The Michelangelo effect. Art improves the performance in a virtual reality task developed for upper limb neurorehabilitation

The vision of an art masterpiece is associated with brain arousal by neural processes occurring quite spontaneously in the viewer. This aesthetic experience may even elicit a response in the motor areas of the observers. In the neurorehabilitation of patients with stroke, art observation has been used for reducing psychological disorders, and creative art therapy for enhancing physical functions and cognitive abilities. Here, we developed a virtual reality task which allows patients, by moving their hand on a virtual canvas, to have the illusion of painting some art masterpieces, such as The Creation of Adam of Michelangelo or The birth of Venus of Botticelli. Twenty healthy subjects (experiment 1) and four patients with stroke (experiment 2) performed this task and a control one in which they simply colored the virtual canvas. Results from User Satisfaction Evaluation Questionnaire and the NASA Task Load Index highlighted an appropriate level of usability. Moreover, despite the motor task was the same for art and control stimuli, the art condition was performed by healthy subjects with shorter trajectories (p = 0.001) and with a lower perception of physical demand (p = 0.049). In experiment 2, only the patients treated with artistic stimuli showed a reduction in the erroneous movements performed orthogonally to the canvas (p < 0.05). This finding reminds the so-called Mozart effect that improves the performance of subjects when they listen to classic music. Thus, we called this improvement in the performance when interacting with an artistic stimulus as Michelangelo effect

Chapter Is Three better than Two? A Study on EEG Activity and Imagination Abilities in 2D vs 3D Stimuli

Real and virtual are often considered terms in reciprocal opposition, but the boundaries between the two are blurred. The main goal of our study consists in answering the question whether the presence of a third dimension (3D) is a fundamental step of the virtual toward the real world, and if it causes some difference in the neural activity of the spectator [8]. Also, the possibility to consider real what is virtual will be discussed [6, 7]

Design of an application with Virtual Reality for neurorehabilitation purposes

The purpose of this project is to carry out a study of virtual reality and its applications in hospital environments such as neurorehabilitation or physiotherapy, since it is a technology which is starting to be used nowadays. A 3D virtual reality application for a basic demonstration of a game which could be useful for these trainings will be also done. To achieve this, we will work with Unity, a graphic motor for 3D application and game creation. The hardware for the development of the virtual reality immersive system will be the HTC Vive system, which additionally allows position and movement detection in a room scale using the light signalling technology Lighthouse. This application will focus on the creation of an immersive videogame to track upper extremity movement from the user so he can do his rehabilitation training in a more enjoyable and motivating way, in the form of avoiding obstacles in the videogame using those movements. In addition, the necessary informatic support will be done so the application can be used in a virtual reality headset to improve visual immersion. It will also be obtained some parameter indicating how the game play was

Development of a Virtual Reality Tool for Respiratory Rehabilitation

Respiratory rehabilitation plays an important role in the management of respiratory complications after spinal cord injury. Abundant evidence supports the need for respiratory rehabilitation as a treatment for respiratory insufficiency and many other breathing conditions, having a huge impact on the physical, mental, social and laboral capacity of each patient. An exhaustive analysis of current systems for respiratory rehabilitation led us to detect some gaps and needs related to that, such as the old-fashionism of devices and, in particular, their low engagement strength. This project introduces a novel, patient-specific and easy-to-use tool for respiratory rehabilitation. We developed a custom respiratory training application, called RespiTrainer, consisting of five entertaining 2D games which are successfully combined with an innovative airflow sensing approach based on a microphone. A total of twelve healthy volunteers participated in the validation of the solution, which consisted of conducting a first conventional inspiratory and expiratory respiratory training, followed by a session with RespiTrainer. Volunteers responded to two questionnaires regarding their experience and the usability of both systems. Results showed a significant increase in the system usability score (SUS) when using our custom application. Participants felt slightly more tired after training with RespiTrainer than with the conventional system (Borg scale). All subjects felt the game was significantly much more entertaining and motivating than conventional training. Hence, we gathered preliminary evidence as to the practicability and feasibility of this solution to conduct respiratory training and improve patient satisfaction and further adherence

Immersive Virtual Reality Training Improved Upper Extremity Function in Patients with Spinal Cord Injuries: A Case Series

Virtual reality (VR) is an emerging treatment tool to engage people in environments that appear and feel similar to real-world objects and events.1 There are various levels of evidence that VR can potentially promote functional activity and neuroplasticity in patients with neurological disorders like spinal cord injury (SCI).2,3 In this case series, we explored the feasibility of using commercially available immersive VR technology as an augmented treatment in the SCI population and compare participant’s suitability for this intervention. Three male SCI participants were recruited in a subacute inpatient rehabilitation facility and participated in VR intervention twice a week in addition to their conventional therapies. Manual strength and functional testing were recorded biweekly until participants discharged. Training includes reaching activities, wrist rotation, gripping, and thumb movement to simulate real-life activities. A questionnaire regarding their experience with VR training was administered at the end. All participants had improvement in strength and functional tests. 9-hole peg test demonstrated clinically meaningful change in two of three participants. Manual muscle test changes were 2, 4.5 and 13.5 points individually. Participants with lower manual muscle test scores at baseline showed more potential to change compared to those who had high scores, which would possibly due to plateau effect. Pinch and grip strength demonstrated small changes which were not clinically important. Participants also rated VR technology of high reality level and great enjoyment in the questionnaire. This case series suggests that immersive VR with head mount display may be viable to provide safe and effective treatment for patients with SCI. VR training appears to be a possible adjunct to physical and occupational therapy as a method of muscle strengthening, improving upper extremity function and improving motivation during subacute rehabilitation

Head-mounted display-based application for cognitive training

Virtual Reality (VR) has had significant advances in rehabilitation, due to the gamification of cognitive activities that facilitate treatment. On the other hand, Immersive Virtual Reality (IVR) produces outstanding results due to the interactive features with the user. This work introduces a VR application for memory rehabilitation by walking through a maze and using the Oculus Go head-mounted display (HMD) technology. The mechanics of the game require memorizing geometric shapes while the player progresses in two modes, autonomous or manual, with two levels of difficulty depending on the number of elements to remember. The application is developed in the Unity 3D video game engine considering the optimization of computational resources to improve the performance in the processing and maintaining adequate benefits for the user, while the generated data is stored and sent to a remote server. The maze task was assessed with 29 subjects in a controlled environment. The obtained results show a significant correlation between participants’ response accuracy in both the maze task and a face–pair test. Thus, the proposed task is able to perform memory assessments

VRShape: A Virtual Reality Tool for Shaping Movement Compensation

The majority of persons living with chronic stroke experience some form of upper extremity motor impairment that affects their functional movement, performance of meaningful activities, and participation in the flow of daily life. Stroke survivors often compensate for these impairments by adapting their movement patterns to incorporate additional degrees of freedom at new joints and body segments. One of the most common compensatory movements is the recruitment of excessive trunk flexion when reaching with the affected upper extremity. Long-term use of these compensations may lead to suboptimal motor recovery and chronic pain or injury due to overuse. Rehabilitation focuses on repetitive practice with the impaired limb to stimulate motor learning and neuroplasticity; however, few interventions achieve the required repetition dose or address the possible negative effects of compensatory movements. Virtual reality (VR) is an emerging tool in rehabilitation science that may be capable of (1) objectively measuring compensation during upper extremity movement, (2) motivating persons to perform large doses of repetitive practice through the integration of virtual environments and computer games, and (3) providing the basis for a motor intervention aimed at improving motor performance and incrementally reducing, or shaping, compensation. The purpose of this project was to develop and test a VR tool with these capabilities for shaping movement compensation for persons with chronic stroke, and to achieve this we performed three separate investigations (Chapters 2-4).First, we investigated the validity and reliability of two generations of an off-the-shelf motion sensor, namely the Microsoft Kinect, for measuring trunk compensations during reaching (Chapter 2). A small group of healthy participants performed various reaching movements on two separate days while simultaneously being recorded by the two sensors and a third considered to be the gold standard. We found that the second generation Kinect sensor was more accurate and showed greater validity for measuring trunk flexion relative to the gold standard, especially during extended movements, and therefore recommended that sensor for future VR development. Research with a more heterogeneous and representative population, such as persons with stroke, will further improve the evaluation of these sensors in future work.Second, we tested a newly-designed VR tool, VRShape, for use during a single session of upper extremity movement practice (Chapter 3). VRShape integrates the Microsoft Kinect and custom software to convert upper extremity movements into the control of various virtual environments and computer games while providing real-time feedback about compensation. A small group of participants with stroke used VRShape to repetitively perform reaching movements while simultaneously receiving feedback concerning their trunk flexion relative to a calibrated threshold. Our tool was able to elicit a large number of successful reaches and limit the amount of trunk flexion used during a single practice session while remaining usable, motivating, and safe. However, areas of improvement were identified relative to the efficiency of the software and the variety of virtual environments available. Third, we implemented VRShape over the course of a motor intervention for persons with stroke and evaluated its feasibility and effect on compensation during reaching tasks (Chapter 4). A small group of participants took part in 18 interventions session using VRShape for repetitive reaching practice with incrementally shaped trunk compensation. Trunk flexion decreased significantly and reaching kinematics improved significantly as a result of the intervention. Even with extended use, participants were able to complete intense practice and thousands of repetitions while continually rating the system as usable, motivating, engaging, and safe. Our VR tool demonstrated feasibility and preliminary efficacy within a small study, but future work is needed to identify its ideal applications and address its limitations. In summary, this project shows that use of a VR tool incorporating an accurate sensor (Chapter 2) and feedback from initial testing (Chapter 3) is capable of changing the amount of trunk flexion used during reaching movements for persons with stroke (Chapter 4). More research is needed to establish its efficacy and effectiveness, but improvements in motor recovery and associated decreases in compensation associated with the use of VRShape are important rehabilitation goals that may lead to improved participation and quality of life for persons living with long-term impairments due to chronic stroke

How to Create Suitable Augmented Reality Application to Teach Social Skills for Children with ASD

Autism spectrum disorders (ASDs) are characterized by a reduced ability to appropriately express social greetings. Studies have indicated that individuals with ASD might not recognize the crucial nonverbal cues that usually aid social interaction. This study applied augmented reality (AR) with tabletop role-playing game (AR-RPG) to focus on the standard nonverbal social cues to teach children with ASD, how to appropriately reciprocate when they socially interact with others. The results showed that intervention system provides an AR combined with physical manipulatives and presents corresponding specific elements in an AR 3D animation with dialogue; thus, it can be used to help them increase their social interaction skills and drive their attention toward the meaning and social value of greeting behavior in specific social situations. We conclude that AR-RPG of social situations helped children with ASD recognize and better understand these situations and moderately effective in teaching the target greeting responses