Immersive VR for upper-extremity rehabilitation in patients with neurological disorders: a scoping review.

BACKGROUND: Neurological disorders, such as stroke and chronic pain syndromes, profoundly impact independence and quality of life, especially when affecting upper extremity (UE) function. While conventional physical therapy has shown effectiveness in providing some neural recovery in affected individuals, there remains a need for improved interventions. Virtual reality (VR) has emerged as a promising technology-based approach for neurorehabilitation to make the patient's experience more enjoyable. Among VR-based rehabilitation paradigms, those based on fully immersive systems with headsets have gained significant attention due to their potential to enhance patient's engagement. METHODS: This scoping review aims to investigate the current state of research on the use of immersive VR for UE rehabilitation in individuals with neurological diseases, highlighting benefits and limitations. We identified thirteen relevant studies through comprehensive searches in Scopus, PubMed, and IEEE Xplore databases. Eligible studies incorporated immersive VR for UE rehabilitation in patients with neurological disorders and evaluated participants' neurological and motor functions before and after the intervention using clinical assessments. RESULTS: Most of the included studies reported improvements in the participants rehabilitation outcomes, suggesting that immersive VR represents a valuable tool for UE rehabilitation in individuals with neurological disorders. In addition, immersive VR-based interventions hold the potential for personalized and intensive training within a telerehabilitation framework. However, further studies with better design are needed for true comparison with traditional therapy. Also, the potential side effects associated with VR head-mounted displays, such as dizziness and nausea, warrant careful consideration in the development and implementation of VR-based rehabilitation programs. CONCLUSION: This review provides valuable insights into the application of immersive VR in UE rehabilitation, offering the foundation for future research and clinical practice. By leveraging immersive VR's potential, researchers and rehabilitation specialists can design more tailored and patient-centric rehabilitation strategies, ultimately improving the functional outcome and enhancing the quality of life of individuals with neurological diseases.

Feasibility study of immersive virtual prism adaptation therapy with depth-sensing camera using functional near-infrared spectroscopy in healthy adults.

Prism Adaptation (PA) is used to alleviate spatial neglect. We combined immersive virtual reality with a depth-sensing camera to develop virtual prism adaptation therapy (VPAT), which block external visual cues and easily quantify and monitor errors than conventional PA. We conducted a feasibility study to investigate whether VPAT can induce behavioral adaptations by measuring after-effect and identifying which cortical areas were most significantly activated during VPAT using functional near-infrared spectroscopy (fNIRS). Fourteen healthy subjects participated in this study. The experiment consisted of four sequential phases (pre-VPAT, VPAT-10°, VPAT-20°, and post-VPAT). To compare the most significantly activated cortical areas during pointing in different phases against pointing during the pre-VPAT phase, we analyzed changes in oxyhemoglobin concentration using fNIRS during pointing. The pointing errors of the virtual hand deviated to the right-side during early pointing blocks in the VPAT-10° and VPAT-20° phases. There was a left-side deviation of the real hand to the target in the post-VPAT phase, demonstrating after-effect. The most significantly activated channels during pointing tasks were located in the right hemisphere, and possible corresponding cortical areas included the dorsolateral prefrontal cortex and frontal eye field. In conclusion, VPAT may induce behavioral adaptation with modulation of the dorsal attentional network.

What is the future for immersive virtual reality in memory rehabilitation? A systematic review.

BACKGROUND: A growing interest in non-pharmacological approaches aimed at cognitive rehabilitation and cognitive enhancement pointed towards the application of new technologies. The complex virtual reality (VR) presented using immersive devices has been considered a promising approach. OBJECTIVE: The article provides a systematic review of studies aimed at the efficacy of VR-based rehabilitation. First, we shortly summarize literature relevant to the role of immersion in memory assessment and rehabilitation. METHODS: We searched Web of Science, ScienceDirect, and PubMed with the search terms "memory rehabilitation", "virtual reality", "memory deficit". Only original studies investigating the efficacy of complex three-dimensional VR in rehabilitation and reporting specific memory output measures were included. RESULTS: We identified 412 citations, of which 21 met our inclusion criteria. We calculated appropriate effect sizes for 10 studies including control groups and providing descriptive data. The effect sizes range from large to small, or no effect of memory rehabilitation was present, depending on the control condition applied. Summarized studies with missing control groups point out to potential positive effects of VR but do not allow any generalization. CONCLUSIONS: Even though there are some theoretical advantages of immersive VE over non-immersive technology, there is not enough evidence yet to draw any conclusions.

Evaluating the effect of immersive virtual reality technology on gait rehabilitation in stroke patients: a study protocol for a randomized controlled trial.

BACKGROUND: The high incidence of cerebral apoplexy makes it one of the most important causes of adult disability. Gait disorder is one of the hallmark symptoms in the sequelae of cerebral apoplexy. The recovery of walking ability is critical for improving patients' quality of life. Innovative virtual reality technology has been widely used in post-stroke rehabilitation, whose effectiveness and safety have been widely verified. To date, however, there are few studies evaluating the effect of immersive virtual reality on stroke-related gait rehabilitation. This study outlines the application of immersive VR-assisted rehabilitation for gait rehabilitation of stroke patients for comparative evaluation with traditional rehabilitation. METHODS: The study describes a prospective, randomized controlled clinical trial. Thirty-six stroke patients will be screened and enrolled as subjects within 1 month of initial stroke and randomized into two groups. The VRT group (n = 18) will receive VR-assisted training (30 min) 5 days/week for 3 weeks. The non-VRT group (n = 18) will receive functional gait rehabilitation training (30 min) 5 days/week for 3 weeks. The primary outcomes and secondary outcomes will be conducted before intervention, 3 weeks after intervention, and 6 months after intervention. The primary outcomes will include time "up & go" test (TUGT). The secondary outcomes will include MMT muscle strength grading standard (MMT), Fugal-Meyer scale (FMA), motor function assessment scale (MAS), improved Barthel index scale (ADL), step with maximum knee angle, total support time, step frequency, step length, pace, and stride length. DISCUSSION: Virtual reality is an innovative technology with broad applications, current and prospective. Immersive VR-assisted rehabilitation in patients with vivid treatment scenarios in the form of virtual games will stimulate patients' interest through active participation. The feedback of VR games can also provide patients with performance awareness and effect feedback, which could be incentivizing. This study may reveal an improved method of stroke rehabilitation which can be helpful for clinical decision-making and future practice. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR1900025375 . Registered on 25 August 2019.

The Effectiveness of a Virtual Reality-Based Intervention on Cognitive Functions in Older Adults with Mild Cognitive Impairment: A Single-Blind, Randomized Controlled Trial.

Objective: Mild cognitive impairment (MCI) is a broad term for people at a stage between normal age-related cognitive decline and dementia, where cognitive problems are present but do not impair activities of daily living. This study aimed at evaluating the effectiveness of a virtual reality (VR)-based rehabilitation program on cognitive functions in MCI. Materials and Methods: Sixty-one older adults (25 men, 36 women) with MCI were randomized to the intervention group (n = 30; 70.12 ± 2.57 years) or control (n = 31; 70.30 ± 2.73 years) group. The intervention group received a VR (computer-generated interactive environments) intervention in addition to a conventional cognitive rehabilitation (CR) intervention, whereas the control group received only the CR intervention. Cognitive functions were assessed in both groups before and after the 12-week interventions by using the Loewenstein Occupational Therapy Cognitive Assessment-Geriatric. Results: Between-group comparisons revealed significantly greater improvements in orientation, visual-spatial perception, visuomotor organization, thinking operation, and attention/concentration functions in the VR group than in the control group (P < 0.001 for all). Conclusion: Our results showed that 12 weeks of VR-based rehabilitation enhanced cognitive functions in older adults with MCI. Using VR applications in CR is recommended to improve cognitive functions of older adults with MCI.

Immersive virtual reality and antigravity treadmill training for gait rehabilitation in Parkinson's disease: a pilot and feasibility study. / Entrenamiento antigravitatorio e inmersivo de realidad virtual para la rehabilitación de la marcha en la enfermedad de Parkinson: estudio piloto y de viabilidad.

INTRODUCTION: Treadmill training is considered an effective intervention to improve gait ability in patients with Parkinson's disease (PD). In parallel, virtual reality shows promising intervention with several applications in the inpatient medical setting. AIM: To evaluate the feasibility and preliminary efficacy of mechanical gait assistance combined with immersive virtual reality in patients with PD. PATIENTS AND METHODS: This pilot and feasibility study followed a pre-post study design. The intervention consisted of 12 sessions of 30 minutes, distributed regularly over four consecutive weeks. Participants walked on a treadmill with a body-weight support system set at approximately 20% of body weight and equipped with a virtual reality helmet controlled by a two-handed joystick. Feasibility and intervention outcomes were collected at baseline and after four weeks of intervention. RESULTS: Twelve participants of 60 patients were finally enrolled. Nine of them (75%) completed the treatment intervention with an adherence rate of 97%. Two participants left the study, one of them due to sickness associated with virtual reality and another because of a lack of motivation. There were significant differences associated with small-medium effect sizes when comparing the pre and post values for walk distance, walk speed, balance, and quality of life. CONCLUSIONS: The present study provided preliminary evidence supporting the feasibility of the combination of antigravity treadmill and immersive virtual reality system for the rehabilitation of patients with PD.

TITLE: Entrenamiento antigravitatorio e inmersivo de realidad virtual para la rehabilitación de la marcha en la enfermedad de Parkinson: estudio piloto y de viabilidad.Introducción. El entrenamiento en tapiz rodante se considera una intervención eficaz para mejorar la capacidad de la marcha en pacientes con enfermedad de Parkinson (EP). Paralelamente, la realidad virtual se muestra como una intervención prometedora con diversas aplicaciones en el entorno médico hospitalario. Objetivo. Evaluar la viabilidad y la eficacia preliminar de la asistencia mecánica para la marcha combinada con la realidad virtual inmersiva en pacientes con EP. Pacientes y métodos. Este estudio piloto y de viabilidad siguió un diseño pre-post. La intervención consistió en 12 sesiones de 30 minutos, distribuidas regularmente durante cuatro semanas consecutivas. Los participantes deambularon sobre un tapiz rodante con un sistema de descarga del peso corporal establecido aproximadamente en el 20% del peso corporal y equipados con un casco de realidad virtual controlado por un joystick para cada mano. Las mediciones de viabilidad y tratamiento se recopilaron al inicio del estudio y después de cuatro semanas de intervención. Resultados. De un total de 60 pacientes, se reclutó finalmente a 12 participantes. Nueve de ellos (75%) completaron el tratamiento, con una tasa de adhesión del 97%. Dos participantes abandonaron el estudio, uno debido a náuseas asociadas con la realidad virtual y otro por falta de motivación. Hubo diferencias significativas asociadas con un tamaño del efecto pequeño-mediano al comparar los valores pre y post para la distancia recorrida, velocidad de la marcha, equilibrio y calidad de vida. Conclusiones. El estudio proporcionó evidencia preliminar que apoya la viabilidad de la combinación de un tapiz rodante antigravitatorio y un sistema de realidad virtual inmersivo para la rehabilitación de pacientes con EP.

Is Xbox 360 Kinect-based virtual reality training as effective as standard physiotherapy in patients undergoing breast cancer surgery?

PURPOSE: Breast cancer surgery may be associated with pain and physical symptoms in the upper limbs. Functional impairment and pain-related avoidance of movement may further increase disability level. This study aimed to investigate the potential effects of early postoperative virtual reality (VR) therapy on pain, range of motion (ROM), muscle strength, functionality, and fear of movement. METHODS: Forty women with breast cancer who had undergone unilateral mastectomy with axillary lymph node dissection and who were receiving adjuvant therapy were included in the study and randomly assigned to two groups: the Kinect-based rehabilitation group (KBRG) and the standardized physical therapy group (SPTG). The KBRG (n = 20) received VR therapy using Xbox Kinect-based games and the SPTG (n = 20) received standard physiotherapy. Study subjects were assessed at baseline and after the 6-week treatment. Outcome measures were pain (visual analogue scale), grip strength (dynamometer), functionality (disabilities of the arm shoulder and hand questionnaire), muscle strength (handheld dynamometer), ROM (digital goniometer), and fear of movement (Tampa kinesiophobia scale (TKS)). RESULTS: Both groups detected significant changes in pain, ROM, muscle strength, grip strength, functionality, and TKS scores after the treatment (p < 0.01). Fear of movement was significantly improved in the KBRG and the SPTG displayed more improvement in functionality (p < 0.05). There were no differences in ROM, muscle strength, grip strength, and pain between the groups after the treatment (p > 0.05). CONCLUSION: Kinect-based VR therapy resulted in significant outcomes that were comparable to those obtained under standard physiotherapy in the early postoperative phase in patients who had undergone breast cancer surgery. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov ( ClinicalTrials.gov identifier: NCT03618433).

Treating patients with driving phobia by virtual reality exposure therapy - a pilot study.

OBJECTIVES: Virtual reality exposure therapy (VRET) is a promising treatment for patients with fear of driving. The present pilot study is the first one focusing on behavioral effects of VRET on patients with fear of driving as measured by a post-treatment driving test in real traffic. METHODS: The therapy followed a standardized manual including psychotherapeutic and medical examination, two preparative psychotherapy sessions, five virtual reality exposure sessions, a final behavioral avoidance test (BAT) in real traffic, a closing session, and two follow-up phone assessments after six and twelve weeks. VRE was conducted in a driving simulator with a fully equipped mockup. The exposure scenarios were individually tailored to the patients' anxiety hierarchy. A total of 14 patients were treated. Parameters on the verbal, behavioral and physiological level were assessed. RESULTS: The treatment was helpful to overcome driving fear and avoidance. In the final BAT, all patients mastered driving tasks they had avoided before, 71% showed an adequate driving behavior as assessed by the driving instructor, and 93% could maintain their treatment success until the second follow-up phone call. Further analyses suggest that treatment reduces avoidance behavior as well as symptoms of posttraumatic stress disorder as measured by standardized questionnaires (Avoidance and Fusion Questionnaire: p < .10, PTSD Symptom Scale-Self Report: p < .05). CONCLUSIONS: VRET in driving simulation is very promising to treat driving fear. Further research with randomized controlled trials is needed to verify efficacy. Moreover, simulators with lower configuration stages should be tested for a broad availability in psychotherapy.

A review of virtual reality technologies in the field of communication disability: implications for practice and research.

Background: Technology devices and applications including virtual reality (VR) are increasingly used in healthcare research and practice as tools to promote health and wellbeing. However, there is limited research examining the potential for VR to enable improved communication for people with communication disability.Aims: To review: (a) current research using VR in speech-language pathology; and (b) the ethical and safety considerations of VR research, to inform an agenda for future research applying VR in the field of speech-language pathology.Main contribution: This review reveals that there is an emergent body of literature applying VR to improve or develop physical, psychological and communication interventions. Use of non-immersive virtual environments to provide speech-language pathology assessment or intervention for people with communication disability has demonstrated positive outcomes, with emerging evidence of the transfer of functional communication skills from virtual to real-world environments. However, the use of VR technology and immersive virtual environments in communication disability practice and research introduces safety and ethical issues that must be carefully considered.Conclusions: Research employing VR is in its infancy in the field of speech-language pathology. Early evidence from other healthcare disciplines suggests that VR is an engaging means of delivering immersive and interactive training to build functional skills that can be generalized to the real world. While the introduction of new technology requires careful consideration of research ethics and patient safety, future VR communication research could proceed safely with adequate engagement of interdisciplinary teams and technology specialists.Implications for rehabilitationImmersive virtual reality may be used in rehabilitation to simulate natural environments to practice and develop communication skills.The sense of immersion that can be achieved using virtual reality may promote the generalization of skills learnt during clinical rehabilitation to real-world situations.Ethical and safety considerations, including cybersecurity and cybersickness, must be carefully monitored during all virtual reality research.

User-centered design of a multisensory power wheelchair simulator: towards training and rehabilitation applications.

Autonomy and social inclusion can reveal themselves everyday challenges for people experiencing mobility impairments. These people can benefit from technical aids such as power wheelchairs to access mobility and overcome social exclusion. However, power wheelchair driving is a challenging task which requires good visual, cognitive and visuo-spatial abilities. Besides, a power wheelchair can cause material damage or represent a danger of injury for others or oneself if not operated safely. Therefore, training and repeated practice are mandatory to acquire safe driving skills to obtain power wheelchair prescription from therapists. However, conventional training programs may reveal themselves insufficient for some people with severe impairments. In this context, Virtual Reality offers the opportunity to design innovative learning and training programs while providing realistic wheelchair driving experience within a virtual environment. In line with this, we propose a user-centered design of a multisensory power wheelchair simulator. This simulator addresses classical virtual experience drawbacks such as cybersickness and sense of presence by combining 3D visual rendering, haptic feedback and motion cues. It relies on a modular and versatile workflow enabling not only easy interfacing with any virtual display, but also with any user interface such as wheelchair controllers or feedback devices. This paper presents the design of the first implementation as well as its first commissioning through pretests. The first setup achieves consistent and realistic behavior.

Is virtual reality useful for pain management in patients who undergo medical procedures?

Pain management is a complex medical issue, and many efforts have been done to develop new non-pharmacological therapies. Virtual reality is a technology apparatus that make an interaction between human and virtual environment through an hardware (usually a headset) linked to a computer or a mobile, by using a software. Additionally, this virtual setting can be adapted to any type of scenario. Thus, it is plausible that the software used should be personalized depending on patient's experiences and expectations. The use of virtual reality as a medical tool for pain relief or decrease analgesics use by promoting a cognitive distraction is a low cost and promising instrument for pain management in patients who undergo medical procedures.

VITA-an everyday virtual reality setup for prosthetics and upper-limb rehabilitation.

OBJECTIVE: Currently, there are some 95 000 people in Europe suffering from upper-limb impairment. Rehabilitation should be undertaken right after the impairment occurs and should be regularly performed thereafter. Moreover, the rehabilitation process should be tailored specifically to both patient and impairment. APPROACH: To address this, we have developed a low-cost solution that integrates an off-the-shelf virtual reality (VR) setup with our in-house developed arm/hand intent detection system. The resulting system, called VITA, enables an upper-limb disabled person to interact in a virtual world as if her impaired limb were still functional. VITA provides two specific features that we deem essential: proportionality of force control and interactivity between the user and the intent detection core. The usage of relatively cheap commercial components enables VITA to be used in rehabilitation centers, hospitals, or even at home. The applications of VITA range from rehabilitation of patients with musculodegenerative conditions (e.g. ALS), to treating phantom-limb pain of people with limb-loss and prosthetic training. MAIN RESULTS: We present a multifunctional system for upper-limb rehabilitation in VR. We tested the system using a VR implementation of a standard hand assessment tool, the Box and Block test and performed a user study on this standard test with both intact subjects and a prosthetic user. Furthermore, we present additional applications, showing the versatility of the system. SIGNIFICANCE: The VITA system shows the applicability of a combination of our experience in intent detection with state-of-the art VR system for rehabilitation purposes. With VITA, we have an easily adaptable experimental tool available, which allows us to quickly and realistically simulate all kind of real-world problems and rehabilitation exercises for upper-limb impaired patients. Additionally, other scenarios such as prostheses simulations and control modes can be quickly implemented and tested.

A Greedy Assist-as-Needed Controller for Upper Limb Rehabilitation.

Previous studies on robotic rehabilitation have shown that subjects' active participation and effort involved in rehabilitation training can promote the performance of therapies. In order to improve the voluntary effort of participants during the rehabilitation training, assist-as-needed (AAN) control strategies regulating the robotic assistance according to subjects' performance and conditions have been developed. Unfortunately, the heterogeneity of patients' motor function capability in task space is not taken into account during the implementation of these controllers. In this paper, a new scheme called greedy AAN (GAAN) controller is designed for the upper limb rehabilitation training of neurologically impaired subjects. The proposed GAAN control paradigm includes a baseline controller and a Gaussian RBF network that is utilized to model the functional capability of subjects and to provide corresponding a task challenge for them. In order to avoid subjects' slacking and encourage their active engagement, the weight vectors of RBF networks evaluating subjects' impairment level are updated based on a greedy strategy that makes the networks progressively learn the maximum forces over time provided by subjects. Simultaneously, a challenge level modification algorithm is employed to adjust the task challenge according to the task performance of subjects. Experiments on 12 subjects with neurological impairment are conducted to validate the performance and feasibility of the GAAN controller. The results show that the proposed GAAN controller has significant potential to promote the subjects' voluntary engagement during training exercises.

Brief Report: Evaluating the Utility of Varied Technological Agents to Elicit Social Attention from Children with Autism Spectrum Disorders.

Technological agents could be effective tools to be used in interventions for enhancing social orienting for some young children with ASD. We examined response to social bids in preschool children with ASD and typical development (TD) at a very early age (i.e., around 3 years) using social prompts presented by technological agents of various forms and human comparisons. Children with ASD demonstrated less response overall to social bids compared to TD controls, across agents or human. They responded more often to a simple humanoid robot and the simple avatar compared to the human. These results support the potential utilization of specific robotic and technological agents for harnessing and potentially increasing motivation to socially-relevant behaviors in some young children with ASD.

Is virtual reality useful for pain management in patients who undergo medical procedures? / A realidade virtual é útil para manejo da dor em pacientes submetidos a procedimentos médicos?

ABSTRACT Pain management is a complex medical issue, and many efforts have been done to develop new non-pharmacological therapies. Virtual reality is a technology apparatus that make an interaction between human and virtual environment through an hardware (usually a headset) linked to a computer or a mobile, by using a software. Additionally, this virtual setting can be adapted to any type of scenario. Thus, it is plausible that the software used should be personalized depending on patient's experiences and expectations. The use of virtual reality as a medical tool for pain relief or decrease analgesics use by promoting a cognitive distraction is a low cost and promising instrument for pain management in patients who undergo medical procedures.

RESUMO O manejo da dor é uma questão médica complexa, e muitos esforços têm sido feito para que novas terapias não farmacológicas sejam desenvolvidas. A realidade virtual é um aparato tecnológico que promove interação entre humanos e ambiente virtual, por meio de hardware (geralmente fones de ouvido), conectado a computador ou celular, e de software. Além disso, este ambiente virtual pode ser adaptado para qualquer tipo de cenário. Portanto, é plausível que o software utilizado seja personalizado, dependendo da experiência do paciente e de suas expectativas. O uso da realidade virtual como ferramenta médica para alívio da dor ou redução do uso de analgésicos, por meio de distração cognitiva, é um instrumento promissor e de baixo custo para manejo da dor em indivíduos submetidos a procedimentos médicos.

Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke (RHOMBUS): protocol of an intervention feasibility trial.

INTRODUCTION: Effective interventions to promote upper-limb recovery poststroke are characterised by intensive and repetitive movements. However, the repetitive nature of practice may adversely impact on adherence. Therefore, the development of rehabilitation devices that can be used safely and easily at home, and are motivating, enjoyable and affordable is essential to the health and well-being of stroke survivors.The Neurofenix platform is a non-immersive virtual reality device for poststroke upper-limb rehabilitation. The platform uses a hand controller (a NeuroBall) or arm bands (NeuroBands) that facilitate upper-limb exercise via games displayed on a tablet. The Rehabilitation via HOMe Based gaming exercise for the Upper-limb post Stroke trial aims to determine the safety, feasibility and acceptability of the Neurofenix platform for home-based rehabilitation of the upper-limb poststroke. METHODS AND ANALYSIS: Thirty people poststroke will be provided with a Neurofenix platform, consisting of a NeuroBall or NeuroBands (dependent on impairment level), seven specially designed games, a tablet and handbook to independently exercise their upper limb for 7 weeks. Training commences with a home visit from a research therapist to teach the participant how to safely use the device. Outcomes assessed at baseline and 8 weeks and 12 weeks are gross level of disability, pain, objectively measured arm function and impairment, self-reported arm function, passive range of movement, spasticity, fatigue, participation, quality of life (QOL) and health service use. A parallel process evaluation will assess feasibility, acceptability and safety of the intervention through assessment of fidelity to the intervention measured objectively through the Neurofenix platform, a postintervention questionnaire and semistructured interviews exploring participants' experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on QOL and resource use. ETHICS AND DISSEMINATION: Ethics approval granted from Brunel University London (10249-MHR-Mar/2018-12322-2). Trial results will be submitted for publication in journals, presented at national and international conferences and distributed to people with stroke. TRIAL REGISTRATION NUMBER: ISRCTN60291412; Pre-results.

0Phobia - towards a virtual cure for acrophobia: study protocol for a randomized controlled trial.

BACKGROUND: Virtual reality exposure therapy (VRET) has been shown to be as effective as traditional forms of in vivo exposure therapy for the treatment of specific phobias. However, as with in vivo exposure, VRET still involves relatively high costs and limited accessibility which makes it prohibitive for a large part of the population. Innovative methods using smartphone applications (apps) may improve accessibility and scalability of VRET. The aim of this study is to evaluate 0Phobia, a gamified self-guided VRET for acrophobia that is delivered through a smartphone app in combination with rudimentary cardboard virtual reality (VR) goggles. METHODS/DESIGN: Participants (N = 180, aged 18-65 years) with acrophobia symptoms will be recruited from the Dutch general population and randomized to either 0Phobia (n = 90) or a waitlist control condition (n = 90). 0Phobia will be delivered over a period of 3 weeks and includes psychoeducation, VR exposure, cognitive techniques, monitoring of symptoms, and relapse prevention. The primary outcome measure will be the Acrophobia Questionnaire. Secondary outcome measures will include user-friendliness, symptoms of anxiety, depression, and mastery. Assessments will take place online at baseline, directly after the intervention (post test) and at follow-up (3 months). DISCUSSION: This study capitalizes on novel technology and recent scientific advances to develop an affordable and scalable treatment modality. TRIAL REGISTRATION: Netherlands Trial Register: NTR6442 . Registered on 29 June 2017.

The effects of semi-immersive virtual reality therapy on standing balance and upright mobility function in individuals with chronic incomplete spinal cord injury: A preliminary study.

BACKGROUND: Individuals with chronic incomplete spinal cord injury (iSCI) commonly face persistent balance or mobility impairments. Virtual reality (VR) therapy is a useful rehabilitation approach; however, little is known about its effects in individuals with chronic iSCI. OBJECTIVE: To investigate the effects of semi-immersive VR therapy on standing balance and upright mobility function in individuals with chronic iSCI. METHODS: Ten subjects with chronic iSCI underwent VR therapy 30 minutes a day, 3 days a week, for 6 weeks. Limit of stability (LOS) and the Berg Balance Scale (BBS) were used to evaluate standing balance function. The Timed Up & Go (TUG) test, Activities-specific Balance Confidence (ABS) Scale, and Walking Index for Spinal Cord Injury-II (WISCI-II) were used to measure the subject's upright mobility function. Outcomes were assessed and recorded pre- and post-intervention. RESULTS: After semi-immersive VR therapy, LOS and BBS scores were significantly increased. In addition, the TUG test results increased significantly over time, while ABC scale scores and WSCI-II levels improved significantly. CONCLUSION: This study is the first to assess the effects of semi-immersive VR therapy for patients with chronic iSCI and limited functional abilities. These results indicated that semi-immersive VR therapy has a positive effect and is a useful intervention for standing balance and upright mobility function in patients with chronic iSCI.

Does motivation matter in upper-limb rehabilitation after stroke? ArmeoSenso-Reward: study protocol for a randomized controlled trial.

BACKGROUND: Fifty percent of all stroke survivors remain with functional impairments of their upper limb. While there is a need to improve the effectiveness of rehabilitative training, so far no new training approach has proven to be clearly superior to conventional therapy. As training with rewarding feedback has been shown to improve motor learning in humans, it is hypothesized that rehabilitative arm training could be enhanced by rewarding feedback. In this paper, we propose a trial protocol investigating rewards in the form of performance feedback and monetary gains as ways to improve effectiveness of rehabilitative training. METHODS: This multicentric, assessor-blinded, randomized controlled trial uses the ArmeoSenso virtual reality rehabilitation system to train 74 first-ever stroke patients (< 100 days post stroke) to lift their impaired upper limb against gravity and to improve the workspace of the paretic arm. Three sensors are attached to forearm, upper arm, and trunk to track arm movements in three-dimensional space while controlling for trunk compensation. Whole-arm movements serve as input for a therapy game. The reward group (n = 37) will train with performance feedback and contingent monetary reward. The control group (n = 37) uses the same system but without monetary reward and with reduced performance feedback. Primary outcome is the change in the hand workspace in the transversal plane. Standard clinical assessments are used as secondary outcome measures. DISCUSSION: This randomized controlled trial will be the first to directly evaluate the effect of rewarding feedback, including monetary rewards, on the recovery process of the upper limb following stroke. This could pave the way for novel types of interventions with significantly improved treatment benefits, e.g., for conditions that impair reward processing (stroke, Parkinson's disease). TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02257125 . Registered on 30 September 2014.

Influência da realidade virtual sobre a dor, fadiga, capacidade funcional e qualidade de vida na fibromialgia: estudo de caso / Influence of virtual reality on pain, fatigue, functional capacity and quality of life in fibromyalgia: a case study

Objetivo: Avaliar o efeito da Realidade Virtual (RV) associado a exercícios físicos na qualidade de vida, fadiga, níveis de dor e capacidade funcional em uma mulher com Fibromialgia (FM). Métodos: Trata-se de um estudo de caso que avaliou uma paciente com diagnóstico de FM, antes e após a intervenção com a RV associada a prática de exercícios físicos. Os instrumentos de avaliação utilizadas foram: Questionário de Impacto da Fibromialgia, Questionário de Capacidade Funcional, a Escala Visual analógica de Dor, Escala de Pensamento catastrófico sobre a dor, Escala de severidade da fadiga e avaliação do limiar de dor à pressão sobre os 18 tender points por meio de um algômetro de pressão digital. O tratamento ocorreu durante 6 semanas, com 2 sessões de tratamento por semana, totalizando 12 sessões. Resultados: O estudo proposto mostrou que o tratamento associado a RV promoveu uma melhora no impacto da FM na qualidade de vida da voluntária, uma diminuição na catastrofização da dor e uma diminuição da fadiga. Também foi possível notar uma melhora no limiar de dor a pressão em 16 tender points. Conclusão: Um programa de reabilitação para pessoas com FM que envolva a RV somado a prática de exercícios físicos contribuiu para melhora dos aspectos cognitivo e físico. A associação destas duas terapias foi benéfica, uma vez que estímulos cognitivos e a prática de uma atividade física foi capaz de promover melhora na função, na fadiga, na qualidade de vida e na percepção de dor desses

Objective: The objective of this study was to evaluate the effect of Virtual Reality (VR) associated with physical exercises on quality of life, fatigue, pain levels, and functional capacity in a woman with Fibromyalgia. Methods: This is a case report that evaluated one patient diagnosed with FM before and after the intervention with RV associated with physical exercise. The evaluation scales used were: Fibromyalgia Impact Questionnaire, Health Assessment Questionnaire, Visual Analogue Scale for Pain, Pain Catastrophizing Scale, Fatigue Severity Scale and pressure pain threshold evaluation at the 18 tender points with a digital pressure algometer. Treatment was conducted for 6 weeks, with 2 sessions per week, totaling 12 treatment sessions. Results: The study showed that treatment with VR promoted an improvement in the impact of FM in the volunteer's quality life, a decrease in catastrophic sensation of pain and a decrease in fatigue. It was also possible to notice an improvement in the pressure pain threshold at 16 tender points. Conclusion: A rehabilitation program for people with FM that involves VR combined with the practice of physical exercises contributed to the improvement of cognitive and physical aspects. The association of these two therapies was beneficial, since cognitive stimuli and the practice of a physical activity could promote improvements in function, fatigue, quality of life, and pain perception of these individuals