Uri Feintuch

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect

Purpose. The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training. Method. Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention. Results. The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing. Conclusions. Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.

Textbook of Neural Repair and Rehabilitation: Virtual reality in neurorehabilitation

This chapter provides an overview of applications of virtual reality (VR) to rehabilitation. A key concept related to VR is immersion. Immersion relates to the extent to which the VR system succeeds in delivering an environment which refocuses a users sensations from the real world to a virtual world. Virtual environments are usually experienced with the aid of special hardware and software for input and output. Visual information is commonly displayed by head mounted displays (HMDs), projection systems or flat screens of varying size. VR applications in rehabilitation are expanding at a rapid pace and a large variety of platforms and programs are currently being used and developed. It has been used as a medium for the assessment and rehabilitation of cognitive processes. The ultimate goal of VR-based intervention is to enable clients to become more able to participate in their own real environments in an independent manner.

Visual Attention and Coactivation of Response Decisions for Features from Different Dimensions

The role of visual attention in task performance has been extensively debated. On the basis of the dimensional-action model, we hypothesized that a major role of attention is to transfer response decisions from targets on which it is focused to high-level centers dealing with response execution. This hypothesis predicts that response decisions for two targets will interact only when attention is focused on both targets, and only when the response to the targets is defined by different dimensions. Three experiments, using the redundancy-gain paradigm, tested and confirmed this prediction. Experiment 1 showed that coactivation of two cross-dimensional targets occurred only when the targets were positioned in the same location, not when they were in separate locations. Experiment 2 manipulated the focus of attention and showed that coactivation can occur even for targets positioned in different locations if they are both within the attentional focus. Experiment 3 showed that this attention-induced coactivation does not occur for targets from the same dimensional module. These results suggest that a major role of attention is postperceptual and involves gating of selected responses to executive functions.

A Virtual Reality System Combined with Biofeedback for Treating Pediatric Chronic Headache—A Pilot Study

OBJECTIVE Pediatric headache is highly widespread and is associated with distress and reduced quality of life. Pharmacological treatment of chronic headache in children has been only partially effective and, as in medication-overuse headache, can sometimes be counterproductive. Therefore, there is a substantial need to develop other effective methods of treatment. Here we present the rationale, feasibility, and preliminary results of a pilot study applying a novel system, combining virtual reality and biofeedback, aimed as an abortive treatment of pediatric chronic headache. DESIGN A prospective single-arm open-label, pilot study. Ten children attending an outpatient pediatric neurology clinic were treated by the proposed system. Participants practiced relaxation with biofeedback and learned to associate successful relaxation with positive pain-free virtual images of themselves. RESULTS Nine patients completed the 10-session intervention. Ratings of pain, daily functioning, and quality of life improved significantly at 1 and at 3 months posttreatment. Most patients reported applying their newly acquired relaxation and imagery skills to relieve headache outside the lab. CONCLUSION This novel system, combining biofeedback and virtual reality, is feasible for pediatric use. Randomized controlled studies in larger populations are needed in order to determine the utility of the system in reducing headache, improving daily functioning, and elevating quality of life.

A Novel Virtual Reality System Integrating Online Self-Face Viewing and Mirror Visual Feedback for Stroke Rehabilitation: Rationale and Feasibility

Abstract Purpose: To introduce the rationale of a novel virtual reality system based on self-face viewing and mirror visual feedback, and to examine its feasibility as a rehabilitation tool for poststroke patients. Method: A novel motion capture virtual reality system integrating online self-face viewing and mirror visual feedback has been developed for stroke rehabilitation.The system allows the replacement of the impaired arm by a virtual arm. Upon making small movements of the paretic arm, patients view themselves virtually performing healthy full-range movements. A sample of 6 patients in the acute poststroke phase received the virtual reality treatment concomitantly with conservative rehabilitation treatment. Feasibility was assessed during 10 sessions for each participant. Results: All participants succeeded in operating the system, demonstrating its feasibility in terms of adherence and improvement in task performance. Patients’ performance within the virtual environment and a set of clinical-functional measures recorded before the virtual reality treatment, at 1 week, and after 3 months indicated neurological status and general functioning improvement. Conclusions: These preliminary results indicate that this newly developed virtual reality system is safe and feasible. Future randomized controlled studies are required to assess whether this system has beneficial effects in terms of enhancing upper limb function and quality of life in poststroke patients.

Post-polio syndrome: impact of hope on quality of life

Purpose: To determine the effect of future-oriented coping strategies on the quality of life (QOL) of individuals with post-polio syndrome (PPS). Methods: A correlative study, in which a cohort of 61 patients was surveyed and a group of 40 healthy, age-matched individuals served as controls. Patients were surveyed as to their QOL, levels of hope and utilization of proactive coping, employment status and degree of functionality. Results: PPS patients had lower total, physical and mental QOL indices compared to controls. Future-oriented coping strategies associated with hope were positively associated with physical and mental QOL in the PPS group, but not in the controls. In a multivariate analysis, hope and employment status predicted higher QOL among those with PPS. Conclusions: Future-oriented coping strategies, particularly hope are distinctively associated with improved QOL benefits in PPS patients. Fostering future-oriented coping related to hope may improve the self-perceived mental and physical status of patients with PPS. Implications for Rehabilitation Coping styles of individuals with post-polio can be conceptualized in terms of positive-optimistic psychological constructs rather than the traditional negative frame of reference. Hope is distinctively associated with improved quality of life among post-polio patients. Enhancing hope through psychotherapy may improve mental and physical health of individuals with postpolio.

Low-cost haptic-aural virtual environments for way-finding by children with congenital blindness: feasibility study

People who are blind find that navigating in new environments constitutes a major hurdle in their road to independence. This study proposes a system which may aid them in overcoming this obstacle. The HaptiGuide is an affordable system which employs a standard desktop computer and a commercially available off-the-shelf haptic joystick. The HaptiGuide enables the construction of simple two dimensional haptic-aural virtual environments. Navigating by the haptic joystick, the user may virtually explore a new environment prior to encountering it in the physical world. This study describes a feasibility study, where nine children who are congenitally blind, were introduced to a novel environment via the HaptiGuide. After traversing the virtual environment, the participants were asked to perform various wayfinding tasks in the equivalent physical environment. In addition, there was a control condition where the participants were introduced to a similar but different novel environment via a direct experience approach. In this condition the participants were personally guided in the physical environment, and then asked to perform wayfinding tasks within the environment. The results indicate that the participants indeed generalized the knowledge acquired during the virtual exploration, and successfully applied it to the physical environment. Preliminary data analysis suggests that performance speed was not diminished compared to that of the control condition. We conclude that the HaptiGuide appears to be feasible and merits further research and development

Visual attention and co-activation of response decisions for features from different dimensions

The role of visual attention in task performance has been extensively debated. On the basis of the dimensional-action model, we hypothesized that a major role of attention is to transfer response decisions from targets on which it is focused to high-level centers dealing with response execution. This hypothesis predicts that response decisions for two targets will interact only when attention is focused on both targets, and only when the response to the targets is defined by different dimensions. Three experiments, using the redundancy-gain paradigm, tested and confirmed this prediction. Experiment 1 showed that coactivation of two cross-dimensional targets occurred only when the targets were positioned in the same location, not when they were in separate locations. Experiment 2 manipulated the focus of attention and showed that coactivation can occur even for targets positioned in different locations if they are both within the attentional focus. Experiment 3 showed that this attention-induced coactivation does not occur for targets from the same dimensional module. These results suggest that a major role of attention is postperceptual and involves gating of selected responses to executive functions.

VirHab - A virtual reality system for treatment of chronic pain and disability

In recent years several lines of research have provided scientific evidence for the therapeutic value of non-invasive methods based on visual feedback and motor imagery. Clinical studies have demonstrated their potential to benefit some patient populations such as cerebrovascular accident (CVA) and complex regional pain syndrome (CRPS). This type of intervention appears appropriate for implementation using virtual reality (VR) technology which can provide the required stimuli. The present study proposes a new VR system based on a motion capture platform, and is currently targeted at treating pain and impairment of upper extremities. The system employs image processing algorithms so the patient sees himself on a screen within a virtual environment. His impaired arm, however, is replaced by a virtual arm. Thus upon making small movements of his paretic arm, he can view his image performing healthy full-range movements with the virtual arm. We hypothesize that this would facilitate plastic changes in the brain, leading to reduced pain and improved function of the impaired limb.

The use of hidden semi-Markov models in clinical diagnosis maze tasks

In this paper, we investigate the use of hidden semi-Markov models (HSMMs) in analyzing data of human activities, a task commonly referred to as activity recognition. In particular, we use the models to recognize normal and abnormal two-dimensional joystick-generated movements of a cursor, controlled by human users in a computerized clinical maze task. This task - as many other activity recognition tasks - places a lot of emphasis on the duration of states. To model the impact of these durations, we present an extension of HSMMs, called Non-Stationary Hidden Semi Markov Models (NSHSMMs). We compare the performance of HMMs, HSMMs and NSHSMMs in recognizing normal and abnormal activities in the data, revealing the advantages of each method under different conditions. We report the results of applying these methods in analyzing real-world data, from 75 subjects executing clinical diagnosis maze-navigation tasks. For relatively simple activity recognition tasks, both HSMMs and NSHSMMs easily and significantly outperform HMMs. Moreover, the results show that HSMM and NSHSMM successfully differentiate between human subject behaviors. However, in some tasks the NSHSMMs outperform the HSMMs and allow significantly more accurate recognition. These results suggest that semi-Markov models, which explicitly account for durations of activities, may be useful in clinical settings for the evaluation and assessment of patients suffering from various cognitive and mental deficits.