Use of low-cost virtual reality in the treatment of the upper extremity in chronic stroke: a randomized clinical trial

 Useless, since they don't tell us where the protocol is so survivors can do this themselves. For chronic survivors who aren't seeing doctors or therapists anymore, don't researchers realize that simple fact and produce usable research that survivors can directly use? I'd fire the mentors and senior researchers that don't understand this simple fact!

Use of low-cost virtual reality in the treatment of the upper extremity in chronic stroke: a randomized clinical trial

• Ángela Aguilera-Rubio,
• Isabel M. Alguacil-Diego,
• Ana Mallo-López,
• Alberto Jardón Huete,
• Edwin D. Oña &
• Alicia Cuesta-Gómez 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 12 (2024) Cite this article

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Abstract

Background

Chronicity and lack of motivation often go together during the upper limb rehabilitation process in stroke. Virtual reality is a useful tool in this context, providing safe, intensive, individualised treatments in a playful environment. B-cost, easy-to-use devices with personalised and motivating games for a specific population seem to be the most effective option in the treatment of the upper limbs.

Methods

A randomised clinical study with follow-up was carried out to assess the effectiveness of the Leap Motion Controller® device in improving the functionality of the upper limb in patients with chronic stroke. Patients (n = 36) were randomised into a control group that performed conventional therapy and an experimental group that combined the virtual reality protocol(Where is it?) with conventional therapy. The outcome measures used were grip strength; the Block and Box Test; the Action Research Arm Test; the Disabilities of the Arm, Shoulder and Hand; as well as a Technology Satisfaction Questionnaire and adherence to treatment.

Results

Inter-group statistical analysis showed no significant differences except in subsection D of the Action Research Arm Test. Intra-group analysis showed significant differences in both groups, but the experimental group reached significance in all long-term variables. Satisfaction and adherence levels were very high.

Conclusions

The Leap Motion Controller^® system, as a complementary tool, produces improvements in grip strength, dexterity and motor function in patients with chronic stroke. It is perceived as a safe, motivating, and easy-to-use device.

Clinical Registration: NCT04166617 Clinical Trials.

Introduction

The chronicity of the upper limb (UL) rehabilitation process in stroke leads to an inherent loss of motivation in the long term, resulting in the need for new treatment approaches that combine both the recovery of functionality and the motivation to continue to achieve functional goals [1, 2].

The use of virtual reality (VR) in neurorehabilitation arose with the aim of creating new, more efficient options for functional recovery by generating environments in which to carry out different tasks and is currently a potential treatment tool [3]. VR is a promising tool in neurorehabilitation, as it promotes neuroplasticity by enabling treatments with a high number of repetitions, allowing changes in task difficulty, and keeping patients motivated and involved during the rehabilitation session [4, 5].

The development of portable and affordable VR devices is making VR therapy accessible to the chronic population [6]. A recent review on the design of serious games in the field of neurorehabilitation [7] outlines three necessary concepts when developing this technology: the game genre, the nature of the game, and the game development strategy. The authors concluded that casual games (any game that involves the completion of single, simple tasks, not tied to a story or extensive development) designed specifically for one type of patient, with a first-person perspective, played in single-player mode, and using non-immersive VR had better clinical outcomes. In contrast to this, they also stated that commercial games are perceived as more engaging and motivating, emphasising the need for future work in this area. Therefore, perhaps the trend should be to use inexpensive, easy-to-use devices, but with games that are personalised and motivating for a specific population.

The Leap Motion Controller^® (LMC^®) system is a small, portable, low-cost, and commercially available tracking device that can capture UL movements in 3D, without the need for motion markers. It is a part of semi-immersive VR and allows the development of customised applications thanks to its software development kit [8, 9]. Its use has been investigated both as a single therapy and in combination with conventional treatment in stroke patients, mainly in the acute and subacute phases. In both cases, the ultimate goal has been to assess its effectiveness on parameters of grip strength, dexterity, or motor function [10]. After a review of the current literature on the use of this device in the stroke population [10], we deduce that studies with a larger sample size, with higher methodological quality, and with follow-up evaluations are needed to assess its effectiveness with greater precision.

Prior to this research, a pilot study of the feasibility of the device was developed together with a VR protocol with games created ad hoc for the chronic stroke population [11]. The results were very positive, which generated the need to verify these results with a study of higher methodological quality.

Despite the amount of scientific literature on the use of virtual reality in the field of neurorehabilitation, and the constant changes in devices, there is a lack of clear detailed protocols, reproducible through low-cost devices.

Therefore, the aim of the present research was to assess the effectiveness of the LMC^® system through games designed specifically for chronic stroke patients, and whether the potential benefit, if any, would be sustained over time. A semi-immersive VR protocol was developed as an adjunct to conventional rehabilitation treatment in improving the functionality of the UL compared to a conventional treatment group, in addition to assessing motivation and adherence to treatment.

A novel upper-limb tracking system in a virtual environment for stroke rehabilitation

Sounds cool, now lets get a provisional protocol written up on it and distributed to all 10 million yearly stroke survivors.

A novel upper-limb tracking system in a virtual environment for stroke rehabilitation

• Kuan Cha,
• Jinying Wang,
• Yan Li,
• Longbin Shen,
• Zhuoming Chen &
• Jinyi Long 

Journal of NeuroEngineering and Rehabilitation volume 18, Article number: 166 (2021) Cite this article

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Abstract

Background

The transfer of the behaviors of a human’s upper limbs to an avatar is widely used in the field of virtual reality rehabilitation. To perform the transfer, movement tracking technology is required. Traditionally, wearable tracking devices are used for tracking; however, these devices are expensive and cumbersome. Recently, non-wearable upper-limb tracking solutions have been proposed, which are less expensive and more comfortable. However, most products cannot track the upper limbs, including the arms and all the fingers at the same time, which limits the limb parts for tracking in a virtual environment and may lead to a limited rehabilitation effect.

Methods

In this paper, a novel virtual reality rehabilitation system (VRRS) was developed for upper-limb rehabilitation. The VRRS could track the motion of both upper limbs, integrate fine finger motion and the range of motion of the entire arm and map the motion to an avatar. To test the performance of VRRS, two experiments were designed. In the first experiment, we investigated the effect of VRRS on virtual body ownership, agency and location of the body and usability in 8 healthy participants by comparing it with a partial upper-limb tracking method based on a Leap Motion controller (LP) in the same virtual environments. In the second experiment, we examined the feasibility of VRRS in upper-limb rehabilitation with 27 stroke patients.

Results

VRRS improved the users’ senses of body ownership, agency, and location of the body. The users preferred using the VRRS to using the LP. In addition, we found that although the upper limb motor function of patients from all groups was improved, the difference between the FM scores tested on the first day and the last day of the experimental group was more significant than that of the control groups.

Conclusions

A VRRS with motion tracking of the upper limbs and avatar control including the arms and all the fingers was developed. It resulted in an improved user experience of embodiment and effectively improved the effects of upper limb rehabilitation in stroke patients.

Trial registration

The study was registered at the First Affiliated Hospital of Jinan University Identifier: KY-2020–036; Date of registration: June 01, 2020.

Introduction

Stroke is a common health-care problem that results in obvious muscle weakness on one side of the body [1]. It is estimated that 50% to 75% of stroke patients have persistent impairment of the affected upper limb and must undergo repetitive physical training to recover their motor function [2]. To provide a more enjoyable and personalized motor rehabilitation experience, the use of virtual environments (VEs) as a tool is gradually becoming popular in the field because it offers richness of experience and is interesting to patients [3]. The virtual nature of the environment allows behaviors that are impossible or very expensive in reality to be implemented in a low-cost way. Bortone et al. [4,5,6] found that the use of a virtual environment and wearable devices offers a viable alternative to conventional therapy for improving upper extremity function in children with neuromotor impairments. Additionally, previous works indicate that the strength and ability of the affected side of the body can be effectively improved during rehabilitation that involves controlling an avatar’s upper limbs to interact with objects in VEs [7].

In many applications, avatars are used as the interface that allows people to interact with VEs [8]. Movement tracking is one of the key technologies for avatar control [9]. For partial upper-limb tracking, consumer devices, including hand-held controllers such as Oculus Touch or HTC VIVE controllers, and motion sensing devices, such as Kinect and Leap Motion controllers, are widely used [10]. Granqvist et al. [11] used HTC VIVE controllers with inverse kinematics for partial upper-limb tracking. However, the hand-held controller can only track the position of the hand and cannot provide information about the position of the fingers. Collingwoode-Williams et al. [12] built a system to study the effect of lip and arm synchronization on the feeling of body ownership. They used a Kinect device for body tracking and an Oculus Rift device for head rotation measurement. However, the Kinect device can only track the arms and a few key points on each hand (one key point on the fingertip, one key point on the thumb, and one key point on the whole hand). Complete upper-limb tracking enhances the realism of an avatar’s upper-limb behavior, which influences patients’ cognition and may be beneficial for rehabilitation [13]. Generally, for high-quality upper-limb tracking including the arms and all the fingers, it is necessary to use marker-based tracking systems that require the user to wear tracking suits, such as that employed by the OptiTrack system [13, 14]. These suits are expensive and cumbersome. The use of consumer devices is another less expensive solution. Lin et al. [15] used the Oculus Rift headset with a Kinect sensor, a Leap Motion controller and a dance pad to allow users navigate and manipulate objects inside synthetic scenes. With this method, only one Kinect was used, and it could not recognize which side of the body was facing the device. Wu et al. [16] introduced a setup that integrated multiple Kinects for robust and accurate full-body 3D skeleton tracking and a Leap Motion controller for tracking the hands. However, the tracking area of the Leap Motion controller was limited to a small range above the device.

In this paper, we propose a method that can control avatars’ upper limbs by tracking the movements of both arms and all fingers in a large tracking space. Using this method, we developed a virtual reality rehabilitation system (VRRS) that can map the movement of a user’s upper limbs to an avatar’s upper limbs to improve the user’s cognitive and affective experience during interaction in VEs. The difficulty of tasks can be conveniently modified to dynamically match the patient’s motor function, which is important for motor learning in general [17] and for rehabilitation in particular [18]. Hence, we hypothesized that VRRS can provide an effective rehabilitation training method to improve stroke patients’ recovery of their upper-limb motor function by enhancing their sense of body ownership, agency, and location of the body.

To test our hypothesis, we first performed an experiment with 8 healthy participants to compare VRRS with the partial tracking method based on Leap Motion [19]. In the experiment, we built VEs customized for upper-limb motion and assessed the senses of body ownership, agency, and location of the body and the usability of the systems. Then, to evaluate the feasibility of using the VRRS for rehabilitation training, another experiment was performed. For that experiment, 27 stroke patients were recruited, and the Fugl-Meyer (FM) scores for the patients’ upper limb motor functions were evaluated.

More at link.

 

Virtual Rehabilitation Programme Using the MIRA Platform, Kinect and Leap Motion Sensors in an 81 Years Old Patient with Ischemic Stroke

You can hope your doctor knows about these 22 posts on Kinect  and these 2 posts on Leap motion. and can compare them to this one.  Every single stroke doctor in the world will have to do this on their own since we have fucking failures of stroke associations that can't set up databases of stroke protocols and summaries of stroke research.
http://blog.mirarehab.com/2017/06/23/virtual-rehabilitation-programme-using-mira-platform-kinect-leap-motion-sensors-81-years-old-patient-ischemic-stroke/
Virtual rehabilitation therapy using the adapted Movement-Based Interactive Video Games (MBIVG) and the Microsoft’s Kinect and the Leap Motion sensors of motion is a promising new therapy for patients with stroke. We report the evolution of an 81 years old male with ischemic stroke and right  hemiparesis who played MIRA interactive video games using the Kinect One sensor and Leap Motion sensor standard games for 10 sessions, with a duration of 30 minutes/session during his 14 days of hospitalization. The patient also benefited from conventional rehabilitation therapy for stroke (kinetotherapy, massage and conventional occupational therapy). At the final examination, the patient showed improved motor skills, the final ARAT score improved from 46 to 57 points (24% amendment), the Fugl-Meyer test score improved from 46 to 52 (13% amendment) and the Berg Balance Scale improved from 43 to 49 points (14% amendment). Virtual rehabilitation therapy was well tolerated, showing no adverse effects after 10 sessions. Despite his age, the patient enjoyed playing MIRA interactive video games and Leap Motion standard games, which ensured a good compliance to the treatment.
Much more at link.

Virtual reality therapy using the Leap Motion Controller for post-stroke upper limb rehabilitation

Useless research, it tells us nothing about the results obtained.

Virtual reality therapy using the Leap Motion Controller for post-stroke upper limb rehabilitation

ABSTRACT

AIMS: To evaluate the applicability of a virtual reality-based motion sensor for post-stroke upper limb rehabilitation.

CASES DESCRIPTION: Three post-stroke patients were subjected to virtual reality training for rehabilitation of their upper limbs using the Leap Motion Controller technology and the game Playground 3D

®

for 3 consecutive days. On the first and last days, the Box and Blocks test, the De Melo Eye-Hand Coordination Test, and transcranial magnetic stimulation were applied. On the last day, the patients were evaluated with

the Experience Evaluation Form. After the proposed training, a lower motor threshold was observed in both cerebral hemispheres, as well as better performance in the tests that evaluated hand and eye-hand coordination skills. The proposed therapy was well received by the patients.

CONCLUSIONS: No adverse effects were observed, and promising and precise results were obtained for the virtual reality-based training using the Leap Motion Controller and Playground 3D

®

. The training allowed patients to have an active role in the rehabilitation of stroke-induced upper limb sequelae

Virtualware Launches Therapeutic Video Game for Neurorehabilitation

Does your therapy department have anything for hand recovery or are you going to have to travel to Europe?
http://www.prweb.com/releases/virtualrehab/therapeutic-video-game/prweb12773336.htm
Virtualware Health today announced the release of VirtualRehab 3.0, the first clinically validated therapeutic video game solution for Hand & Body therapy with CE approval. Designed for professional therapists who work with patients that suffer from severe neurological conditions, VirtualRehab 3.0 will help patients to improve balance and fine motor skills using clinically tested therapeutic games and motion capture technology powered by Microsoft’s® Kinect Xbox One and Leap Motion®. VirtualRehab 3.0 is available now and will be on demo at Rehab Week in Valencia, Spain from June 9 to 12 at the International Conference of Virtual Rehabilitation (ICVR).
“We developed VirtualRehab 3.0 in close collaboration with leading neurologists and physiotherapists in Europe who wanted to offer individualized treatment for their patients in a simple and cost effective way,” said Unai Extremo, CEO and founder of Virtualware Group. “By offering patients the flexibility to play in both a clinical setting or at home we can reach more people who need multiple therapy sessions a week but don’t have the time, resources or motivation to put in the exercise. Stroke patients for example are recommended to have up to 3 hours a day of therapy, a minimum of 5 days per week. As a result, the cost per hour of traditional treatment for extended rehabilitation can become restrictive and inaccessible. For more serious conditions, the need for rehabilitation is a lifetime requirement. We’ve already completed over 13,000 sessions and 1,300 hours of therapeutic game play and this is only the beginning.”
Designed for supervised use with clinical professionals and therapists, the VirtualRehab 3.0 platform was created for patients who suffer from temporary to long-term neurological conditions including stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, peripheral neuropathies, cerebral palsy, Parkinson’s disease and to help improve mobility in the elderly.
According to Dr. Manuel Murie, director of the Centro Neurológico de Atención Integral (C.N.A.I.), a specialized neurorehabilitation center in Pamplona, “We recently started using VirtualRehab to re-teach stroke patients how to coordinate small muscle movements in their hands and fingers, tasks controlled by the nervous system that are essential to day-to-day life. In only a short time our patients were more engaged and confident, the motivation they have is critical to their progress, with therapeutic games we are able to transform how they feel about therapy and it makes our day to day work more engaging.”
Virtual Rehab 3.0 is a scalable solution designed for small clinics to large hospitals. It includes VirtualRehab BODY using the Kinect® Xbox One to work on balance and physical movement of the upper and lower extremities; and introduces the new VirtualRehab HANDS for games and exercises aimed at improving fine motor skills and dexterity of the hands. VirtualRehab HANDS comes complete with a Leap Motion® sensor to detect precision movements of the fingers and an ergonomic armrest for comfort. Virtual Rehab 3.0 includes a cloud-based software management tool to help health care providers keep track of patient progress. VirtualRehab is the first virtual reality rehabilitation platform to receive CE mark approval from the European Commission.
Demos of VirtualRehab 3.0 and Mind Play Games, an innovative solution that combines collaborative cognitive gaming applications on a 55” multitouch interactive table, by Virtualware’s hardware division, Activa Media will be available at RehabWeek Booth # 17-18 and they will also be hosting the following workshops.
Virtual Reality Game–Based Therapy with Motion Sensor Capture Devices on June 10 from 11:00 to 12:30 with notable speakers Dr. Nick Ward (UCL Queen Square) and Dr. Manuel Murie (CNAI).
VIDEO: http://www.virtualrehab.info/#video
ABOUT VIRTUALREHAB® | http://www.virtualrehab.info | @virtualrehab_en
VirtualRehab® is a tool designed by experts in neurorehabilitation that offers simulated physical rehabilitation training programs for patients with different degrees of physical disability. By using virtual environments in a videogame format combined with the Microsoft® Kinect®, the Microsoft® Azure® cloud platform and Leap Motion sensor, the patient can do physiotherapy exercises customized by their therapist both in the centre where they are being treated as well as do telerehabilitation in their own home. This technology allows the patient to be monitored remotely by their physiotherapist who evaluates their progress.
ABOUT VIRTUALWARE | http://www.virtualwaregroup.com | @virtualwareUK
Virtualware Group is a business group of technology companies that specialize in the development of hardware and software solutions based on immersive and interactive technologies. The company designs and creates high-tech value-added solutions, products and services for culture, education, training and health through offices in the United Kingdom, Spain, Latin America and the Middle East as well as through partners around the world. It is the only virtual rehabilitation manufacturer with CE Mark approval to develop both hardware and software for medical purposes.