Positive Technology Journal

Use of Virtual Reality Distraction to Reduce Claustrophobia Symptoms during a Mock Magnetic Resonance Imaging Brain Scan: A Case Report.

Cyberpsychol Behav. 2007 Jun;10(3):485-8

Authors: Garcia-Palacios A, Hoffman HG, Richards TR, Seibel EJ, Sharar SR

The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.

a little self-promotion... ;-)

last week we presented NeuroVR, an open-source virtual reality software platform for clinical and neuroscience applications, to the Congressional Modeling & Simulation Caucus , during the CyberTherapy Reception.

The Reception was held on Wednesday, June 13 from 5-7 pm in the foyer of the Rayburn House Office Building, Washington, DC, USA.

read the full news release

Introduction to the special issue from the proceedings of the 2006 International Workshop on Virtual Reality in Rehabilitation.

J Neuroengineering Rehabil. 2007 Jun 6;4(1):18

Authors: Keshner EA, Weiss PT

ABSTRACT: New technologies are rapidly having a great impact on the development of novel rehabilitation interventions. One of the more popular of these technological advances is virtual reality. The wide range of applications of this technology, from immersive environments to tele-rehabilitation equipment and care, lends versatility to its use as a rehabilitation intervention. But increasing access to this technology requires that we further our understanding about its impact on a performer. The International Workshop on Virtual Reality in Rehabilitation (IWVR), now known as Virtual Rehabilitation 2007, is a conference that emerged from the need to discover how virtual reality could be applied to rehabilitation practice. Individuals from multiple disciplines concerned with the development, transmission, and evaluation of virtual reality as a technology applied to rehabilitation attend this meeting to share their work. In this special issue of the Journal of NeuroEngineering and Rehabilitation we are sharing some of the papers presented at the 2006 meeting of IWVR with the objective of offering a description of the state of the art in this research field. A perusal of these papers will provide a good cross-section of the emerging work in this area as well as inform the reader about new findings relevant to research and practice in rehabilitation.

http://www.jneuroengrehab.com/content/4/1/18 

Virtual reality exposure therapy for anxiety disorders: A meta-analysis.

J Anxiety Disord. 2007 Apr 27;

Authors: Powers MB, Emmelkamp PM

There is now a substantial literature investigating virtual reality exposure therapy (VRET) as a viable treatment option for anxiety disorders. In this meta-analysis we provide effect size estimates for virtual reality treatment in comparison to in vivo exposure and control conditions (waitlist, attention control, etc.). A comprehensive search of the literature identified 13 studies (n=397) that were included in the final analyses. Consistent with prediction the primary random effects analysis showed a large mean effect size for VRET compared to control conditions, Cohen's d=1.11 (S.E.=0.15, 95% CI: 0.82-1.39). This finding was consistent across secondary outcome categories as well (domain-specific, general subjective distress, cognition, behavior, and psychophysiology). Also as expected in vivo treatment was not significantly more effective than VRET. In fact, there was a small effect size favoring VRET over in vivo conditions, Cohen's d=0.35 (S.E.=0.15, 95% CI: 0.05-0.65). There was a trend for a dose-response relationship with more VRET sessions showing larger effects (p=0.06). Outcome was not related to publication year or sample size. Implications are discussed.

Via Medgadget 

Researchers at Technion Institute of Technology in Israel have developed a wearable virtual reality that  device to provide patients suffering from balance disorders with supplemental auditory and visual information to restore normal gait. 

From the press release 

From KurzweilAI.net

Researchers at Johns Hopkins University Applied Physics Laboratory has developed a prototype of the first fully integrated prosthetic arm that can be controlled naturally, provide sensory feedback, and allow for eight degrees of freedom

Link

Graphical tactile displays for visually-impaired people.

IEEE Trans Neural Syst Rehabil Eng. 2007 Mar;15(1):119-30

Authors: Vidal-Verdú F, Hafez M

New technologies and concepts for rehabilitation in the acute phase of stroke: a collaborative matrix.

Neurodegener Dis. 2007;4(1):57-69

Authors: Siekierka EM, Eng K, Bassetti C, Blickenstorfer A, Cameirao MS, Dietz V, Duff A, Erol F, Ettlin T, Hermann DM, Keller T, Keisker B, Kesselring J, Kleiser R, Kollias S, Kool JP, Kurre A, Mangold S, Nef T, Pyk P, Riener R, Schuster C, Tosi F, Verschure PF, Zimmerli L

The process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation - functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use. Copyright (c) 2007 S. Karger AG, Basel.

Virtual reality in mental health: A review of the literature.

Soc Psychiatry Psychiatr Epidemiol. 2007 Mar 12;

Authors: Gregg L, Tarrier N

BACKGROUND: Several virtual reality (VR) applications for the understanding, assessment and treatment of mental health problems have been developed in the last 10 years. The purpose of this review is to outline the current state of virtual reality research in the treatment of mental health problems. METHODS: PubMed and PsycINFO were searched for all articles containing the words "virtual reality". In addition a manual search of the references contained in the papers resulting from this search was conducted and relevant periodicals were searched. Studies reporting the results of treatment utilizing VR in the mental health field and involving at least one patient were identified. RESULTS: More than 50 studies using VR were identified, the majority of which were case studies. Seventeen employed a between groups design: 4 involved patients with fear of flying; 3 involved patients with fear of heights; 3 involved patients with social phobia/public speaking anxiety; 2 involved people with spider phobia; 2 involved patients with agoraphobia; 2 involved patients with body image disturbance and 1 involved obese patients. There are both advantages in terms of delivery and disadvantages in terms of side effects to using VR. Although virtual reality based therapy appears to be superior to no treatment the effectiveness of VR therapy over traditional therapeutic approaches is not supported by the research currently available. CONCLUSIONS: There is a lack of good quality research on the effectiveness of VR therapy. Before clinicians will be able to make effective use of this emerging technology greater emphasis must be placed on controlled trials with clinically identified populations.

Via Medgadget

From the Press Release: InfraScan Announces First Patients Enroll in Clinical Trial in Brain Hematoma Detection (PDF)

The application of eye-tracking technology in the study of autism.

J Physiol. 2007 Apr 12;

Authors: Boraston ZL, Blakemore SJ

For over three decades, eye-tracking has been used to investigate looking behaviour in the normal population. Recent studies have extended its use to individuals with disorders on the autism spectrum. Such studies typically focus on the processing of socially salient stimuli. In this review, we discuss the potential for this technique to reveal the strategies adopted by individuals with high-functioning autism when processing social information. We suggest that eye-tracking techniques have the potential to offer insight into the downstream difficulties in everyday social interaction which such individuals experience.

Socially assistive robotics for post-stroke rehabilitation

By Maja J Mataric', Jon Eriksson, David J Feil-Seifer and Carolee J Winstein, Journal of NeuroEngineering and Rehabilitation

Background: Although there is a great deal of success in rehabilitative robotics applied to patient recovery post-stoke, most of the rehabilitation research to date has dealt with providing physical assistance. However, new studies support the theory that not all therapy need be hands-on. We describe a new area, called socially assistive robotics, that focuses on non-contact patient/user assistance. We demonstrate the approach with an implemented and tested post-stroke recovery robot and discuss its potential for effectiveness. Results: We describe a pilot study involving an autonomous assistive mobile robot that aids stoke patient rehabilitation by providing monitoring, encouragement, and reminders. The robot navigates autonomously, monitors the patient's arm activity, and helps the patient remember to follow a rehabilitation program. We also show preliminary results from a follow-up study that studied the role of robot physical embodiment in a rehabilitation context. Conclusions: Future experimental design and factors that will be considered in order to develop effective socially assistive post-stroke rehabilitation robot are outlined and discussed.

Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training.

Cyberpsychol Behav. 2007 Feb;10(1):16-23

Authors: Bisson E, Contant B, Sveistrup H, Lajoie Y

Fear of flying treatment methods: virtual reality exposure vs. cognitive behavioral therapy.

Aviat Space Environ Med. 2007 Feb;78(2):121-8

Authors: Krijn M, Emmelkamp PM, Olafsson RP, Bouwman M, van Gerwen LJ, Spinhoven P, Schuemie MJ, van der Mast CA

INTRODUCTION: Fear of flying (FOF) can be a serious problem for individuals who develop this condition and for military and civilian organizations that operate aircraft. The aim of this study was to compare the effectiveness of three treatments: bibliotherapy (BIB) without therapist contact; individualized virtual reality exposure therapy (VRE); and cognitive behavior therapy (CB). In addition, we evaluated the effect of following up VRE and CB with 2 d of group cognitive-behavioral training (GrCB). METHODS: There were 86 subjects suffering from FOF who entered the study; 19 BIB, 29 VRE, and 16 CB subjects completed the treatment protocols. The BIB subjects were then treated with VRE (n = 7) or CB (n = 12). There were 59 subjects who were then trained with GrCB. RESULTS: Treatment with VRE or CB was more effective than BIB. Both VRE and CB showed a decline in FOF on the two main outcome measures. There was no statistically significant difference between those two therapies. However, effect sizes were lower for VRE (small to moderate) than for CB (moderate) and the addition of GrCB had less effect for VRE than for CB. DISCUSSION: VRE holds promise as treatment for FOF, but in this trial CB followed by GrCB showed the largest decrease in subjective anxiety. The results suggest that future research should focus on comparing the effectiveness of VRE vs. VRE plus cognitive techniques or measure the effectiveness of each component of treatment. Moreover, the effectiveness of the GrCB as stand-alone treatment should be investigated, which might even be superior in cost-effectiveness.

Assessment and training in a 3-dimensional virtual environment with haptics: a report on 5 cases of motor rehabilitation in the chronic stage after stroke.

Neurorehabil Neural Repair. 2007 Jun;21(2):180-9

Authors: Broeren J, Rydmark M, Björkdahl A, Sunnerhagen KS

Virtual Reality Exposure Therapy for PTSD Symptoms After a Road Accident: An Uncontrolled Case Series.

Behav Ther. 2007 Mar;38(1):39-48

Authors: Beck JG, Palyo SA, Winer EH, Schwagler BE, Ang EJ

This report examined whether Virtual Reality Exposure Therapy (VRET) could be used in the treatment of posttraumatic stress disorder (PTSD) symptoms in the aftermath of a serious motor vehicle accident. Six individuals reporting either full or severe subsyndromal PTSD completed 10 sessions of VRET, which was conducted using software designed to create real-time driving scenarios. Results indicated significant reductions in posttrauma symptoms involving reexperiencing, avoidance, and emotional numbing, with effect sizes ranging from d=.79 to d=1.49. Indices of clinically significant and reliable change suggested that the magnitude of these changes was meaningful. Additionally, high levels of perceived reality ("presence") within the virtual driving situation were reported, and patients reported satisfaction with treatment. Results are discussed in light of the possibility for VRET to be useful in guiding exposure in the treatment of PTSD following road accidents.

Diagnosis and rehabilitation of patients with hemispatial neglect using virtual reality technology.

Conf Proc IEEE Eng Med Biol Soc. 2004;7:4908-11

Authors: Baheux K, Yoshikawa M, Tanaka A, Seki K, Handa Y

Our objective is to develop and test a system for diagnosis and rehabilitation of patients with hemispatial neglect. The system consists of a 3D-haptic virtual world seen through stereo shutter-glasses. Patients interact by manipulating a haptic interface. The software adapts the virtual world accordingly to haptic interface and eye tracking feedback. Offline analysis is possible by reviewing recorded data. Observations made during experimentations with hemiplegics patients and future works with hemispatial neglect patients are discussed.

Evaluation of an Internet virtual world chat room for adolescent smoking cessation.

Addict Behav. 2006 Dec 19;

Authors: Woodruff SI, Conway TL, Edwards CC, Elliott SP, Crittenden J

The goal of this longitudinal study was to test an innovative approach to smoking cessation that might be particularly attractive to adolescent smokers. The study was a participatory research effort between academic and school partners. The intervention used an Internet-based, virtual reality world combined with motivational interviewing conducted in real-time by a smoking cessation counselor. Participants were 136 adolescent smokers recruited from high schools randomized to the intervention or a measurement-only control condition. Those who participated in the program were significantly more likely than controls to report at the immediate post-intervention assessment that they had abstained from smoking during the past week (p</=.01), smoked fewer days in the past week (p</=.001), smoked fewer cigarettes in the past week (p</=.01), and considered themselves a former smoke (p</=.05). Only the number of times quit was statistically significant at a one-year follow-up assessment (p</=.05). The lack of longer-term results is discussed, as are methodological challenges in conducting a cluster-randomized smoking cessation study.

Robotics and virtual reality: a perfect marriage for motor control research and rehabilitation.

Assist Technol. 2006;18(2):181-95

Authors: Patton J, Dawe G, Scharver C, Mussa-Ivaldi F, Kenyon R

This article's goal is to outline the motivations, progress, and future objectives for the development of a state-of-the-art device that allows humans to visualize and feel synthetic objects superimposed on the physical world. The programming flexibility of these devices allows for a variety of scientific questions to be answered in psychology, neurophysiology, rehabilitation, haptics, and automatic control. The benefits are most probable in rehabilitation of brain-injured patients, for whom the costs are high, therapist time is limited, and repetitive practice of movements has been shown to be beneficial. Moreover, beyond simple therapy that guides, strengthens, or stretches, the technology affords a variety of exciting potential techniques that can combine our knowledge of the nervous system with the tireless, precise, and swift capabilities of a robot. Because this is a prototype, the system will also guide new experimental methods by probing the levels of quality that are necessary for future design cycles and related technology. Very important to the project is the early and intimate involvement of therapists and other clinicians in the design of software and its user interface. Inevitably, it should also lead the way to new modes of practice and to the commercialization of haptic/graphic systems.

Critical illness VR rehabilitation device (X-VR-D): Evaluation of the potential use for early clinical rehabilitation.

J Electromyogr Kinesiol. 2007 Jan 11;

Authors: Van de Meent H, Baken BC, Van Opstal S, Hogendoorn P

We present a new critical illness VR rehabilitation device (X-VR-D) that enables diversified self-training and is applicable early in the rehabilitation of severely injured or ill patients. The X-VR-D consists of a VR program delivering a virtual scene on a flat screen and simultaneously processing commands to a moving chair mounted on a motion system. Sitting in the moving chair and exposed to a virtual reality environment the device evokes anticipatory and reactive muscle contractions in trunk and extremities for postural control. In this study we tested the device in 10 healthy subjects to evaluate whether the enforced perturbations indeed evoke sufficient and reproducible EMG muscle activations. We found that particular fast roll and pitch movements evoke adequate trunk and leg muscle activity. Higher angular velocities and higher angles of inclination elicited broader EMG bursts and larger amplitudes. The muscle activation pattern was highly consistent between different subjects and although we found some habituation of EMG responses in consecutive training sessions, the general pattern was maintained and was predictable for specific movements. The habituation was characterized by more efficient muscle contractions and better muscle relaxation during the rest positions of the device. Furthermore we found that the addition of a virtual environment to the training session evoked more preparatory and anticipatory muscle activation than sessions without a virtual environment. We conclude that the X-VR-D is safe and effective to elicit consistent and reproducible muscle activity in trunk and leg muscles in healthy subjects and thus can be used as a training method.