Positive Technology Journal

From the MIT press release

Researchers at MIT and two Boston hospitals provide early evidence that a simple, unobtrusive wrist sensor could gauge the severity of epileptic seizures as accurately as electroencephalograms (EEGs) do — but without the ungainly scalp electrodes and electrical leads. The device could make it possible to collect clinically useful data from epilepsy patients as they go about their daily lives, rather than requiring them to come to the hospital for observation. And if early results are borne out, it could even alert patients when their seizures are severe enough that they need to seek immediate medical attention.

Rosalind Picard, a professor of media arts and sciences at MIT, and her group originally designed the sensors to gauge the emotional states of children with autism, whose outward behavior can be at odds with what they’re feeling. The sensor measures the electrical conductance of the skin, an indicator of the state of the sympathetic nervous system, which controls the human fight-or-flight response.

In a study conducted at Children’s Hospital Boston, the research team — Picard, her student Ming-Zher Poh, neurologist Tobias Loddenkemper and four colleagues from MIT, Children’s Hospital and Brigham and Women’s Hospital — discovered that the higher a patient’s skin conductance during a seizure, the longer it took for the patient’s brain to resume the neural oscillations known as brain waves, which EEG measures.

At least one clinical study has shown a correlation between the duration of brain-wave suppression after seizures and the incidence of sudden unexplained death in epilepsy (SUDEP), a condition that claims thousands of lives each year in the United States alone. With SUDEP, death can occur hours after a seizure.

Currently, patients might use a range of criteria to determine whether a seizure is severe enough to warrant immediate medical attention. One of them is duration. But during the study at Children’s Hospital, Picard says, “what we found was that this severity measure had nothing to do with the length of the seizure.” Ultimately, data from wrist sensors could provide crucial information to patients deciding whether to roll over and go back to sleep or get to the emergency room.

Read the full press release

A combined robotic and cognitive training for locomotor rehabilitation: evidences of cerebral functional reorganization in two chronic traumatic brain injured patients.

Front Hum Neurosci. 2011;5:146

Authors: Sacco K, Cauda F, D'Agata F, Duca S, Zettin M, Virgilio R, Nascimbeni A, Belforte G, Eula G, Gastaldi L, Appendino S, Geminiani G

Abstract. It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

OPTIMI is a r&d project funded by the European Commission under funded by the European Union's 7th Framework Programme "Personal Health Systems - Mental Health" .

The project has two key goals goals: a) the development of new tools to monitor coping behavior in individuals exposed to high levels of stress; b) the development of online interventions to improve this behavior and reduce the incidence of depression.

To achieve its first goal, OPTIMI will develop technology-based tools to monitor the physiological state and the cognitive, motor and verbal behavior of high risk individuals over an extended period of time and to detect changes associated with stress, poor coping and depression.  

A series of “calibration trials” will allow the project will test a broad range of technologies. These will include wearable EEG and ECG sensors to detect subjects’ physiological and cognitive state, accelerometers to characterize their physical activity, and voice analysis to detect signs of depression. These automated measurements will be complemented with electronic diaries, in which subjects report their own behaviors and the stressful situations to which they are exposed. Further, the project will use machine learning to identify patterns in the behavioral and physiological data that predict the findings from the psychologist and the corticol measurements.

Although the project's objectives are very ambitious, OPTIMI represents one of the most advanced  initiatives in the field of Positive Technology, so I am very excited to follow its progresses and see how far it can go.

The Key to Unlocking the Virtual Body: Virtual Reality in the Treatment of Obesity and Eating Disorders

Giuseppe Riva, Journal of Diabetes Science and Technology, Volume 5, Issue 2, March 2011

Obesity and eating disorders are usually considered unrelated problems with different causes. However, various studies identify unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse), induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. But how might negative body image—common to most adolescents, not only to medical patients—be behind the development of obesity and eating disorders? In this paper, I review the “allocentric lock theory” of negative body image as the possible antecedent of both obesity and eating disorders. Evidence from psychology and neuroscience indicates that our bodily experience involves the integration of different sensory inputs within two different reference frames: egocentric (first-person experience) and allocentric (third-person experience). Even though functional relations between these two frames are usually limited, they influence each other during the interaction between long- and short-term memory processes in spatial cognition. If this process is impaired either through exogenous (e.g., stress) or endogenous causes, the egocentric sensory inputs are unable to update the contents of the stored allocentric representation of the body. In other words, these patients are locked in an allocentric (observer view) negative image of their body, which their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. This article discusses the possible role of virtual reality in addressing this problem within an integrated treatment approach based on the allocentric lock theory.

June 19th to 22nd 2011 in Gatineau, Canada

This year the Interactive Media Institute (IMI) and Université du Québec en Outaouais (UQO) are organizing the 16th Annual CyberPsychology and CyberTherapy Conference (CT16), the official conference of the International Association of CyberPsychology, Training, & Rehabilitation (iACToR). The abstract submission deadline is January 15th, 2011.

To submit your abstract, register for the conference or obtain additional information, please visit the CT16 website at http://www.interactivemediainstitute.com/CT16.

Note that abstracts will be published in a regular issue of the Journal of CyberTherapy & Rehabilitation (JCR).

Outstanding features this year:

• 12 hands-on / “how to” workshops
• Two and a half day of scientific presentations
• WorldViz offering one-day seminars on Virtual Reality development.
• Presence of experts in clinical therapy and rehabilitation, cognitive sciences, neurosciences, social sciences, and computer sciences.
• Interactive Cyberarium open to the general public.
• Representatives of funding agency, policymakers, and industrial partners present on site.

Conference website: http://www.interactivemediainstitute.com/CT16

We have just released a new video introducing the INTERSTRESS project, an EU-funded initiative that aims to design, develop and test an advanced ICT-based solution for the assessment and treatment of psychological stress. The specific objectives of the project are:

• Quantitative and objective assessment of symptoms using biosensors and behavioral analysis
• Decision support for treatment planning through data fusion and detection algorithms
• Provision of warnings and motivating feedback to improve compliance and long-term outcomes

Credits: Virtual Reality Medical Institute

Scientists at the University of Arizona in Tucson have developed a new form of holographic telepresence that projects a three-dimensional, full-color, moving image without viewers needing to use 3-D glasses. While the technology could be used in TV or movies, it also could be used in telemedicine and mapping, as well as in everyday corporate meetings, the report notes. The image is recorded using an array of regular cameras, each one viewing the object from a different angle. Then, using fast-pulsed laser beams, a holographic, or three-dimensional, pixel is created. Such technology could be a “game changer” in some industries, including telemedicine, lead researcher Nasser Peyghambarian said. “Holographic telepresence means we can record a three-dimensional image in one location and show it in another location, in real-time, anywhere in the world,” he added. “Surgeons at different locations around the world can observe in 3-D, in real time, and participate in the surgical procedure.

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Potential for new technologies in clinical practice.

Curr Opin Neurol. 2010 Oct 18;

Authors: Burridge JH, Hughes AM

PURPOSE OF REVIEW: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. RECENT FINDINGS: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. SUMMARY: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.

Change in brain activity through virtual reality-based brain-machine communication in a chronic tetraplegic subject with muscular dystrophy.

BMC Neurosci. 2010 Sep 16;11(1):117

Authors: Hashimoto Y, Ushiba J, Kimura A, Liu M, Tomita Y

ABSTRACT: BACKGROUND: For severely paralyzed people, a brain-computer interface (BCI) provides a way of re-establishing communication. Although subjects with muscular dystrophy (MD) appear to be potential BCI users, the actual long-term effects of BCI use on brain activities in MD subjects have yet to be clarified. To investigate these effects, we followed BCI use by a chronic tetraplegic subject with MD over 5 months. The topographic changes in an electroencephalogram (EEG) after long-term use of the virtual reality (VR)-based BCI were also assessed. Our originally developed BCI system was used to classify an EEG recorded over the sensorimotor cortex in real time and estimate the user's motor intention (MI) in 3 different limb movements: feet, left hand, and right hand. An avatar in the internet-based VR was controlled in accordance with the results of the EEG classification by the BCI. The subject was trained to control his avatar via the BCI by strolling in the VR for 1 hour a day and then continued the same training twice a month at his home. RESULTS: After the training, the error rate of the EEG classification decreased from 40% to 28%. The subject successfully walked around in the VR using only his MI and chatted with other users through a voice-chat function embedded in the internet-based VR. With this improvement in BCI control, event-related desynchronization (ERD) following MI was significantly enhanced (p < 0.01) for feet MI (from -29% to -55%), left-hand MI (from -23% to -42%), and right-hand MI (from -22% to -51%). CONCLUSIONS: These results show that our subject with severe MD was able to learn to control his EEG signal and communicate with other users through use of VR navigation and suggest that an internet-based VR has the potential to provide paralyzed people with the opportunity for easy communication.

Using mirror visual feedback and virtual reality to treat fibromyalgia.

Med Hypotheses. 2010 Aug 5;

Authors: Ramachandran VS, Seckel EL

Fibromyalgia is a condition characterized by long term body-wide pain and tender points in joints, muscles and soft tissues. Other symptoms include chronic fatigue, morning stiffness, and depression. It is well known that these symptoms are exacerbated under periods of high stress. When pain becomes severe enough, the mind can enter what is known as a dissociative state, characterized by depersonalization - the feeling of detachment from one's physical body and the illusion of watching one's physical body from outside. In evolutionary terms, dissociative states are thought to be an adaptive mechanism to mentally distance oneself from pain, often during trauma. Similar dissociative experiences are reported by subjects who have used psychoactive drugs such as ketamine. We have previously used non-invasive mirror visual feedback to treat subjects with chronic pain from phantom limbs and suggested its use for complex regional pain syndrome: once considered intractable pain. We wondered whether such methods would work to alleviate the chronic pain of fibromyalgia. We tested mirror visual feedback on one fibromyalgia patient. On 15 trials, the patient's lower limb pain rating (on a scale from 1 to 10) decreased significantly. These preliminary results suggest that non-invasive dissociative anesthetics such as VR goggles, ketamine, and mirror visual feedback could be used to alleviate chronic pain from fibromyalgia. This would furnish us with a better understanding of the mechanism by which external visual feedback interacts with the internal physical manifestation of pain.

A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns.

Burns. 2010 Aug 6;

Authors: Schmitt YS, Hoffman HG, Blough DK, Patterson DR, Jensen MP, Soltani M, Carrougher GJ, Nakamura D, Sharar SR

This randomized, controlled, within-subjects (crossover design) study examined the effects of immersive virtual reality as an adjunctive analgesic technique for hospitalized pediatric burn inpatients undergoing painful physical therapy. Fifty-four subjects (6-19 years old) performed range-of-motion exercises under a therapist's direction for 1-5 days. During each session, subjects spent equivalent time in both the virtual reality and the control conditions (treatment order randomized and counterbalanced). Graphic rating scale scores assessing the sensory, affective, and cognitive components of pain were obtained for each treatment condition. Secondary outcomes assessed subjects' perception of the virtual reality experience and maximum range-of-motion. Results showed that on study day one, subjects reported significant decreases (27-44%) in pain ratings during virtual reality. They also reported improved affect ("fun") during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions. Maximum range-of-motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use.

Virtual reality hypnosis for pain associated with recovery from physical trauma.

Int J Clin Exp Hypn. 2010 Jul;58(3):288-300

Authors: Patterson DR, Jensen MP, Wiechman SA, Sharar SR

Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)-hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.

Therapists' Perception of Benefits and Costs of Using Virtual Reality Treatments.

Cyberpsychol Behav Soc Netw. 2010 Jun 14;

Authors: Segal R, Bhatia M, Drapeau M

Abstract Research indicates that virtual reality is effective in the treatment of many psychological difficulties and is being used more frequently. However, little is known about therapists' perception of the benefits and costs related to the use of virtual therapy in treatment delivery. In the present study, 271 therapists completed an online questionnaire that assessed their perceptions about the potential benefits and costs of using virtual reality in psychotherapy. Results indicated that therapists perceived the potential benefits as outweighing the potential costs. Therapists' self-reported knowledge of virtual reality, theoretical orientation, and interest in using virtual reality were found to be associated with perceptual measures. These findings contribute to the current knowledge of the perception of virtual reality amongst psychotherapists.

An Adaptive Display for the Treatment of Diverse Trauma PTSD Victims.

Cyberpsychol Behav. 2009 Dec 20;

Authors: Botella C, García-Palacios A, Guillen V, Baños RM, Quero S, Alcaniz M

Abstract Posttraumatic stress disorder (PTSD) can develop after exposure to a terrifying event. People who suffer from PTSD experience hyperarousal and avoidance, and they reexperience symptoms that provoke distress and impairment in significant life areas. Cognitive behavior programs, including exposure therapy, are currently the treatment of choice for PTSD. Although these programs are effective, there is room for improvement; utilization of exposure therapy by clinicians is low, and attrition rates are high. Application of new technologies, especially virtual reality (VR), could help to overcome these issues. Several VR programs that address PTSD already exist. This study presents preliminary data on the efficacy of a VR adaptive display called EMMA's World, as applied in the treatment of diverse trauma PTSD victims. This VR program is unique; its flexibility allows it to be used to treat patients who suffer from PTSD due to different kinds of traumatic events. Results support the utility of EMMA's World in the treatment of PTSD.

Virtual reality for obsessive-compulsive disorder: past and the future.

Psychiatry Investig. 2009 Sep;6(3):115-21

Authors: Kim K, Kim CH, Kim SY, Roh D, Kim SI

The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention.

Reactivity to cannabis cues in virtual reality environments.

J Psychoactive Drugs. 2009 Jun;41(2):105-12

Authors: Bordnick PS, Copp HL, Traylor A, Graap KM, Carter BL, Walton A, Ferrer M

Virtual reality (VR) cue environments have been developed and successfully tested in nicotine, cocaine, and alcohol abusers. Aims in the current article include the development and testing of a novel VR cannabis cue reactivity assessment system. It was hypothesized that subjective craving levels and attention to cannabis cues would be higher in VR environments with cannabis cues compared to VR neutral environments. Twenty nontreatment-seeking current cannabis smokers participated in the VR cue trial. During the VR cue trial, participants were exposed to four virtual environments that contained audio, visual, olfactory, and vibrotactile sensory stimuli. Two VR environments contained cannabis cues that consisted of a party room in which people were smoking cannabis and a room containing cannabis paraphernalia without people. Two VR neutral rooms without cannabis cues consisted of a digital art gallery with nature videos. Subjective craving and attention to cues were significantly higher in the VR cannabis environments compared to the VR neutral environments. These findings indicate that VR cannabis cue reactivity may offer a new technology-based method to advance addiction research and treatment.

Increased personal space of patients with schizophrenia in a virtual social environment.

Psychiatry Res. 2009 Sep 15;

Authors: Park SH, Ku J, Kim JJ, Jang HJ, Kim SY, Kim SH, Kim CH, Lee H, Kim IY, Kim SI

Virtual reality may be a good alternative method for measuring personal space and overcoming some limitations in previous studies on the social aspects of schizophrenia. Using this technology, we aimed to investigate the characteristics of personal space in patients with schizophrenia and evaluate the relationship between their social behaviors and schizophrenic symptoms. The distance from a virtual person and the angle of head orientation while talking to a virtual person in a virtual environment were measured in 30 patients with schizophrenia and 30 normal controls. It was found that patients with schizophrenia had longer distances and larger angles than did normal controls. The severity of the negative syndrome had significant inverse correlations with the distance from the angry and neutral virtual persons and with the angle of head orientation toward the happy and angry virtual persons, suggesting that negative symptoms may have a close relationship with personal space, including distancing and eye gaze. The larger personal space of patients may reflect their discomfort in close situations or cognitive deficits. Showing these profiles to patients could help them realize the amount of personal space they need.

The use of biofeedback in clinical virtual reality: the intrepid project.

Stud Health Technol Inform. 2009;144:128-32

Authors: Repetto C, Gorini A, Algeri D, Vigna C, Gaggioli A, Riva G

In our protocol for the treatment of Generalized Anxiety Disorders we use Virtual reality (VR) to facilitate emotional regulation and the relaxation process. Using a biofeedback biomonitoring system (GSR, HR, Thermal) the patient is made aware of his or her reactions through the modification of some features of the VR environment in real time. Using mental exercises the patient learns to control these physiological parameters and using the feedback provided by the virtual environment is able to gauge his or her success. To test this concept, we planned a randomized controlled trial (NCT00602212), including three groups of 15 patients each (for a total of 45 patients): (1) the VR group, (2) the non-VR group, and (3) the waiting list (WL) group.

A virtual reality-based system integrated with fmri to study neural mechanisms of action observation-execution: A proof of concept study.

Restor Neurol Neurosci. 2009;27(3):209-23

Authors: Adamovich SV, August K, Merians A, Tunik E

Purpose: Emerging evidence shows that interactive virtual environments (VEs) may be a promising tool for studying sensorimotor processes and for rehabilitation. However, the potential of VEs to recruit action observation-execution neural networks is largely unknown. For the first time, a functional MRI-compatible virtual reality system (VR) has been developed to provide a window into studying brain-behavior interactions. This system is capable of measuring the complex span of hand-finger movements and simultaneously streaming this kinematic data to control the motion of representations of human hands in virtual reality. Methods: In a blocked fMRI design, thirteen healthy subjects observed, with the intent to imitate (OTI), finger sequences performed by the virtual hand avatar seen in 1st person perspective and animated by pre-recorded kinematic data. Following this, subjects imitated the observed sequence while viewing the virtual hand avatar animated by their own movement in real-time. These blocks were interleaved with rest periods during which subjects viewed static virtual hand avatars and control trials in which the avatars were replaced with moving non-anthropomorphic objects. Results: We show three main findings. First, both observation with intent to imitate and imitation with real-time virtual avatar feedback, were associated with activation in a distributed frontoparietal network typically recruited for observation and execution of real-world actions. Second, we noted a time-variant increase in activation in the left insular cortex for observation with intent to imitate actions performed by the virtual avatar. Third, imitation with virtual avatar feedback (relative to the control condition) was associated with a localized recruitment of the angular gyrus, precuneus, and extrastriate body area, regions which are (along with insular cortex) associated with the sense of agency. Conclusions: Our data suggest that the virtual hand avatars may have served as disembodied training tools in the observation condition and as embodied "extensions" of the subject's own body (pseudo-tools) in the imitation. These data advance our understanding of the brain-behavior interactions when performing actions in VE and have implications in the development of observation- and imitation-based VR rehabilitation paradigms.

Scientists from the Universities of York and Warwick have developed the first Virtual Reality system that allows users to see, hear, smell taste and even touch. The prototype will be presented at Pioneers 09', an EPSRC showcase event to be held at London's Olympia Conference Centre on March 4

If the prototype can really do what it promises, it can have widespread applications in education, business, medical visualization and cybertherapy.