Validity of Virtual Reality Environments for Sensorimotor Rehabilitation

Levin, Mindy F.; Deutsch, Judith E.; Kafri, Michal; Liebermann, Dario G.

doi:10.1007/978-1-4939-0968-1_6

Cited by 15 publications

(9 citation statements)

References 79 publications

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“…The hypothesis of specificity of practice expects that transfer is enhanced when therapeutic practice simulates the conditions of real-life performance as closely as possible [83]. There are clear differences in perceptuo-motor affordances and somatosensory information between object interaction in flat-screen VEs, stereoscopic 3D HMD VEs, and the real-world [84, 85]. Critical is the lack of haptic information about interaction forces with virtual objects in a VE.…”

Section: Methodsmentioning

confidence: 99%

Learning and transfer of complex motor skills in virtual reality: a perspective review

Levac

Huber

Sternad

2019

J NeuroEngineering Rehabil

159

158

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The development of more effective rehabilitative interventions requires a better understanding of how humans learn and transfer motor skills in real-world contexts. Presently, clinicians design interventions to promote skill learning by relying on evidence from experimental paradigms involving simple tasks, such as reaching for a target. While these tasks facilitate stringent hypothesis testing in laboratory settings, the results may not shed light on performance of more complex real-world skills. In this perspective, we argue that virtual environments (VEs) are flexible, novel platforms to evaluate learning and transfer of complex skills without sacrificing experimental control. Specifically, VEs use models of real-life tasks that afford controlled experimental manipulations to measure and guide behavior with a precision that exceeds the capabilities of physical environments. This paper reviews recent insights from VE paradigms on motor learning into two pressing challenges in rehabilitation research: 1) Which training strategies in VEs promote complex skill learning? and 2) How can transfer of learning from virtual to real environments be enhanced? Defining complex skills by having nested redundancies, we outline findings on the role of movement variability in complex skill acquisition and discuss how VEs can provide novel forms of guidance to enhance learning. We review the evidence for skill transfer from virtual to real environments in typically developing and neurologically-impaired populations with a view to understanding how differences in sensory-motor information may influence learning strategies. We provide actionable suggestions for practicing clinicians and outline broad areas where more research is required. Finally, we conclude that VEs present distinctive experimental platforms to understand complex skill learning that should enable transfer from therapeutic practice to the real world.

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Section: Methodsmentioning

confidence: 99%

Learning and transfer of complex motor skills in virtual reality: a perspective review

Levac

Huber

Sternad

2019

J NeuroEngineering Rehabil

159

158

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“…Biomechanical (motor) fidelity is defined as movements that are made with similar temporal and spatial parameters, muscle activation patterns, and joint forces in both the VE and a RW [ 46 ]. An additional source of demonstrating fidelity can be obtained from surrogate measures of motor performance including energy expenditure and neural activity [ 47 ]. Overall, the differences in motor and physiological outcomes between the environments found in the current study suggest that the motor fidelity of the VE while performing the VMET was low.…”

Section: Discussionmentioning

confidence: 99%

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

Kafri

Weiss

Zeilig

et al. 2021

J NeuroEngineering Rehabil

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Background Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall. Methods Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures. Results There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p < 0.0001) with higher step lengths (F(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F(1,32) = 19.77, p < 0.0001) and total time (F(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment. Conclusions This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

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“…However, immersive large environments have specific advantages over head-mounted displays (e.g., non-intrusive equipment) that make such environments relevant to rehabilitation clinics. Last but not least, as suggested by Levin et al [20], in general, further evaluation of the performance, quality and surrogate aspects of motor behavior are needed to analyze the fidelity of VR environment tasks to physical environment tasks. We note, nevertheless, on the deliberate simplicity of the exercise set we designed and we tested in this work, in collaboration with a domain expert.…”

Section: Assumptions and Limitationsmentioning

confidence: 99%

User perspective and higher cognitive task-loads influence movement and performance in immersive training environments

et al. 2019

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Background: In virtual reality (VR) applications such as games, virtual training, and interactive neurorehabilitation, one can employ either the first-person user perspective or the third-person perspective to perceive the virtual environment; however, applications rarely offer both perspectives for the same task. We used a targeted-reaching task in a large-scale virtual reality environment (N = 30 healthy volunteers) to evaluate the effects of user perspective on the head and upper extremity movements, and on user performance. We further evaluated how different cognitive challenges would modulate these effects. Finally, we obtained the user-reported engagement level under the different perspectives. Results: We found that first-person perspective resulted in larger head movements (3.52 ± 1.3m) than the third-person perspective (2.41 ± 0.7m). First-person perspective also resulted in more upper-extremity movement (30.08 ± 7.28m compared to 26.66 ± 4.86m) and longer completion times (61.3 ± 16.4s compared to 53 ± 10.4s) for more challenging tasks such as the "flipped mode", in which moving one arm causes the opposite virtual arm to move. We observed no significant effect of user perspective alone on the success rate. Subjects reported experiencing roughly the same level of engagement in both first-person and third-person perspectives (F(1.58) = 0.9, P = .445). Conclusion: User perspective and its interaction with higher-cognitive load tasks influences the extent of movement and user performance in a virtual theater environment, and may influence the choice of the interface type (first or third person) in immersive training depending on the user conditions and exercise requirements.

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Validity of Virtual Reality Environments for Sensorimotor Rehabilitation

Cited by 15 publications

References 79 publications

Learning and transfer of complex motor skills in virtual reality: a perspective review

Learning and transfer of complex motor skills in virtual reality: a perspective review

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

User perspective and higher cognitive task-loads influence movement and performance in immersive training environments

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