Nick Mumford

Virtual reality in acquired brain injury upper limb rehabilitation: Evidence-based evaluation of clinical research

Primary objective: Acquired brain injury (ABI) is associated with significant cognitive, behavioural, psychological and physical impairment. Hence, it has been important to leverage assessment approaches in rehabilitation by using current and emerging technologies, including virtual reality (VR). A number of VR rehabilitation programmes have been designed in recent years, mainly to improve upper limb function. However, before this technology gains widespread use, evaluation of the scientific evidence supporting VR-assisted rehabilitation is needed. The present review aimed to assess the rationale, design and methodology of research investigating the clinical impact of VR on ABI upper-limb rehabilitation. Research design: A total of 22 studies were surveyed using a Cochrane-style review. Research methods: Studies were classified on a number of key criteria: theoretical bases and aims, sample populations and recruitment procedures, characteristics of the VR systems, evaluation design including control procedures and statistical analysis of results. Studies were rated using the Downs and Black (DB) scale. Results: The review demonstrated that few studies used a conventional randomized controlled study design. Moderate support was shown for both teacher-animation and game-like systems. Conclusion: While VR-assisted rehabilitation shows early promise, clinicians are advised to be cautious about adopting these technologies before adequate data is available.

Upper limb virtual rehabilitation for traumatic brain injury: Initial evaluation of the elements system

Primary objective: To evaluate the effectiveness of a tabletop virtual-reality (VR) based upper-limb rehabilitation system (called Elements) for promoting movement skill in patients with TBI. Research design: An ABA case study design with multiple baselines was employed. Baseline performance in this design is contrasted against the results during the treatment phase. Research methods: Three patients with TBI participated in 12 1-hour sessions of VR-based training. The VR system consisted of a 42-inch tabletop LCD, camera tracking system and tangible user interface. The system requires participants to move an object to cued locations while receiving augmented movement feedback to reinforce speed, trajectory and placement. Upper limb performance was assessed using these three system-measured variables and standardized tests. Trends in the time-sequence plots for each patient were assessed by sight inspection of smoothed data and then by statistical analyses. Results: Participants demonstrated improvements on movement accuracy, efficiency and bimanual dexterity and mixed improvement on speed and other measures of movement skill. Conclusion: Taken together, the findings demonstrate that the Elements system shows promise in facilitating motor learning in these TBI patients. Larger scale trials are now deemed a viable step in further validating the system.

A virtual tabletop workspace for the assessment of upper limb function in Traumatic Brain Injury (TBI)

Traditional methods of movement assessment in clinical rehab are often labor intensive and provide a limited number of outcome variables for tracking recovery. Entry level virtual reality (VR) systems afford new possibilities for systematic assessment and treatment. This paper describes the development of a virtual tabletop environment for the assessment of upper limb function in Traumatic Brain Injury (TBI). The system is designed to present realistic virtual workspaces and to measure performance at both a functional and kinematic level. In addition, we incorporate the use of Tangible User Interfaces (TUIs) as a means of integrating performance with the workspace. Unlike top-end movement analysis systems, the experimental system utilizes readily available computing technologies: mid-range PC, LCD panels, stereo camera, Virtools software, and TUI enabled by Wii Remote, Wii Sensor Bar (Nintendo¿) and passive markers. The combination of vision-based marker tracking with a low cost game controller (viz Wii system) provides a stable and accurate means of tracking the TUI on the virtual workspace, and for interactivity within this space. The system provides a compelling sense of realism for the performer and an innovative means of assessing movement capabilities over time.

Cognitive and neuroimaging findings in developmental coordination disorder: new insights from a systematic review of recent research

To better understand the neural and performance factors that may underlie developmental coordination disorder (DCD), and implications for a multi‐component account.

A virtual tabletop workspace for upper-limb rehabilitation in Traumatic Brain Injury (TBI): A multiple case study evaluation

Deficits in upper limb function are common among patients with traumatic brain injury (TBI). Accordingly, new technologies, such as virtual reality (VR), are being developed to further upper limb rehabilitation. The study described here successfully trialed a table-top VR-based system (called Elements). Two patients with TBI participated in case-studies using a multiple-baseline, AB time-sequence design; the intervention consisted of 12 1-hour sessions. Performance was measured on both system-rated measures and standardized tests of functional skill. Time-sequence plots for each patient were first sight inspected for trends; this was followed by split-middle trend analysis. Participants demonstrated significant improvements in their movement accuracy, efficiency, and bimanual dexterity; and mixed improvement on speed and other measures of movement skill. Taken together, these findings demonstrate that the Elements system facilitated motor learning in both TBI patients. Larger scale clinical trials are now deemed a viable step in further validating the system.

Resonance: An Interactive Tabletop Artwork for Co-located Group Rehabilitation and Play

In this paper we describe the design and development of Resonance, an interactive tabletop artwork that targets upper-limb movement rehabilitation for patients with an acquired brain injury. The artwork consists of several interactive game environments, which enable artistic expression, exploration and play. Each environment aims to encourage collaborative, cooperative, and competitive modes of interaction for small groups (2-4) of co-located participants. We discuss how participants can perform movement tasks face-to-face with others using tangible user interfaces in creative and engaging activities. We pay particular attention to design elements that support multiple users and discuss preliminary user evaluation of the system. Our research indicates that group based rehabilitation using Resonance has the potential to stimulate a high level of interest and enjoyment in patients; facilitates social interaction, complements conventional therapy; and is intrinsically motivating.

Tabletop Computer Game Mechanics for Group Rehabilitation of Individuals with Brain Injury

In this paper we provide a rationale for using tabletop displays for the upper-limb movement rehabilitation of individuals with brain injury. We consider how computer game mechanics may leverage this technology to increase patient engagement and social interaction, and subsequently enhance prescribed training. In recent years there has been a growing interest among health professionals in the use of computer games and interactive technology for rehabilitation. Research indicates that games have the potential to stimulate a high level of interest and enjoyment in patients; enhance learning; provide safe task conditions; complement conventional therapy; and become intrinsically motivating. We explore how game mechanics that include reward structures, game challenges and augmented audiovisual feedback may enhance a goal-orientated rehabilitation learning space for individuals with brain injury. We pay particular attention to game design elements that support multiple players and show how these might be designed for interactive tabletop display systems in group rehabilitation.

Virtual rehabilitation of upper-limb function in traumatic brain injury: A mixed-approach evaluation of the Elements system

The aim of this study was to assess the efficacy of the Elements virtual reality (VR) system for rehabilitation of upper-limb function in patients with traumatic brain injury (TBI). A mixed-approach design was used. Performance was evaluated at three time points using a within-group design: Preintervention 1 and 2, conducted 4 weeks apart, and Postintervention. Subjective ratings were provided after patients completed exploratory tasks. The intervention consisted of 12 1-hour training sessions over 4 weeks in addition to conventional physical therapy. Nine patients aged 18–48 years with severe TBI were recruited. The Elements system is comprised of a 40-inch tabletop LCD, camera tracking system, tangible user interfaces (i.e., graspable objects), and software. The system provided two modes of interaction with augmented feedback: goal-directed and exploratory. Upper-limb performance was assessed using system-rated measures (movement speed, accuracy, & efficiency), and standardised tests. Planned comparisons revealed little change in performance over the pretest period apart from an increase in movement speed. Significant training effects, with large effect sizes were shown on most measures. Subjective data revealed high levels of presence (inc. user involvement/control) and user satisfaction for the exploratory tasks. These findings support an earlier case study evaluation of the Elements system, further demonstrating that VR training is a viable adjunct in movement rehabilitation of TBI.