A Multisession Evaluation of a Collaborative Virtual Environment for Arm Rehabilitation

Abstract

In recent years, several multi-user virtual environments (VEs) have been developed to promote motivation and exercise intensity in motor rehabilitation. While competitive VEs have been extensively evaluated, collaborative and competitive rehabilitation VEs have seen relatively little study. Therefore, this article presents an evaluation of a VE for post-stroke arm rehabilitation that mimics everyday kitchen tasks and can be used either solo or collaboratively. Twenty subacute stroke survivors exercised with the VE for four sessions, with the first and third sessions involving solo exercise and the other two involving collaborative exercise. Exercise intensity was measured using inertial sensors while motivation was measured with questionnaires. Results showed high motivation and exercise intensity over all four sessions, and 11 of 20 participants preferred collaborative over solo exercise while only 4 preferred solo exercise. However, there were no differences in motivation, exercise duration, or exercise intensity between solo and collaborative sessions. Thus, we cannot currently claim that collaborative exercises are beneficial for upper limb rehabilitation. Future studies should evaluate other collaborative VE designs in different settings (e.g., at home) and with different participant pairs (e.g., patient-unimpaired) to find effective ways to utilize collaborative exercises in motor rehabilitation.

The use of game modes to promote engagement and social involvement in multi-user serious games: a within-person randomized trial with stroke survivors

“…When we analyzed all the sample together, we found that participants felt significantly more Flow and Challenge with the Competitive mode than the Co-active mode. This is coherent with studies that have reported competitive mode as being more motivating [ 35 , 37 ]–[ 40 ]. In fact, Flow and Challenge are important cornerstones of Flow Theory [ 41 ].…”

“…In fact, Flow and Challenge are important cornerstones of Flow Theory [ 41 ]. In a recent study that compared a multiplayer co-active mode (according to criteria defined by Baur et al [ 12 ]) with a solo mode, results showed no significant differences in motivation as measured by the Intrinsic Motivation Inventory [ 37 ]. Comparing this result with what we observed on our study, the Co-active mode was also the one that produced less Flow and Challenge, which can be related to motivation to some extent, as in principle, a person feels flow and challenge at the same time only when being engaged in the task [ 41 ].…”

Automated patient-robot assignment for a robotic rehabilitation gym: a simplified simulation model

“…The first steps beyond the classic "one patient, one robot, one therapist" model involved connecting two robots (or passive sensorized rehabilitation devices), allowing two patients to exercise together either independently or in a competitive/collaborative manner while supervised by a single therapist [7][8][9][10][11][12]. To reduce the burden on the therapist, such two-robot setups commonly include automated difficulty adaptation algorithms that aim to keep the exercise difficulty appropriate for both patients [13][14][15], removing the need for the therapist to constantly modify the exercise settings. Short-term studies have shown benefits to such paired rehabilitation such as improved motivation, exercise intensity and motor learning [7][8][9][10][11][12], and a recent clinical trial found greater improvements in functional outcome after paired therapy than after individual therapy [16].…”

“…x r a ,p j − (y r b ,p j + e r b − V * b r a ,r b ,p j ) * z r a ,p j * z r b ,p j ≥ 0, ∀r a , r b ∈ R, p j ∈ P (15) x r b ,p j − (y r a ,p j + e r a − V * (1 − b r a ,r b ,p j )) * z r a ,p j * z r b ,p j ≥ 0, ∀r a , r b ∈ R, p j ∈ P (16)…”