Effects of home-based virtual reality telerehabilitation system in people with multiple sclerosis: A randomized controlled trial

Background and objective Multiple sclerosis is an inflammatory and neurodegenerative disorder of the central nervous system that can lead to severe motor disability. The aim of this study was to verify the health care effects of an integrated telerehabilitation approach involving dual-domains (motor and cognitive) in people with multiple sclerosis using a virtual reality rehabilitation system compared to a home-based conventional rehabilitative intervention usual care for patient-relevant outcomes (motor, cognitive and participation). Methods This multicentre interventional, randomized controlled trial included 70 participants with multiple sclerosis, 35 in the telerehabilitation group (30 sessions of home-based virtual reality rehabilitation system training, five sessions for week each lasting 45 min) and 35 in the usual care group (30 sessions of conventional treatment, five sessions for week). Participants completed the assessment of motor, cognitive and participation outcomes at baseline and after 6 weeks of treatment. Results In total, 63.3% of the telerehabilitation group exhibited improvement in the physical domain of the quality of life ( p = 0.045). The telerehabilitation group showed greater improvement than the usual care group in Mini-BESTest domains of balance ( p = 0.014), postural control ( p = 0.024), and dynamic walking ( p = 0.020) at post-treatment. Higher adherence was registered for telerehabilitation compared with usual care (86.67% vs . 80.0%). Discussion This study provides evidence that people with multiple sclerosis can benefit from telerehabilitation treatment in the physical domain of the quality of life and motor symptoms. Moreover, considering the persistent COVID-19 emergency, telerehabilitation can represent an effective telemedicine solution for safely delivering effective rehabilitation care to people with multiple sclerosis. Trial registration number and trial register This trial was registered at ClinicalTrials.gov (NCT03444454).

A novel upper-limb tracking system in a virtual environment for stroke rehabilitation

Background The transfer of the behaviors of a human’s upper limbs to an avatar is widely used in the field of virtual reality rehabilitation. To perform the transfer, movement tracking technology is required. Traditionally, wearable tracking devices are used for tracking; however, these devices are expensive and cumbersome. Recently, non-wearable upper-limb tracking solutions have been proposed, which are less expensive and more comfortable. However, most products cannot track the upper limbs, including the arms and all the fingers at the same time, which limits the limb parts for tracking in a virtual environment and may lead to a limited rehabilitation effect. Methods In this paper, a novel virtual reality rehabilitation system (VRRS) was developed for upper-limb rehabilitation. The VRRS could track the motion of both upper limbs, integrate fine finger motion and the range of motion of the entire arm and map the motion to an avatar. To test the performance of VRRS, two experiments were designed. In the first experiment, we investigated the effect of VRRS on virtual body ownership, agency and location of the body and usability in 8 healthy participants by comparing it with a partial upper-limb tracking method based on a Leap Motion controller (LP) in the same virtual environments. In the second experiment, we examined the feasibility of VRRS in upper-limb rehabilitation with 27 stroke patients. Results VRRS improved the users’ senses of body ownership, agency, and location of the body. The users preferred using the VRRS to using the LP. In addition, we found that although the upper limb motor function of patients from all groups was improved, the difference between the FM scores tested on the first day and the last day of the experimental group was more significant than that of the control groups. Conclusions A VRRS with motion tracking of the upper limbs and avatar control including the arms and all the fingers was developed. It resulted in an improved user experience of embodiment and effectively improved the effects of upper limb rehabilitation in stroke patients. Trial registration The study was registered at the First Affiliated Hospital of Jinan University Identifier: KY-2020–036; Date of registration: June 01, 2020.

Assessment of Task Demand and Usability of a Virtual Reality-Based Rehabilitation Protocol for Combat Related Traumatic Brain Injury From the Perspective of Veterans Affairs Healthcare Providers: A Pilot Study

The risk of traumatic brain injury (TBI) is significantly higher among Veterans compared to non- Veterans. Access to treatment for TBI and post concussive symptoms is sometimes difficult, because of barriers related to distance, finances, and public safety (i.e., COVID-19 infection). Virtual reality rehabilitation (VRR) offers an opportunity to incorporate a virtual space into a rehabilitation environment. To our knowledge, VRR has not been used to assist Veterans with TBI and related health problems with Instrumental Activities of Daily Living (iADLs). The purpose of this study is to investigate the usability of a novel VRR ADL and iADL training protocols, developed by the Gaming Research Integration for Learning Laboratory (GRILL®) at the Air Force Research Laboratory, for cognitive rehabilitation for Veterans with a TBI. We deployed a prototype protocol among healthcare providers (n = 20) to obtain feedback on usability, task demand, and recommended adjustments. Our preliminary analysis shows that providers found the VRR protocol involved low physical demand and would likely recommend it to their patients. Although they had some concerns with vertigo-like symptoms from using a digital technology, they believed the protocol would improve iADL functioning and was a good addition to pre-existing rehabilitation protocols. These outcomes provide justification for more impactful studies investigating the effectiveness of this protocol among Veterans with TBI.

Tele-Rehabilitation for Postural Control by Means of Virtual Reality Rehabilitation System in an Adolescent With Motor Disorder: A Case Study

The coming of an unforeseen and hostile event such as the COVID-19 pandemic has brought about various changes in everyone's daily life. During the lockdown period, a huge number of restrictions were imposed, hence interrupting a wide range of activities previously proven to be necessary for some people. Due to the circumstances, rehabilitation treatments for children with neurodevelopmental disorders have been suspended, resulting in consequent distress for the children themselves and their parents. To overcome this problem, a tele-rehabilitation approach has proven to be an excellent solution to give continuity to children's rehabilitation. The tele-rehabilitation approach allows access to rehabilitation services directly from home. During lockdown due to the COVID-19 pandemic, the Virtual Reality Rehabilitation System (VRRS) HomeKit, developed by Khymeia, was employed as a rehabilitation system for the treatment of posture and balance of an adolescent with disabilities for the first time ever. Specifically, a 17-year-old female patient was enrolled and evaluated by the clinical staff before and after the home-training sessions. The system was delivered to the patient's home so that she could perform the tasks in a familiar environment, while under the supervision of the clinical staff. Through a specific platform, using different modules of the system, therapists could remotely check that the proposed exercises were properly performed and provide feedback and/or increase the difficulty according to the patient's needs and progress. Therefore, the treatment performed was carried out at home in a personalized, intensive, and playful way; characteristics do not present in a traditional treatment. Our results are promising and demonstrate both the efficacy of rehabilitation exercises carried out at home and the feasibility of home-based rehabilitation, when using the VRRS HomeKit even with adolescents. The VRRS HomeKit presents some limitations, such as the need to have the line connection and free space at home, the presence of technical issues, and the education of parents and patients to understand the instructions. Despite the limitations, this study provides the basis for continuing the experience of tele-rehabilitation on patients with a motor disorder also by customizing the exercises to their characteristics.

A Virtual Reality Algorithm for the Study of Clinical Efficacy of Sports Injury Rehabilitation Training

This paper aims to explore the influence of virtual reality technology interactive rehabilitation training system and PT and OT operation therapy on the exercise function, daily life activity ability (ADL), and the quality of life in patients with a sports injury. In this context, this paper mainly designed three experiments to test the virtual rehabilitation system: two action experiments (experiment 1), two experiments with actions in 3 different positions (experiment 2), and five different actions (experiment 3), and the motion intention recognition rate, average total time, and task completion degree of the three experiments were calculated. The virtual scene and hardware equipment were kept stable, and the human-machine interaction effect was good. The effectiveness of the proposed virtual reality rehabilitation training system is demonstrated from other aspects. The results showed that the average completion time of 5 volunteers was 57.72 seconds, with an average offline accuracy of 89.03%. In experiment 2, the five volunteers averaged 54.98 seconds, with an average offline accuracy of 91.73%. The average recognition accuracy of the training system reached 90%, demonstrating the effectiveness of the virtual reality rehabilitation training system in terms of motor intention recognition rate, average total use time, and task completion.