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virtual reality training in rehab

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  • ??? virtual reality training in rehab

    Wondering if anyone knows if there have been any studies using a virtual reality device in rehabilitation?? Could be with stroke, and other neurological type conditions.

    I have a few ideas in my head that I would like to read up on if anything exists. Will do some searching tomorrow at work, but thought I might ask here (typically a better resource that pubmed itself)



  • #2
    I recently did a lit. search on virtual reality in rehab after reading a Herta Flor article, and there is quite a bit out there regarding pain, burns and other. I will try to post some articles here


    • #3
      Free access

      Pain Manag. 2011 Mar;1(2):147-157.
      Virtual reality and pain management: current trends and future directions.
      Li A, Montaño Z, Chen VJ, Gold JI.
      Children's Hospital Los Angeles, Departments of Anesthesiology Critical Care Medicine & Radiology, 4650 West Sunset Boulevard, MS#12, Los Angeles, CA 90027, USA.
      Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.
      PMID: 21779307 [PubMed] PMCID: PMC3138477 Free PMC Article


      • #4
        Does using a nintendo Wii for training count as virtual reality?

        Here a just a few articles. The Herta Flor one is fantastic

        Burns. 2012 Feb 18. [Epub ahead of print]
        Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial.
        Kipping B, Rodger S, Miller K, Kimble RM.
        The Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The Department of Paediatrics and Child Health, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; The University of Queensland, School of Health and Rehabilitation, Division of Occupational Therapy, Brisbane, Australia; The University of Queensland, School of Medicine, Department of Paediatrics and Child Health, Brisbane, Australia; Department of Occupational Therapy and Music Therapy, Royal Children's Hospital, Brisbane, Australia.
        Effective pain management remains a challenge for adolescents during conscious burn wound care procedures. Virtual reality (VR) shows promise as a non-pharmacological adjunct in reducing pain.
        This study assessed off-the-shelf VR for (1) its effect on reducing acute pain intensity during adolescent burn wound care, and (2) its clinical utility in a busy hospital setting.
        Forty-one adolescents (11-17 years) participated in this prospective randomized controlled trial. Acute pain outcomes including adolescent self-report, nursing staff behavioral observation, caregiver observation and physiological measures were collected. Length of procedure times and adolescent reactions were also recorded to inform clinical utility.
        Nursing staff reported a statistically significant reduction in pain scores during dressing removal, and significantly less rescue doses of Entonox given to those receiving VR, compared to those receiving standard distraction. For all other pain outcomes and length of treatment, there was a trend for lower pain scores and treatment times for those receiving VR, but these differences were not statistically significant.
        Despite only minimal pain reduction achieved using off-the-shelf VR, other results from this trial and previous research on younger children with burns suggest a customized, adolescent and hospital friendly device may be more effective in pain reduction.
        Copyright © 2012. Published by Elsevier Ltd.

        Curr Opin Psychiatry. 2012 Mar;25(2):109-13.
        New developments in the understanding and management of persistent pain.
        Flor H.
        Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
        It is proposed that central rather than peripheral factors may be important in pain chronicity. We review recent empirical findings on these processes and discuss implications for treatment and prevention.
        The literature on neuroimaging of pain and on learning processes shows that learning-induced functional and structural brain changes involving sensorimotor, as well as limbic and frontal, areas are important in the transition from acute to chronic pain. These alterations share many similarities with brain changes in emotional disorders and the specificity for pain needs to be determined. Further important contributors to chronic pain may be disturbed processing of the body image, impaired multisensory integration and faulty feedback from interoceptive processes. These findings have led to new treatment approaches that focus on the extinction of aversive memories, restoration of the body image and normal brain function and include approaches such as brain stimulation, mirror training, virtual reality applications or behavioral extinction training.
        We propose that chronic pain is characterized by learning-related and memory-related plastic changes of the central nervous system with concomitant maladaptive changes in body perception. These alterations require new treatments that focus on the alteration of central pain memories and maladaptive body perception.

        J Trauma. 2011 Jul;71(1 Suppl):S125-30.
        Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles.
        Maani CV, Hoffman HG, Morrow M, Maiers A, Gaylord K, McGhee LL, DeSocio PA.
        US Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam, Houston, Texas, USA.
        This is the first controlled study to explore whether adjunctive immersive virtual reality (VR) can reduce excessive pain of soldiers with combat-related burn injuries during wound debridement.
        Patients were US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan. During the same wound care session using a within-subject experimental design, 12 patients received half of their severe burn wound cleaning procedure (~6 minutes) with standard of care pharmacologies and half while in VR (treatment order randomized). Three 0 to 10 Graphic Rating Scale pain scores for each of the treatment conditions served as the primary variables.
        Patients reported significantly less pain when distracted with VR. "Worst pain" (pain intensity) dropped from 6.25 of 10 to 4.50 of 10. "Pain unpleasantness" ratings dropped from "moderate" (6.25 of 10) to "mild" (2.83 of 10). "Time spent thinking about pain" dropped from 76% during no VR to 22% during VR. Patients rated "no VR" as "no fun at all" (<1 of 10) and rated VR as "pretty fun" (7.5 of 10). Follow-up analyses showed VR was especially effective for the six patients who scored 7 of 10 or higher (severe to excruciating) on the "worst pain" (pain intensity) ratings.
        These preliminary results provide the first evidence from a controlled study that adjunctive immersive VR reduced pain of patients with combat-related burn injuries during severe burn wound debridement. Pain reduction during VR was greatest in patients with the highest pain during no VR. These patients were the first to use a unique custom robot-like arm mounted VR goggle system.
        PMID: 21795888 [PubMed - indexed for MEDLINE]
        Publication Types, MeSH Terms, Grant Support

        LinkOut - more resources


        • #5
          Back from the dead to attempt to revive this idea.

          I have been toying with the idea of getting something going collaboratively with my local PT school, the neuroscience department at my alma mater as well as with my employer. However I would like to have some data or research to back it up. anyone have any new information on virtual reality in a rehab setting? I would love to see some applications in the ortho setting that would knock the socks off of the meatheads. However the clinical implications are immense if effective.

          As always thank you all..
          Michael Heinrich DPT.

          My opinions and statements on this site are not a reflection of the Department of Veterans Affairs or the Federal government.


          • #6

            I actually did a literature review on the subject but never got around to bringing it to full publication. It reads like an extended essay but is sectional and draws conclusions. It is highly referenced and covers pretty much all the available VR studies in PubMed from 2008-2016. In my own clinical experience we used it for vestibular patients with Google Cardboard for a variety of purposes but the newer apps being developed can actually make it mobile- VR pacman, VR mazes. If you are still interested since this is an old thread, I'll send it your way.


            • #7
              Influence of the Perspectives on the Movement of One-Leg Lifting in an Interactive-Visual Virtual Environment: A Pilot Study




              Numerous studies have confirmed the feasibility of active video games for clinical rehabilitation. To maximize training effectiveness, a personal program is necessary; however, little evidence is available to guide individualized game design for rehabilitation. This study assessed the perspectives and kinematic and temporal parameters of a participant’s postural control in an interactive-visual virtual environment.


              Twenty-four healthy participants performed one-leg standing by leg lifting when a posture frame appeared either in a first- or third-person perspective of a virtual environment. A foot force plate was used to detect the displacement of the center of pressure. A three-way mixed factor design was applied, where the perspective was the between-participant factor, and the leg-lifting times (0.7 and 2.7 seconds) and leg-lifting angles (30°and 90°) were the within-participant factors. The reaction time, accuracy of the movement, and ability to shift weight were the dependent variables.


              Regarding the reaction time and accuracy of the movement, there were no significant main effects of the perspective, leg-lifting time, or angle. For the ability to shift weight, however, both the perspective and time exerted significant main effects, F(1,22) = 6.429 and F(1,22) = 13.978, respectively.


              Participants could shift their weight more effectively in the third-person perspective of the virtual environment. The results can serve as a reference for future designs of interactive-visual virtual environment as applied to rehabilitation.
              Jo Bowyer
              Chartered Physiotherapist Registered Osteopath.
              "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


              • #8
                Could Virtual Reality Dodgeball motivate fear-avoidant CLBP patients to move? Implications for future treatment.


                The aim of the study was to investigate whether Virtual Reality Dodgeball is a feasible and safe approach for CLBP patients with high levels of pain-related fear avoidance and whether this treatment changed pain/harm expectancies and/or increased trunk range of movement outside of game play sessions.
                Jo Bowyer
                Chartered Physiotherapist Registered Osteopath.
                "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


                • #9
                  Virtual Reality May Help Improve Motor Skills in Damaged Limbs


                  Novel training may rehabilitate impaired limbs by allowing healthy limbs to lead “by example,” say TAU researchers.

                  A combination of traditional physical therapy and technology may improve the motor skills and mobility of an impaired hand by having its partner, more mobile hand lead by example through virtual reality training, new Tel Aviv University research suggests.

                  “Patients suffering from hemiparesis — the weakness or paralysis of one of two paired limbs — undergo physical therapy, but this therapy is challenging, exhausting, and usually has a fairly limited effect,” said lead investigator Prof. Roy Mukamel of TAU’s School of Psychological Sciences and Sagol School of Neuroscience, who conducted the research with his student Ori Ossmy. “Our results suggest that training with a healthy hand through a virtual reality intervention provides a promising way to repair mobility and motor skills in an impaired limb.” The research was published in Cell Reports.

                  Effects of Virtual Reality Training using Xbox Kinect on Motor Function in Stroke Survivors: A Preliminary Study.



                  Although the Kinect gaming system (Microsoft Corp, Redmond, WA) has been shown to be of therapeutic benefit in rehabilitation, the applicability of Kinect-based virtual reality (VR) training to improve motor function following a stroke has not been investigated. This study aimed to investigate the effects of VR training, using the Xbox Kinect-based game system, on the motor recovery of patients with chronic hemiplegic stroke. METHODS:

                  This was a randomized controlled trial. Twenty patients with hemiplegic stroke were randomly assigned to either the intervention group or the control group. Participants in the intervention group (n = 10) received 30 minutes of conventional physical therapy plus 30 minutes of VR training using Xbox Kinect-based games, and those in the control group (n = 10) received 30 minutes of conventional physical therapy only. All interventions consisted of daily sessions for a 6-week period. All measurements using Fugl-Meyer Assessment (FMA-LE), the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the 10-meter Walk Test (10mWT) were performed at baseline and at the end of the 6 weeks. RESULTS:

                  The scores on the FMA-LE, BBS, TUG, and 10mWT improved significantly from baseline to post intervention in both the intervention and the control groups after training. The pre-to-post difference scores on BBS, TUG, and 10mWT for the intervention group were significantly more improved than those for the control group (P <.05). CONCLUSIONS:

                  Evidence from the present study supports the use of additional VR training with the Xbox Kinect gaming system as an effective therapeutic approach for improving motor function during stroke rehabilitation.

                  Update 07/08/2017

                  Neural Network Underlying Intermanual Skill Transfer in Humans

                  Physical practice with one hand results in performance gains of the other (un-practiced) hand, yet the role of sensory feedback and underlying neurophysiology is unclear. Healthy subjects learned sequences of finger movements by physical training with their right hand while receiving real-time movement-based visual feedback via 3D virtual reality devices as if their immobile left hand was training. This manipulation resulted in significantly enhanced performance gain with the immobile hand, which was further increased when left-hand fingers were yoked to passively follow right-hand voluntary movements. Neuroimaging data show that, during training with manipulated visual feedback, activity in the left and right superior parietal lobule and their degree of coupling with motor and visual cortex, respectively, correlate with subsequent left-hand performance gain. These results point to a neural network subserving short-term motor skill learning and may have implications for developing new approaches for learning and rehabilitation in patients with unilateral motor deficits.
                  Last edited by Jo Bowyer; 07-08-2017, 02:58 PM.
                  Jo Bowyer
                  Chartered Physiotherapist Registered Osteopath.
                  "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


                  • #10
                    Virtual reality can be used to improve motor functions in Parkinson’s disease
                    link here
                    Now a group of Spanish researchers show that virtual reality (VR) technique can be used in this motor training and help PD patients improve their motor functions. The study is recently published in Parkinsonism and Related Disorders.

                    A group of 16 PD patients took part in the study. They received 4 weeks of training of finger tapping via a VR system. The VR-avatar did the finger movement at three different rates, and PD patients imitated the avatar’s movement as close as possible with their dominant hand (e.g., right hand if the person is right-handed).

                    Researchers found that PD patients showed larger movement amplitude after therapy. Remarkably, the effect was found in both the trained hand and untrained hand.
                    Virtual reality for stroke rehabilitation
                    Cochrane review 2015
                    We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.
                    Last edited by marcel; 18-12-2016, 03:00 PM.

                    "Evolution is a tinkerer not an engineer" F.Jacob
                    "Without imperfection neither you nor I would exist" Stephen Hawking


                    • #11
                      The Impact of Virtual Reality on Chronic Pain



                      The treatment of chronic pain could benefit from additional non-opioid interventions. Virtual reality (VR) has been shown to be effective in decreasing pain for procedural or acute pain but to date there have been few studies on its use in chronic pain. The present study was an investigation of the impact of a virtual reality application for chronic pain. Thirty (30) participants with various chronic pain conditions were offered a five-minute session using a virtual reality application called Cool! Participants were asked about their pain using a 0–10 visual analog scale rating before the VR session, during the session and immediately after the session. They were also asked about immersion into the VR world and about possible side effects. Pain was reduced from pre-session to post-session by 33%. Pain was reduced from pre-session during the VR session by 60%. These changes were both statistically significant at the p < .001 level. Three participants (10%) reported no change between pre and post pain ratings. Ten participants (33%) reported complete pain relief while doing the virtual reality session. All participants (100%) reported a decrease in pain to some degree between pre-session pain and during-session pain. The virtual reality experience was found here to provide a significant amount of pain relief. A head mounted display (HMD) was used with all subjects and no discomfort was experienced. Only one participant noted any side effects. VR seems to have promise as a non-opioid treatment for chronic pain and further investigation is warranted.
                      Jo Bowyer
                      Chartered Physiotherapist Registered Osteopath.
                      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi


                      • #12
                        Multisensory Integration in the Virtual Hand Illusion with Active Movement



                        Improving the sense of immersion is one of the core issues in virtual reality. Perceptual illusions of ownership can be perceived over a virtual body in a multisensory virtual reality environment. Rubber Hand and Virtual Hand Illusions showed that body ownership can be manipulated by applying suitable visual and tactile stimulation. In this study, we investigate the effects of multisensory integration in the Virtual Hand Illusion with active movement. A virtual xylophone playing system which can interactively provide synchronous visual, tactile, and auditory stimulation was constructed. We conducted two experiments regarding different movement conditions and different sensory stimulations. Our results demonstrate that multisensory integration with free active movement can improve the sense of immersion in virtual reality.

                        1. Introduction

                        The mutual interaction of the sensory signals is a critical aspect in human perception and cognition. Recently, with the development of virtual reality (VR) technology, increasing researches were carried out on projecting multisensory information to virtual representations of the actual body. Ideally, the virtual representations in VR space should be identical to the actual body. However, in practice, physical differences arise due to the spatial limitation when constructing the VR space. The real-time representation of multisensory information plays a pivotal role in an immersive VR environment.

                        The shifts between physical stimuli and human perceptions are known as illusions. Using these sensory distortions, more realistic perceptions can be represented despite the physical limitations of sensory display interfaces.

                        Body ownership illusion, which is typically induced by VR, has been widely studied in the past few decades. Self-recognition is necessary for human cognition adapting to changes in the environment [1]. Mental representation of one’s own body, which is called body image, is not limited to the sense of body ownership but also comprises the multisensory perceptions such as visual and tactile information [2]. In addition, body image can be extended to an object or an artificial limb attached to the human body. Therefore, body image can be intentionally manipulated by displaying coherent multisensory information.
                        Jo Bowyer
                        Chartered Physiotherapist Registered Osteopath.
                        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi