Positive Technology Journal

The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones).

Full text paper available at: http://www.jmir.org/2014/7/e167/

A post-stroke rehabilitation system integrating robotics, VR and high-resolution EEG imaging.

IEEE Trans Neural Syst Rehabil Eng. 2013 Sep;21(5):849-59

Authors: Steinisch M, Tana MG, Comani S

Abstract
We propose a system for the neuro-motor rehabilitation of upper limbs in stroke survivors. The system is composed of a passive robotic device (Trackhold) for kinematic tracking and gravity compensation, five dedicated virtual reality (VR) applications for training of distinct movement patterns, and high-resolution EEG for synchronous monitoring of cortical activity. In contrast to active devices, the Trackhold omits actuators for increased patient safety and acceptance levels, and for reduced complexity and costs. VR applications present all relevant information for task execution as easy-to-understand graphics that do not need any written or verbal instructions. High-resolution electroencephalography (HR-EEG) is synchronized with kinematic data acquisition, allowing for the epoching of EEG signals on the basis of movement-related temporal events. Two healthy volunteers participated in a feasibility study and performed a protocol suggested for the rehabilitation of post-stroke patients. Kinematic data were analyzed by means of in-house code. Open source packages (EEGLAB, SPM, and GMAC) and in-house code were used to process the neurological data. Results from kinematic and EEG data analysis are in line with knowledge from currently available literature and theoretical predictions, and demonstrate the feasibility and potential usefulness of the proposed rehabilitation system to monitor neuro-motor recovery.

Via Mashable

Move over Google Glass and Oculus Rift, there's a new kid on the block: Glyph, a mobile, personal theater.

Glyph looks like a normal headset and operates like one, too. That is, until you move the headband down over your eyes and it becomes a fully-functional visual visor that displays movies, television shows, video games or any other media connected via the attached HDMI cable.

Using Virtual Retinal Display (VRD), a technology that mimics the way we see light, the Glyph projects images directly onto your retina using one million micromirrors in each eye piece. These micromirrors reflect the images back to the retina, producing a reportedly crisp and vivid quality.

Measuring the effects through time of the influence of visuomotor and visuotactile synchronous stimulation on a virtual body ownership illusion.

Perception. 2014;43(1):43-58

Authors: Kokkinara E, Slater M

Abstract. Previous studies have examined the experience of owning a virtual surrogate body or body part through specific combinations of cross-modal multisensory stimulation. Both visuomotor (VM) and visuotactile (VT) synchronous stimulation have been shown to be important for inducing a body ownership illusion, each tested separately or both in combination. In this study we compared the relative importance of these two cross-modal correlations, when both are provided in the same immersive virtual reality setup and the same experiment. We systematically manipulated VT and VM contingencies in order to assess their relative role and mutual interaction. Moreover, we present a new method for measuring the induced body ownership illusion through time, by recording reports of breaks in the illusion of ownership ('breaks') throughout the experimental phase. The balance of the evidence, from both questionnaires and analysis of the breaks, suggests that while VM synchronous stimulation contributes the greatest to the attainment of the illusion, a disruption of either (through asynchronous stimulation) contributes equally to the probability of a break in the illusion.

Via Neurogadget

Researchers have developed a new way to explore the human brain in virtual reality. The system, called Glass Brain, which is developed by Philip Rosedale, creator of the famous game Second Life, and Adam Gazzaley, a neuroscientist at the University of California San Francisco, combines brain scanning, brain recording and virtual reality to allow a user to journey through a person’s brain in real-time.

Read the full story on Neurogadget

Virtual reality for the assessment of frontotemporal dementia, a feasibility study.

Disabil Rehabil Assist Technol. 2014 Feb 14;

Authors: Mendez MF, Joshi A, Jimenez E

Abstract
Abstract Purpose: Behavioral variant frontotemporal dementia (bvFTD) is a non-Alzheimer dementia characterized by difficulty in documenting social-emotional changes. Few investigations have used virtual reality (VR) for documentation and rehabilitation of non-Alzheimer dementias. Methods: Five bvFTD patients underwent insight interviews while immersed in a virtual environment. They were interviewed by avatars, their answers were recorded, and their heart rates were monitored. They were asked to give ratings of their stress immediately at the beginning and at the end of the session. Results: The patients tolerated the head-mounted display and VR without nausea or disorientation, heart rate changes, or worsening stress ratings. Their insight responses were comparable to real world interviews. All bvFTD patients showed their presence in the VR environment as they moved their heads to face and respond to each avatar's questions. The bvFTD patients tended to greater verbal elaboration of answers with larger mean length of utterances compared to their real world interviews. Conclusions: VR is feasible and well-tolerated in bvFTD. These patients may have VR responses comparable to real world performance and they may display a presence in the virtual environment which could even facilitate assessment. Further research can explore the promise of VR for the evaluation and rehabilitation of dementias beyond Alzheimer's disease. Implications for Rehabilitation Clinicians need effective evaluation and rehabilitation strategies for dementia, a neurological syndrome of epidemic proportions and a leading cause of disability. Memory and cognitive deficits are the major disabilities and targets for rehabilitation in Alzheimer's disease, the most common dementia. In contrast, social and emotional disturbances are the major disabilities and targets for rehabilitation in behavioral variant frontotemporal dementia (bvFTD), an incompletely understood non-Alzheimer dementia. Virtual reality is a technology that holds great promise for the evaluation and rehabilitation of patients with bvFTD and other non-Alzheimer dementias, and preliminary evidence suggests that this technology is feasible in patients with bvFTD.

Evaluation of a virtual reality prospective memory task for use with individuals with severe traumatic brain injury.

Neuropsychol Rehabil. 2014 Feb 24;

Authors: Canty AL, Fleming J, Patterson F, Green HJ, Man D, Shum DH

Abstract
The current study aimed to evaluate the sensitivity, convergent validity and ecological validity of a newly developed virtual reality prospective memory (PM) task (i.e., the Virtual Reality Shopping Task; VRST) for use with individuals with traumatic brain injury (TBI). Thirty individuals with severe TBI and 24 uninjured adults matched on age, gender and education level were administered the VRST, a lexical decision PM task (LDPMT), an index of task-friendliness and a cognitive assessment battery. Significant others rated disruptions in the TBI participants' occupational activities, interpersonal relationships and independent living skills. The performance of the TBI group was significantly poorer than that of controls on event-based PM as measured by the LDPMT, and on time- and event-based PM as measured by the VRST. Performance on the VRST significantly predicted significant others' ratings of patients' occupational activities and independent living skills. The VRST was rated as significantly more reflective of an everyday activity, interesting and was afforded a higher recommendation than the LDPMT. For the TBI group, event and total PM performance on the VRST significantly correlated with performance on measures of mental flexibility and verbal fluency, and total PM performance correlated with verbal memory. These results provide preliminary but promising evidence of the sensitivity, as well as the convergent and ecological validity of the VRST.

Virtual Reality for Sensorimotor Rehabilitation Post-Stroke: The Promise and Current State of the Field.

Curr Phys Med Rehabil Reports. 2013 Mar;1(1):9-20

Authors: Fluet GG, Deutsch JE

Abstract
Developments over the past 2 years in virtual reality (VR) augmented sensorimotor rehabilitation of upper limb use and gait post-stroke were reviewed. Studies were included if they evaluated comparative efficacy between VR and standard of care, and or differences in VR delivery methods; and were CEBM (center for evidence based medicine) level 2 or higher. Eight upper limb and two gait studies were included and described using the following categories hardware (input and output), software (virtual task and feedback and presentation) intervention (progression and dose), and outcomes. Trends in the field were commented on, gaps in knowledge identified, and areas of future research and translation of VR to practice were suggested.

In this demo video, artist Alex McLeod shows an environment he designed for Interaxon to use at CES in 2011 interaxon.ca/CES#.

The glasses display the scene in 3D and attaches sensors read users brain-states which control elements of the scene.

3D Thought controlled environment via Interaxon from Alex McLeod on Vimeo.

Humanlike robot hands controlled by brain activity arouse illusion of ownership in operators.

Sci Rep. 2013;3:2396

Authors: Alimardani M, Nishio S, Ishiguro H

Abstract
Operators of a pair of robotic hands report ownership for those hands when they hold image of a grasp motion and watch the robot perform it. We present a novel body ownership illusion that is induced by merely watching and controlling robot's motions through a brain machine interface. In past studies, body ownership illusions were induced by correlation of such sensory inputs as vision, touch and proprioception. However, in the presented illusion none of the mentioned sensations are integrated except vision. Our results show that during BMI-operation of robotic hands, the interaction between motor commands and visual feedback of the intended motions is adequate to incorporate the non-body limbs into one's own body. Our discussion focuses on the role of proprioceptive information in the mechanism of agency-driven illusions. We believe that our findings will contribute to improvement of tele-presence systems in which operators incorporate BMI-operated robots into their body representations.

A high-fidelity virtual environment for the study of paranoia.

Schizophr Res Treatment. 2013;2013:538185

Authors: Broome MR, Zányi E, Hamborg T, Selmanovic E, Czanner S, Birchwood M, Chalmers A, Singh SP

Abstract. Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR) environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n = 32) entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.

Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: A pilot randomized controlled trial.

NeuroRehabilitation. 2014 Jan 28;

Authors: Viana RT, Laurentino GE, Souza RJ, Fonseca JB, Silva Filho EM, Dias SN, Teixeira-Salmela LF, Monte-Silva KK

Abstract. BACKGROUND: Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies.
OBJECTIVE: This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals.
METHODS: Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data.
RESULTS: Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID.
CONCLUSIONS: These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.

The importance of synchrony and temporal order of visual and tactile input for illusory limb ownership experiences - an FMRI study applying virtual reality.

PLoS One. 2014;9(1):e87013

Authors: Bekrater-Bodmann R, Foell J, Diers M, Kamping S, Rance M, Kirsch P, Trojan J, Fuchs X, Bach F, Cakmak HK, Maaß H, Flor H

Abstract. In the so-called rubber hand illusion, synchronous visuotactile stimulation of a visible rubber hand together with one's own hidden hand elicits ownership experiences for the artificial limb. Recently, advanced virtual reality setups were developed to induce a virtual hand illusion (VHI). Here, we present functional imaging data from a sample of 25 healthy participants using a new device to induce the VHI in the environment of a magnetic resonance imaging (MRI) system. In order to evaluate the neuronal robustness of the illusion, we varied the degree of synchrony between visual and tactile events in five steps: in two conditions, the tactile stimulation was applied prior to visual stimulation (asynchrony of -300 ms or -600 ms), whereas in another two conditions, the tactile stimulation was applied after visual stimulation (asynchrony of +300 ms or +600 ms). In the fifth condition, tactile and visual stimulation was applied synchronously. On a subjective level, the VHI was successfully induced by synchronous visuotactile stimulation. Asynchronies between visual and tactile input of ±300 ms did not significantly diminish the vividness of illusion, whereas asynchronies of ±600 ms did. The temporal order of visual and tactile stimulation had no effect on VHI vividness. Conjunction analyses of functional MRI data across all conditions revealed significant activation in bilateral ventral premotor cortex (PMv). Further characteristic activation patterns included bilateral activity in the motion-sensitive medial superior temporal area as well as in the bilateral Rolandic operculum, suggesting their involvement in the processing of bodily awareness through the integration of visual and tactile events. A comparison of the VHI-inducing conditions with asynchronous control conditions of ±600 ms yielded significant PMv activity only contralateral to the stimulation site. These results underline the temporal limits of the induction of limb ownership related to multisensory body-related input.

Activation of the human mirror neuron system during the observation of the manipulation of virtual tools in the absence of a visible effector limb.

Neurosci Lett. 2013 Oct 25;555:220-4

Authors: Modroño C, Navarrete G, Rodríguez-Hernández AF, González-Mora JL

Abstract. This work explores the mirror neuron system activity produced by the observation of virtual tool manipulations in the absence of a visible effector limb. Functional MRI data was obtained from healthy right-handed participants who manipulated a virtual paddle in the context of a digital game and watched replays of their actions. The results show how action observation produced extended bilateral activations in the parietofrontal mirror neuron system. At the same time, three regions in the left hemisphere (in the primary motor and the primary somatosensory cortex, the supplementary motor area and the dorsolateral prefrontal cortex) showed a reduced BOLD, possibly related with the prevention of inappropriate motor execution. These results can be of interest for researchers and developers working in the field of action observation neurorehabilitation.

The Intel® Core™ i7-based MemoryMirror takes the clothes shopping experience to a whole different level, allowing shoppers to try on multiple outfits, then virtually view and compare previous choices on the mirror itself using intuitive hand gestures. Users control all their data and can remain anonymous to the retailer if they so choose. The Memory Mirror uses Intel integrated graphics technology to create avatars of the shopper wearing various clothing that can be shared with friends to solicit feedback or viewed instantly to make an immediate in-store purchase. Shoppers can also save their looks in mobile app should they decide to purchase at a later time online.

Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review.

Miller KJ, Adair BS, Pearce AJ, Said CM, Ozanne E, Morris MM. Age Ageing. 2013 Dec 17. [Epub ahead of print]

BACKGROUND: use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. OBJECTIVE: to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. METHODS: a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. RESULTS: fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. CONCLUSIONS: existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.

Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review.

Age Ageing. 2013 Dec 17; Authors: Miller KJ, Adair BS, Pearce AJ, Said CM, Ozanne E, Morris MM

BACKGROUND: use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity. OBJECTIVE: to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation. METHODS: a systematic review searching 12 electronic databases from 1 January 2000-10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality. RESULTS: fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported. CONCLUSIONS: existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.