Post-stroke functional assessments based on rehabilitation games and their correlation with clinical scales: A scoping review.

Considering that stroke is one of the main causes of adult impairment and the growing interest in Virtual Reality (VR) as a potential assessment and treatment tool for the rehabilitation of stroke patients, a scoping review was conducted to check whether user's motion data obtained from VR games and simulations can be clinically valid. This was done by reviewing studies on parameters for assessing the functional skills and rehabilitation progress using data from VR games or simulations. Then, identifying the most widely used and validated parameters for the quantification of motor ability in a virtual environment and suggesting challenges for future research. For the validation of the parameters obtained from the VR software, only the studies that correlated them with traditional physiotherapy scales were considered. In December 2022, a search of the following databases was performed: IEEE Xplore, ACM Digital Library, PubMed and PEDro. The selection criteria were studies published in English during the past 10 years, with upper-limb based interaction and tested on more than one stroke patient. A total of 14 were included in the PRISMA scoping review. Favorable results were found in 12 of the 14 studies, which reported positive or strongly positive correlations with clinical scales, even when diverse variables were used. In-depth research using a larger sample size is needed. The results demonstrate that data collected while playing a virtual serious game has the potential to be clinically valid, after conducting high-quality supportive studies with controlled variables, potentially helping the practice in terms of time and resources.

RehaBEElitation: the architecture and organization of a serious game to evaluate motor signs in Parkinson's disease.

Background: The use of serious games (SG) has received increasing attention in health care, and can be applied for both rehabilitation and evaluation of motor signs of several diseases, such as Parkinson's disease (PD). However, the use of these instruments in clinical practice is poorly observed, since there is a scarcity of games that, during their development process, simultaneously address issues of usability and architectural design, contributing to the non-satisfaction of the actual needs of professionals and patients. Thus, this study aimed to present the architecture and usability evaluation at the design stage of a serious game, so-called RehaBEElitation, and assess the accessibility of the game. Methods: The game was created by a multidisciplinary team with experience in game development and PD, taking into consideration design guidelines for the development of SG. The user must control the movements of a bee in a 3D environment. The game tasks were designed to mimic the following movements found in the gold-standard method tool-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS)-for the assessment of individuals with PD: hand opening and closing, hand extension and flexion, hand adduction and abduction, finger tapping, and forearm supination and pronation. The user interacts with the game using a wearable interface device that embeds inertial and tactile sensors. The architecture of RehaBEElitation was detailed using the business process model (BPM) notation and the usability of the architecture was evaluated using the Nielsen-Shneiderman heuristics. Game accessibility was evaluated by comparing the overall scores of each phase between 15 healthy participants and 15 PD patients. The PD group interacted with the game in both the ON and OFF states. Results: The system was modularized in order to implement parallel, simultaneous and independent programming at different levels, requiring less computational effort and enabling fluidity between the game and the control of the interface elements in real time. The developed architecture allows the inclusion of new elements for patient status monitoring, extending the functionality of the tool without changing its fundamental characteristics. The heuristic evaluation contemplated all the 14 heuristics proposed by Shneiderman, which enabled the implementation of improvements in the game. The evaluation of accessibility revealed no statistically significant differences (p < 0.05) between groups, except for the healthy group and the PD group in the OFF state of medication during Phase 3 of the game. Conclusions: The proposed architecture was presented in order to facilitate the reproduction of the system and extend its application to other scenarios. In the same way, the heuristic evaluation performed can serve as a contribution to the advancement of the SG design for PD. The accessibility evaluation revealed that the game is accessible to individuals with PD.

Skills assessment metrics of electric powered wheelchair driving in a virtual environment: a survey.

The purpose of this review is to present studies on the parameters for assessing the skills of users of electric wheelchair driving simulators in a virtual environment. In addition, this study also aims to identify the most widely used and validated parameters for the quantification of electric wheelchair driving ability in a virtual environment and to suggest challenges for future research. To carry out this research, the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. Literature searches in English, French, and Portuguese were conducted up to December 2020 in the PubMed, SciELO, Science Direct, World Wide Science, and Scopus databases. The keywords used were electric wheelchair, simulator, performance indicators, performance skills, driving skills, training platform, virtual environment, and virtual reality. We excluded studies involving "real" wheelchairs without a simulator in a virtual environment. We have selected a total of 42 items. In these studies, we identified 32 parameters (3 qualitative and 29 quantitative) that are used as parameters for the evaluation of the ability to control a powered wheelchair in a virtual environment. Although the amount of research in this area has increased significantly in recent years, additional studies are still needed to provide a more accurate and objective assessment of skills among the target population. A challenge for future work is the increasing application of artificial intelligence techniques and the exploration of biomedical data measurements, which may be a promising alternative to improve the quantification of user competencies.

Multidimensional Assessment of Individuals with Parkinson's Disease: Development and Structure Validation of a Self-Assessment Questionnaire.

(1) Background: Several instruments are used to assess individuals with Parkinson's disease (PD). However, most instruments necessitate the physical presence of a clinician for evaluation, were not designed for PD, nor validated for remote application. (2) Objectives: To develop and validate a self-assessment questionnaire that can be used remotely, and to assess the respondents' health condition. (3) Methods: A questionnaire, so-called Multidimensional Assessment Questionnaire for Individuals with PD (MAQPD), was developed, administered remotely, and completed by 302 people with PD. MAQPD was validated using factor analysis (FA). The participants' level of impairment was estimated using factor loadings. The scale's accuracy was assessed estimating floor and ceiling effects and Cronbach's alpha. (4) Results: FA suggested classifying the questions into daily activities, cognition, and pain. The respondents did not have extremely severe impairment (most scores ranged from 100 to 180 points), and the factors with the lowest scores were cognition and pain. The instrument had no significant floor or ceiling effects (rates less than 15%), and the Cronbach's alpha value was larger than 0.90. (5) Conclusion: MAQPD is the only remote self-administered tool found in the literature capable of providing a detailed assessment of the general health status of individuals with PD.

Wrist Rigidity Evaluation in Parkinson's Disease: A Scoping Review.

(1) Background: One of the main cardinal signs of Parkinson's disease (PD) is rigidity, whose assessment is important for monitoring the patient's recovery. The wrist is one of the joints most affected by this symptom, which has a great impact on activities of daily living and consequently on quality of life. The assessment of rigidity is traditionally made by clinical scales, which have limitations due to their subjectivity and low intra- and inter-examiner reliability. (2) Objectives: To compile the main methods used to assess wrist rigidity in PD and to study their validity and reliability, a scope review was conducted. (3) Methods: PubMed, IEEE/IET Electronic Library, Web of Science, Scopus, Cochrane, Bireme, Google Scholar and Science Direct databases were used. (4) Results: Twenty-eight studies were included. The studies presented several methods for quantitative assessment of rigidity using instruments such as force and inertial sensors. (5) Conclusions: Such methods present good correlation with clinical scales and are useful for detecting and monitoring rigidity. However, the development of a standard quantitative method for assessing rigidity in clinical practice remains a challenge.

ViEW: A wheelchair simulator for driving analysis.

The powered wheelchair (PW) has become an essential mobility assistive technology for people with motor disabilities. A critical step involved in maximizing the end-user experience is evaluating individual functional abilities. Using powered wheelchair simulation for driving analysis offers flexibility for safely evaluating the individual's driving performance in a variable environment and situations ranging in difficulty. Additionally, it makes it possible to measure numerous variables involved in the driving process. The main objectives of this pilot study were to assess PW users' outdoor driving abilities to study how the simulator can improve outdoor driving task performance, and to define new objective criteria for evaluating the overall driving process. The study presented involved a group of 12 children and young adults diagnosed with cerebral palsy. Simulations were conducted using ViEW (Virtual Electrical Wheelchair), a 3D wheelchair simulator designed in our laboratory. A customized virtual environment was designed to immerse the user in a life-like driving experience. We used the data collected on the simulator to define driving skills indicators. The acquired skills during simulations were transferable to on-road wheelchair driving. The participants' performance indicators produced positive results. Computed performance indicators can be a valuable decision-making tool for occupational therapists.