Albert A. Rizzo

A SWOT analysis of the field of virtual reality rehabilitation and therapy

The use of virtual-reality technology in the areas of rehabilitation and therapy continues to grow, with encouraging results being reported for applications that address human physical, cognitive, and psychological functioning. This article presents a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis for the field of VR rehabilitation and therapy. The SWOT analysis is a commonly employed framework in the business world for analyzing the factors that influence a companys competitive position in the marketplace with an eye to the future. However, the SWOT framework can also be usefully applied outside of the pure business domain. A quick check on the Internet will turn up SWOT analyses for urban-renewal projects, career planning, website design, youth sports programs, and evaluation of academic research centers, and it becomes obvious that it can be usefully applied to assess and guide any organized human endeavor designed to accomplish a mission. It is hoped that this structured examination of the factors relevant to the current and future status of VR rehabilitation will provide a good overview of the key issues and concerns that are relevant for understanding and advancing this vital application area.

Virtual Reality in Brain Damage Rehabilitation: Review

Given the high incidence of brain injury in the population, brain damage rehabilitation is still a relatively undeveloped field. Virtual reality (VR) has the potential to assist current rehabilitation techniques in addressing the impairments, disabilities, and handicaps associated with brain damage. The main focus of much of the exploratory research performed to date has been to investigate the use of VR in the assessment of cognitive abilities, but there is now a trend for more studies to encompass rehabilitation training strategies. This review describes studies that have used VR in the assessment and rehabilitation of specific disabilities resulting from brain injury, including executive dysfunction, memory impairments, spatial ability impairments, attention deficits, and unilateral visual neglect. In addition, it describes studies that have used VR to try to offset some of the handicaps that people experience after brain injury. Finally, a table is included which, although not an exhaustive list of everything that has been published, includes many more studies that are relevant to the use of VR in the assessment and rehabilitation of brain damage. The review concludes that the use of VR in brain damage rehabilitation is expanding dramatically and will become an integral part of cognitive assessment and rehabilitation in the future.

Analysis of assets for virtual reality applications in neuropsychology

Abstract Virtual reality (VR) technology offers new opportunities for the development of innovative neuropsychological assessment and rehabilitation tools. VR-based testing and training scenarios that would be difficult, if not impossible, to deliver using conventional neuropsychological methods are now being developed that take advantage of the assets available with VR technology. If empirical studies continue to demonstrate effectiveness, virtual environment applications could provide new options for targeting cognitive and functional impairments due to traumatic brain injury, neurological disorders, and learning disabilities. This article focuses on specifying the assets that are available with VR for neuropsychological applications along with discussion of current VR-based research that serves to illustrate each asset. VR allows for the precise presentation and control of dynamic multi-sensory 3D stimulus environments, as well as providing advanced methods for recording behavioural responses. This serves as the basis for a diverse set of VR assets for neuropsychological approaches that are detailed in this article. We take the position that when combining these assets within the context of functionally relevant, ecologically valid virtual environments, fundamental advancements can emerge in how human cognition and functional behaviour is assessed and rehabilitated.

Sex differences in mental rotation and spatial rotation in a virtual environment

The visuospatial ability referred to as mental rotation has been shown to produce one of the largest and most consistent sex differences, in favor of males, in the cognitive literature. The current study utilizes both a paper-and-pencil version of the mental rotations test (MRT) and a virtual environment for investigating rotational ability among 44 adult subjects. Results replicate sex differences traditionally seen on paper-and-pencil measures, while no sex effects were observed in the virtual environment. These findings are discussed in terms of task demands and motor involvement. Sex differences were also seen in the patterns of correlations between rotation tasks and other neuropsychological measures. Current results suggest men may rely more on left hemisphere processing than women when engaged in rotational tasks.

FAAST: The Flexible Action and Articulated Skeleton Toolkit

The Flexible Action and Articulated Skeleton Toolkit (FAAST) is middleware to facilitate integration of full-body control with virtual reality applications and video games using OpenNI-compliant depth sensors (currently the PrimeSensor and the Microsoft Kinect). FAAST incorporates a VRPN server for streaming the users skeleton joints over a network, which provides a convenient interface for custom virtual reality applications and games. This body pose information can be used for goals such as realistically puppeting a virtual avatar or controlling an on-screen mouse cursor. Additionally, the toolkit also provides a configurable input emulator that detects human actions and binds them to virtual mouse and keyboard commands, which are sent to the actively selected window. Thus, FAAST can enable natural interaction for existing off-the-shelf video games that were not explicitly developed to support input from motion sensors. The actions and input bindings are configurable at run-time, allowing the user to customize the controls and sensitivity to adjust for individual body types and preferences. In the future, we plan to substantially expand FAASTs action lexicon, provide support for recording and training custom gestures, and incorporate real-time head tracking using computer vision techniques.

Emerging treatments for PTSD

Recent innovations in posttraumatic stress disorder (PTSD) research have identified new treatments with significant potential, as well as novel enhancements to empirically-validated treatments. This paper reviews emerging psychotherapeutic and pharmacologic interventions for the treatment of PTSD. It examines the evidence for a range of interventions, from social and family-based treatments to technological-based treatments. It describes recent findings regarding novel pharmacologic approaches including propranolol, ketamine, prazosin, and methylenedioxymethamphetamine. Special emphasis is given to the description of virtual reality and D-cycloserine as enhancements to prolonged exposure therapy.

A Randomized, Double-Blind Evaluation of d-Cycloserine or Alprazolam Combined With Virtual Reality Exposure Therapy for Posttraumatic Stress Disorder in Iraq and Afghanistan War Veterans

OBJECTIVE The authors examined the effectiveness of virtual reality exposure augmented with D-cycloserine or alprazolam, compared with placebo, in reducing posttraumatic stress disorder (PTSD) due to military trauma. METHOD After an introductory session, five sessions of virtual reality exposure were augmented with D-cycloserine (50 mg) or alprazolam (0.25 mg) in a double-blind, placebo-controlled randomized clinical trial for 156 Iraq and Afghanistan war veterans with PTSD. RESULTS PTSD symptoms significantly improved from pre- to posttreatment across all conditions and were maintained at 3, 6, and 12 months. There were no overall differences in symptoms between D-cycloserine and placebo at any time. Alprazolam and placebo differed significantly on the Clinician-Administered PTSD Scale score at posttreatment and PTSD diagnosis at 3 months posttreatment; the alprazolam group showed a higher rate of PTSD (82.8%) than the placebo group (47.8%). Between-session extinction learning was a treatment-specific enhancer of outcome for the D-cycloserine group only. At posttreatment, the D-cycloserine group had the lowest cortisol reactivity and smallest startle response during virtual reality scenes. CONCLUSIONS A six-session virtual reality treatment was associated with reduction in PTSD diagnoses and symptoms in Iraq and Afghanistan veterans, although there was no control condition for the virtual reality exposure. There was no advantage of D-cycloserine for PTSD symptoms in primary analyses. In secondary analyses, alprazolam impaired recovery and D-cycloserine enhanced virtual reality outcome in patients who demonstrated within-session learning. D-cycloserine augmentation reduced cortisol and startle reactivity more than did alprazolam or placebo, findings that are consistent with those in the animal literature.

Virtual Reality Exposure Therapy Using a Virtual Iraq: Case Report

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.

Development of an interactive game-based rehabilitation tool for dynamic balance training.

Abstract Conventional physical therapy techniques have been shown to improve balance, mobility, and gait following neurological injury. Treatment involves training patients to transfer weight onto the impaired limb to improve weight shift while standing and walking. Visual biofeedback and force plate systems are often used for treatment of balance and mobility disorders. Researchers have also been exploring the use of video game consoles such as the Nintendo Wii Fit as rehabilitation tools. Case studies have demonstrated that the use of video games may have promise for balance rehabilitation. However, initial usability studies and anecdotal evidence suggest that the current commercial games are not compatible with controlled, specific exercise required to meet therapy goals. Based on focus group data and observations with patients, a game has been developed to specifically target weight shift training using an open source game engine and the Nintendo Wii Fit Balance Board. The prototype underwent initial usability testing with a sample of clinicians and with persons with neurological injury. Overall, feedback was positive, and areas for improvement were identified. This preliminary research provides support for the development of a game that caters specifically to the key requirements of balance rehabilitation.

Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV Placement

The objective of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (i.v.) placement. Twenty children (12 boys, 8 girls) requiring i.v. placement for a magnetic resonance imaging/computed tomography (MRI/CT) scan were randomly assigned to two conditions: (1) VR distraction using Street Luge (5DT), presented via a head-mounted display, or (2) standard of care (topical anesthetic) with no distraction. Children, their parents, and nurses completed self-report questionnaires that assessed numerous health-related outcomes. Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition; by contrast, no significant differences were detected within the VR condition. Significant associations between multiple measures of anticipatory anxiety, affective pain, i.v. pain intensity, and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception. There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v. placement: an adequate level of presence, no simulator sickness, and significantly more child-, parent-, and nurse-reported satisfaction with pain management. VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain, and anxiety in children undergoing acute medical interventions. However, further research with larger sample sizes and other routine medical procedures is warranted.