Positive Technology Journal

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.

Virtual reality, telemedicine, web and data processing innovations in medical and psychiatric education and clinical care.

Acad Psychiatry. 2006;30(6):528-33

Authors: Hilty DM, Alverson DC, Alpert JE, Tong L, Sagduyu K, Boland RJ, Mostaghimi A, Leamon ML, Fidler D, Yellowlees PM

OBJECTIVE: This article highlights technology innovations in psychiatric and medical education, including applications from other fields. METHOD: The authors review the literature and poll educators and informatics faculty for novel programs relevant to psychiatric education. RESULTS: The introduction of new technologies requires skill at implementation and evaluation to assess the pros and cons. There is a significant body of literature regarding virtual reality and simulation, including assessment of outcomes, but other innovations are not well studied. CONCLUSIONS: Innovations, like other uses of technology, require collaboration between parties and integration within the educational framework of an institution.

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.

Computer- and robot-aided head surgery.

Acta Neurochir Suppl. 2006;98:51-61

Authors: Wörn H

In this paper new methods and devices for computer and robot based head surgery are presented. A computer based planning system for CMF-surgery allows the surgeon to plan complex trajectories on the head of the patient for operations where bone segments were cut out and shifted. Different registration methods have been developed and tested. A surgical robot system for bone cutting on the head has been developed and evaluated at the patient in the operating theatre. In future, laser cutting of bones with a robot will be seen as a new powerful method for robot based surgery. A 3D augmented reality system will assist the surgeon in the future by augmenting virtual anatomical structure into the situs.

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.

High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.

Eur Psychiatry. 2006 Oct;21(7):501-8

Authors: Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R

The primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory-visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use.

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.

Assessment of emotional reactivity produced by exposure to virtual environments in patients with eating disorders.

Cyberpsychol Behav. 2006 Oct;9(5):507-13

Authors: Gutiérrez-Maldonado J, Ferrer-García M, Caqueo-Urízar A, Letosa-Porta A

The aim of this study was to assess the usefulness of virtual environments representing situations that are emotionally significant to subjects with eating disorders (ED). These environments may be applied with both evaluative and therapeutic aims and in simulation procedures to carry out a range of experimental studies. This paper is part of a wider research project analyzing the influence of the situation to which subjects are exposed on their performance on body image estimation tasks. Thirty female patients with eating disorders were exposed to six virtual environments: a living-room (neutral situation), a kitchen with highcalorie food, a kitchen with low-calorie food, a restaurant with high-calorie food, a restaurant with low-calorie food, and a swimming-pool. After exposure to each environment the STAI-S (a measurement of state anxiety) and the CDB (a measurement of depression) were administered to all subjects. The results show that virtual reality instruments are particularly useful for simulating everyday situations that may provoke emotional reactions such as anxiety and depression, in patients with ED. Virtual environments in which subjects are obliged to ingest high-calorie food provoke the highest levels of state anxiety and depression.

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

Via Mindware Forum

DietMate is a hand-held computer that provides a program of weight loss, cholesterol reduction, and hypertension control. DietMate is made by Personal Improvement Computer Systems (PICS), which also makes two other tiny computerized mindgadgets: SleepKey Insomnia Treatment Hand-held Computer and the QuitKey Smoking Cessation Hand-Held Computer.

From the PICS website:

DietMate provides a sophisticated, yet easy to use, nutrition and exercise program that is tailored to each user's nutritional requirements, food preferences, and habits. By providing hundreds of nutritionally balanced menus which can be customized as desired, DietMate picks up where calorie counters leave off.

DietMate also tracks calories, fat, saturated fat, cholesterol and sodium. It provides daily nutritional targets, charts progress and even creates a shopping list. DietMate has been proven effective in both weight and cholesterol reduction, in clinical studies funded by the National Heart Lung and Blood Institute.

fMRI-compatible rehabilitation hand device

Journal of Neuroengineering and Rehabilitation (October 2006)  

Authors: Azadeh Khanicheh, Andrew Muto, Christina Triantafyllou, Brian Weinberg, Loukas Astrakas, Aria Tzika and Constantinos Mavroidis

Frequency of stuttering during challenging and supportive virtual reality job interviews.

J Fluency Disord. 2006 Sep 23;

Authors: Brundage SB, Graap K, Gibbons KF, Ferrer M, Brooks J

This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals' time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants' subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed. Educational objectives: After reading this article, the reader will be able to-(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.

Via VR Geek

The Gametrak is a real 3DOF tracker, which can be used with both hands. According to the company, the system is able to calculate the exact position in 3D space, with a spatial resolution of 1 millimetre anywhere within a 3m cube around the unit, with no processor overhead or time delay (that seems quite unrealistic to me, but if they write it...)

Strings attached to the user's hands allows the system to measure the distance and angles from the base item on the ground; these information are used to calculate the x,y, and z coordinates of the hands.

Given these features, the Gametrack system could be effectively applied in post-stroke rehabilitation of the upper limb and in other computer-based programs for neurorehabilitation. In fact, the Gametrack can be easily programmed and adapted to existing applications. Further, the cost of the device is very cheap (about 30€) if compared to other virtual rehabilitation hardware.    

If any Positive Technology reader wishes to try the system for rehabilitation purposes, we would be very interested in knowing the results  

See The Original Gametrak Promotional Video