Trends in robot-assisted and virtual reality-assisted neuromuscular therapy: a systematic review of health-related multiplayer games

Abstract

BackgroundMultiplayer games have emerged as a promising approach to increase the motivation of patients involved in rehabilitation therapy. In this systematic review, we evaluated recent publications in health-related multiplayer games that involved patients with cognitive and/or motor impairments. The aim was to investigate the effect of multiplayer gaming on game experience and game performance in healthy and non-healthy populations in comparison to individual game play. We further discuss the publications within the context of the theory of flow and the challenge point framework.MethodsA systematic search was conducted through EMBASE, Medline, PubMed, Cochrane, CINAHL and PsycINFO. The search was complemented by recent publications in robot-assisted multiplayer neurorehabilitation. The search was restricted to robot-assisted or virtual reality-based training.ResultsThirteen articles met the inclusion criteria. Multiplayer modes used in health-related multiplayer games were: competitive, collaborative and co-active multiplayer modes. Multiplayer modes positively affected game experience in nine studies and game performance in six studies. Two articles reported increased game performance in single-player mode when compared to multiplayer mode.ConclusionsThe multiplayer modes of training reviewed improved game experience and game performance compared to single-player modes. However, the methods reviewed were quite heterogeneous and not exhaustive. One important take-away is that adaptation of the game conditions can individualize the difficulty of a game to a player’s skill level in competitive multiplayer games. Robotic assistance and virtual reality can enhance individualization by, for example, adapting the haptic conditions, e.g. by increasing haptic support or by providing haptic resistance. The flow theory and the challenge point framework support these results and are used in this review to frame the idea of adapting players’ game conditions.Electronic supplementary materialThe online version of this article (10.1186/s12984-018-0449-9) contains supplementary material, which is available to authorized users.

Competition Enhances the Effectiveness and Motivation of Attention Rehabilitation After Stroke. A Randomized Controlled Trial

“…The greater improvements demonstrated by participants in the competitive group, in almost all attentional domains, could be explained by the increased effort of participants compared with those in the non-competitive group, which could potentially be promoted by the anxiety-inducing factors derived from competition, such as social evaluation (Cooke et al, 2013). The increased benefits of competition observed in this study are in line with previous reports on motor function (Baur et al, 2018;Mandehgary Najafabadi et al, 2019), physical effort, and intensity (Le Bouc and Pessiglione, 2013;Goršič et al, 2017). The increased effects of competition could be detected in almost all timedependent measures.…”

“…Social interactions, with a strong preference for competitive over collaborative paradigms (Schmierbach et al, 2012), can also promote fun and improve the subjective experience (Gajadhar et al, 2008). In rehabilitation, as in other fields, social interactions derived from group interventions can positively influence not only the experience but also the performance of individuals (Baur et al, 2018). Additionally, the inclusion of competitive group dynamics in rehabilitative interventions has also been shown to increase commitment and involvement in the intervention tasks compared with other game modalities (Ede et al, 2015).…”

Virtual reality training enhances gait poststroke: a systematic review and meta‐analysis

“…Furthermore, the patient-centered, closed-loop approach of VR, such as patient-specific difficulty progression, could be an additional reason explaining the observed enhancements in gait performance (see flow theory 117 ). 118 Mishra and Gazzaley 119 have demonstrated that using an adaptive virtual task according to a person's cognitive and physical capabilities promotes robust neural mechanisms that can facilitate plasticity. 119 In addition to the direct influence of VR training, we elucidated the efficacy of adjunct gait training strategies like robot-assisted training with VR on gait recovery.…”

Fuzzy Logic-Based Risk Assessment of a Parallel Robot for Elbow and Wrist Rehabilitation

“…In order to overcome this difficult situation, robotic structures for post-stroke rehabilitation of upper or lower limb started to be developed, being a suitable aid for the kinetotherapist performing the repetitive rehabilitation motions. In the last decades, a series of robotic structures for medical rehabilitation of the upper limb have been developed and analyzed by Huang [6], Al-Fahaan [7], Vaida [8,9], Carbone [10], Görgülü [11], Husty [12], Berceanu [13], Tarnita [14], Gherman [15], Tucan [16] and furthermore systematically reviewed by Ona [17,18], Baur [19], Onase [20], and Rehmat [21]. Some significant research prototypes are presented below.…”