Increasing Patient Engagement During Virtual Reality-Based Motor Rehabilitation

Zimmerli, Lukas; Jacky, Mario; Lünenburger, Lars; Riener, Robert; Bolliger, Marc

doi:10.1016/j.apmr.2013.01.029

Cited by 129 publications

(94 citation statements)

References 44 publications

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“…Although it is generally assumed that VF systems inducing higher levels of VF immersion are associated with higher effectiveness, 2,6,40 this was not explicitly demonstrated by any of the retrieved studies. Rather, it was shown that even a simple mirror may do the trick.…”

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 98%

“…This may coincide with a loss of the awareness of oneself, a sense of control over one's activity and an altered sense of time. 2 Not surprisingly, higher levels of immersion or 'presence' in a virtual environment have been associated with increased distraction and analgesia. 40 Although distraction is not expected to have long-term effects on the clinical (neuropathic) pain complaints often associated with SCI, it might contribute to the prevention of additional increases in pain and fatigue and as such to increased therapy intensity.…”

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

“…Indeed, SCI patients may show increased effort when training in a VF environment, 17 with interactive VF leading to particularly high levels of enjoyment, motivation and attention. 2,6 FUTURE DIRECTIONS: TOWARDS CLOSING KNOWLEDGE GAPS On the basis of the overview of studies that aimed to improve motor functions and/or reduce pain in patients with SCI, as well as considering our present understanding of potential mechanisms underlying the effects of VF, the following knowledge gaps have been identified (see Figure 1). …”

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

“…Still, increased levels of VF interaction have been associated with increased muscle activation, 2 with reduced pain, 40 and with high levels of enjoyment, motivation and attention. 2,6 Adding or removing competitive elements or performance feedback could be useful for task progression, but the actual effectiveness of adding these elements has not yet been demonstrated in patients with SCI. 1,2,13 Theoretically it could be argued that a graded application of VF protocols would be important to avoid additional increases in pain and fatigue, 41 however, there is currently no evidence that this is indeed the case.…”

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

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Virtual feedback for motor and pain rehabilitation after spinal cord injury

Roosink

Mercier

2014

Spinal Cord

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Study design: Interventions using virtual feedback (VF) impact on motor functions and pain and may be relevant for neurorehabilitation after spinal cord injury (SCI) in which motor dysfunctions and (concomitant) pain are frequently observed. Potential mechanisms underlying VF include a modulation of cortical sensorimotor integration, increased therapy engagement and distraction from effort and pain. Still, the optimal parameters for VF and their technical implementation are currently unknown. Objectives: To provide an overview of interventions that have used VF to improve motor functions or to reduce pain after SCI. Methods: Literature review. Results: A total number of 17 studies were identified. VF interventions commonly focused on improving motor functions (n = 12) or reducing pain (n = 4). Only one study assessed both motor functions and pain. Studies generally report beneficial effects. However, the evidence is of low-level quality and many practical as well as theoretical issues remain unclear. Remaining knowledge gaps include: (1) optimal VF system characteristics, (2) the impact of different VF modalities and tasks, (3) dose-response relationships and (4) the identification of patients that are likely to benefit from VF. Future work should start by closing these knowledge gaps using systematic and controlled multi-session interventions and by assessing the underlying mechanisms involved. Conclusion: These results provide an important incentive to further assess the potential of VF interventions to simultaneously improve motor functions and reduce pain after SCI, which could contribute to better neurorehabilitation outcomes after SCI.

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Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 98%

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

Section: Vf Interventions Modulate Cortical Sensorimotor Integrationmentioning

confidence: 99%

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Virtual feedback for motor and pain rehabilitation after spinal cord injury

Roosink

Mercier

2014

Spinal Cord

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“…The use of MR to help increase levels of enjoyment and engagement in rehabilitation is a promising area of investigation. [25][26][27] The results of this pilot study show the need to advance this study into a more complex and comprehensive trial that will include different technology perspectives and MR approaches, especially for persons with SCI. 27 Additionally, the results of this study support the finding that individuals with SCI have greater difficulty in sustaining prolonged exercise practices, possibly due to the physical barriers associated with SCI.…”

Section: Participants' Experience Of Presencementioning

confidence: 99%

Mixed-Reality Exercise Effects on Participation of Individuals with Spinal Cord Injuries and Developmental Disabilities: A Pilot Study

Heyn

Baumgardner

McLachlan

et al. 2014

Topics in Spinal Cord Injury Rehabilitation

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Objective: The purpose of this pilot study was to investigate the effectiveness of a mixed-reality (MR) exercise environment on engagement and enjoyment levels of individuals with spinal cord injury (SCI) and intellectual and developmental disabilities (IDD). Methods: Six people participated in this cross-sectional, observational pilot study involving one MR exercise trial. The augmented reality environment was based on a first-person perspective video of a scenic biking/walking trail in Colorado. Males and females (mean age, 43.3 ± 13.7 years) were recruited from a research database for their participation in previous clinical studies. Of the 6 participants, 2 had SCI, 2 had IDD, and 2 were without disability. The primary outcome measurement of this pilot study was the self-reported engagement and enjoyment level of each participant after the exercise trial. Results: All participants reported increased levels of engagement, enjoyment, and immersion involving the MR exercise environment as well as positive feedback recommending this type of exercise approach to peers with similar disabilities. All the participants reported higher than normal levels of enjoyment and 66.7% reported higher than normal levels of being on a real trail. Conclusion: Participants' feedback suggested that the MR environment could be entertaining, motivating, and engaging for users with disabilities, resulting in a foundation for further development of this technology for use in individuals with cognitive and physical disabilities.

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Different physiotherapy protocols after coronary artery bypass graft surgery: A randomized controlled trial

Ribeiro

Poça

Rocha

et al. 2020

Physiotherapy Res Intl

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Background and purpose The aim of this study was to investigate the influence of different physiotherapy protocols on heart rate variability (HRV) and hospital length of stay in older adults undergoing coronary artery bypass graft (CABG). Methods Randomized controlled trial with allocation and researcher blinding and intention‐to‐treat analysis. Forty‐eight patients undergoing CABG were randomly assigned to a control group (CG), early mobilization group (EMG), or virtual reality group (VRG). CG performed respiratory physiotherapy and metabolic exercises, the EMG performed cycle ergometer exercises and ambulation, and the VRG performed the same activities as the EMG, with the addition of two Nintendo Wii games during 3 postoperative days. The variables of heart rate variability on preoperative and fourth postoperative day, and time of discharge of hospital was analyzed. Results The VRG presented a shorter hospital length of stay (p = 0.03). The CG showed a decline in HRV from the preoperative period to fourth postoperative day on square root of the mean of the squared differences between successive RR intervals (33.18 ± 9.89–9.74 ± 6.88, p < 0.05), standard deviation of all RR intervals (25.48 ± 7.50–15.23 ± 11.27, p < 0.05), and dispersion of points perpendicular to identity line (28.26 ± 21.6–2.73 ± 1.31, p < 0.05). The EMG and VRG presented a higher cardiac autonomic modulation compared to the CG (p < 0.05), with improved parasympathetic activity. Conclusions Different protocols of physiotherapy intervention affected autonomic modulation of the heart rate and hospital length of stay in patients undergoing CABG.

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Increasing Patient Engagement During Virtual Reality-Based Motor Rehabilitation

Cited by 129 publications

References 44 publications

Virtual feedback for motor and pain rehabilitation after spinal cord injury

Virtual feedback for motor and pain rehabilitation after spinal cord injury

Mixed-Reality Exercise Effects on Participation of Individuals with Spinal Cord Injuries and Developmental Disabilities: A Pilot Study

Different physiotherapy protocols after coronary artery bypass graft surgery: A randomized controlled trial

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