Positive Technology Journal

Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.

J Pediatr Oncol Nurs. 2007 Jan-Feb;24(1):8-19

Authors: Windich-Biermeier A, Sjoberg I, Dale JC, Eshelman D, Guzzetta CE

This study evaluates the effect of self-selected distracters (ie, bubbles, I Spy: Super Challenger book, music table, virtual reality glasses, or handheld video games) on pain, fear, and distress in 50 children and adolescents with cancer, ages 5 to 18, with port access or venipuncture. Using an intervention-comparison group design, participants were randomized to the comparison group (n = 28) to receive standard care or intervention group (n = 22) to receive distraction plus standard care. All participants rated their pain and fear, parents rated participant fear, and the nurse rated participant fear and distress at 3 points in time: before, during, and after port access or venipuncture. Results show that self-reported pain and fear were significantly correlated (P = .01) within treatment groups but not significantly different between groups. Intervention participants demonstrated significantly less fear (P <.001) and distress (P = .03) as rated by the nurse and approached significantly less fear (P = .07) as rated by the parent. All intervention parents said the needlestick was better because of the distracter. The authors conclude that distraction has the potential to reduce fear and distress during port access and venipuncture.

Smoking cues in a virtual world provoke craving in cigarette smokers.

Psychol Addict Behav. 2006 Dec;20(4):484-9

Authors: Baumann SB, Sayette MA

Twenty smoking-deprived cigarette smokers participated in a study to test the ability of smoking cues within a virtual world to provoke self-reported craving to smoke. Participants were exposed to 2 virtual-reality simulations displayed on a computer monitor: a control environment not containing any intentional smoking stimuli and a cue-exposure environment containing smoking stimuli. At various points, participants rated their urge to smoke on a scale of 0-100. Results indicated that baseline urge ratings were equivalent in both conditions, but the maximum increase in urge ratings was significantly higher in the cue-exposure environment than in the control environment. This is comparable to what in vivo studies have reported, but with the advantage of simulating more naturalistic and complex settings in a controlled environment.

Recent trends in robot-assisted therapy environments to improve real-life functional performance of affected limbs.

J Neuroengineering Rehabil. 2006 Dec 18;3(1):29

Authors: Johnson MJ

ABSTRACT: Upper and lower limb robotic tools for neuro-rehabilitation are effective in reducing motor impairment but they are limited in their ability to improve real world function. There is a need to improve functional outcomes after robot-assisted therapy. Improvements in the effectiveness of these environments may be achieved by incorporating into their design and control strategies important elements key to inducing motor learning and cerebral plasticity such as mass-practice, feedback, task-engagement, and complex problem solving. This special issue presents nine articles. The novel strategies covered in this issue encourage more natural movements through the use of virtual reality and real objects and faster motor learning through the use of error feedback to guide acquisition of natural movements that are salient to real activities. In addition, several articles describe novel systems and techniques that use of custom and commercial games combined with new low-cost robot systems and a humanoid robot to embody the supervisory presence of the therapy as possible solutions to exercise compliance in under-supervised environments such as the home.

Virtual reality training for stroke rehabilitation.

NeuroRehabilitation. 2006;21(3):245-53

Authors: Lam YS, Man DW, Tam SF, Weiss PL

Objective: To evaluate the effectiveness of a 2-D virtual reality (2DVR) programme in the training of people with stroke on how to access and use the station facilities of the Mass Transit Railway (MTR). Method: A flat-screen 2DVR based training programme and a corresponding, typical psycho-educational programme with video modelling were developed for comparison through a research design that involved a randomised control group pre-test and post-test. Results: Twenty and sixteen subjects respectively received 10 training sessions using the 2DVR strategy and a video-based psycho-educational programme. An additional 22 subjects formed the control group. They were assessed by using a behavioural checklist of MTR skills and a newly validated MTR self-efficacy scale. The subjects of both training groups showed a significant improvement in their knowledge, skills and self-efficacy in using the MTR (p<0.01), whereas, the MTR skills and self-efficacy of the control group remained stable over a four-week interval. Conclusion: Though both training programmes were effective in training the patients with stroke, they demonstrated differential improvements in MTR skills and related self-efficacy. Additional studies are recommended to identify the most effective training procedures for maintaining these skills and the best transfer ratio in the training of VR-based community living skills of people with stroke.

Visuomotor learning in immersive 3D virtual reality in Parkinson's disease and in aging.

Exp Brain Res. 2006 Dec 5;

Authors: Messier J, Adamovich S, Jack D, Hening W, Sage J, Poizner H

Successful adaptation to novel sensorimotor contexts critically depends on efficient sensory processing and integration mechanisms, particularly those required to combine visual and proprioceptive inputs. If the basal ganglia are a critical part of specialized circuits that adapt motor behavior to new sensorimotor contexts, then patients who are suffering from basal ganglia dysfunction, as in Parkinson's disease should show sensorimotor learning impairments. However, this issue has been under-explored. We tested the ability of 8 patients with Parkinson's disease (PD), off medication, ten healthy elderly subjects and ten healthy young adults to reach to a remembered 3D location presented in an immersive virtual environment. A multi-phase learning paradigm was used having four conditions: baseline, initial learning, reversal learning and aftereffect. In initial learning, the computer altered the position of a simulated arm endpoint used for movement feedback by shifting its apparent location diagonally, requiring thereby both horizontal and vertical compensations. This visual distortion forced subjects to learn new coordinations between what they saw in the virtual environment and the actual position of their limbs, which they had to derive from proprioceptive information (or efference copy). In reversal learning, the sign of the distortion was reversed. Both elderly subjects and PD patients showed learning phase-dependent difficulties. First, elderly controls were slower than young subjects when learning both dimensions of the initial biaxial discordance. However, their performance improved during reversal learning and as a result elderly and young controls showed similar adaptation rates during reversal learning. Second, in striking contrast to healthy elderly subjects, PD patients were more profoundly impaired during the reversal phase of learning. PD patients were able to learn the initial biaxial discordance but were on average slower than age-matched controls in adapting to the horizontal component of the biaxial discordance. More importantly, when the biaxial discordance was reversed, PD patients were unable to make appropriate movement corrections. Therefore, they showed significantly degraded learning indices relative to age-matched controls for both dimensions of the biaxial discordance. Together, these results suggest that the ability to adapt to a sudden biaxial visuomotor discordance applied in three-dimensional space declines in normal aging and Parkinson disease. Furthermore, the presence of learning rate differences in the PD patients relative to age-matched controls supports an important contribution of basal ganglia-related circuits in learning novel visuomotor coordinations, particularly those in which subjects must learn to adapt to sensorimotor contingencies that were reversed from those just learned.

Postural adaptation in elderly patients with instability and risk of falling after balance training using a virtual-reality system.

Int Tinnitus J. 2006;12(1):41-4

Authors: Suárez H, Suárez A, Lavinsky L

Our aim in this study was to assess postural control adaptation quantitatively in unsteady elderly patients at risk of falls in open spaces and given balance training with a virtual-reality system reproducing environmental stimulation. Using a balance rehabilitation unit based on a virtual-reality system that changes sensory information (visual, vestibular, and somatosensory), we treated 26 elderly, unsteady patients who were prone to falling (age range, 73-82 years) and who were enrolled in a customized vestibular rehabilitation program. We assessed postural responses by posturography before and after 6 weeks in the vestibular rehabilitation program under two conditions: (1) standing, eyes open, static visual field, and (2) standing, eyes open, dynamic visual field through virtual-reality goggles, generating horizontal optokinetic stimulation (70 degrees per second angular velocity). We recorded postural responses with a platform measuring the confidential ellipse of the center-of-pressure distribution area and sway velocity with a scalogram analyzing postural behavior by wavelets. After 6 weeks of treatment, postural response confidential ellipse and sway velocity values were lower, evincing decreased amplitudes and sway frequency contents in the scalogram by wavelet under both stimulation paradigm conditions. These findings suggest postural adaptation under the two perceptual conditions when patients had static and dynamic visual fields. The possibility of treating elderly fallers with balance disorders using a virtual-reality environmental stimulation reproduction system is discussed.

Visuomotor learning in immersive 3D virtual reality in Parkinson's disease and in aging.

Exp Brain Res. 2006 Dec 5;

Authors: Messier J, Adamovich S, Jack D, Hening W, Sage J, Poizner H

Successful adaptation to novel sensorimotor contexts critically depends on efficient sensory processing and integration mechanisms, particularly those required to combine visual and proprioceptive inputs. If the basal ganglia are a critical part of specialized circuits that adapt motor behavior to new sensorimotor contexts, then patients who are suffering from basal ganglia dysfunction, as in Parkinson's disease should show sensorimotor learning impairments. However, this issue has been under-explored. We tested the ability of 8 patients with Parkinson's disease (PD), off medication, ten healthy elderly subjects and ten healthy young adults to reach to a remembered 3D location presented in an immersive virtual environment. A multi-phase learning paradigm was used having four conditions: baseline, initial learning, reversal learning and aftereffect. In initial learning, the computer altered the position of a simulated arm endpoint used for movement feedback by shifting its apparent location diagonally, requiring thereby both horizontal and vertical compensations. This visual distortion forced subjects to learn new coordinations between what they saw in the virtual environment and the actual position of their limbs, which they had to derive from proprioceptive information (or efference copy). In reversal learning, the sign of the distortion was reversed. Both elderly subjects and PD patients showed learning phase-dependent difficulties. First, elderly controls were slower than young subjects when learning both dimensions of the initial biaxial discordance. However, their performance improved during reversal learning and as a result elderly and young controls showed similar adaptation rates during reversal learning. Second, in striking contrast to healthy elderly subjects, PD patients were more profoundly impaired during the reversal phase of learning. PD patients were able to learn the initial biaxial discordance but were on average slower than age-matched controls in adapting to the horizontal component of the biaxial discordance. More importantly, when the biaxial discordance was reversed, PD patients were unable to make appropriate movement corrections. Therefore, they showed significantly degraded learning indices relative to age-matched controls for both dimensions of the biaxial discordance. Together, these results suggest that the ability to adapt to a sudden biaxial visuomotor discordance applied in three-dimensional space declines in normal aging and Parkinson disease. Furthermore, the presence of learning rate differences in the PD patients relative to age-matched controls supports an important contribution of basal ganglia-related circuits in learning novel visuomotor coordinations, particularly those in which subjects must learn to adapt to sensorimotor contingencies that were reversed from those just learned.

Education about hallucinations using an internet virtual reality system: a qualitative survey.

Acad Psychiatry. 2006;30(6):534-9

Authors: Yellowlees PM, Cook JN

OBJECTIVE: The authors evaluate an Internet virtual reality technology as an education tool about the hallucinations of psychosis. METHOD: This is a pilot project using Second Life, an Internet-based virtual reality system, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients with schizophrenia. Eight hundred sixty-three self-referred users took a self-guided tour. RESULTS: Five hundred seventy-nine (69%) of the users who toured the environment completed a survey. Of the survey responders, 440 (76%) thought the environment improved their understanding of auditory hallucinations, 69% thought it improved their understanding of visual hallucinations, and 82% said they would recommend the environment to a friend. CONCLUSIONS: Computer simulations of the perceptual phenomena of psychiatric illness are feasible with existing personal computer technology. Integration of the evaluation survey into the environment itself was possible. The use of Internet-connected graphics environments holds promise for public education about mental illness.

Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain.

J Abnorm Psychol. 2006 Nov;115(4):834-41

Authors: Patterson DR, Hoffman HG, Palacios AG, Jensen MJ

The individual and combined effects of posthypnotic suggestion (PHS) and virtual reality distraction (VRD) on experimentally induced thermal pain were examined using a 2 x 2, between-groups design. After receiving baseline thermal pain, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. Consistent with the hypothesis that hypnosis and VRD work via different mechanisms, results show that posthypnotic analgesia was moderated by hypnotizability but VRD analgesia was not. The impact of PHSs for analgesia was specific to high hypnotizables, whereas VRD was effective independent of hypnotizability. Results also show a nonsignificant but predicted pattern for high hypnotizables: Audio hypnosis combined with VRD reduced worst pain 22% more and pain unpleasantness 25% more than did VRD alone. Theoretical and clinical implications are discussed. ((c) 2006 APA, all rights reserved).

Rehabilitation after Stroke using Virtual Reality, Haptics (force feedback) and Telemedicine.

Stud Health Technol Inform. 2006;124:51-56

Authors: Broeren J, Dixon M, Stibrant Sunnerhagen K, Rydmark M

We have constructed a haptic immersive workbench to be placed in the patients' home for daily adjusted rehabilitation. We also propose a system for Internet based connection and communication between patients and between patients and a clinical rehabilitation center and clinical assessment/evaluation centers. The benefits of a system for rehabilitation after stroke, based on VR, Haptics and Telemedicine should be: increased quality of life, lesser isolation, feeling more secure, fewer tiring transportations, more frequent exercising, better compliance to training, lower cost for transportation. The long term recovery for a larger group of patients with motor impairments is presently under evaluation.

Virtual reality applications for the remapping of space in neglect patients.

Restor Neurol Neurosci. 2006;24(4-6):431-41

Authors: Ansuini C, Pierno AC, Lusher D, Castiello U

Purpose: The aims of the present article were the following: (i) to provide some evidence of the potential of virtual reality (VR) for the assessment, training and recovery of hemispatial neglect; (ii) to present data from our laboratory which seem to confirm that the clinical manifestation of neglect can be improved by using VR techniques; and (iii) to ascertain the neural bases of this improvement. Methods: We used a VR device (DataGlove) interfaced with a specially designed computer program which allowed neglect patients to reach and grasp a real object while simultaneously observing the grasping of a virtual object located within a virtual environment by a virtual hand. The virtual hand was commanded in real time by their real hand. Results: After a period of training, hemispatial neglect patients coded the visual stimuli within the neglected space in an identical fashion as those presented within the preserved portions of space. However it was also found that only patients with lesions that spared the inferior parietal/superior temporal regions were able to benefit from the virtual reality training. Conclusions: It was concluded that using VR it is possible to re-create links between the affected and the nonaffected space in neglect patients. Furthermore, that specific regions may play a crucial role in the recovery of space that underlies the improvement of neglect patients when trained with virtual reality. The implications of these results for determining the neural bases of a higher order attentional and/or spatial representation, and for the treatment of patients with unilateral neglect are discussed.

A strategy for computer-assisted mental practice in stroke rehabilitation.

Neurorehabil Neural Repair. 2006 Dec;20(4):503-7

Authors: Gaggioli A, Meneghini A, Morganti F, Alcaniz M, Riva G

OBJECTIVE: To investigate the technical and clinical viability of using computer-facilitated mental practice in the rehabilitation of upper-limb hemiparesis following stroke. DESIGN: A single-case study. SETTING: Academic-affiliated rehabilitation center.Participant. A 46-year-old man with stable motor deficit of the upper right limb following subcortical ischemic stroke.Intervention. Three computer-enhanced mental practice sessions per week at the rehabilitation center, in addition to usual physical therapy. A custom-made virtual reality system equipped with arm-tracking sensors was used to guide mental practice. The system was designed to superimpose over the (unseen) paretic arm a virtual reconstruction of the movement registered from the nonparetic arm. The laboratory intervention was followed by a 1-month home-rehabilitation program, making use of a portable display device. MAIN OUTCOME MEASURES: Pretreatment and posttreatment clinical assessment measures were the upper-extremity scale of the Fugl-Meyer Assessment of Sensorimotor Impairment and the Action Research Arm Test. Performance of the affected arm was evaluated using the healthy arm as the control condition. RESULTS: The patient's paretic limb improved after the first phase of intervention, with modest increases after home rehabilitation, as indicated by functional assessment scores and sensors data. CONCLUSION: Results suggest that technology-supported mental training is a feasible and potentially effective approach for improving motor skills after stroke.

Neural internet: web surfing with brain potentials for the completely paralyzed.

Neurorehabil Neural Repair. 2006 Dec;20(4):508-15

Authors: Karim AA, Hinterberger T, Richter J, Mellinger J, Neumann N, Flor H, Kübler A, Birbaumer N

Neural Internet is a new technological advancement in brain-computer interface research, which enables locked-in patients to operate a Web browser directly with their brain potentials. Neural Internet was successfully tested with a locked-in patient diagnosed with amyotrophic lateral sclerosis rendering him the first paralyzed person to surf the Internet solely by regulating his electrical brain activity. The functioning of Neural Internet and its clinical implications for motor-impaired patients are highlighted.

Virtual reality helmet display quality influences the magnitude of virtual reality analgesia.

J Pain. 2006 Nov;7(11):843-50

Authors: Hoffman HG, Seibel EJ, Richards TL, Furness TA, Patterson DR, Sharar SR

Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). PERSPECTIVE: Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.

Via Engadget

HAL (short for Hybrid Assistive Limb) is a robotic suite designed "to expand and improve physical capabilities of human being".

The system, a brainchild of Yoshiyuki Sankai, engineering professor at Tsukuba University, is getting ready for mass production, Engadget reports. The  robotic suite could be used in applications such as "walking assistance and rehabilitation, nursing, factory work and disaster relief."  

HAL is originally developed to help elderly or disabled people walk around with their own legs and HAL-3 achieved the primary goal in 2000.

In 2005, the latest model HAL-5 was given upper body limbs as well as weight saving and more compact POWER units, longer life battery and much smaller control unit and spectacularly designed outer shells.

HAL is a robot suit which can expand and improve physical capabilities of human being. By wearing HAL-5 and you can hold up to 40 kg load by arms and can increase the maximum weight of leg press from 100 kg to 180 kg.

 

Read more at Engadget

Re-blogged from eHealth

In a new article from the Journal of Medical Internet Research, Kenneth Adler of Tuscon reports on his study of 346 patients in his practice regarding their use of online services and willingness to pay for them. Conclusion: patient's of any age would be willing to pay $10 per year for a web portal where they could view their test results and other medical information. While this may seem small, the author points out that if around 50% of patients in a large practice were willing to pay this, the program would pay for itself.  Reimbursement for email consultations or eVisits is still rare so this business model is one to consider.

Via Medgadget

BioMAP (Biological Marker of Auditory Processing) is a new, easy-to-use diagnostic tool that can quickly identify a sizeable subset of learning disabled children. Based on more than a decade of neuroscience research at Northwestern University, it is expected to become one of the most important resources for learning disabilities specialists trying to identify appropriate treatments for children with dyslexia and other language-based learning disabilities:

"Learning disabilities are believed to affect nearly one in 10 children, but their causes are difficult to pinpoint," says Nina Kraus, director of Northwestern University's Auditory Neuroscience Laboratory. Kraus and Northwestern researchers Trent Nicol and Steven Zecker have found that a third of the 1,000-plus children they have tested show a dysfunction in the way the brainstem encodes basic sounds of speech...

"The beauty of BioMAP as a diagnostic tool is that it does not require a child to follow directions or perform an assigned task," says Kraus. "Instead, it objectively measures whether a child's nervous system is able to accurately translate sounds into brain waves." If it can't, the affected child will have difficulty discriminating between speech sounds. And that difficulty at the most fundamental level complicates a wide range of learning activities, including reading and writing, Kraus finds.

Getting objective measures from BioMAP software is simple. "All a child needs to do is stay awake and sit quietly for 20 to 30 minutes," says Kraus, Northwestern's Hugh Knowles Professor of Communication Sciences, Neurobiology and Otolaryngology.

From WashingtonPost.com

Researchers at Cornell University's Weill Medical College in New York, the Cleveland Clinic in Ohio and the JFK Johnson Rehabilitation Institute in Edison, N.J., have tried deep-brain stimulation (a procedure that involves inserting tiny electrodes into the brain to stimulate specific regions) on a patient in a minimally conscious state. In previous studies, DBS has been successfully used for treating Parkinson's disease, severe pain, epilepsy, depression or obsessive-compulsive disorder.

The patient was a 38-year-old man who had suffered a severe brain injury that left him in a minimally conscious state for six years, unable to communicate or function. After an intensive four-month evaluation to assess his capabilities, surgeons at the Cleveland Clinic implanted electrodes into parts of his brain known as the thalamus, believed to be involved in helping integrate the functions of other areas.

According to the researchers, the stimulation promoted significant improvement in the man's abilities to move, communicate and function, including his abilities to eat and respond verbally. They reported that even when the stimulation is off, the patient continues to demonstrate improved "gestural and verbal communication abilities," which suggests that the stimulation may be having lasting effects on his brain. These findings were presented at a meeting of the Society for Neuroscience in Atlanta.

Head-Mounted Displays for Clinical Virtual Reality Applications: Pitfalls in Understanding User Behavior while Using Technology.

Cyberpsychol Behav. 2006 Oct;9(5):591-602

Authors: Simone LK, Schultheis MT, Rebimbas J, Millis SR

The use of virtual environments with head-mounted displays (HMDs) offers unique assets to the evaluation and therapy of clinical populations. However, research examining the effects of this technology on clinical populations is sparse. Understanding how wearers interact with the HMD is vital. Discomfort leads to altered use of the HMD that could confound performance measures; the very measures which might be used as tools for clinical decision making. The current study is a post-hoc analysis of the relationship between HMD use and HMD comfort. The analysis was conducted to examine contributing factors for a high incidence of simulator sickness observed in an HMD-based driving simulator. Pearson correlation analysis was used to evaluate objective and subjective measures of HMD performance and self-reported user comfort ratings. The results indicated weak correlations between these variables, indicating the complexity of quantifying user discomfort and HMD performance. Comparison of two case studies detailing user behavior in the virtual environment demonstrates that selected variables may not capture how individuals use the HMD. The validity and usefulness of the HMD-based virtual environments must be understood to fully reap the benefits of virtual reality (VR) in rehabilitation medicine.

From AADT 

In order to offer underserviced patients expanded access to medical and therapuetic options, an increasing number of doctors and institutions have begun to offer long-distance video therapy options. One might think that the very personal, revealing aspects of psychotherapy do not lend themselves to video or phone conferencing. In recent surveys, however, patients receiving long-distance therapy reported satisfaction levels nearly identical to those who met with therapists face-to-face.

Read the full article