The Effectiveness of Occupation-based Virtual Reality Intervention on Upper Extremity Functional Improvement in Post-stroke Individuals: A Systematic Review

Purpose: Virtual reality (VR)-based therapy is an emerging practice in the clinical setting and still requires research documenting its efficacy. This review analyzed the effectiveness of VR-based therapy on upper extremity (UE) motor recovery in individuals with chronic stroke by analyzing multiple randomized controlled trials. Methods: Search limits for this review consisted of articles published between January 2010 and January 2020 and available in English. Search keywords were based on language in individual databases (e.g. stroke or cerebrovascular accident, upper extremity, occupational therapy). Articles were limited to include only randomized control trials consisting of adult patients (18+) with UE impairment due to chronic stroke (onset at least 3 months prior) and occupation-based virtual reality intervention. Results: 242 articles were screened; eight met the inclusion criteria. Forms of VR within the reviewed articles included traditional gaming systems, mobile-based game devices, and VR combined with real instrument training. These studies showed improved outcomes following VR training such as improvement of UE function, activity participation, and health-related quality of life. Conclusion: The results of this review suggest that VR-based therapy has efficacy equal to or greater than conventional therapy for improving function in the upper extremity of adult patients with chronic stroke. As supported by research, practitioners may incorporate virtual reality-based therapy into conventional clinical sessions to assist in improving UE function and interactions within different environments and to help enhance overall participation in daily tasks and occupational performance in their clients.

Virtual Reality Simulator for Training on Surgery Ergonomics Skills

This work focuses on ergonomics skills based on Virtual Reality (VR) training simulator for spine surgery. The proposed system used the Head Mounted Display (HMD) device for monitoring and data collection. The aim of the project was to provide a training approach for residents that would enable them to acquire the proper ergonomic skills needed while performing spine surgery. A VR training simulator has been designed and implemented to measure two ergonomic skills required that need to be maintained during any surgery. The two components were neck’s angle and table’s height. The experiments showed that the users are usually focused on their work and tend to pay less attention to their body’s position and movements. This can result in a wrong ergonomics setup, which leads to musculoskeletal pain. Thus, the users (residents) need to be trained to have good ergonomics positions. The proposed system measured this using a specific metric that collected head positions, angles, elbow height, and other parameters. The designed model was a VR simulator for neurosurgical education in particular; however, it might be good for some other similar surgeries. The study concluded that incorporating simulations into residents’ training and simulated surgeries can strengthen the surgeons’ skills and outcomes. As a result, both residents and expert surgeons can benefit from the use of the developed model.

Increased cognitive load in immersive virtual reality during visuomotor adaptation is associated with decreased long-term retention and context transfer

Background: Complex motor tasks in immersive virtual reality using a head-mounted display (HMD-VR) have been shown to increase cognitive load and decrease motor performance compared to conventional computer screens (CS). Separately, visuomotor adaptation in HMD-VR has been shown to recruit more explicit, cognitive strategies, resulting in decreased implicit mechanisms thought to contribute to motor memory formation. However, it is unclear whether visuomotor adaptation in HMD-VR increases cognitive load and whether cognitive load is related to explicit mechanisms and long-term motor memory formation.Methods: We randomized 36 healthy participants into three equal groups. All groups completed an established visuomotor adaptation task measuring explicit and implicit mechanisms, combined with a dual-task probe measuring cognitive load. Then, all groups returned after 24-hours to measure retention of the overall adaptation. One group completed both training and retention tasks in CS (measuring long-term retention in a CS environment), one group completed both training and retention tasks in HMD-VR (measuring long-term retention in an HMD-VR environment), and one group completed the training task in HMD-VR and the retention task in CS (measuring context transfer from an HMD-VR environment). A Generalized Linear Mixed-Effect Model (GLMM) was used to compare cognitive load between CS and HMD-VR during visuomotor adaptation, t-tests were used to compare overall adaptation and explicit and implicit mechanisms between CS and HMD-VR training environments, and ANOVAs were used to compare group differences in long-term retention and context transfer.Results: Cognitive load was found to be greater in HMD-VR than in CS. This increased cognitive load was related to decreased use of explicit, cognitive mechanisms early in adaptation. Moreover, increased cognitive load was also related to decreased long-term motor memory formation. Finally, training in HMD-VR resulted in decreased long-term retention and context transfer.Conclusions: Our findings show that cognitive load increases in HMD-VR and relates to explicit learning and long-term motor memory formation during motor learning. Future studies should examine what factors cause increased cognitive load in HMD-VR motor learning and whether this impacts HMD-VR training and long-term retention in clinical populations.

The Future of Learning

The unexpected discomfort caused by Covid-19 pandemic and all the consequent government restrictions on travels and social distancing have pushed all the Training Organizations worldwide into an unusual challenge, being forced to support their Customers from afar. This work aims to thoroughly analyze the success of the Remote Learning methodology, highlighting key factors impacting the learning curve, and to share effective improvement ideas for this approach to deliver training focused on technical and human skills. Many companies reacted to this situation by investing largely in and increasing the adoption of digital technologies to facilitate internal and external communications and more specifically to support Remote Learning. However, despite the prompt response, many Training Organizations found themselves delivering their products through a series of trials, mistakes and lesson learned on methodology and tools. The detection of few but significant improvements increased effectiveness and improved interaction in our Remote Classes. The improvement actions concerned learning how to make the most of the available digital technologies and identifying the most effective applications for sharing documents and interacting with participants; at the same time, a great focus on the human skills approach was crucial to learn how to promote trust, motivation and interaction between our staff and Customers’ personnel. In this perspective, Operator Training Simulations (OTS) and Remote VR Training have emerged as one of the best applications to increase the attendees’ learning curve and help develop Customers’ personnel skills. Our study, however, isn't all about bright stars. The feedback told us that some Customers still prefer to take in-person training classes rather than remote ones. Sometimes this relates with biases against remote or digital activities, but it often applies where hard activities need to be performed.

Integration of Virtual Reality into Transcranial Magnetic Stimulation Improves Cognitive Function in Patients with Parkinson’s Disease with Cognitive Impairment: A Proof-of-Concept Study

Background: Emerging evidence has indicated the positive effects of repetitive transcranial magnetic stimulation (rTMS) on patients with Parkinson’s disease (PD) for the treatment of mild cognitive impairment (MCI). Objective: Investigating whether combining virtual reality (VR) training with rTMS can further enhance cognitive improvement induced by rTMS treatment. Methods: We randomly assigned 40 patients with PD and MCI into three groups, namely the rTMS-VR group (n = 13), rTMS group (n = 11), and sham rTMS group (n = 16). rTMS was administered as 10 consecutive sessions of intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex. In the rTMS-VR group, VR training was administered immediately after each rTMS session. Cognitive function was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Montreal Cognitive Assessment (MoCA) at baseline, immediately after intervention, and at 3-month follow-up. Results: Compared with the rTMS group, the rTMS-VR group exhibited significantly more improvements in total and delayed memory scores of the RBANS and the visuospatial/executive function score of the MoCA after intervention (p = 0.000∼0.046) and the delayed memory score of the RBANS at 3-month follow-up (p = 0.028). Conclusion: The integrated rTMS-VR protocol achieved a superior outcome in global cognitive function, more effectively enhancing working memory and visuospatial executive function than did the rTMS protocol alone. The combination of VR and rTMS can be an effective regimen for improving the cognitive function of patients with PD.

CLINICAL AND PHYSICAL EFFICIENCY OF VIRTUAL REALITY GAMES IN SOCCER PLAYERS WITH LOW BACK PAIN

ABSTRACT Introduction: Virtual reality training (VRT) is an advanced technology that creates virtual games by a computer through specific software. It is a type of rehabilitation training commonly used in balance problems to treat musculoskeletal conditions. Objective: To determine and compare the effects of virtual reality games with those of core stabilization training on physical efficiency in soccer players with chronic low back pain. Methods: A randomized, double-blinded, controlled study was conducted on 60 LBP participants at a university hospital. The first group (n=20) received virtual reality (VR) training; the second group (n=20) received core stabilization (CS) training; and the third group (n=20) received conventional training exercises for four weeks. Scores of clinical and sports performance were measured at baseline, and after 4 weeks, 8 weeks and 6 months. Results: The baseline demographic and clinical characters did not show any significant differences (p>0.05) in the statistical analysis, which shows a homogenous population. Four weeks following the training, the VR training group showed more significant changes in clinical scores than the CS training and control groups (p≤0.001). The scores for sports performance also showed more significant improvement in the VR training group than in the other two groups (p≤0.001). The same improved clinical and sports performance changes were seen at 8 weeks and 6 months of follow-up in the VR training group, when compared to the other two groups (p≤0.001). Conclusion: This study suggests that training through virtual reality games results in long-term improvement in clinical and sports performance compared to other forms of training in soccer players with chronic low back pain.Level of evidence I b; Therapeutic studies – Investigation of treatment results.

Embodying the Aging Experience: How Virtual Reality Is Transforming Medical and Nursing Education

Virtual reality (VR) has long been standard in healthcare education. Recent advances in VR hardware and software applications have coalesced to allow for higher fidelity, more highly realistic simulations that are also deployable at scale — not just in highly specialized, single location simulation labs. In tandem, there has been an examination in both the corporate and academic sectors around the efficacy of VR training and learning. While VR has been long proven to be effective in training students and workers in hard skills, its lack of realism has been a barrier to explore efficacy in simulations related to soft skills and emotional intelligence. This symposium will discuss the implementation of virtual reality “labs”, where learners embody in a live 360 film environment the first-person point of view of an older adult — interacting with gaze, voice, and natural hand motions – into four university’s medical and nursing curriculum. Lab outcomes include decreased ageism and stereotyping, and increased empathy, sensitivity, cultural competency, and disease knowledge. The first paper reports outcomes of increased understanding, comfort, compassion and empathy of students and informal caregivers after experiencing various labs. The second discusses comparative data on knowledge and attitudes of medical students experiencing the virtual labs individually vs. the group distance mode. The third reports the results of an initial study on how embodying an older adult with sensory impairment affects participant empathy using a standardized scale. The fourth discusses how one university transitioned to delivering immersive labs to nursing students remotely during COVID19.

Virtual reality application with nano-display improves training of pipeline installation in oil and gas industry

Nanotechnology has the potential to have a huge effect on all industries, including the oil and gas industry. Virtual Reality (VR) also has large and comprehensive perspective in the interest of oil and gas industry. VR approach becomes essential at different phases in oil and gas industry. This study aims to identify the causes of Thermoelectric Generator (TEG) defect in oil and gas industry. This work also develops VR training platform with nano-display devices. The training platform is to be used in the oil and gas industry for heat pipe removal and pipeline construction. Implementation of VR training platform offers huge advantage to the industry as it does not interrupt the operation and does not require investment in the training facilities. Case study was used to determine the causes of TEG defects. Continuous exposure to heat, over production and prolonged run are the three factors that were found to be the defect of Thermoelectric Generator (TEG) in oil and gas industry. Unity 3D, HTC™ Vive device, Autodesk Maya software and C# Programming were used to develop the VR platform. Finally, the 3D models of TEGs were designed and modelled for heat pipe removal and pipeline installation in oil and gas industry. As we understand that nanotechnology plays an integral role in hardware and communications for virtual reality technology, one might propose nano-display which provides the best resolution and pixels smaller than a micrometer.

Development and Pilot Implementation of TACTICS VR: A Virtual Reality-Based Stroke Management Workflow Training Application and Training Framework

Delays in acute stroke treatment contribute to severe and negative impacts for patients and significant healthcare costs. Variability in clinical care is a contributor to delayed treatment, particularly in rural, regional and remote (RRR) areas. Targeted approaches to improve stroke workflow processes improve outcomes, but numerous challenges exist particularly in RRR settings. Virtual reality (VR) applications can provide immersive and engaging training and overcome some existing training barriers. We recently initiated the TACTICS trial, which is assessing a “package intervention” to support advanced CT imaging and streamlined stroke workflow training. As part of the educational component of the intervention we developed TACTICS VR, a novel VR-based training application to upskill healthcare professionals in optimal stroke workflow processes. In the current manuscript, we describe development of the TACTICS VR platform which includes the VR-based training application, a user-facing website and an automated back-end data analytics portal. TACTICS VR was developed via an extensive and structured scoping and consultation process, to ensure content was evidence-based, represented best-practice and is tailored for the target audience. Further, we report on pilot implementation in 7 Australian hospitals to assess the feasibility of workplace-based VR training. A total of 104 healthcare professionals completed TACTICS VR training. Users indicated a high level of usability, acceptability and utility of TACTICS VR, including aspects of hardware, software design, educational content, training feedback and implementation strategy. Further, users self-reported increased confidence in their ability to make improvements in stroke management after TACTICS VR training (post-training mean ± SD = 4.1 ± 0.6; pre-training = 3.6 ± 0.9; 1 = strongly disagree, 5 = strongly agree). Very few technical issues were identified, supporting the feasibility of this training approach. Thus, we propose that TACTICS VR is a fit-for-purpose, evidence-based training application for stroke workflow optimisation that can be readily deployed on-site in a clinical setting.