Positive Technology Journal

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 

Are complex psychotherapies more effective than biofeedback, progressive muscle relaxation, or both? A meta-analysis.

Psychol Rep. 2007 Feb;100(1):303-24

Authors: Stevens SE, Hynan MT, Allen M, Braun MM, McCart MR

A meta-analysis of 26 studies was conducted to assess whether more complex forms of psychotherapy would be superior to control treatments of either biofeedback, progressive muscle relaxation, or both. Consistent with hypotheses, more complex treatments provided a small, significant improvement over biofeedback and progressive muscle relaxation (r = .09). A subset of the more complex behavioral treatments accounted for most of this small incremental effectiveness of more complex treatments (r = .15). Possible sources of this incremental effectiveness are discussed.

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.

Via Medgadget

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

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.

From Medgadget

Psychologist Mark Baldwin has developed and clinically tested a new commercial software, Mindhabits, that aims to decrease stress and build self-esteem:

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.

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.

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.