Positive Technology Journal

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.

Neurocognitive systems related to real-world prospective memory.

PLoS One. 2010;5(10):

Authors: Kalpouzos G, Eriksson J, Sjölie D, Molin J, Nyberg L

BACKGROUND: Prospective memory (PM) denotes the ability to remember to perform actions in the future. It has been argued that standard laboratory paradigms fail to capture core aspects of PM. METHODOLOGY/PRINCIPAL FINDINGS: We combined functional MRI, virtual reality, eye-tracking and verbal reports to explore the dynamic allocation of neurocognitive processes during a naturalistic PM task where individuals performed errands in a realistic model of their residential town. Based on eye movement data and verbal reports, we modeled PM as an iterative loop of five sustained and transient phases: intention maintenance before target detection (TD), TD, intention maintenance after TD, action, and switching, the latter representing the activation of a new intention in mind. The fMRI analyses revealed continuous engagement of a top-down fronto-parietal network throughout the entire task, likely subserving goal maintenance in mind. In addition, a shift was observed from a perceptual (occipital) system while searching for places to go, to a mnemonic (temporo-parietal, fronto-hippocampal) system for remembering what actions to perform after TD. Updating of the top-down fronto-parietal network occurred at both TD and switching, the latter likely also being characterized by frontopolar activity. CONCLUSION/SIGNIFICANCE: Taken together, these findings show how brain systems complementary interact during real-world PM, and support a more complete model of PM that can be applied to naturalistic PM tasks and that we named PROspective MEmory DYnamic (PROMEDY) model because of its dynamics on both multi-phase iteration and the interactions of distinct neurocognitive networks.

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.

Testing the continuum of delusional beliefs: An experimental study using virtual reality.

J Abnorm Psychol. 2010 Feb;119(1):83-92

Authors: Freeman D, Pugh K, Vorontsova N, Antley A, Slater M

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose-response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Evidence for grid cells in a human memory network.

Nature. 2010 Jan 20;

Authors: Doeller CF, Barry C, Burgess N

Grid cells in the entorhinal cortex of freely moving rats provide a strikingly periodic representation of self-location which is indicative of very specific computational mechanisms. However, the existence of grid cells in humans and their distribution throughout the brain are unknown. Here we show that the preferred firing directions of directionally modulated grid cells in rat entorhinal cortex are aligned with the grids, and that the spatial organization of grid-cell firing is more strongly apparent at faster than slower running speeds. Because the grids are also aligned with each other, we predicted a macroscopic signal visible to functional magnetic resonance imaging (fMRI) in humans. We then looked for this signal as participants explored a virtual reality environment, mimicking the rats' foraging task: fMRI activation and adaptation showing a speed-modulated six-fold rotational symmetry in running direction. The signal was found in a network of entorhinal/subicular, posterior and medial parietal, lateral temporal and medial prefrontal areas. The effect was strongest in right entorhinal cortex, and the coherence of the directional signal across entorhinal cortex correlated with spatial memory performance. Our study illustrates the potential power of combining single-unit electrophysiology with fMRI in systems neuroscience. Our results provide evidence for grid-cell-like representations in humans, and implicate a specific type of neural representation in a network of regions which supports spatial cognition and also autobiographical memory.

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.

The AlloSphere is a spherical space in which immersive, virtual environments allow researchers to convert large data sets into experiences of sight and sound. For example, it allows researchers to “fly” through a hydrogen atom while hearing sonified features of the wavefunction of its single electron to help describe invisible processes of nature.

The facility consists of a 30-foot diameter sphere built inside a 3-story cube that’s nearly echo-free. Inside the chamber are two spherical hemispheres that are constructed of perforated aluminum designed to be optically opaque and acoustically transparent. A 7-foot-wide bridge runs across the center, supporting the users. High-resolution video projectors can project images across the entire inner surface enabling seamless stereo-optic 3D projection.

Avatar - A multi-sensory system for real time body position monitoring.

Conf Proc IEEE Eng Med Biol Soc. 2009;1:2462-5

Authors: Jovanov E, Hanish N, Courson V, Stidham J, Stinson H, Webb C, Denny K

Virtual reality and computer assisted physical rehabilitation applications require an unobtrusive and inexpensive real time monitoring systems. Existing systems are usually complex and expensive and based on infrared monitoring. In this paper we propose Avatar, a hybrid system consisting of off-the-shelf components and sensors. Absolute positioning of a few reference points is determined using infrared diode on subject's body and a set of Wii((c)) Remotes as optical sensors. Individual body segments are monitored by intelligent inertial sensor nodes iSense. A network of inertial nodes is controlled by a master node that serves as a gateway for communication with a capture device. Each sensor features a 3D accelerometer and a 2 axis gyroscope. Avatar system is used for control of avatars in Virtual Reality applications, but could be used in a variety of augmented reality, gaming, and computer assisted physical rehabilitation applications.

Impact of the virtual reality on the neural representation of an environment.

Hum Brain Mapp. 2009 Dec 4;

Authors: Mellet E, Laou L, Petit L, Zago L, Mazoyer B, Tzourio-Mazoyer N

Despite the increasing use of virtual reality, the impact on cerebral representation of topographical knowledge of learning by virtual reality rather than by actual locomotion has never been investigated. To tackle this challenging issue, we conducted an experiment wherein participants learned an immersive virtual environment using a joystick. The following day, participants' brain activity was monitored by functional magnetic resonance imaging while they mentally estimated distances in this environment. Results were compared with that of participants performing the same task but having learned the real version of the environment by actual walking. We detected a large set of areas shared by both groups including the parieto-frontal areas and the parahippocampal gyrus. More importantly, although participants of both groups performed the same mental task and exhibited similar behavioral performances, they differed at the brain activity level. Unlike real learners, virtual learners activated a left-lateralized network associated with tool manipulation and action semantics. This demonstrated that a neural fingerprint distinguishing virtual from real learning persists when subjects use a mental representation of the learnt environment with equivalent performances. Hum Brain Mapp, 2010. (c) 2009 Wiley-Liss, Inc.

RAVE 2010 - Real Actions in Virtual Environments - Call for Papers

See website: http://www.raveconference.com

* When: 3rd March, 2010.

* Where:

Palau de les Heures, University of Barcelona, Campus Mundet, Passeig de la Vall d’Hebron, 171 08035 Barcelona.

* Keynote Speaker - Dr Hunter Hoffman,

http://www.hitl.washington.edu/people/hunter/, University of Washington, USA

* Papers -  may be submitted directly for oral presentation at the conference and a special issue of PRESENCE: Teleoperators and Virtual Environments, MIT Press, to be published in August 2010.

* Abstracts may be submitted for oral presentation at the conference or will presented as posters (see website for details).

***Deadline for paper submission: 8th January, 2010*** 23.59 Central European Time (Paris, Madrid)

Driving dreams: cortical activations during imagined passive and active whole body movement.

Ann N Y Acad Sci. 2009 May;1164:372-5

Authors: Flanagin VL, Wutte M, Glasauer S, Jahn K

It is unclear how subjects perceive and process self-motion cues in virtual reality environments. Movement could be perceived as passive, akin to riding in a car, or active, such as walking down the street. These two very different types of self-motion were studied here using motor imagery in fMRI. In addition, the relative importance of visual and proprioceptive training cues was examined. Stronger activations were found during proprioceptive motor imagery compared with visual motor imagery, suggesting that proprioceptive signals are important for successful imagined movement. No significant activations were found during active movement with proprioceptive training. Passive locomotion, however, was correlated with activity in an occipital-parietal and parahippocampal cortical network, which are the same regions found during navigation with virtual reality stimuli.

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.