor impairment in children with Movement Disorders (MDs), the assessment of postural control becomes essential. For its assessment, only a few tools objectively quantify and recognize the difference among children with MDs. In this study, we use the Virtual Reality Rehabilitation System (VRRS) for assessing the postural control in children with MD. Furthermore, 16 children (mean age 10.68 ± 3.62 years, range 4.29-18.22 years) were tested with VRRS by using a stabilometric balance platform. Postural parameters, related to the movements of the Centre of Pressure (COP), were collected and analyzed. Three different MD groups were identified according to the prevalent MD: dystonia, chorea and chorea-dystonia. Statistical analyses tested the differences among MD groups in the VRRS-derived COP variables. The mean distance, root mean square, excursion, velocity and frequency values of the dystonia group showed significant differences (p < 0.05) between the chorea group and the chorea-dystonia group. Technology provides quantitative data to support clinical assessment: in this case, the VRRS detected differences among the MD patterns, identifying specific group features. This tool could be useful also for monitoring the longitudinal trajectories and detecting post-treatment changes.

A narrative review of the use of a cutting-edge virtual reality rehabilitation technology in neurological and neuropsychological rehabilitation.

Virtual reality (VR) interventions have been increasingly used in the rehabilitation of a wide range of neurological and neuropsychological dysfunctions. Findings of previous reviews showed positive and promising effects of VR-based interventions. However, they summarized findings on VR-based intervention carried out through different VR systems and tasks. We carried out a narrative review with the aim of qualitatively synthesising the results of previous studies that used specific VR systems, i.e. the Khymeia -Virtual Reality Rehabilitation System, for treatment purposes. We searched the literature in various databases (i.e. EMBASE, Web of Science, SCOPUS, PubMed and PubMed Central) for studies published until November 23, 2023. 30 studies were selected. The VRRS was used for neuromotor rehabilitation only in 13 studies, for cognitive rehabilitation in 11 studies, and for both neuromotor and cognitive rehabilitation in six studies. The study design was heterogeneous including 15 randomised controlled trials. After discussing each study according to the type of rehabilitation we concluded that the use and efficacy of VRRS rehabilitative intervention for increasing the neurological and neuropsychological functioning of patients are promising but more evidence is needed to make a comparison with conventional treatment. Future studies should also include long-term follow-up as well as cost-effectiveness analysis.

Development and Usability Evaluation of A Virtual Reality-Based Vestibular Rehabilitation System for Balance Enhancement

Development and Usability Evaluation of A Virtual Reality-Based Vestibular Rehabilitation System for Balance Enhancement

Enhancing the Quality of Life of Patients with Multiple Sclerosis: Promising Results on the Role of Cognitive Tele-Rehabilitation Plus Virtual Reality.

(1) Background: Patients with multiple sclerosis often face obstacles accessing traditional rehabilitation programs, primarily due to mobility limitations. Tele-rehabilitation (TR) is seen as a promising solution to overcome these barriers, though its precise influence on patients' quality of life (QoL) has not been thoroughly investigated. Thus, the aim of the present study was to assess the feasibility of a cognitive TR in a sample of Italian patients with MS. (2) Methods: Thirty-six patients diagnosed with MS, attending the Robotic and Behavioral Neurorehabilitation Unit of the IRCCS "Bonino-Pulejo" Neurolesi Center in Messina, Italy, between October 2019 and March 2020 were enrolled in the study. All patients were randomly assigned, using block randomization with a block size of 2 × 2, to two groups: the control group (CG), composed of 16 patients who received traditional cognitive training, and the experimental group (EG), composed of 20 patients who underwent TR training with a VRRS (virtual reality rehabilitation system). Each patient underwent an assessment before (T0) and immediately after (T1) the rehabilitation treatment, using the Quality of Life-54 Multiple Sclerosis (MSQoL-54). (3) Results: Only in the EG, we observed a statistically significant improvement in the QoL related to mental well-being following the paired T-test (MSQoL p-value < 0.001). Notably, no significant differences were found in the CG (MSQoL p-value of 0.67). (4) Conclusions: Our data suggest that TR training combined with VR has the potential to improve the well-being of individuals with MS.

Benefits of Telerehabilitation for Patients With Severe Acquired Brain Injury: Promising Results From a Multicenter Randomized Controlled Trial Using Nonimmersive Virtual Reality.

In neurorehabilitation, the use of innovative technologies offers many opportunities to monitor and improve the health status of patients with severe acquired brain injury (SABI). Telerehabilitation allows for continuity of service through the entire rehabilitation cycle, including assessment, intervention, consultation, and education, affording early reintegration and positively enhancing the quality of life (QoL). The main purpose of this multicenter randomized controlled trial was to test the effectiveness of advanced training provided using a nonimmersive virtual reality rehabilitation system (ie, the VRRS HomeKit device) in improving functional outcomes in patients with SABI. In total, 40 patients with SABI and their 40 caregivers visiting 2 Italian rehabilitation centers were enrolled in the study protocol and randomized into 2 groups. Of the 40 patients, 20 (50%) underwent the experimental training using the VRRS HomeKit (teleneuro-VRRS group), whereas the other 20 (50%) were administered usual territorial rehabilitative treatments (UTRTs; control group). To investigate motor and neuropsychological functioning, patients with SABI were evaluated before (T0) and at the end of (T1) each training session by a multispecialist team through a complete clinical and psychometric battery: the Barthel Index (BI), the Tinetti Scale (TS), the Modified Ashworth Scale (MAS), the Montreal Cognitive Assessment (MoCa), the Frontal Assessment Battery (FAB), the Beck Depression Inventory II (BDI-II), the Short Form Health Survey 36 (SF-36), and the Psychological General Well-Being Index (PGWBI). In addition, the Caregiver Burden Inventory (CBI) was administered to each caregiver to investigate the emotional burden status. The teleneuro-VRRS group achieved a statistically significant improvement in both general and motor outcomes, as well as psychological well-being and QoL, compared to the control group. In particular, the BI (P<.001), FAB (P<.001), and BDI-II (P<.001) were the outcome scales with the best improvement. The burden of caregivers also significantly improved in the teleneuro-VRRS group (CBI; P<.004). Between-group analysis showed statistical differences in the anxiety (effect size [ES]=0.85, P<.02) and self-control (ES=0.40, P<.03) subtests of the PGWBI and in the social role functioning (ES=0.85, P<.02) subtest of the SF-36, confirmed by quite medium and large ESs. Our results suggest that the VRRS is a suitable alternative tool or complementary tool or both to improve motor (level of functional independence) and cognitive (frontal/executive abilities) outcomes, reducing behavioral alterations (anxiety and depression symptoms) in patients with SABI, with a beneficial impact also on the caregivers' burden distress management, mitigating distress and promoting positive aspects of caring. ClinicalTrials.gov NCT03709875; https://classic.clinicaltrials.gov/ct2/show/NCT03709875.

Feasibility and Effectiveness of Speech Intervention Implemented with a Virtual Reality System in Children with Developmental Language Disorders: A Pilot Randomized Control Trial.

Language disorders are characterized by impairments in verbal expression/understanding, including difficulties with one or more language components. The Virtual Reality Rehabilitation System (VRRS) is a bioelectromedical device equipped with exercise sections aimed at improving cognitive and language deficits. It also increases patient motivation and engagement. The aim of our study was to test the feasibility and efficacy of VRRS intervention to improve speech therapy treatment for children with speech disorders. Thirty-two patients were enrolled in this study and randomly assigned to the experimental (EG) or control group (CG). The CG underwent conventional speech therapy, while EG underwent VRRS-implemented speech therapy. Both groups were evaluated before (T0) and after (T1) the intervention using the Language Assessment Test. The results showed improvements in both groups. However, the EG group showed greater improvement in various areas, including comprehension of total words, repetition, naming of body parts, naming of everyday objects, total naming, morphosyntactic accuracy, sentence construction, average length of utterance, and spontaneous word production. This study demonstrated that VRRS can be a valuable tool for implementing effective speech rehabilitation. Further studies are needed, as the use of VRRS is still in its early stages, requiring larger samples sizes and long-term follow-up.

Development of a compensation-aware virtual rehabilitation system for upper extremity rehabilitation in community-dwelling older adults with stroke

BackgroundCompensatory movements are commonly observed in older adults with stroke during upper extremity (UE) motor rehabilitation, which could limit their motor recovery.AimThis study aims to develop a compensation-aware virtual rehabilitation system (VRS) that can detect compensatory movements and improve the outcome of UE rehabilitation in community-dwelling older adults with stroke.MethodsThe VRS development includes three main components: (1) the use of thresholds for determining compensatory movements, (2) the algorithm for processing the kinematic data stream from Kinect to detect compensation in real-time, and (3) the audio-visual feedback to assist older adults with stroke to be aware of the compensation. Two studies were conducted following the VRS development, where Study 1 identified the value of thresholds for determining compensatory movements in two planar motor exercises, and Study 2 provided preliminary validation for the developed VRS by comparing two groups undergoing VR training or conventional training (CT) in a community rehabilitation center.ResultsThe VRS could effectively detect all determined compensatory movements and timely trigger feedback in response to the detected compensatory movements. The VR participants showed significant improvements in Fugl-Meyer Assessment-Upper Extremity (FMA-UE, p = 0.045) and Wolf Motor Function Test (WMFT, p = 0.009). However, the VR and CT groups had no significant differences in outcome measures.ConclusionThe VRS demonstrates the ability to detect compensation and the potential of assisting older adults with stroke to improve motor functions. Suggestions are given for further improvements of the VRS to support the older adult with stroke to reduce compensation.

Can Virtual Reality Cognitive Rehabilitation Improve Executive Functioning and Coping Strategies in Traumatic Brain Injury? A Pilot Study

Executive dysfunction is among the most common and disabling facets of cognitive impairment following traumatic brain injury (TBI), and may include deficits in reasoning, planning, mental flexibility, some aspects of attention and orientation, awareness and behavior. Rehabilitation programs based on cognitive-behavioral approaches to retrain planning and problem-solving and other executive deficits may improve such cognitive dysfunction. The purpose of this study is to investigate the effects of non-immersive virtual reality-based training to improve executive abilities and to reduce anxiety and depression symptoms in patients with TBI. Twenty patients with moderate to severe TBI were enrolled at our Neurorehabilitation Unit and divided to receive either the standard cognitive training or the virtual reality (VR) based cognitive training using the virtual reality rehabilitation system (VRRS-Evo). Each group received the same amount of rehabilitative training, including ROT (Reality Orientation Therapy) and Executive Training (ET), but using a different approach, i.e., a paper and pencil and an advanced approach. All patients were evaluated with a specific psychometric battery before (T0) and after the end (T1) of each program. Comparing pre- and post- treatment scores, in the VR-CT group, we found statistically significant differences in all administered outcome measures for cognitive and executive functioning, i.e., MoCA (p < 0.005), FAB (p < 0.005), TMT-A (p < 0.005), TMT-B (p < 0.005), TMT-BA (p < 0.001), and mood, i.e., HRS-D (p < 0.008). In the Conventional cognitive training (C-CT) group, we found a significant improvement only in MoCA (p < 0.03), FAB (p < 0.02) and in TMT-BA (p < 0.01). Coping strategies also improved, with better results in the VR-CT group. Our results suggest that VR rehabilitation, using the VRRS system, may be a valuable and motivational approach to improve visuo-executive abilities and coping strategies as well as mood in chronic TBI patients.

Laboratory-Based Examination of the Reliability and Validity of Kinematic Measures of Wrist and Finger Function Collected by a Telerehabilitation System in Persons with Chronic Stroke.

We have developed the New Jersey Institute of Technology-Home Virtual Rehabilitation System (NJIT-HoVRS) to facilitate intensive, hand-focused rehabilitation in the home. We developed testing simulations with the goal of providing richer information for clinicians performing remote assessments. This paper presents the results of reliability testing examining differences between in-person and remote testing as well as discriminatory and convergent validity testing of a battery of six kinematic measures collected with NJIT-HoVRS. Two different groups of persons with upper extremity impairments due to chronic stroke participated in two separate experiments. Data Collection: All data collection sessions included six kinematic tests collected with the Leap Motion Controller. Measurements collected include hand opening range, wrist extension range, pronation-supination range, hand opening accuracy, wrist extension accuracy, and pronation-supination accuracy. The system usability was evaluated by therapists performing the reliability study using the System Usability Scale. When comparing the in-laboratory collection and the first remote collection, the intra-class correlation coefficients (ICC) for three of the six measurements were above 0.900 and the other three were between 0.500 and 0.900. Two of the first remote collection/second remote collection ICCs were above 0.900, and the other four were between 0.600 and 0.900. The 95% confidence intervals for these ICC were broad, suggesting that these preliminary analyses need to be confirmed by studies with larger samples. The therapist's SUS scores ranged from 70 to 90. The mean was 83.1 (SD = 6.4), which is consistent with industry adoption. There were statistically significant differences in the kinematic scores when comparing unimpaired and impaired UE for all six measures. Five of six impaired hand kinematic scores and five of six impaired/unimpaired hand difference scores demonstrated correlations between 0.400 and 0.700 with UEFMA scores. Reliability for all measures was acceptable for clinical practice. Discriminant and convergent validity testing suggest that scores on these tests may be meaningful and valid. Further testing in a remote setting is necessary to validate this process.

Virtual Reality Gaming in Rehabilitation after Musculoskeletal Injury—User Experience Pilot Study

The purposes of this study were twofold: (1) to describe a new technological solution for the rehabilitation of musculoskeletal injuries based on virtual reality (VR) gaming, and (2) to analyze the variation in rated perceived exertion (RPE) and heart rate (HR) of the participants when undergoing a rehabilitation session based on different VR games. Thirty-seven participants aged 23.7 ± 7.0 years tested during five customized VR games to provide a complete rehabilitation session after a musculoskeletal injury. The results of the Friedman test indicated a statistically significant difference in RPE scale and HR across the five VR games throughout a complete rehabilitation session (χ2 (4, n = 35) = 75.59; p &lt; 0.001 and χ2 (4, n = 35) = 27.75, p &lt; 0.001, respectively). RPE and HR increased significantly from Game 1 to Game 2 (z = −5.16, p &lt; 0.001), from Game 1 to Game 3 (z = −5.05, p &lt; 0.001), from Game 1 to Game 4 (z = −4.87, p &lt; 0.001), and from Game 1 to Game 5 (z = −3.61, p &lt; 0.001). Moreover, the results showed a high perceived usability of the system, greater intrinsic motivation to perform the rehabilitation exercises, a high level of immersion, and a good experience in the VR gaming environment. Our study stimulates extended intervention programs following-up on this immersive virtual reality rehabilitation system to support soccer players recovering from musculoskeletal injuries.

Technical aspects of virtual augmented reality-based rehabilitation systems for musculoskeletal disorders of the lower limbs: a systematic review

IntroductionMusculoskeletal disorders are one of the most common causes of physical disability. The rehabilitation process after musculoskeletal disorders is long and tedious, and patients are not motivated to follow rehabilitation protocols. Therefore, new systems must be used to increase patient motivation. Virtual reality (VR) and augmented reality (AR) technologies can be used in this regard. In developing such systems, various technologies and methods of movement recognition are used; therefore, this study aims to summarize the technical aspects of using VR/AR in rehabilitation and evaluate and discuss efficient methods of investigating studies using the Statement of Standards for Reporting Implementation Studies (StaRI).MethodsSearch in four scientific databases was done systematically based on PRISMA through online search engines from inception to June 2021. These databases include Medline (PubMed), Scopus, IEEE, and Web of Science. An updated search was also conducted on 17 December 2021. The research used keywords and MeSH terms associated with VR/AR, musculoskeletal disorder, and rehabilitation. Selected articles were evaluated qualitatively using the Standards for Reporting Implementation Studies (StaRI) statement.ResultsA total of 2343 articles were found, and 20 studies were included. We found that 11 (55%) studies used Kinect technology as input tools, and 15 (75%) studies have described the techniques used to analyze human movements, such as dynamic time warping (DTW) and support vector machines (SVM). In 10 (50%) studies, the Unity game engine was used for visualization. In 8 studies (40%), usability was assessed, and high usability was reported. Similarly, the results of the review of studies according to the StaRI checklist showed poor reporting in the title and discussion of the studies.ConclusionsWe found that academic studies did not describe the technical aspects of rehabilitation systems. Therefore, a good description of the technical aspects of the system in such studies should be considered to provide repeatability and generalizability of these systems for investigations by other researchers.

Dynamic Software Architecture Design for Virtual Rehabilitation System for Manual Motor Dexterity

The architectural design is fundamental in the construction process of a virtual rehabilitation system since it allows to understand the components and their interaction, and it is a guide to develop the software. This article proposes a dynamic architecture design that could be used independently of software and hardware in a virtual rehabilitation system for motor dexterity. This proposal contributes to the software engineering area since it provides a starting point for the development of virtual rehabilitation systems. The system implementation was done with two tracking devices (hardware) and two rehabilitation games (software). It was validated with the User Experience Questionnaire (UEQ). Results show that the use of a dynamic architecture allowed to use different devices efficiently and quickly, regardless of the game, preventing the user from feeling a change or difficulty in carrying out the tasks.

Development of immersive virtual reality-based hand rehabilitation system using a gesture-controlled rhythm game with vibrotactile feedback: an fNIRS pilot study.

Recently, virtual reality (VR) has been widely utilized with rehabilitation to promote user engagement, which has been shown to induce brain plasticity. In this study, we developed a VR-based hand rehabilitation system consisting of a personalized gesture-controlled rhythm game with vibrotactile feedback and investigated the cortical activation pattern induced by our system using functional near-infrared spectroscopy (fNIRS). Our system provides vibrotactile feedback as the user matches their hand gestures to VR targets customized to their pre-recorded hand gestures. Cortical activation was measured via fNIRS during 420 seconds of alternating gameplay and rest in 11 healthy subjects and one stroke survivor. Regions of interest (ROI) were the prefrontal cortex (PFC), the premotor cortex & the supplementary motor area (PMC&SMA), the primary sensorimotor cortex (SM1), and the somatosensory association cortex (SAC). The mean success rate of gesture matching among healthy subjects was 90 % with a standard deviation of 10.7 %, and the success rate of the stroke survivor was 79.6 %. The averaged cortical activation map for the 11 healthy subjects and the individual cortical activation map for the single stroke survivor showed increased hemodynamic responses of oxygenated hemoglobin (HbO) during the VR-based hand rehabilitation compared to the resting condition. Paired t-test analysis demonstrated a significant increase in HbO activation values in 19 out of 51 channels, corresponding to all ROIs except the left PFC and PMC&SMA, which exhibited high subject variability. The experimental results indicate that the proposed system successfully activated brain areas related to motor planning/execution, multisensory integration, and attention.