Sergio Albiol-Pérez

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.

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.

Augmented Reality for the Assessment of Children's Spatial Memory in Real Settings

Short-term memory can be defined as the capacity for holding a small amount of information in mind in an active state for a short period of time. Although some instruments have been developed to study spatial short-term memory in real environments, there are no instruments that are specifically designed to assess visuospatial short-term memory in an attractive way to children. In this paper, we present the ARSM (Augmented Reality Spatial Memory) task, the first Augmented Reality task that involves a users movement to assess spatial short-term memory in healthy children. The experimental procedure of the ARSM task was designed to assess the childrens skill to retain visuospatial information. They were individually asked to remember the real place where augmented reality objects were located. The children (N = 76) were divided into two groups: preschool (5–6 year olds) and primary school (7–8 year olds). We found a significant improvement in ARSM task performance in the older group. The correlations between scores for the ARSM task and traditional procedures were significant. These traditional procedures were the Dot Matrix subtest for the assessment of visuospatial short-term memory of the computerized AWMA-2 battery and a parents questionnaire about a childs everyday spatial memory. Hence, we suggest that the ARSM task has high verisimilitude with spatial short-term memory skills in real life. In addition, we evaluated the ARSM tasks usability and perceived satisfaction. The study revealed that the younger children were more satisfied with the ARSM task. This novel instrument could be useful in detecting visuospatial short-term difficulties that affect specific developmental navigational disorders and/or school academic achievement.

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.

A Virtual Fine Rehabilitation System for Children with Cerebral Palsy: Assesment of the Usability of a Low-Cost System

Children with Cerebral Palsy (CP) have difficulty performing correct movements for activities of daily living. Impairments in the first stages of the birth produce motor disorders of the neuromuscular system. Specific goals in traditional rehabilitation are based on the outcomes obtained in the Gross Motor Function Classification System (GMFCS) and are focused on the improvements of muscle strength and length. In the last few years, novel Virtual Environments have been designed to reduce impairments in upper limbs, but few studies have been validated with the use of specific usability tests that are focused on the rehabilitation process of children with CP. The purpose of this study is to analyze the usability, enjoyment, and security of a novel virtual system. To do this, we tested the System Usability Scale with a child that has CP during one session. The outcomes show that our system achieves the goals in terms of usability, enjoyment, and security.

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.

A Neurocognitive Virtual Rehabilitation System for Children with Cerebral Palsy: A Preliminary Usability Study

One of the main neurological disorders in children worldwide is cerebral palsy (CP). The main alterations are postural control, balance, and gait disorders, and difficulty in performing activities of daily living. Techniques in traditional rehabilitation are focused on therapies such as constraint-induced movement, strength training, and functional electrical stimulation. In the last few years, novel and customizable virtual systems have been incorporated in the rehabilitation of children with cerebral palsy, but there are few studies that have tested the usability of these systems. Therefore, the purpose of this paper is to test our tool in terms of usability, acceptance, and security. To do this, we analyzed the system usability questionnaire with subjects without neurological disorders. The results that we obtained show that our tool follows the standards of usability, security, and acceptance. Therefore, we will validate this novel system with children that have CP.

Acceptance and Suitability of a Novel Virtual System in Chronic Acquired Brain Injury Patients

Acquired Brain Injury is one of the leading causes of death in the world. The main alterations are postural control, balance, and gait disorders, that limit activities of daily living. Therapies in traditional gross/fine rehabilitation of upper limbs are: constraint-induced movement therapy, hand splints, or fine motor coordination. Groundbreaking virtual environments have been tested in patients with neurological disorders with encouraging outcomes. However these systems have not been tested with specific and customizable questionnaires that focus on usability, dizziness, disorientation, or realism. Therefore, the aim of this paper is to validate the suitability evaluation questionnaire (SEQ) with our system, the Virtual Rehabilitation Sphero (VRSphero). To do this, we tested previously the SEQ questionnaire with subjects that did not have any cognitive impairment. Since the results show that these subjects did not have problems related to nausea, disorientation or dizziness, we plan to test our tool with chronic ABI patients.

Effects of sensory cueing in virtual motor rehabilitation. A review

OBJECTIVES To critically identify studies that evaluate the effects of cueing in virtual motor rehabilitation in patients having different neurological disorders and to make recommendations for future studies. METHODS Data from MEDLINE®, IEEExplore, Science Direct, Cochrane library and Web of Science was searched until February 2015. We included studies that investigate the effects of cueing in virtual motor rehabilitation related to interventions for upper or lower extremities using auditory, visual, and tactile cues on motor performance in non-immersive, semi-immersive, or fully immersive virtual environments. These studies compared virtual cueing with an alternative or no intervention. RESULTS Ten studies with a total number of 153 patients were included in the review. All of them refer to the impact of cueing in virtual motor rehabilitation, regardless of the pathological condition. After selecting the articles, the following variables were extracted: year of publication, sample size, study design, type of cueing, intervention procedures, outcome measures, and main findings. The outcome evaluation was done at baseline and end of the treatment in most of the studies. All of studies except one showed improvements in some or all outcomes after intervention, or, in some cases, in favor of the virtual rehabilitation group compared to the control group. CONCLUSIONS Virtual cueing seems to be a promising approach to improve motor learning, providing a channel for non-pharmacological therapeutic intervention in different neurological disorders. However, further studies using larger and more homogeneous groups of patients are required to confirm these findings.

Virtual fine rehabilitation in patients with carpal tunnel syndrome using low-cost devices

Carpal tunnel syndrome (CTS) happens when there is a compression of the median nerve between the forearm and the hand. This disorder causes an influence on basic and instrumental Activities of Daily Living. The motor disruptions are muscle weakness, tingling, and heaviness in the hand. The main disorder which subjects suffer with CTS is pain. To alleviate or mitigate pain in CTS, there are different techniques such as pharmacologic treatments, splints to immobilize the wrist, surgery, and physical therapy. Novel and customizable low-cost devices together with Virtual Environments are a good complement in rehabilitation sessions for this syndrome. The aim of this present study is to test a novel system, Virtual Rehabilitation Carpal Tunnel (VRCT), in patients with CTS. For this purpose, we have tested our system with four CTS patients (experimental group). At the same time, four CTS patients were tested using traditional rehabilitation. Phalen and Tinel test were used to analyze the results. The results obtained showed greater improvement in the experimental group during the intervention period. Future research will be focused on the analysis of the follow-up period.