Flexible Virtual Reality System for Neurorehabilitation and Quality of Life Improvement

As life expectancy is mostly increasing, the incidence of many neurological disorders is also constantly growing. For improving the physical functions affected by a neurological disorder, rehabilitation procedures are mandatory, and they must be performed regularly. Unfortunately, neurorehabilitation procedures have disadvantages in terms of costs, accessibility and a lack of therapists. This paper presents Immersive Neurorehabilitation Exercises Using Virtual Reality (INREX-VR), our innovative immersive neurorehabilitation system using virtual reality. The system is based on a thorough research methodology and is able to capture real-time user movements and evaluate joint mobility for both upper and lower limbs, record training sessions and save electromyography data. The use of the first-person perspective increases immersion, and the joint range of motion is calculated with the help of both the HTC Vive system and inverse kinematics principles applied on skeleton rigs. Tutorial exercises are demonstrated by a virtual therapist, as they were recorded with real-life physicians, and sessions can be monitored and configured through tele-medicine. Complex movements are practiced in gamified settings, encouraging self-improvement and competition. Finally, we proposed a training plan and preliminary tests which show promising results in terms of accuracy and user feedback. As future developments, we plan to improve the system’s accuracy and investigate a wireless alternative based on neural networks.

[1]  Max W. J. Slutter Creating a feedback system with the Myo Armband, for home training for frail older adults , 2017 .

[2]  Alok Mishra,et al.  Algorithm for adaptive learning process and improving learners’ skills in Java programming language , 2018, Comput. Appl. Eng. Educ..

[3]  Min Ho Chun,et al.  Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke. , 2014, Archives of physical medicine and rehabilitation.

[4]  Gorka Epelde,et al.  Virtual Arm Representation and Multimodal Monitoring for the Upper Limb Robot Assisted Teletherapy , 2018, NEUROTECHNIX.

[5]  Eugenio Guglielmelli,et al.  Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art , 2018, Journal of healthcare engineering.

[6]  Osvaldo Gervasi,et al.  Nu!RehaVR: virtual reality in neuro tele-rehabilitation of patients with traumatic brain injury and stroke , 2009, Virtual Reality.

[7]  J. Bongaarts,et al.  United Nations Department of Economic and Social Affairs, Population Division World Family Planning 2020: Highlights, United Nations Publications, 2020. 46 p. , 2020 .

[8]  Roberto Gatti,et al.  Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. , 2015, Journal of physiotherapy.

[9]  Anton Umek,et al.  Validation of smartphone gyroscopes for mobile biofeedback applications , 2016, Personal and Ubiquitous Computing.

[10]  C. Neuper,et al.  It's how you get there: walking down a virtual alley activates premotor and parietal areas , 2014, Front. Hum. Neurosci..

[11]  Berthil Borges Longo,et al.  A Setup for Lower-Limb Post-stroke Rehabilitation Based on Motor Imagery and Motorized Pedal , 2019, IFMBE Proceedings.

[12]  Roberto Lloréns,et al.  Balance Recovery Through Virtual Stepping Exercises Using Kinect Skeleton Tracking: A Follow-Up Study With Chronic Stroke Patients , 2012, Annual Review of Cybertherapy and Telemedicine.

[13]  Zeljka Mihajlovic,et al.  A system for head-neck rehabilitation exercises based on serious gaming and virtual reality , 2017, Multimedia Tools and Applications.

[14]  Andrea Turolla,et al.  Assessment of the cervical spine mobility by immersive and non-immersive virtual reality. , 2020, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[15]  M. Levin,et al.  Maximizing post-stroke upper limb rehabilitation using a novel telerehabilitation interactive virtual reality system in the patient's home: study protocol of a randomized clinical trial. , 2016, Contemporary clinical trials.

[16]  K. Singh,et al.  The clinical development process for a novel preventive vaccine: An overview , 2016, Journal of postgraduate medicine.

[17]  Florica Moldoveanu,et al.  From neuromotor command to feedback: A survey of techniques for rehabilitation through altered perception , 2015, 2015 E-Health and Bioengineering Conference (EHB).

[18]  Alireza Gharabaghi,et al.  Closed-Loop Task Difficulty Adaptation during Virtual Reality Reach-to-Grasp Training Assisted with an Exoskeleton for Stroke Rehabilitation , 2016, Front. Neurosci..

[19]  M. Masruha,et al.  Virtual Rehabilitation through Nintendo Wii in Poststroke Patients: Follow-Up. , 2018, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[20]  Miguel Cazorla,et al.  Inferring Static Hand Poses from a Low-Cost Non-Intrusive sEMG Sensor , 2019, Sensors.

[21]  John Paulin Hansen,et al.  Brain Computer Interface for Neuro-rehabilitation With Deep Learning Classification and Virtual Reality Feedback , 2019, AH.

[22]  Scott Koziol,et al.  A quantitative method for evaluation of 6 degree of freedom virtual reality systems. , 2019, Journal of biomechanics.

[23]  Gaetano Tieri,et al.  Virtual reality in cognitive and motor rehabilitation: facts, fiction and fallacies , 2018, Expert review of medical devices.

[24]  M. Alcañiz,et al.  Embodiment and Presence in Virtual Reality After Stroke. A Comparative Study With Healthy Subjects , 2019, Front. Neurol..

[25]  R. Simons,et al.  Stress recovery during exposure to natural and urban environments , 1991 .

[26]  Dieter Schmalstieg,et al.  Human upper-body inverse kinematics for increased embodiment in consumer-grade virtual reality , 2018, VRST.

[27]  Cinna Soltanpur,et al.  A review on wearable photoplethysmography sensors and their potential future applications in health care , 2018, International journal of biosensors & bioelectronics.

[28]  Mansueto Gomes Neto,et al.  Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients , 2015, Topics in stroke rehabilitation.

[29]  Alberto Jardón Huete,et al.  The Impact of a Novel Immersive Virtual Reality Technology Associated with Serious Games in Parkinson’s Disease Patients on Upper Limb Rehabilitation: A Mixed Methods Intervention Study , 2020, Sensors.

[30]  P. Archambault,et al.  Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle , 2019, International journal of environmental research and public health.

[31]  M. White,et al.  Virtual Activities of Daily Living for Recovery of Upper Extremity Motor Function , 2018, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[32]  Hae Kyung Park,et al.  Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm , 2012, Journal of NeuroEngineering and Rehabilitation.

[33]  M. Owolabi,et al.  Stroke: a global response is needed , 2016, Bulletin of the World Health Organization.

[34]  A. Ward,et al.  Physical and rehabilitation medicine in Europe. , 2006, Journal of rehabilitation medicine.

[35]  Andrea d'Avella,et al.  Towards a Myoelectrically Controlled Virtual Reality Interface for Synergy-Based Stroke Rehabilitation , 2017 .

[36]  Robert V Kenyon,et al.  A Pneumatic Glove and Immersive Virtual Reality Environment for Hand Rehabilitative Training After Stroke , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[37]  D. Gheonea UNIVERSITY OF MEDICINE AND PHARMACY OF CRAIOVA , 2021 .

[38]  William M Carroll,et al.  The global burden of neurological disorders , 2019, The Lancet Neurology.

[39]  George Howard,et al.  Population shifts and the future of stroke: forecasts of the future burden of stroke , 2012, Annals of the New York Academy of Sciences.

[40]  An ICF-based education programme in amputation rehabilitation for medical residents in the Netherlands , 2011, Prosthetics and orthotics international.

[41]  Kelly P Westlake,et al.  Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke , 2009, Journal of NeuroEngineering and Rehabilitation.

[42]  Eyal Oren,et al.  Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, The Lancet. Neurology.

[43]  Kay Jann,et al.  Embodiment Is Related to Better Performance on a Brain–Computer Interface in Immersive Virtual Reality: A Pilot Study , 2020, Sensors.

[44]  Jong-Ling Fuh,et al.  Virtual Reality–Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson’s Disease , 2015, Neurorehabilitation and neural repair.

[45]  Camila Torriani-Pasin,et al.  Aerobic Stimulus Induced by Virtual Reality Games in Stroke Survivors. , 2018, Archives of physical medicine and rehabilitation.

[46]  N. Paik,et al.  Mobile Game-based Virtual Reality Program for Upper Extremity Stroke Rehabilitation. , 2018, Journal of visualized experiments : JoVE.

[47]  B. Saltin,et al.  The “Saltin–Grimby Physical Activity Level Scale” and its application to health research , 2015, Scandinavian journal of medicine & science in sports.

[48]  W. McIlroy,et al.  Effectiveness of Virtual Reality Using Wii Gaming Technology in Stroke Rehabilitation: A Pilot Randomized Clinical Trial and Proof of Principle , 2010, Stroke.

[49]  Attiya Baqai,et al.  Interactive Physiotherapy: An Application Based on Virtual Reality and Bio-feedback , 2018, Wireless Personal Communications.

[50]  P. King Biomechatronics , 2020, IEEE Pulse.

[51]  Deborah M. Miller,et al.  The neurology quality-of-life measurement initiative. , 2011, Archives of physical medicine and rehabilitation.

[52]  A. Curt,et al.  Home-Based Virtual Reality-Augmented Training Improves Lower Limb Muscle Strength, Balance, and Functional Mobility following Chronic Incomplete Spinal Cord Injury , 2017, Front. Neurol..

[53]  Eric Wade,et al.  Virtual Reality and Robotics for Stroke Rehabilitation: Where Do We Go from Here? , 2011, Topics in stroke rehabilitation.

[54]  Arpad Kelemen,et al.  Virtual reality gaming in the rehabilitation of the upper extremities post-stroke , 2016, Brain injury.

[55]  Kwang-Soo Kim,et al.  Pluripotent stem cell-based therapy for Parkinson’s disease: Current status and future prospects , 2018, Progress in Neurobiology.

[56]  James S. Thomas,et al.  Agreement analysis between Vive and Vicon tracking systems to monitor lumbar postural changes , 2018 .

[57]  GervasiOsvaldo,et al.  Nu!RehaVR: virtual reality in neuro tele-rehabilitation of patients with traumatic brain injury and stroke , 2010 .

[58]  Stephanie Wu Diabetic Neuropathy: Clinical Management , 2008 .

[59]  Sook-Lei Liew,et al.  Effects of a Brain-Computer Interface With Virtual Reality (VR) Neurofeedback: A Pilot Study in Chronic Stroke Patients , 2019, Front. Hum. Neurosci..

[60]  G. Lewis,et al.  Virtual reality games for movement rehabilitation in neurological conditions: how do we meet the needs and expectations of the users? , 2012, Disability and rehabilitation.

[61]  James M. Finley,et al.  Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson’s disease , 2017, Journal of NeuroEngineering and Rehabilitation.

[62]  Aitor Ardanza,et al.  Upper Limb Robot Assisted Rehabilitation Platform Combining Virtual Reality, Posture Estimation and Kinematic Indices , 2017 .

[63]  Frank Biocca,et al.  The Cyborg's Dilemma: Progressive Embodiment in Virtual Environments , 2006, J. Comput. Mediat. Commun..

[64]  Florica Moldoveanu,et al.  The TRAVEE System for a Multimodal Neuromotor Rehabilitation , 2019, IEEE Access.

[65]  Kiavash Bahreini,et al.  A fuzzy logic approach to reliable real-time recognition of facial emotions , 2019, Multimedia Tools and Applications.

[66]  Adam Gazzaley,et al.  In Brief , 2011, Nature Reviews Neuroscience.

[67]  R. R. Reijo Pera,et al.  Treatment of Parkinson’s Disease through Personalized Medicine and Induced Pluripotent Stem Cells , 2019, Cells.

[68]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[69]  Mi-Young Kim,et al.  Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study. , 2018, Archives of physical medicine and rehabilitation.

[70]  W. Rymer,et al.  Comparison of Robot-Assisted Reaching to Free Reaching in Promoting Recovery From Chronic Stroke , 2001 .

[71]  Silvia Cirstea,et al.  ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience , 2018, Heliyon.