Rehabilitative devices for a top-down approach

In recent years, neurorehabilitation has moved from a "bottom-up" to a "top down" approach. This change has also involved the technological devices developed for motor and cognitive rehabilitation. It implies that during a task or during therapeutic exercises, new "top-down" approaches are being used to stimulate the brain in a more direct way to elicit plasticity-mediated motor re-learning. This is opposed to "Bottom up" approaches, which act at the physical level and attempt to bring about changes at the level of the central neural system. Areas covered: In the present unsystematic review, we present the most promising innovative technological devices that can effectively support rehabilitation based on a top-down approach, according to the most recent neuroscientific and neurocognitive findings. In particular, we explore if and how the use of new technological devices comprising serious exergames, virtual reality, robots, brain computer interfaces, rhythmic music and biofeedback devices might provide a top-down based approach. Expert commentary: Motor and cognitive systems are strongly harnessed in humans and thus cannot be separated in neurorehabilitation. Recently developed technologies in motor-cognitive rehabilitation might have a greater positive effect than conventional therapies

Virtual Reality Games for Motor Rehabilitation

This paper presents a fuzzy logic based method to track user satisfaction without the need for devices to monitor users physiological conditions. User satisfaction is the key to any product’s acceptance; computer applications and video games provide a unique opportunity to provide a tailored environment for each user to better suit their needs. We have implemented a non-adaptive fuzzy logic model of emotion, based on the emotional component of the Fuzzy Logic Adaptive Model of Emotion (FLAME) proposed by El-Nasr, to estimate player emotion in UnrealTournament 2004. In this paper we describe the implementation of this system and present the results of one of several play tests. Our research contradicts the current literature that suggests physiological measurements are needed. We show that it is possible to use a software only method to estimate user emotion

Virtual reality with customized positive stimuli in a cognitive-motor rehabilitation task: a feasibility study with subacute stroke patients with mild cognitive impairment

Virtual Reality applications for integrated cognitive and motor stroke rehabilitation show promise for providing more comprehensive rehabilitation programs. However, we are still missing evidence on its impact in comparison with standard rehabilitation, particularly in patients with cognitive impairment. Additionally, little is known on how specific stimuli in the virtual environment affect task performance and its consequence on recovery. Here we investigate the impact in stroke recovery of a virtual cognitive-motor task customized with positive stimuli, in comparison to standard rehabilitation. The positive stimuli were images based on individual preferences, and self-selected music (half of the sessions). 13 participants in the subacute stage of stroke, with cognitive and motor deficits, were allocated to one of two groups (VR, Control). Motor and cognitive outcomes were assessed at end of treatment (4-6 weeks) and at a 4-week followup. Both groups showed significant improvements over time in functional ability during task performance, but without changes in motor impairment. Cognitive outcomes were modest in both groups. For participants in the VR group, the score in the task was significantly higher in sessions with music. There were no statistical differences between groups at end of treatment and follow-up. The impact of VR therapy was lower than in similar studies with stroke patients without cognitive deficits. This study is a first step towards understanding how VR could be shaped to address the particular needs of this population.info:eu-repo/semantics/publishedVersio

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

Combining brain-computer interfaces and assistive technologies: state-of-the-art and challenges

In recent years, new research has brought the field of EEG-based Brain-Computer Interfacing (BCI) out of its infancy and into a phase of relative maturity through many demonstrated prototypes such as brain-controlled wheelchairs, keyboards, and computer games. With this proof-of-concept phase in the past, the time is now ripe to focus on the development of practical BCI technologies that can be brought out of the lab and into real-world applications. In particular, we focus on the prospect of improving the lives of countless disabled individuals through a combination of BCI technology with existing assistive technologies (AT). In pursuit of more practical BCIs for use outside of the lab, in this paper, we identify four application areas where disabled individuals could greatly benefit from advancements in BCI technology, namely,“Communication and Control”, “Motor Substitution”, “Entertainment”, and “Motor Recovery”. We review the current state of the art and possible future developments, while discussing the main research issues in these four areas. In particular, we expect the most progress in the development of technologies such as hybrid BCI architectures, user-machine adaptation algorithms, the exploitation of users’ mental states for BCI reliability and confidence measures, the incorporation of principles in human-computer interaction (HCI) to improve BCI usability, and the development of novel BCI technology including better EEG devices

Analysing Movement, The Body and Immersion in Virtual Reality

The purpose of this paper is to explore the relationships between embodiment, presence and immersion in contemporary forms of VR. The term virtual reality (VR) refers to the generation of three-dimensional environments using computer-graphics or 360° video imagery. Using VR headsets such as Google Daydream, HTC Vive, Oculus Rift, Samsung Gear and Sony PlayStation™ (PSVR) it is possible to remove visual stimuli from the outside world, replacing them with computer-generated or video imagery, to create a sense of being present within another realm. At present, commercially available hand-held devices such as motion controllers do not replicate the weight, solidity or surface texture of objects. However, these hand-held devices do enable us to interact and respond to objects within VR environments and add to the sense of immersion. A key issue to explore is what happens to our sense of embodiment, when we feel immersed and present within VR environments? Debates surrounding phenomenological approaches to embodiment, as well as the ideas found within dance and movement scholarship, provide useful entry points to explore embodiment and VR. For instance, Rudolph Von Laban provides a precise lexicon for describing movement. By testing out and applying Laban’s movement analysis, it is possible to offer fresh insight into embodiment, immersion and VR. Furthermore, by focusing on Laban’s insights into movement, it is possible to heighten our sense of embodiment in order to become more aware of how we interact and respond immersive VR experiences