José-Antonio Gil-Gómez

Effectiveness of a Wii balance board-based system (eBaViR) for balance rehabilitation: a pilot randomized clinical trial in patients with acquired brain injury

BackgroundAcquired brain injury (ABI) is the main cause of death and disability among young adults. In most cases, survivors can experience balance instability, resulting in functional impairments that are associated with diminished health-related quality of life. Traditional rehabilitation therapy may be tedious. This can reduce motivation and adherence to the treatment and thus provide a limited benefit to patients with balance disorders. We present eBaViR (easy Balance Virtual Rehabilitation), a system based on the Nintendo® Wii Balance Board® (WBB), which has been designed by clinical therapists to improve standing balance in patients with ABI through motivational and adaptative exercises. We hypothesize that eBaViR, is feasible, safe and potentially effective in enhancing standing balance.MethodsIn this contribution, we present a randomized and controlled single blinded study to assess the influence of a WBB-based virtual rehabilitation system on balance rehabilitation with ABI hemiparetic patients. This study describes the eBaViR system and evaluates its effectiveness considering 20 one-hour-sessions of virtual reality rehabilitation (n = 9) versus standard rehabilitation (n = 8). Effectiveness was evaluated by means of traditional static and dynamic balance scales.ResultsThe final sample consisted of 11 men and 6 women. Mean ± SD age was 47.3 ± 17.8 and mean ± SD chronicity was 570.9 ± 313.2 days. Patients using eBaViR had a significant improvement in static balance (p = 0.011 in Berg Balance Scale and p = 0.011 in Anterior Reaches Test) compared to patients who underwent traditional therapy. Regarding dynamic balance, the results showed significant improvement over time in all these measures, but no significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. There were no serious adverse events during treatment in either group.ConclusionsThe results suggest that eBaViR represents a safe and effective alternative to traditional treatment to improve static balance in the ABI population. These results have encouraged us to reinforce the virtual treatment with new exercises, so an evolution of the system is currently being developed.

Improvement in balance using a virtual reality-based stepping exercise: a randomized controlled trial involving individuals with chronic stroke:

Objective: To study the clinical effectiveness and the usability of a virtual reality-based intervention compared with conventional physical therapy in the balance recovery of individuals with chronic stroke. Design: Randomized controlled trial. Setting: Outpatient neurorehabilitation unit. Participants: A total of 20 individuals with chronic stroke. Interventions: The intervention consisted of 20 one-hour sessions, five sessions per week. The experimental group combined 30 minutes with the virtual reality-based intervention with 30 minutes of conventional training. The control group underwent one hour conventional therapy. Main measures: Balance performance was assessed at the beginning and at the end of the trial using the Berg Balance Scale, the balance and gait subscales of the Tinetti Performance-Oriented Mobility Assessment, the Brunel Balance Assessment, and the 10-m Walking Test. Subjective data of the virtual reality-based intervention were collected from the experimental group, with a feedback questionnaire at the end of the trial. Results: The results revealed a significant group-by-time interaction in the scores of the Berg Balance Scale (p < 0.05) and in the 10-m Walking Test (p < 0.05). Post-hoc analyses showed greater improvement in the experimental group: 3.8 ±2.6 vs. 1.8 ±1.4 in the Berg Balance Scale, –1.9 ±1.6 seconds vs. 0.0 ±2.3 seconds in the 10-m Walking Test, and also in the number of participants who increased level in the Brunel Balance Assessment (χ2 = 2.5, p < 0.01). Conclusions: Virtual reality interventions can be an effective resource to enhance the improvement of balance in individuals with chronic stroke.

Virtual Rehabilitation for Multiple Sclerosis Using a Kinect-Based System: Randomized Controlled Trial

Background The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients’ motivation and adherence to treatment. Objective We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient’s progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers. Methods A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales. Results Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system. Conclusions The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed.

Nintendo Wii Balance board for balance disorders

This contribution presents the eBaViR System, a virtual rehabilitation system designed to be used in the patients home. The system uses a conventional PC and the Wii Balance Board to carry out exercises specifically designed for the rehabilitation of postural instability and balance disorders.

The Role of Virtual Motor Rehabilitation: A Quantitative Analysis Between Acute and Chronic Patients With Acquired Brain Injury

Acquired brain injury (ABI) is one of the main problems of disability and death in the world. Its incidence and survival rate are increasing annually. Thus, the number of chronic ABI patients is gradually growing. Traditionally, rehabilitation programs are applied to postacute and acute patients, but recent publications determine that chronic patients may benefit from rehabilitation. Also, in the last few years, the potential of virtual rehabilitation (VR) systems has been demonstrated. However, until now, no previous studies have been carried out to compare the evolution of chronic patients with acute patients in a VR program. To perform this study, we developed a VR system for ABI patients. The system, vestibular virtual rehabilitation (V2R), was designed with clinical specialists. V2R has been tested with 21 people ranging in age from 18 to 80 years old that were classified in two groups: chronic patients and acute patients. The results demonstrate a similar recovery for chronic and acute patients during the intervention period. Also, the results showed that chronic patients stop their improvement when they finish their training. This conclusion encourages us to direct our developments toward VR systems that can be easily integrated at home, allowing chronic patients to have a permanent VR training program.

A comparative study using an autostereoscopic display with augmented and virtual reality

Advances in display devices are facilitating the integration of stereoscopic visualisation in our daily lives. However, autostereoscopic visualisation has not been extensively exploited. In this paper, we present a system that combines augmented reality (AR) and autostereoscopic visualisation. We also present the first study that compares different aspects using an autostereoscopic display with AR and virtual reality (VR), in which 39 children from 8 to 10 years old participated. In our study, no statistically significant differences were found between AR and VR. However, the scores were very high in nearly all of the questions, and the children also scored the AR version higher in all cases. Moreover, the children explicitly preferred the AR version (81%). For the AR version, a strong and significant correlation was found between the use of the autostereoscopic screen in games and seeing the virtual object on the marker. For the VR version, two strong and significant correlations were found. The first correlation was between the ease of play and the use of the rotatory controller. The second correlation was between depth perception and the game global score. Therefore, the combinations of AR and VR with autostereoscopic visualisation are possibilities for developing edutainment systems for children.

BioTrak: a comprehensive overview

This paper describes the BioTrak system, a balance rehabilitation system that uses virtual reality technology to immerse patients in a virtual environment where they are challenged to fulfill simple tasks by means of their own movements. The system tries to motivate and involve patients in order to improve their adherence to the treatment, their effort and, thus, their recovery. This manuscript presents an overview of the system and an early validation. Thirteen patients with acquired brain injury participated in 15 sessions with the system and show significant improvement in Berg Balance Scale, Tinetti Gait Assessment, and balance control in medial-lateral and anterior-posterior plane, quantified with a posturography study.

Balance rehabilitation using custom-made Wii Balance Board exercises: clinical effectiveness and maintenance of gains in an acquired brain injury population

Abstract Balance disorders are a common impairment after an acquired brain injury (ABI). Neurorehabilitation programs focus on the rehabilitation of balance skills to enhance patients’ self-dependency. The Wii Balance Board has been adopted with rehabilitative purposes due to its low cost and widespread battery of exercises. However, this entertainment system is oriented to healthy people and cannot easily adapt to the patient’s motor (and possible cognitive) deficits. The objective of this study was two-fold: a) to study whether custom-made rehabilitative exercises on a force platform could improve the balance condition of ABI patients compared with conventional physical therapy programs; and b) to study if their clinical effects persisted in absence of the virtual training. To prove the first hypothesis, a randomized controlled trial (RCT) was carried out involving 17 ABI participants (control group: 8 participants; experimental group: 9 participants). To prove the second hypothesis a follow-up study (FUS) was carried out involving 7 ABI participants. The participants of both studies underwent 20 1-h sessions, from 3 to 5 sessions per week. The participants were assessed at the beginning and at the end of the treatment (RCT, FUS) and 1 month after the therapy (FUS). Significant improvements were detected in some scales for those participants who underwent the virtual therapy (RCT). The effects persisted over time (FUS). Balance training through low-cost force platforms and custom-made exercises can provide lasting clinical benefits to ABI chronic patients when compared to conventional treatments.

Use of the Wii balance board system in vestibular rehabilitation

Therapies for the treatment of vestibular rehabilitation are focused on postural control, the risk of falls, and the inclusion of patients in activities of daily living (ADL). Recent studies show that virtual reality provides a low-cost system for rehabilitating patients with vestibular disorders. In this paper, we introduce an interdisciplinary project to develop a virtual rehabilitation system, Vestibular Virtual Rehabilitation (V2R), for patients with vestibular disorders. Specifically, we propose an innovative way for interaction between the system and the patients. In the developed system, patients interact with the system following auditory cues, not visual inputs. Due to the features of the disorder of the patients --visual dependency- the proposed system is very promising, as the first results indicate. To obtain this objective, we have generated a low-cost system that is based on the Nintendo® Wii Balance Board® (WBB) and is designed specifically to rehabilitate patients. The results suggest that the use of a virtual rehabilitation system with auditory cues increases the postural control in patients with vestibular disorders.

USEQ: A Short Questionnaire for Satisfaction Evaluation of Virtual Rehabilitation Systems

New emerging technologies have proven their efficacy in aiding people in their rehabilitation. The tests that are usually used to evaluate usability (in general) or user satisfaction (in particular) of this technology are not specifically focused on virtual rehabilitation and patients. The objective of this contribution is to present and evaluate the USEQ (User Satisfaction Evaluation Questionnaire). The USEQ is a questionnaire that is designed to properly evaluate the satisfaction of the user (which constitutes part of usability) in virtual rehabilitation systems. Forty patients with balance disorders completed the USEQ after their first session with ABAR (Active Balance Rehabilitation), which is a virtual rehabilitation system that is designed for the rehabilitation of balance disorders. Internal consistency analysis and exploratory factor analysis were carried out to identify the factor structure of the USEQ. The six items of USEQ were significantly associated with each other, and the Cronbach alpha coefficient for the questionnaire was 0.716. In an analysis of the principal components, a one-factor solution was considered to be appropriate. The findings of the study suggest that the USEQ is a reliable questionnaire with adequate internal consistency. With regard to patient perception, the patients found the USEQ to be an easy-to-understand questionnaire with a convenient number of questions.