In this paper, the current "state of the art" for virtual reality (VR) applications in the field of motor rehabilitation is reviewed. The paper begins with a brief overview of available equipment options. Next, a discussion of the scientific rationale for use of VR in motor rehabilitation is provided. Finally, the major portion of the paper describes the various VR systems that have been developed for use with patients, and the results of clinical studies reported to date in the literature. Areas covered include stroke rehabilitation (upper and lower extremity training, spatial and perceptual-motor training), acquired brain injury, Parkinson's disease, orthopedic rehabilitation, balance training, wheelchair mobility and functional activities of daily living training, and the newly developing field of telerehabilitation. Four major findings emerge from these studies: (1) people with disabilities appear capable of motor learning within virtual environments; (2) movements learned by people with disabilities in VR transfer to real world equivalent motor tasks in most cases, and in some cases even generalize to other untrained tasks; (3) in the few studies (n = 5) that have compared motor learning in real versus virtual environments, some advantage for VR training has been found in all cases; and (4) no occurrences of cybersickness in impaired populations have been reported to date in experiments where VR has been used to train motor abilities.

/pdf/virtual-environments-for-motor-rehabilitation-review-2vvfh2eumw.pdf

Virtual environments for motor rehabilitation: review.

The use of virtual-reality technology in the areas of rehabilitation and therapy continues to grow, with encouraging results being reported for applications that address human physical, cognitive, and psychological functioning. This article presents a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis for the field of VR rehabilitation and therapy. The SWOT analysis is a commonly employed framework in the business world for analyzing the factors that influence a company's competitive position in the marketplace with an eye to the future. However, the SWOT framework can also be usefully applied outside of the pure business domain. A quick check on the Internet will turn up SWOT analyses for urban-renewal projects, career planning, website design, youth sports programs, and evaluation of academic research centers, and it becomes obvious that it can be usefully applied to assess and guide any organized human endeavor designed to accomplish a mission. It is hoped that this structured examination of the factors relevant to the current and future status of VR rehabilitation will provide a good overview of the key issues and concerns that are relevant for understanding and advancing this vital application area.

/pdf/a-swot-analysis-of-the-field-of-virtual-reality-3q1uid6pyq.pdf

A SWOT analysis of the field of virtual reality rehabilitation and therapy

Virtual Reality (VR) provides a unique medium suited to the achievement of several requirements for effective rehabilitation intervention. Specifically, therapy can be provided within a functional, purposeful and motivating context. Many VR applications present opportunities for individuals to participate in experiences, which are engaging and rewarding. In addition to the value of the rehabilitation experience for the user, both therapists and users benefit from the ability to readily grade and document the therapeutic intervention using various systems. In VR, advanced technologies are used to produce simulated, interactive and multi-dimensional environments. Visual interfaces including desktop monitors and head-mounted displays (HMDs), haptic interfaces, and real-time motion tracking devices are used to create environments allowing users to interact with images and virtual objects in real-time through multiple sensory modalities. Opportunities for object manipulation and body movement through virtual space provide frameworks that, in varying degrees, are perceived as comparable to similar opportunities in the real world. This paper reviews current work on motor rehabilitation using virtual environments and virtual reality and where possible, compares outcomes with those achieved in real-world applications.

/pdf/motor-rehabilitation-using-virtual-reality-3ejfuoo7te.pdf

Motor rehabilitation using virtual reality.

This paper posits the usefulness of mental shifts of scale and perspective in thinking and communicating about spatial relations, and describes two experimental techniques for researching such cognitive activities. The first example involves mentally expanding a hand-sized piece of entangled string, a knot, so that following a portion of the string into a crossing resembles the act of walking along a path and over a bridge. The second example involves transforming experience and conceptions of the large-scale environment to small-scale representations through the act of mapmaking, and then translating the map to depictions of street-level views. When used in the context of clinical research methodologies, these techniques can help to elicit multimodal expressions of conceived topological relationships and geographical detail, with particular attention to individual differences.

Spatial Cognition II

Within psychology, at least two research communities study spatial cognition. One community studies systematic errors in spatial memory and judgement, accounting for them as a consequence of and clue to normal perceptual and cognitive processing. The other community studies navigation in real space, isolating the contributions of various sensory cues and sensorimotor systems to successful navigation. The former group emphasizes error, the latter, selective mechanisms, environmental or evolutionary, that produce fine-tuned correct responses. How can these approaches be reconciled and integrated? First, by showing why errors are impervious to selective pressures. The schematization that leads to errors is a natural consequence of normal perceptual and cognitive processes; it is inherent to the construction of mental spaces and to using them to make judgments in limited capacity working memory. Selection can act on particular instances of errors, yet it is not clear that selection can act on the general mechanisms that produce them. Next, in the wild, there are a variety of correctives. Finally, closer examination of navigation in the wild shows systematic errors, for example, over-shooting in dead reckoning across species. Here, too, environments may provide correctives, specifically, landmarks. General cognitive mechanisms generate general solutions. The errors inevitably produced may be reduced by local specific sensori-motor couplings as well as local environmental cues. Navigation, and other behaviors as well, are a consequence of both. 1 Two Research Communities in Psychology Yes, the title evokes the mind-body problem. However one regards the venerable monumental mind-body problem in philosophy, there is a contemporary minor mindbody problem in the psychological research on spatial cognition. While the major 1 I am grateful to Christian Freksa for helpful comments and encouragement and to two anonymous reviewers for critiques of an earlier version of this manuscript. Preparation of the manuscript was supported by Office of Naval Research, Grants Number NOOO14-PP-1O649 and N000140110717 to Stanford University.

Spatial Cognition III

Virtual environments (VEs) are extensively used in training but there have been few rigorous scientific investigations of whether and how skills learned in a VE are transferred to the real world. This research aimed to measure and evaluate what is transferring from training a simple sensorimotor task in a VE to real world performance. In experiment 1, real world performances after virtual training, real training and no training were compared. Virtual and real training resulted in equivalent levels of post-training performance, both of which significantly exceeded task performance without training. Experiments 2 and 3 investigated whether virtual and real trained real world performances differed in their susceptibility to cognitive and motor interfering tasks (experiment 2) and in terms of spare attentional capacity to respond to stimuli and instructions which were not directly related to the task (experiment 3). The only significant difference found was that real task performance after training in a VE was less affected by concurrently performed interference tasks than was real task performance after training on the real task. This finding is discussed in terms of the cognitive load characteristics of virtual training. Virtual training therefore resulted in equivalent or even better real world performance than real training in this simple sensorimotor task, but this finding may not apply to other training tasks. Future research should be directed towards establishing a comprehensive knowledge of what is being transferred to real world performance in other tasks currently being trained in VEs and investigating the equivalence of virtual and real trained performances in these situations.

Training in virtual environments: transfer to real world tasks and equivalence to real task training.

Traumatic brain injury (TBI) is the leading cause of death and permanent disability in children and adolescents. Although cognitive and behavioural effects have now been reported for all degrees of TBI severity in children, other aspects of functioning which might be related (such as psychosocial adjustment), have been neglected. In the present study the social and behavioural effects of TBI were assessed by comparing 27 TBI children with 27 controls. TBI children demonstrated significantly lower levels of self-esteem and adaptive behaviour, and higher levels of loneliness, maladaptive behaviour and aggressive/antisocial behaviour. These findings confirm the previously demonstrated detrimental effects of TBI on children's behavioural functioning and offer new evidence for the detrimental effects of TBI on children's social functioning.

Social and behavioural effects of traumatic brain injury in children

Two experiments investigated differences between active and passive participation in a computer-generated virtual environment in terms of spatial memory, object memory, and object location memory. It was found that active participants, who controlled their movements in the virtual environment using a joystick, recalled the spatial layout of the virtual environment better than passive participants, who merely watched the active participants' progress. Conversely, there were no significant differences between the active and passive participants' recall or recognition of the virtual objects, nor in their recall of the correct locations of objects in the virtual environment. These findings are discussed in terms of subject-performed task research and the specificity of memory enhancement in virtual environments.

The specificity of memory enhancement during interaction with a virtual environment.

The need for improved neurological rehabilitation strategies is self-evident. Recent developments in the computer technology of virtual reality hold the promise of exciting progress in this area. In this paper four areas of potential application of virtual reality to neurological rehabilitation are reviewed.

Virtual reality: an assistive technology in neurological rehabilitation.

There is a dearth of empirical evidence about prospective memory (remembering to perform actions in the future) in stroke patients. A probable reason for this is that it is difficult to perform a realistic and controlled assessment of prospective memory ability in a rehabilitation setting. Virtual reality may provide a solution to this difficulty by allowing prospective memory to be tested in a simulation of a real-life situation whilst retaining a laboratory level of scientific control. This exploratory study assessed the performance of stroke patients and age-matched control participants on event-, time- and activity-based prospective memory retrieval tasks in a personal computer-based virtual environment. Stroke patients were severely impaired at the event- and activity-based tasks compared with age-matched controls, but only marginally impaired at the time-based task. The additional knowledge gained from this form of assessment could direct rehabilitation more effectively towards specific impairments of individual patients.

F D Rose

Papers

Training in virtual environments: transfer to real world tasks and equivalence to real task training.

Social and behavioural effects of traumatic brain injury in children

The specificity of memory enhancement during interaction with a virtual environment.

Virtual reality: an assistive technology in neurological rehabilitation.

Assessing stroke patients' prospective memory using virtual reality