The potential of virtual reality for rehabilitation.

Today’s clinician is privileged to have access to a variety of technologies that provide tools for both research and clinical intervention. The papers in this issue illustrate some of the ways in which technology improves therapy and enhances evaluation. We learn how dynamic posturography can lead to a better understanding of standing balance in clinical settings, how a variety of innovative biomechanical techniques (e.g., polycentric knee mechanism, optical scanner imaging of the transtibial residua) may improve gait for people with amputations, how automatic speech recognition is being used as a computer input method, and how ultrasound and laser treatments may benefit wound healing. An equally innovative technology that has not yet been presented within these pages is virtual reality (VR), the use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real-world objects and events [1–3]. VR is considered one of the most innovative technologies and promises to have a considerable impact on neurorehabilitation over the next 10 years [4]. Virtual environments are usually experienced with the aid of special hardware and software for input (transfer of information from the user to the system) and output (transfer of information from the system to the user). The selection of appropriate hardware and software is important because their characteristics may greatly influence the way users respond to a virtual environment [5]. The output to the user can be delivered by different modalities including visual, auditory, haptic, vestibular, and olfactory stimuli, although, to date, most VR systems deliver primarily visual-auditory feedback. Visual information is commonly displayed by headmounted displays, projection systems, or flat screens of varying size. In addition to specialized hardware, application software is also necessary. In recent years, off-the-shelf, ready-for-clinical-use VR software has become available for purchase. However, more frequently, special software development tools are required for the design and coding of an interactive simulated environment that will achieve a desired rehabilitation goal. In many cases, innovative intervention ideas may entail customized programming for the construction of a virtual environment from scratch, with the use of traditional programming languages. VR technologies have now begun to be used as an assessment and treatment tool in rehabilitation [3,6]. Applications have been directed at a variety of clinical populations including those with cognitive [7–11] and metacognitive [12–14] deficits. Other applications are being directed at the rehabilitation of motor deficits [15–17] to help provide recreational opportunities for people with severe disabilities [18]. VR also shows promise for training in activities of daily living with different populations, including use of a virtual kitchen and vending machine, street crossing, and a hospital and university way-finding environment [11,19,20]. The rehabilitation of driving skills following traumatic brain injury is one example in which individuals may begin at a simple level (i.e., straight, Patrice L. (Tamar) Weiss, PhD; Noomi Katz, OTR, PhD Department of Occupational Therapy, University of Haifa, Haifa, Israel; School of Occupational Therapy, Hadassah-Hebrew University, Jerusalem, Israel

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