Debbie Rand

Video capture virtual reality as a flexible and effective rehabilitation tool

Video capture virtual reality (VR) uses a video camera and software to track movement in a single plane without the need to place markers on specific bodily locations. The users image is thereby embedded within a simulated environment such that it is possible to interact with animated graphics in a completely natural manner. Although this technology first became available more than 25 years ago, it is only within the past five years that it has been applied in rehabilitation. The objective of this article is to describe the way this technology works, to review its assets relative to other VR platforms, and to provide an overview of some of the major studies that have evaluated the use of video capture technologies for rehabilitation.

How Active Are People With Stroke? Use of Accelerometers to Assess Physical Activity

Background and Purpose— Accelerometers are a unique tool used to objectively measure free-living physical activity, but their reliability for people with stroke has not been established. The primary aim was to assess the day-to-day reliability of these instruments for the paretic and nonparetic hips. The secondary aims were to measure the amount of physical activity with accelerometers that people with stroke undertake in the community and its relationship with walking capacity (6-minute walk test distance). Methods— Forty people with stroke wore one Actical accelerometer on each hip for 3 consecutive days at home and during the 6-minute walk test in the laboratory. The accelerometer measured physical activity using total activity counts per day and energy expenditure (kcal/d). Results— Excellent intraclass correlation coefficients (ICCs) for the activity counts (paretic hip ICC[1,3]=0.95, nonparetic hip ICC[1,3]=0.94) and for the energy expenditure (paretic hip ICC[1,3]=0.95, nonparetic hip ICC[1,3]=0.95) were found across the 3 consecutive days at home. Excellent ICCs were also found between the paretic versus the nonparetic hips for the activity counts (ICC[1,3]=0.98) and for the energy expenditure (ICC[1,3]=0.96). Free-living physical activity was very low and 58% of the participants did not meet recommended physical activity levels. Only moderate correlations (r=0.6 to 0.73, P<0.001) were found between the 6-minute walk test distance in the laboratory and 3-day physical activity recording at home. Conclusions— The accelerometer was found to be a reliable objective instrument. The use of accelerometers quantified the low level of free-living physical activity of people with stroke.

The Sony PlayStation II EyeToy: low-cost virtual reality for use in rehabilitation.

The objective of this study was to investigate the potential of using a low-cost video-capture virtual reality (VR) platform, the Sony PlayStation II EyeToy, for the rehabilitation of older adults with disabilities. This article presents three studies that were carried out to provide information about the EyeToys potential for use in rehabilitation. The first study included the testing of healthy young adults (N = 34) and compared their experiences using the EyeToy with those using GestureTeks IREX VR system in terms of a sense of presence, level of enjoyment, control, success, and perceived exertion. The second study aimed to characterize the VR experience of healthy older adults (N = 10) and to determine the suitability and usability of the EyeToy for this population and the third study aimed to determine the feasibility of the EyeToy for use by individuals (N = 12) with stroke at different stages. The implications of these three studies for applying the system to rehabilitation are discussed.

Validation of the Virtual MET as an assessment tool for executive functions

The purpose of this study was to establish ecological validity and initial construct validity of a Virtual Multiple Errands Test (VMET) as an assessment tool for executive functions. It was implemented within the Virtual Mall (VMall), a novel functional video-capture virtual shopping environment. The main objectives were (1) to examine the relationships between the performance of three groups of participants in the Multiple Errands Test (MET) carried out in a real shopping mall and their performance in the VMET, (2) to assess the relationships between the MET and VMET of the post-stroke participants level of executive functioning and independence in instrumental activities of daily living, and (3) to compare the performance of post-stroke participants to those of healthy young and older controls in both the MET and VMET. The study population included three groups; post-stroke participants (n = 9), healthy young participants (n = 20), and healthy older participants (n = 20). The VMET was able to differentiate between two age groups of healthy participants and between healthy and post-stroke participants thus demonstrating that it is sensitive to brain injury and ageing and supports construct validity between known groups. In addition, significant correlations were found between the MET and the VMET for both the post-stroke participants and older healthy participants. This provides initial support for the ecological validity of the VMET as an assessment tool of executive functions. However, further psychometric data on temporal stability are needed, namely test–retest reliability and responsiveness, before it is ready for clinical application. Further research using the VMET as an assessment tool within the VMall with larger groups and in additional populations is also recommended.

Feasibility of a 6-Month Exercise and Recreation Program to Improve Executive Functioning and Memory in Individuals With Chronic Stroke

Background. Physical activity is beneficial for improving cognitive function in healthy older adults. However, research results on the benefits of physical activity on cognitive performance after stroke are limited. Objective. To determine if a combined exercise and recreation program can improve the executive functioning and memory of individuals with chronic stroke. Methods. In all, 11 ambulatory participants with chronic stroke (mean age 67 ± 10.8 years) participated in a 6-month program of exercise for 2 hours and recreation for 1 hour weekly. Executive functions and memory were assessed at baseline and at 3 and 6 months by a battery of standard neuropsychological tests, including response inhibition, cognitive flexibility, dual task (motor plus cognitive), and memory. Motor ability was also assessed. Nonparametric statistics were used to obtain the differences between the 3 assessments. Results . At baseline, substantial deficits in all aspects of executive functioning were revealed. From baseline to 3 months, the mean improvement was 10% ± 14% for the dual task (Walking While Talking), -3% ± 22% (χ 2 = 2.4; P > .05) for response inhibition (Stroop Test), and 61% ± 69% for memory (Rey Auditory Verbal Learning Test—long delay). From baseline to 6 months, the mean improvement was 7% ± 7.5% for response inhibition (Stroop Test). In addition, knee strength and walking speed improved significantly at 3 months. Conclusions. This pilot study suggests that exercise and recreation may improve memory and executive functions of community-dwelling individuals with stroke. Further studies require a larger sample size and a control group.

Daily physical activity and its contribution to the health-related quality of life of ambulatory individuals with chronic stroke

BackgroundParticipation in daily physical activity (PA) post-stroke has not previously been investigated as a possible explanatory variable of health-related quality of life (HRQL). The aims were 1) to determine the contribution of daily PA to the HRQL of individuals with chronic stroke and 2) to assess the relationship between the functional ability of these individuals to the amount of daily PA.MethodsThe amount of daily PA of forty adults with chronic stroke (mean age 66.5 ± 9.6 years) was monitored using two measures. Accelerometers (Actical) were worn on the hip for three consecutive days in conjunction with a self-report questionnaire [the PA Scale for Individuals with Physical Disabilities (PASIPD)]. The daily physical activity was measured as the mean total accelerometer activity counts/day and the PASIPD scores as the metabolic equivalent (MET) hr/day. HRQL was assessed by the Physical and Mental composite scores of the Medical Outcomes Study Short-Form 36 (SF-36) in addition to the functional ability of the participants. Correlation and regression analyses were performed.ResultsAfter controlling for the severity of the motor impairment, the amount of daily PA, as assessed by the PASIPD and accelerometers, was found to independently contribute to 10-12% of the variance of the Physical Composite Score of the SF-36. No significant relationship was found between PA and the Mental Composite Score of the SF-36.The functional ability of the participants was found to be correlated to the amount of daily PA (r = 0.33 - 0.67, p < 0.01).ConclusionThe results suggest that daily PA is associated with better HRQL (as assessed by the Physical composite score of the SF-36) for people living with stroke. Daily PA should be encouraged to potentially increase HRQL. Accelerometers in conjunction with a self-report questionnaire may provide important measures of PA which can be monitored and modified, and potentially influence HRQL.

Disparity between functional recovery and daily use of the upper and lower extremities during subacute stroke rehabilitation

Background. Although inpatient rehabilitation may enhance an individual’s functional ability after stroke, it is not known whether these improvements are accompanied by an increase in daily use of the arms and legs. Objectives. To determine the change in daily use of the upper and lower extremities of stroke patients during rehabilitation and to compare these values with that of community-dwelling older adults. Methods. A total of 60 stroke patients underwent functional assessments and also wore 3 accelerometers for 3 consecutive weekdays on admission to rehabilitation and 3 weeks later prior to hospital discharge. The number of steps and upper-extremity activity counts were measured over the waking hours and during daily use for occupational therapy (OT) and physical therapy (PT) sessions. Healthy older adults (n = 40) also wore 3 accelerometers for 5 consecutive days. Results. Stroke patients demonstrated a significant increase in mobility function, and this was accompanied by an increase in daily walking over the entire day as well as in PT. However, increases in daily walking were found predominantly in patients who were wheelchair users (and not walkers) at the time of admission. Control walking values (5202 steps) were more than 17 times that of stroke patients. Despite significant improvements in paretic hand function, no increase in daily use of the paretic or nonparetic hand was found over the entire day or in PT. Conclusions. A disparity between functional recovery and increases in daily use of the upper and lower extremities was found during inpatient stroke rehabilitation.

Video capture virtual reality: A decade of rehabilitation assessment and intervention

Abstract Background: Video capture virtual reality (VR) systems display the users on a TV or projected screen where they see themselves within a virtual environment (VE) and interact with the virtual stimuli by naturalistic movements without any encumbrance. This is one of the greatest assets of video capture VR systems, making it ideally suited as a tool for rehabilitation. Objective: To provide an overview of how single camera-based markerless video-capture technology has developed and been applied to rehabilitation over the past decade. Method: Short summaries are provided of the numerous studies that use video capture VR for motor and cognitive rehabilitation of clinical populations including stroke, spinal cord injury, traumatic brain injury, cerebral palsy and intellectual disabilities. Results and conclusions: VEs running on video capture VR systems have been shown to be feasible for clinical use for a wide variety of patient populations. The summarised papers include reports of case studies, group comparisons and review articles. Most of the studies using video-capture VR systems were aimed at improving motor aspects of individuals with neurologic conditions but some also address cognitive impairment and motivation in populations with developmental disorders. The majority of the VEs are gaming environments (involving competitive games such as virtual soccer) but functional environments (e.g. street crossing, supermarket shopping) have also been developed. The VEs have been found to be sensitive to differences in motor and cognitive ability and appear to provide an enjoyable and motivating setting for implementing a wide variety of therapeutic goals.

Interventions for addressing low balance confidence in older adults: a systematic review and meta-analysis

BACKGROUND low balance confidence is a major health problem among older adults restricting their participation in daily life. OBJECTIVES to determine what interventions are most effective in increasing balance confidence in older adults. DESIGN systematic review with meta-analysis of randomised controlled trials including at least one continuous end point of balance confidence. Studies, including adults 60 years or older without a neurological condition, were included in our study. METHODS the standardised mean difference (SMD) of continuous end points of balance confidence was calculated to estimate the pooled effect size with random-effect models. Methodological quality of trials was assessed using the Physical Therapy Evidence Database (PEDro) Scale. RESULTS thirty studies were included in this review and a meta-analysis was conducted for 24 studies. Interventions were pooled into exercise (n = 9 trials, 453 subjects), Tai Chi (n = 5 trials, 468 subjects), multifactorial intervention (n = 10 trials, 1,233 subjects). Low significant effects were found for exercise and multifactorial interventions (SMD 0.22-0.31) and medium (SMD 0.48) significant effects were found for Tai Chi. CONCLUSION Tai chi interventions are the most beneficial in increasing the balance confidence of older adults.

TheraGame - a home based virtual reality rehabilitation system

The limitations of existing virtual reality (VR) systems in terms of their use for home-based VR therapy led us to develop “TheraGame”, a novel video capture VR system. TheraGame operates on a standard PC with a simple webcam. The software is programmed using a Javabased visual interaction system. This system enables a quick and easy definition of virtual objects and their behavior. The user sits in front of the monitor, sees himself and uses his movements to interact with the virtual objects. The objective of this presentation is to present the system, a number of the current applications, and some initial pilot usage results. Results from a study of 12 healthy elderly subjects showed moderate to high levels of enjoyment and usability. These scores were also high as reported by 4 participants with neurological deficits. Some limitations in system functionality were reported by one person with stroke who used TheraGame at home for a period of 2.5 weeks. Overall, TheraGame appears to have considerable potential for home based rehabilitation.