Feasibility and Acceptance of a Virtual Reality System for Gait Training of Individuals with Multiple Sclerosis

4"The goals of motor rehabilitation are the improvement of mobility and the achievement of greater independence in everyday life, which requires specific multi-factorial improvements in sensory, motor, and cognitive functions. These can be addressed through multi-sensory interventions delivering stimuli, while engaging the participant in dual task activities, typical of daily living, using customized virtual reality (VR) rehabilitation tools. A prerequisite of a successful VR-based rehabilitation intervention is the patient’s engagement, motivation and satisfaction. In this study, a newly developed VR-based gait training approach for patients affected by multiple sclerosis is described and the technology required for its implementation is evaluated in terms of acceptance and feasibility. The results have shown that the use of this technology was well accepted by the participants, the system was durable and demonstrated high adaptability to patient's motor and cognitive status. This pilot study has demonstrated the usability of such a system for the training of patients with MS and suggests that VR-treadmill training could be useful to improve gait and cognitive function in such a cohort"openopenPeruzzi A; Cereatti A; Mirelman A; Della Croce UPeruzzi, A; Cereatti, A; Mirelman, A; Della Croce,

Exoskeletons with virtual reality, augmented reality and gamification for stroke patients' rehabilitation : systematic review

Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation of post-stroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for a majority of stroke survivors. With the advancement in technology, there has been the introduction of Virtual Reality, Augmented Reality, customizable games or a combination thereof that aid robotic therapy in retaining or increasing the interests of patients to keep performing the exercises. However, there are gaps in evidence regarding the transition from clinical rehabilitation to home-based therapy and it calls for an updated synthesis of literature showcasing this trend. The present review proposes a categorization of these studies according to technologies used by them and also details research in upper limb and lower limb applications. Objective: The goal of this work was to review the practices and technologies implemented for the rehabilitation of post-stroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies, Virtual Reality, Augmented Reality or Gamification for improving activity and participation in post-stroke survivors. Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies, Virtual Reality, Augmented Reality or Gamification, was performed in the databases namely; MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), Science Direct & The Cochrane Library. Exoskeleton based studies that did not include any VR, AR or gamification elements were excluded and publications from the year 2010 to 2017 were included. Results in the form of improvements in patients were also recorded and taken into consideration in finding the effectiveness of therapy on patients. Results: Thirty studies were identified based on the inclusion criteria that included randomised controlled trials as well as explorative research pieces. There was a total of around 385 participants across the studies. Use of technologies such as Virtual Reality/Augmented Reality/Gamification based Exoskeletons are capable of filling the transition from clinical to home-based settings. Our analysis showed that there were in general improvements in the motor deficiency for patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps in understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation. Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the therapy individually

Development and evaluation of a haptic framework supporting telerehabilitation robotics and group interaction

Telerehabilitation robotics has grown remarkably in the past few years. It can provide intensive training to people with special needs remotely while facilitating therapists to observe the whole process. Telerehabilitation robotics is a promising solution supporting routine care which can help to transform face-to-face and one-on-one treatment sessions that require not only intensive human resource but are also restricted to some specialised care centres to treatments that are technology-based (less human involvement) and easy to access remotely from anywhere. However, there are some limitations such as network latency, jitter, and delay of the internet that can affect negatively user experience and quality of the treatment session. Moreover, the lack of social interaction since all treatments are performed over the internet can reduce motivation of the patients. As a result, these limitations are making it very difficult to deliver an efficient recovery plan. This thesis developed and evaluated a new framework designed to facilitate telerehabilitation robotics. The framework integrates multiple cutting-edge technologies to generate playful activities that involve group interaction with binaural audio, visual, and haptic feedback with robot interaction in a variety of environments. The research questions asked were: 1) Can activity mediated by technology motivate and influence the behaviour of users, so that they engage in the activity and sustain a good level of motivation? 2) Will working as a group enhance users’ motivation and interaction? 3) Can we transfer real life activity involving group interaction to virtual domain and deliver it reliably via the internet? There were three goals in this work: first was to compare people’s behaviours and motivations while doing the task in a group and on their own; second was to determine whether group interaction in virtual and reala environments was different from each other in terms of performance, engagement and strategy to complete the task; finally was to test out the effectiveness of the framework based on the benchmarks generated from socially assistive robotics literature. Three studies have been conducted to achieve the first goal, two with healthy participants and one with seven autistic children. The first study observed how people react in a challenging group task while the other two studies compared group and individual interactions. The results obtained from these studies showed that the group interactions were more enjoyable than individual interactions and most likely had more positive effects in terms of user behaviours. This suggests that the group interaction approach has the potential to motivate individuals to make more movements and be more active and could be applied in the future for more serious therapy. Another study has been conducted to measure group interaction’s performance in virtual and real environments and pointed out which aspect influences users’ strategy for dealing with the task. The results from this study helped to form a better understanding to predict a user’s behaviour in a collaborative task. A simulation has been run to compare the results generated from the predictor and the real data. It has shown that, with an appropriate training method, the predictor can perform very well. This thesis has demonstrated the feasibility of group interaction via the internet using robotic technology which could be beneficial for people who require social interaction (e.g. stroke patients and autistic children) in their treatments without regular visits to the clinical centres

Are Behaviour Change Approaches Incorporated Within Digital Technology-Based Physical Rehabilitation Interventions Following Stroke? A Scoping Review

Background: Digital health technologies (DHTs) are increasingly used in physical stroke rehabilitation to support individuals to successfully engage with the frequent, intensive, and lengthy activities required to optimise recovery. Despite this, little is known about behaviour change within these interventions. Objective: This scoping review aimed to identify if, and how behaviour change approaches (i.e., theories, models and frameworks, and techniques to influence behaviour) are incorporated within physical stroke rehabilitation interventions that include a DHT. Methods: Databases (Embase, Medline, PyscINFO, CINAHL, Cochrane Library and AMED) were searched using keywords relating to behaviour change, DHT, physical rehabilitation and stroke. Results were independently screened by 2 reviewers. Sources were included if they reported a completed primary research study in which a behaviour change approach could be identified within a physical stroke rehabilitation intervention that included a DHT. Data including the study design, DHT utilised, and behaviour change approaches were charted. Specific behaviour change techniques were coded to the behaviour change technique taxonomy version 1 (BCTTv1). Results: From a total of 1973 identified sources, 103 studies (5%) were included for data charting. The most common reason for exclusion at full text screening, was the absence of an explicit approach to behaviour change (165/245, 67%). Almost half of the included studies (45/103, 44%) were described as pilot or feasibility studies. Virtual reality (VR) was the most frequently identified DHT type (58/103, 56%) and almost two-thirds of studies focused on upper limb rehabilitation (65/103, 63%). Only a limited number of studies (18/103, 17%) included a theory, model, or framework for behaviour change. The most frequently used BCTTv1 clusters were feedback and monitoring (88/103, 85%), reward and threat (56, 54%), goals and planning (33, 32%), and shaping knowledge (33, 32%). Relationships between feedback and monitoring, and reward and threat were identified using a relationship map with prominent use of both these clusters in interventions which included VR. Conclusions: Despite an assumption that DHTs can promote engagement in rehabilitation, this scoping review demonstrates that very few studies of physical stroke rehabilitation which include a DHT, overtly utilised any form of behaviour change approach. From those studies that did consider behaviour change, most did not report robust underpinning theory. Future development and research need to explicitly articulate how including DHTs within an intervention may support the behaviour change required for optimal engagement in physical rehabilitation following stroke, as well as establish their effectiveness. This understanding is likely to support the realisation of the transformative potential of DHTs in stroke rehabilitation

O design na educação de crianças com dislexia: o projeto Disletra

Mestrado em DesignO presente trabalho pretende explorar o potencial contributo do design na educação e reabilitação de crianças com dislexia, partindo de um enquadramento sobre esta patologia e a sua prevalência no contexto português. Considerando a problemática da resposta do sistema educativo tradicional face às necessidades educativas especiais, esta investigação surge com o objetivo de criar, através do design, uma nova ferramenta de educação para crianças diagnosticadas com dislexia, adequada a facilitar as comp etências de aprendizagem da escrita da língua portuguesa. Assim, procurámos uma abordagem capaz de auxiliar o público alvo a aprender de uma forma mais eficaz, mas simultaneamente lúdica, já que esta patologia é também sinónimo de um estigma negativo decorrente do frequente insucesso escolar, que por norma traz consequências nocivas ao desenvolvimento académico da criança. Em resposta a este desafio, foi desenvolvido o projeto “Disletra”, um jogo digital que oferece uma abordagem multissensorial – através da ilustração, animação e música – estimulando a memória visual e a aprendizagem da ortografia correta da língua portuguesa.The present work aims to explore the potential design can have in the education and rehabilitation of children diagnosed with dyslexia and to bring light to the reality of this learning disability, especially in Portugal. Considering the scarce amount of options the traditional educational system offers students with learning disabilities, this research is driven by the goal of creating, through design, a new educational tool dyslexic children, in order to help improve the learning of writing within the context of the Portuguese language. This way, it was studied which would be the better approach to help this target audience learning in a more efficient and playful way, seeing that this pathology can also be a synonym of a negative stigma connected with the usual struggle in school, that frequently brings devastating consequences to the academic development of the child. As a solution, the “Disletra” project was developed, a digital game that offers a multisensorial approach for the resolution of the presented problem, through illustration, animation and music, stimulating visual memory in order to help learning the correct spelling of words

Protocolos de realidad virtual en el accidente cerebrovascular: revisión de los efectos en la funcionalidad del sistema motor humano

[Resumen] Objetivos: el objetivo de esta revisión sistemática es saber qué efectos ocurren sobre la funcionalidad motora en individuos con ACV, tras la aplicación de programas de RV. Metodología: se han realizado búsquedas de revisiones sistemáticas y artículos originales, en las bases de datos de la Biblioteca Cochrane Plus, Medline, Cinahl, ISI Web of Knoweldge y Scopus. Las variables de análisis escogidas han sido la función motora y funcionalidad en las AVD, medidas por diferentes escalas, pruebas neurofisiológicas y biomecánicas. Resultados: Teniendo en cuenta los resultados de las revisiones sistemáticas y estudios originales, la función motora mostró mejoras tras la RV en 18 de los 24 estudios analizados sobre la extremidad superior, y en 2 ocasiones sobre la marcha. Se apuntó la existencia de reorganización cortical en 1 estudio. La funcionalidad en las AVD manifestó mejora tras el programa de RV en 11 de los 24 estudios considerados. Conclusiones: Existe fuerte evidencia sobre los beneficios de la RV en la función motora, sin embargo son menos homogéneos en cuanto a la funcionalidad en las AVD. No se puede concluir que tenga efectos positivos sobre la marcha debido a la poca evidencia que valore la misma.[Abstract] Objectives: the aim of this systematic review is to know the effects that virtual reality (VR) programs have on motor fuction in stroke survivors. Methods: searching included systematic review and original articles present in the databases of Cochrane Library, Medline, Cinahl, ISI Web of Knoweldge and Scopus. The analysed variables chose motor function and ADL functionality, as measured by different scales, neurophysiological and biomechanical test. Results: Considering the results, the motor function showed improvements in upper extremity after VR in 18 of the 24 studies analyzed, and in 2 occasions on gait. One original Research showed existence of cortical reorganization. ADL functionality was improved after VR program in 11 of the 24 studies considered. Conclusions: There is strong evidence of the VR benefits in motor function, however, there is less homogeneus evidence in terms of ADL functionality. We can not conclude that VR has positive effects on gait because there have less evidence that values the same.Traballo fin de mestrado (UDC.FCS). Asistencia e investigación sanitaria. Especialidade en reeducación funcional, autonomía persoal e calidade de vida. Curso 2013/201