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Journal articles on the topic 'Virtual reality, embodiment, rehabilitation, neuroplasticity'
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1
Kiper, Paweł, Andrea Turolla, Lamberto Piron, Michela Agostini, Alfonc Baba, Simonetta Rossi, and Paolo Tonin. "Virtual Reality for Stroke Rehabilitation: assessment, training and the effect of virtual therapy." Rehabilitacja Medyczna 14, no. 2 (January 21, 2011): 23–32. http://dx.doi.org/10.5604/01.3001.0009.3141.
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The motor function impairment deriving from stroke injury has a negative impact on autonomy and on the activities of daily living. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. To facilitate the activation of brain areas and consequently neuroplasticity, it may be advantageous to combine traditional motor rehabilitation with innovative technology, in order to promote motor re-learning and skill re-acquisition by means of an enhanced training. Following these principles, exercises should involve multiple sensory modalities exploiting the adaptive nature of the nervous system, in order to promote active patient participation. Movement re-learning could be improved by means of training in an enriched environment focused on optimizing the affordances between the motor system and the physical environment: virtual reality technologies allow for the possibility to create specific settings where the affordances are optimized. Several autors report that patients treated in virtual representation could, in both acute and chronic stroke, improve their arm motor function. Reinforced Feedback in a Virtual Environment (RFVE), can incorporate the elements necessary to maximize motor learning, such as repetitive and differentiated task practice, feedback of performance and results, and reinforcement of the motivation. The RFVE approach may lead to better rehabilitation outcomes in the treatment of the upper limb in stroke patients.
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Johnson, D. A., ED Rose, S. Rushton, B. Pentland, and E. A. Attree. "Virtual Reality: A New Prosthesis for Brain Injury Rehabilitation." Scottish Medical Journal 43, no. 3 (June 1998): 81–83. http://dx.doi.org/10.1177/003693309804300307.
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Virtual Reality (VR) technology is a relatively new application to rehabilitation medicine, yet it offers considerable potential to achieve significant successes in assessment, treatment and improved outcome, thereby increasing our knowledge of neuroplasticity. The capabilities of VR are especially evident in neurological rehabilitation, where cognitive and behavioural problems often interact with physical impairments to reduce the overall level of functioning and interaction. The need for effective interventions in neurological rehabilitation demands communication and collaboration between disciplines. This paper presents some of the current areas of the clinical applications of VR, emphasising the link between experimental evidence on recovery after brain damage and the clinical problems encountered in a ward setting.
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Pratama, Aditya Denny, Naufal Rafi Raihan, and Aisyah Aji Furqonah. "Efektivitas Virtual Reality Training Terhadap Kemampuan Fungsional Ekstremitas Atas pada Kasus Stroke: Studi Literatur." Jurnal Fisioterapi dan Rehabilitasi 6, no. 1 (November 19, 2021): 16–23. http://dx.doi.org/10.33660/jfrwhs.v6i1.158.
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Background. Stroke is a disease caused by the death of tissues in the brain. Clinical problems arise such as motor, sensory, cognitive, language, and emotional disorders. Motor disorders experienced by stroke patients are a decrease in functional ability. Virtual reality training is one of the physiotherapy exercises in handling stroke cases and is estimated to be able to modulate neuroplasticity so as to improve the functional capabilities of the extremities of stroke patients. Materials and Methods. This study is a literature review study with narrative methods. Purpose. Know how effective virtual reality exercises against improving the functional ability of the upper extremities in case of stroke. Result. The provision of virtual reality exercises is proven to improve the functional capabilities of the upper extremities in stroke patients. Virtual reality exercises for stroke provide audio and visual stimulation that triggers neuro-rehabilitation resulting in cortical re-mapping. And also provide motivation that triggers stroke patients to do exercises with a lot of reps so that neuroplasticity occurs. with various parameters such as Fugl-Meyer Upper Extremity Scale (FMA-UE), Wolf Motor Function Test (WMFT), and Box and Block Test (BBT). Conclusion. The administration of physiotherapy exercises using virtual reality can be an interventional solution to rehabilitate and improve the function of the upper extremities if paying attention to several things, such as virtual reality methods, dosages, and the availability of therapeutic tools.
Keywords: Stroke, Virtual Reality training, Functional Abilities
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Coco-Martin, María B., David P. Piñero, Luis Leal-Vega, Carlos J. Hernández-Rodríguez, Joaquin Adiego, Ainhoa Molina-Martín, Dolores de Fez, and Juan F. Arenillas. "The Potential of Virtual Reality for Inducing Neuroplasticity in Children with Amblyopia." Journal of Ophthalmology 2020 (June 29, 2020): 1–9. http://dx.doi.org/10.1155/2020/7067846.
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In recent years, virtual reality (VR) has emerged as a new safe and effective tool for neurorehabilitation of different childhood and adulthood conditions. VR-based therapies can induce cortical reorganization and promote the activation of different neuronal connections over a wide range of ages, leading to contrasted improvements in motor and functional skills. The use of VR for the visual rehabilitation in amblyopia has been investigated in the last years, with the potential of using serious games combining perceptual learning and dichoptic stimulation. This combination of technologies allows the clinician to measure, treat, and control changes in interocular suppression, which is one of the factors leading to cortical alterations in amblyopia. Several clinical researches on this issue have been conducted, showing the potential of promoting visual acuity, contrast sensitivity, and stereopsis improvement. Indeed, several systems have been evaluated for amblyopia treatment including the use of different commercially available types of head mounted displays (HMDs). These HMDs are mostly well tolerated by patients during short exposures and do not cause significant long-term side effects, although their use has been occasionally associated with some visual discomfort and other complications in certain types of subjects. More studies are needed to confirm these promising therapies in controlled randomized clinical trials, with special emphasis on the definition of the most adequate planning for obtaining an effective recovery of the visual and binocular function.
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Bourgeois, Alexia, Armin Schnider, Francesco Turri, and Radek Ptak. "Virtual Reality in the Rehabilitation of Cognitive Impairment after Stroke." Clinical and Translational Neuroscience 7, no. 1 (January 2, 2023): 3. http://dx.doi.org/10.3390/ctn7010003.
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Virtual reality (VR) is seen by some as a tool that may greatly improve, or even revolutionize cognitive rehabilitation. VR offers distinct advantages compared to classic rehabilitation using paper-and-pencil or computer-based training, such as immersion, the feeling of presence, embodiment of virtual players, ecological and multisensory stimulation. We here review recent clinical studies examining the effects of VR training in patients with stroke-induced cognitive deficits. Several trials reported evidence that VR training improves general cognition compared to standard cognitive training. However, the evidence remains controversial, as some of these studies had a high risk of bias. Regarding mood, there is some indication that immersive training improves depression scores in stroke patients, but the number of studies examining mood changes is very low. Finally, in the domain of spatial cognition the development of specific intervention techniques such as virtual prism adaptation provide avenues for clinical interventions, though well-controlled clinical trials are lacking. Together, the available evidence suggests that VR has the potential to improve rehabilitation particularly in domains requiring repetitive training in an immersed, ecological setting, or when a mismatch between body frames and the environment is created. Controlled clinical studies are required to examine the specific advantages of VR compared to classic interventions.
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Jung, Myeongul, Sangyong Sim, Jejoong Kim, and Kwanguk Kim. "Impact of Personalized Avatars and Motion Synchrony on Embodiment and Users’ Subjective Experience: Empirical Study." JMIR Serious Games 10, no. 4 (November 8, 2022): e40119. http://dx.doi.org/10.2196/40119.
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Background Embodiment through a virtual avatar is a key element for people to feel that they are in the virtual world. Objective This study aimed to elucidate the interaction between 2 methods of eliciting embodiment through a virtual avatar: motion synchronization and appearance similarity between a human and avatar, to understand embodiment (agency, body ownership, and self-location) and subjective experience (presence, simulator sickness, and emotion) in virtual reality. Methods Using a full-body motion capture system, 24 participants experienced their virtual avatars with a 3D-scanned face and size-matched body from a first-person perspective. This study used a 2 (motion; sync and async) × 2 (appearance; personalized and generic) within-subject design. Results The results indicated that agency and body ownership increased when motion and appearance were matched, whereas self-location, presence, and emotion were affected by motion only. Interestingly, if the avatar’s appearance was similar to the participants (personalized avatar), they formed an agency toward the avatar’s motion that was not performed by themselves. Conclusions Our findings would be applicable in the field of behavioral therapy, rehabilitation, and entertainment applications, by eliciting higher agency with a personalized avatar.
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Soccini, Agata Marta, Alessandro Clocchiatti, and Tetsunari Inamura. "Effects of Frequent Changes in Extended Self-Avatar Movements on Adaptation Performance." Journal of Robotics and Mechatronics 34, no. 4 (August 20, 2022): 756–66. http://dx.doi.org/10.20965/jrm.2022.p0756.
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Among several perceptive traits of virtual reality, the relationship between the physical body and a self-avatar is unclear. In this study, we investigate a case of hyper-adaptability, i.e., the capability of users to adjust to the movements of an altered self-avatar when such movements abruptly and frequently change. Focusing on movements of the upper limbs, we show experimentally the effect of the frequency of variations in virtual body alterations on adaptability. Moreover, we report a positive evaluation of the sense of embodiment and the overall user experience with virtual reality, and finally underline how these studies can be considered a basis for the design and development of virtual rehabilitation systems.
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Juliano, Julia M., Ryan P. Spicer, Athanasios Vourvopoulos, Stephanie Lefebvre, Kay Jann, Tyler Ard, Emiliano Santarnecchi, David M. Krum, and Sook-Lei Liew. "Embodiment Is Related to Better Performance on a Brain–Computer Interface in Immersive Virtual Reality: A Pilot Study." Sensors 20, no. 4 (February 22, 2020): 1204. http://dx.doi.org/10.3390/s20041204.
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Electroencephalography (EEG)-based brain–computer interfaces (BCIs) for motor rehabilitation aim to “close the loop” between attempted motor commands and sensory feedback by providing supplemental information when individuals successfully achieve specific brain patterns. Existing EEG-based BCIs use various displays to provide feedback, ranging from displays considered more immersive (e.g., head-mounted display virtual reality (HMD-VR)) to displays considered less immersive (e.g., computer screens). However, it is not clear whether more immersive displays improve neurofeedback performance and whether there are individual performance differences in HMD-VR versus screen-based neurofeedback. In this pilot study, we compared neurofeedback performance in HMD-VR versus a computer screen in 12 healthy individuals and examined whether individual differences on two measures (i.e., presence, embodiment) were related to neurofeedback performance in either environment. We found that, while participants’ performance on the BCI was similar between display conditions, the participants’ reported levels of embodiment were significantly different. Specifically, participants experienced higher levels of embodiment in HMD-VR compared to a computer screen. We further found that reported levels of embodiment positively correlated with neurofeedback performance only in HMD-VR. Overall, these preliminary results suggest that embodiment may relate to better performance on EEG-based BCIs and that HMD-VR may increase embodiment compared to computer screens.
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Haar, Shlomi, Guhan Sundar, and A. Aldo Faisal. "Embodied virtual reality for the study of real-world motor learning." PLOS ONE 16, no. 1 (January 27, 2021): e0245717. http://dx.doi.org/10.1371/journal.pone.0245717.
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Motor-learning literature focuses on simple laboratory-tasks due to their controlled manner and the ease to apply manipulations to induce learning and adaptation. Recently, we introduced a billiards paradigm and demonstrated the feasibility of real-world-neuroscience using wearables for naturalistic full-body motion-tracking and mobile-brain-imaging. Here we developed an embodied virtual-reality (VR) environment to our real-world billiards paradigm, which allows to control the visual feedback for this complex real-world task, while maintaining sense of embodiment. The setup was validated by comparing real-world ball trajectories with the trajectories of the virtual balls, calculated by the physics engine. We then ran our short-term motor learning protocol in the embodied VR. Subjects played billiard shots when they held the physical cue and hit a physical ball on the table while seeing it all in VR. We found comparable short-term motor learning trends in the embodied VR to those we previously reported in the physical real-world task. Embodied VR can be used for learning real-world tasks in a highly controlled environment which enables applying visual manipulations, common in laboratory-tasks and rehabilitation, to a real-world full-body task. Embodied VR enables to manipulate feedback and apply perturbations to isolate and assess interactions between specific motor-learning components, thus enabling addressing the current questions of motor-learning in real-world tasks. Such a setup can potentially be used for rehabilitation, where VR is gaining popularity but the transfer to the real-world is currently limited, presumably, due to the lack of embodiment.
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Kiper, Paweł, Andrzej Szczudlik, Elżbieta Mirek, Roman Nowobilski, Józef Opara, Michela Agostini, Paolo Tonin, and Andrea Turolla. "The application of virtual reality in neuro-rehabilitation: motor re-learning supported by innovative technologies." Rehabilitacja Medyczna 17, no. 4 (April 22, 2014): 29–36. http://dx.doi.org/10.5604/01.3001.0009.3087.
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The motor function impairment resulting from a stroke injury has a negative impact on autonomy, the activities of daily living thus the individuals affected by a stroke need long-term rehabilitation. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. Innovative technologies used in rehabilitation allow one the possibility to enhance training throughout generated feedback. It seems advantageous to combine traditional motor rehabilitation with innovative technology in order to promote motor re-learning and skill re-acquisition by means of enhanced training. An environment enriched by feedback involves multiple sensory modalities and could promote active patient participation. Exercises in a virtual environment contain elements necessary to maximize motor learning, such as repetitive and diffe-rentiated task practice and feedback on the performance and results. The recovery of the limbs motor function in post-stroke subjects is one of the main therapeutic aims for patients and physiotherapist alike. Virtual reality as well as robotic devices allow one to provide specific treatment based on the reinforced feedback in a virtual environment (RFVE), artificially augmenting the sensory information coherent with the real-world objects and events. Motor training based on RFVE is emerging as an effective motor learning based techniques for the treatment of the extremities.
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Arcuri, Francesco, Camillo Porcaro, Irene Ciancarelli, Paolo Tonin, and Antonio Cerasa. "Electrophysiological Correlates of Virtual-Reality Applications in the Rehabilitation Setting: New Perspectives for Stroke Patients." Electronics 10, no. 7 (April 1, 2021): 836. http://dx.doi.org/10.3390/electronics10070836.
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Here we reviewed the last evidence on the application of electroencephalography (EEG) as a non-invasive and portable neuroimaging method useful to extract hallmarks of neuroplasticity induced by virtual reality (VR) rehabilitation approaches in stroke patients. In the neurorehabilitation context, VR training has been used extensively to hamper the effects of motor treatments on the stroke’s brain. The concept underlying VR therapy is to improve brain plasticity by engaging users in multisensory training. In this narrative review, we present the key concepts of VR protocols applied to the rehabilitation of stroke patients and critically discuss challenges of EEG signal when applied as endophenotype to extract neurophysiological markers. When VR technology was applied to magnify the effects of treatments on motor recovery, significant EEG-related neural improvements were detected in the primary motor circuit either in terms of power spectral density or as time-frequency domains.
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Leitner, Michael Christian, Dirk Christoph Guetlin, and Stefan Hawelka. "Salzburg Visual Field Trainer (SVFT): A virtual reality device for (the evaluation of) neuropsychological rehabilitation." PLOS ONE 16, no. 9 (September 16, 2021): e0249762. http://dx.doi.org/10.1371/journal.pone.0249762.
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Objective “Visual Restitution Therapies” (VRT) claim to ameliorate visual field defects of neurological patients by repeated visual light stimulation, leading to training-related neuroplasticity and resulting in reconnection of lesioned neurons in early cortical areas. Because existing systems are stationary, uncomfortable, and unreliable, we developed a training instrument based on virtual reality goggles. The goal of the “Salzburg Visual Field Trainer” (SVFT) is twofold: (1) The device facilitates the clinical evaluation of established neuropsychological rehabilitation approaches, such as VRT. (2) The device enables patients to independently perform VRT based (or other) neuropsychological training methodologies flexibly and comfortably. Methods and analysis The SVFT was developed on the principles of VRT. Individual configuration of the SVFT is based on perimetric data of the respective patient’s visual field. To validate the utmost important aspect of neuropsychological rehabilitation methodologies—that is displaying stimuli precisely in desired locations in the user’s visual field—two steps were conducted in this proof-of-concept study: First, we assessed the individual “blind spots” location and extent of 40 healthy, normal sighted participants. This was done with the help of our recently developed perimetric methodology “Eye Tracking Based Visual Field Analysis” (EFA). Second, depending on the individual characteristics of every participant’s blind spots, we displayed—by means of the SVFT—15 stimuli in the respective locations of every participants’ blind spots and 85 stimuli in the surrounding, intact visual area. The ratio between visible and non-visible stimuli, which is reflected in the behavioral responses (clicks on a remote control) of the 40 participants, provides insight into the accuracy of the SVFT to display training stimuli in areas desired by the investigator. As the blind spot is a naturally occurring, absolute scotoma, we utilized this blind area as an objective criterion and a “simulated” visual field defect to evaluate the theoretical applicability of the SVFT. Results Outcomes indicate that the SVFT is highly accurate in displaying training stimuli in the desired areas of the user’s visual field with an accuracy of 99.0%. Data analysis further showed a sensitivity of .98, specificity of .99, a positive predictive value of .96, a negative predictive value of .996, a hit rate of .99, a random hit rate of .74 and a RATZ-Index of .98. This translates to 14.7% correct non-reactions, 0.7% false non-reactions, 0.3% false reactions and 84.3% correct reactions to displayed test stimuli during the evaluation study. Reports from participants further indicate that the SVFT is comfortable to wear and intuitive to use. Conclusions The SVFT can help to investigate the true effects of VRT based methodologies (or other neuropsychological approaches) and the underlying mechanisms of training-related neuroplasticity in the visual cortex in neurological patients suffering from visual field defects.
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Feitosa, Jamille A., Corina A. Fernandes, Raphael F. Casseb, and Gabriela Castellano. "Effects of virtual reality-based motor rehabilitation: a systematic review of fMRI studies." Journal of Neural Engineering 19, no. 1 (January 24, 2022): 011002. http://dx.doi.org/10.1088/1741-2552/ac456e.
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Abstract Background. The use of virtual reality (VR) as a rehabilitation tool has been shown to induce motor and cognitive improvements in different populations. Functional magnetic resonance imaging (fMRI) has been used to investigate neuroplasticity resulting from these treatments. We hypothesize that VR rehabilitation induces functional improvement and brain changes that can be detected by fMRI. Objective. To systematically review the effects of VR intervention on the cortical reorganization measured by fMRI and associated with functional improvement. Approach. We performed a systematic review of studies published between 2005 and 2021. Papers were retrieved from six databases using the following keywords: ‘motor rehabilitation’, ‘fMRI’ and ‘virtual reality’. Case studies, pre-post studies, cross-sectional studies, and randomized controlled trials published were included. Manuscripts were assessed by The National Institutes of Health study quality assessment tools to determine their quality. Main results. Twenty-three articles met our eligibility criteria: 18 about VR rehabilitation in stroke and five on other clinical conditions (older adults, cerebral palsy, and Parkinson’s disease). Changes in neural patterns of activation and reorganization were revealed in both the ipsilesional and the contralesional hemispheres. Results were located mainly in the primary motor cortex, sensorimotor cortex and supplementary motor area in post-stroke patients in the acute, subacute, and chronic rehabilitation phases, and were associated with functional improvement after VR intervention. Similar effects were observed in older adults and in patients with other neurological diseases with improved performance. Significance. Most stroke-related studies showed either restoration to normal or increase of activation patterns or relateralization at/to the ipsilesional hemisphere, with some also reporting a decrease in activity or extent of activation after VR therapy. In general, VR intervention demonstrated evidence of efficacy both in neurological rehabilitation and in performance improvement of older adults, accompanied by fMRI evidence of brain reorganization.
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Kim, Won-Seok, Sungmin Cho, Jeonghun Ku, Yuhee Kim, Kiwon Lee, Han-Jeong Hwang, and Nam-Jong Paik. "Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence." Journal of Clinical Medicine 9, no. 10 (October 21, 2020): 3369. http://dx.doi.org/10.3390/jcm9103369.
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Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
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Grigoras, Alexandru-Valer, Bogdan Ignat, Marian Poboroniuc, Dragos Popescu, and Cristian Dinu Popescu. "STATE OF THE ART AND EFFICIENCY OF ROBOTIC THERAPY IN UPPER LIMB REHABILITATION – A LITERATURE REVIEW." Romanian Journal of Neurology 14, no. 4 (December 31, 2015): 175–81. http://dx.doi.org/10.37897/rjn.2015.4.1.
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Stroke represents the main cause of disability in adults. The disability is caused by motor or sensitive impairment, loss of interjoint coordination, spasticity and pathological synergies that occur after stroke. The new directions in motor rehabilitation point at facilitating neuroplasticity by multimodal stimulation, like virtual reality, or by active assistance in task specific training, like rehabilitation robots associated or not with functional electrical stimulation (FES). The aim of this article is, on one hand, to analyze the way in which the existing robots face the biomechanical challenges of modeling the upper limb`s movements and, on the other hand, to evaluate the efficiency of robotics in rehabilitation, by pointing out the results of the existing clinical trials. Finally, possible directions for future research are discussed.
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Koleva, Ivet B. "Robotic Neurorehabilitation in Neuro-COVID with Presentation of Clinical Cases." Clinical Studies and Medical Case Reports 9, no. 3 (December 26, 2022): 1. http://dx.doi.org/10.24966/csmc-8801/1000143.
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Ultimately, contemporary Information and Communication Technologies (ICT) were introduced in the rehabilitation practice. We use Exoskeletons, virtual reality, robotic rehabilitation with Locomat (Hocoma system for balance and gait training) and ThyroMotion system (for grasp training). Our purpose was to emphasize the impact of robotic rehabilitation in the process of recovery of patients with neurological complications of COVID-19, as follows: cerebral vascular accidents, spinal ischemic stroke, relapses of multiple sclerosis, Guillain-Barre syndrome, development of rare diseases (as cerebellar ataxia or amyotrophic lateral sclerosis /motor neuron disease), etc. We present typical and rare clinical cases (consequences and complications of COVID-19), treated by robotic neurorehabilitation. Our results demonstrated positive effects of ICT-application on the neuroplasticity, functional recovery and quality of life of neurological patients. We consider introduction of robotics as necessary tool in the process of neurorehabilitation.
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Naro, Antonino, and Rocco Salvatore Calabrò. "What Do We Know about The Use of Virtual Reality in the Rehabilitation Field? A Brief Overview." Electronics 10, no. 9 (April 28, 2021): 1042. http://dx.doi.org/10.3390/electronics10091042.
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Over the past two decades, virtual reality technology (VRT)-based rehabilitation has been increasingly examined and applied to assist patient recovery in the physical and cognitive domains. The advantages of the use of VRT in the neurorehabilitation field consist of the possibility of training an impaired function as a way to stimulate neuron reorganization (to maximize motor learning and neuroplasticity) and restoring and regaining functions and abilities by interacting with a safe and nonthreatening yet realistic virtual reality environment (VRE). Furthermore, VREs can be tailored to patient needs and provide personalized feedback on performance. VREs may also support cognitive training and increases patient motivation and enjoyment. Despite these potential advantages, there are inconclusive data about the usefulness of VRT in neurorehabilitation settings, and some issues on feasibility and safety remain to be ascertained for some neurological populations. The present brief overview aims to summarize the available literature on VRT applications in neurorehabilitation settings, along with discussing the pros and cons of VR and introducing the practical issues for research. The available studies on VRT for rehabilitation purposes over the past two decades have been mostly preliminary and feature small sample sizes. Furthermore, the studies dealing with VRT as an assessment method are more numerous than those harnessing VRT as a training method; however, the reviewed studies show the great potential of VRT in rehabilitation. A broad application of VRT is foreseeable in the near future due to the increasing availability of low-cost VR devices and the possibility of personalizing VR settings and the use of VR at home, thus actively contributing to reducing healthcare costs and improving rehabilitation outcomes.
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Bonanno, Mirjam, Rosaria De Luca, Alessandro Marco De Nunzio, Angelo Quartarone, and Rocco Salvatore Calabrò. "Innovative Technologies in the Neurorehabilitation of Traumatic Brain Injury: A Systematic Review." Brain Sciences 12, no. 12 (December 7, 2022): 1678. http://dx.doi.org/10.3390/brainsci12121678.
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Motor and cognitive rehabilitation in individuals with traumatic brain injury (TBI) is a growing field of clinical and research interest. In fact, novel rehabilitative approaches allow a very early verticalization and gait training through robotic devices and other innovative tools boosting neuroplasticity, thanks to the high-intensity, repetitive and task-oriented training. In the same way, cognitive rehabilitation is also evolving towards advanced interventions using virtual reality (VR), computer-based approaches, telerehabilitation and neuromodulation devices. This review aimed to systematically investigate the existing evidence concerning the role of innovative technologies in the motor and cognitive neurorehabilitation of TBI patients. We searched and reviewed the studies published in the Cochrane Library, PEDro, PubMed and Scopus between January 2012 and September 2022. After an accurate screening, only 29 papers were included in this review. This systematic review has demonstrated the beneficial role of innovative technologies when applied to cognitive rehabilitation in patients with TBI, while evidence of their effect on motor rehabilitation in this patient population is poor and still controversial.
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Tsveov, Mihail, Pavel Venev, Dimitar Chakarov, and Ivanka Veneva. "Simulations and experimental evaluation of an active orthosis for interaction in virtual environments." MATEC Web of Conferences 145 (2018): 01006. http://dx.doi.org/10.1051/matecconf/201814501006.
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In this work, the development of a human arm active orthosis is presented. The orthosis is designed primarily for training and rehabilitation in virtual environments.The orthosis system is intended for embodiment in virtual reality where it is allowing human to perceive forces at different body parts or the weight of lifted objects. In the paper the choice of a mechanical structure is shown equivalent to the structure of the human arm. A mechanical model of the orthosis arm as haptic device is built, where kinematic and dynamic parameters are evaluated. Impedance control scheme is selected as the most suitable for force refection at the hand or arm. An open-loop impedance controller is presented in the paper. Computer experiments are carried out using the dimensions of a real arm orthosis. Computer experiments have been carried out to provide force reflection by VR, according to virtual scenario. The conducted simulations show the range of the forces on the operator hand, orthosis can provide. The results of additional measurements and experimental evaluations of physical quantities in the interaction in a virtual environment are revealed in the paper.
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Gonçalves, Maicon Gabriel, Mariana Floriano Luiza Piva, Carlos Leonardo Sacomani Marques, Rafael Dalle Molle da Costa, Rodrigo Bazan, Gustavo José Luvizutto, and Luiz Eduardo Gomes Garcia Betting. "Effects of virtual reality therapy on upper limb function after stroke and the role of neuroimaging as a predictor of a better response." Arquivos de Neuro-Psiquiatria 76, no. 10 (October 2018): 654–62. http://dx.doi.org/10.1590/0004-282x20180104.
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ABSTRACT Background: Virtual reality therapy (VRT) is an interactive intervention that induces neuroplasticity. The aim was to evaluate the effects of VRT associated with conventional rehabilitation for an upper limb after stroke, and the neuroimaging predictors of a better response to VRT. Methods: Patients with stroke were selected, and clinical neurological, upper limb function, and quality of life were evaluated. Statistical analysis was performed using a linear model comparing pre- and post-VRT. Lesions were segmented in the post-stroke computed tomography. A voxel-based lesion-symptom mapping approach was used to investigate the relationship between the lesion and upper limb function. Results: Eighteen patients were studied (55.5 ± 13.9 years of age). Quality of life, functional independence, and dexterity of the upper limb showed improvement after VRT (p < 0.001). Neuroimaging analysis showed negative correlations between the internal capsule lesion and functional recovery. Conclusion: VRT showed benefits for patients with stroke, but when there was an internal capsule lesion, a worse response was observed.
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Hoffman, Hunter G., David A. Boe, Eric Rombokas, Christelle Khadra, Sylvie LeMay, Walter J. Meyer, Sam Patterson, Ann Ballesteros, and Stephen W. Pitt. "Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain." Journal of Hand Therapy 33, no. 2 (April 2020): 254–62. http://dx.doi.org/10.1016/j.jht.2020.04.001.
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Parisi, Alessandra, Francesca Bellinzona, Daniele Di Lernia, Claudia Repetto, Stefano De Gaspari, Giulia Brizzi, Giuseppe Riva, and Cosimo Tuena. "Efficacy of Multisensory Technology in Post-Stroke Cognitive Rehabilitation: A Systematic Review." Journal of Clinical Medicine 11, no. 21 (October 26, 2022): 6324. http://dx.doi.org/10.3390/jcm11216324.
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Post-stroke, in addition to sensorimotor signs and symptoms, could lead to cognitive deficits. Theories of embodiment stress the role of sensorimotor system and multisensory integration in sustaining high-order cognitive domains. Despite conventional post-stroke cognitive rehabilitation being effective, innovative technologies could overcome some limitations of standard interventions and exploit bodily information during cognitive rehabilitation. This systematic review aims to investigate whether ‘multisensory technologies’ compared to usual care treatment can be a viable alternative for cognitive rehabilitation. By applying PRISMA guidelines, we extracted data and assessed the bias of 10 studies that met the required criteria. We found that multisensory technologies were at least comparable to standard treatment but particularly effective for attention, spatial cognition, global cognition, and memory. Multisensory technologies consisted principally of virtual reality alone or combined with a motion tracking system. Multisensory technologies without motion tracking were more effective than standard procedures, whereas those with motion tracking showed balanced results for the two treatments. Limitations of the included studies regarded the population (e.g., no study on acute stroke), assessment (e.g., lack of multimodal/multisensory pre-post evaluation), and methodology (e.g., sample size, blinding bias). Recent advancements in technological development and metaverse open new opportunities to design embodied rehabilitative programs.
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Leemhuis, Erik, Francesca Favieri, Giuseppe Forte, and Mariella Pazzaglia. "Integrated Neuroregenerative Techniques for Plasticity of the Injured Spinal Cord." Biomedicines 10, no. 10 (October 13, 2022): 2563. http://dx.doi.org/10.3390/biomedicines10102563.
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On the slow path to improving the life expectancy and quality of life of patients post spinal cord injury (SCI), recovery remains controversial. The potential role of the regenerative capacity of the nervous system has led to numerous attempts to stimulate the SCI to re-establish the interrupted sensorimotor loop and to understand its potential in the recovery process. Numerous resources are now available, from pharmacological to biomolecular approaches and from neuromodulation to sensorimotor rehabilitation interventions based on the use of various neural interfaces, exoskeletons, and virtual reality applications. The integration of existing resources seems to be a promising field of research, especially from the perspective of improving living conditions in the short to medium term. Goals such as reducing chronic forms of neuropathic pain, regaining control over certain physiological activities, and enhancing residual abilities are often more urgent than complete functional recovery. In this perspective article, we provide an overview of the latest interventions for the treatment of SCI through broad phases of injury rehabilitation. The underlying intention of this work is to introduce a spinal cord neuroplasticity-based multimodal approach to promote functional recovery and improve quality of life after SCI. Nonetheless, when used separately, biomolecular therapeutic approaches have been shown to have modest outcomes.
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Grampurohit, Namrata, Alison Bell, Susan V. Duff, MJ Mulcahey, Christina Calhoun Thielen, Gary Kaplan, and Ralph J. Marino. "Highlighting gaps in spinal cord injury research in activity-based interventions for the upper extremity: A scoping review." NeuroRehabilitation 49, no. 1 (August 14, 2021): 23–38. http://dx.doi.org/10.3233/nre-210042.
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BACKGROUND: Upper extremity activity-based therapy for neurologic disorders employs high-intensity, high repetition functional training to exploit neuroplasticity and improve function. Research focused on high-intensity upper extremity activity-based therapy for persons with spinal cord injury (SCI) is limited. OBJECTIVE: To summarize high-intensity activity-based interventions used in neurological disorders for their current or potential application to SCI. METHODS: The scoping review included articles from MEDLINE, CINAHL, Cochrane CENTRAL, and OTSeeker with the criteria: non-invasive activity-based interventions delivered at least three times/week for two weeks, upper extremity functional outcomes, age 13 years or older, English language, and neurological disorders three months post onset/injury. RESULTS: The search yielded 172 studies. There were seven studies with SCI, all in adults. Activity-based interventions in SCI included task-specific training and gaming, with and without electrical stimulation, and a robotic exoskeleton. The other populations found in the review included studies in stroke, cerebral palsy, and multiple sclerosis. Thirty-four different interventions were reported in other populations. In comparison to the extensive stroke research, work in SCI was not found for high-intensity interventions using virtual reality, brain stimulation, rehabilitation devices, and applications to the home and telerehab settings. CONCLUSION: The results highlight critical gaps within upper extremity high-intensity activity-based research in SCI.
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Inguaggiato, E., G. Sgandurra, S. Perazza, A. Guzzetta, and G. Cioni. "Brain Reorganization following Intervention in Children with Congenital Hemiplegia: A Systematic Review." Neural Plasticity 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/356275.
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Noninvasive rehabilitation strategies for children with unilateral cerebral palsy are routinely used to improve hand motor function, activity, and participation. Nevertheless, the studies exploring their effects on brain structure and function are very scarce. Recently, structural neuroplasticity was demonstrated in adult poststroke patients, in response to neurorehabilitation. Our purpose is to review current evidence on the effects of noninvasive intervention strategies on brain structure or function, in children with unilateral cerebral palsy. The main literature databases were searched up to October 2013. We included studies where the effects of upper limb training were evaluated at neurofunctional and/or neurostructural levels. Only seven studies met our selection criteria; selected studies were case series, six using the intervention of the constraint-induced movement therapy (CIMT) and one used virtual reality therapy (VR). CIMT and VR seem to produce measurable neuroplastic changes in sensorimotor cortex associated with enhancement of motor skills in the affected limb. However, the level of evidence is limited, due to methodological weaknesses and small sample sizes of available studies. Well-designed and larger experimental studies, in particular RCTs, are needed to strengthen the generalizability of the findings and to better understand the mechanism of intervention-related brain plasticity in children with brain injury.
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Jopowicz, Anna, Justyna Wiśniowska, and Beata Tarnacka. "Cognitive and Physical Intervention in Metals’ Dysfunction and Neurodegeneration." Brain Sciences 12, no. 3 (March 3, 2022): 345. http://dx.doi.org/10.3390/brainsci12030345.
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Metals—especially iron, copper and manganese—are important elements of brain functions and development. Metal-dysregulation homeostasis is associated with brain-structure damage to the motor, cognitive and emotional systems, and leads to neurodegenerative processes. There is more and more evidence that specialized cognitive and motor exercises can enhance brain function and attenuate neurodegeneration in mechanisms, such as improving neuroplasticity by altering the synaptic structure and function in many brain regions. Psychological and physical methods of rehabilitation are now becoming increasingly important, as pharmacological treatments for movement, cognitive and emotional symptoms are limited. The present study describes physical and cognitive rehabilitation methods of patients associated with metal-induced neurotoxicity such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis, Huntington’s disease and Wilson’s disease. In our review, we describe physical (e.g., virtual-reality environments, robotic-assists training) and psychological (cognitive training, cognitive stimulation, neuropsychological rehabilitation and cognitive-behavioral and mindfulness-based therapies) methods, significantly improving the quality of life and independence of patients associated with storage diseases. Storage diseases are a diverse group of hereditary metabolic defects characterized by the abnormal cumulation of storage material in cells. This topic is being addressed due to the fact that rehabilitation plays a vital role in the treatment of neurodegenerative diseases. Unfortunately so far there are no specific guidelines concerning physiotherapy in neurodegenerative disorders, especially in regards to duration of exercise, type of exercise and intensity, as well as frequency of exercise. This is in part due to the variety of symptoms of these diseases and the various levels of disease progression. This further proves the need for more research to be carried out on the role of exercise in neurodegenerative disorder treatment.
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Altaf, Shafaq. "TECHNOLOGICAL ADVANCEMENTS IN NEUROREHABILITATION." Rehabilitation Journal 3, no. 2 (December 31, 2019): 105–6. http://dx.doi.org/10.52567/trj.v3i02.14.
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It has been a few decades since neurological rehabilitation is recognized as a formal technique for therapeutic treatment of stroke patients or individuals suffering disabilities following spinal cord injuries. Despite the nervous system having a plasticity mechanism that facilitates spontaneous recovery to some extent, it is essential for most patients to receive specialized treatment protocol, to restore their motor function, including physical therapy and occupational therapy. More recently, experts of neurological rehabilitation have inculcated specialized therapies making use of computer and electronic devices to positively influence cortical excitability of damaged parts of cerebral hemispheres in order to improve neuroplasticity.1 The advancements aim to take advantage of the functionally preserved neuromuscular structures in compensating for the functions of the damaged areas as well as restoring function of the affected brain tissue; something for which the use of technology was not seen being implemented around two decades back.1, 2 While traditional approach to neuro-rehabilitation would focus on preventing worsening of a functional limitation through exercises such as passive range of motion and stretching,2 a better understanding of neuroplasticity has swung the rehabilitation pendulum in favor of use of several electrotherapeutic devices including transcranial magnetic stimulation modality, robot for limb training, robotic lower extremity orthoses and brain-computer interfaces which offer benefits for patients with neuronal injury.1 Non-invasive brain stimulation facilitates perceptual learning as well motor and cognitive performance in case of brain lesions.2 In order to ensure adherence to various therapies in the process of rehabilitation, interactive treatment strategies are being developed. These include the application of virtual and augmented reality systems which not only motivate the patient but make the repetitive exercise interesting in a controlled environment.3, 4 This approach has challenged the traditional paradigm by the use of biosensors as biofeedback tools to enlighten the patients about internal activities by them visualizing their muscle activity eventually helping them control their bodies better by knowing which muscles to contract to produce the correct movement.5 A proven successful mode of rehabilitation includes virtual reality (VR) technology, which is practical to use at homes, however, requires professional input when it comes to software development and application. Along with ensuring safety and effectiveness, new strategies are being developed which would allow clinicians who do not hold programming expertise to create game-based VR tasks and make further advancements in the field of neurological rehabilitation.6 Amongst the many causes of disability including trauma and musculoskeletal degenerative changes, nervous system disorders are most prevalent resulting in physical, cognitive, linguistic and behavioral issues all at the same time. According to a report by World Health Organization in year 2006, up to 1 billion people are suffering from neurological disorders worldwide constituting around 6% of the global burden of disease and is only escalating since then. Lower-income countries are significantly more affected than high-income countries as 80% disability- stricken individuals live in low-income countries.7 Considering rehabilitation, particularly the neurological aspect, as being relatively young medical specialty, improvement have been made in the years especially in the developed world with better quality rehabilitation services being offered by multidisciplinary teams consisting of highly trained physicians and physical therapists along with supporting staff.8 We are gradually, however, surely moving in the direction of figuring out new and effective approaches to neurorehabilitation by not only compensating for disabilities following neurological injuries but trying to reduce T Rehabili. J. Volume 03, Issue 02 2019 106 impairments by restoring neuronal structure and function.2 The technological advancements made in the developing countries are slow paced; however, keeping in mind the available resources, the responsibility lies with the clinicians to select and provide a comprehensive rehabilitation program which cost-efficient and easy to implement in the long run 9. In a nutshell, a truly effective neuro-rehabilitative program would focus on strategies to fully enable an individual to carry out activities of daily life, increase mobility, improve the ability to function independently and be an integral part of society.
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Dimante, Dace, Ināra Logina, Marco Sinisi, and Angelika Krūmiņa. "Sensory Feedback in Upper Limb Prostheses." Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 74, no. 5 (October 1, 2020): 308–17. http://dx.doi.org/10.2478/prolas-2020-0047.
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Abstract Loss of an arm is a devastating condition that can cross all socioeconomic groups. A major step forward in rehabilitation of amputees has been the development of myoelectric prostheses. Current robotic arms allow voluntary movements by using residual muscle contraction. However, a significant issue is lack of movement control and sensory feedback. These factors play an important role in integration and embodiment of a robotic arm. Without feedback, users rely on visual cues and experience overwhelming cognitive demand that results in poorer use of a prosthesis. The complexity of the afferent system presents a great challenge of creating a closed-loop hand prosthesis. Several groups have shown progress providing sensory feedback for upper limb amputees using robotic arms. Feedback, although still limited, is achieved through direct implantation of intraneural electrodes as well as through non-invasive methods. Moreover, evidence shows that over time some amputees develop a phantom sensation of the missing limb on their stump. This phenomenon can occur spontaneously as well as after non-invasive nerve stimulation, suggesting the possibility of recreating a sensory homunculus of the hand on the stump. Furthermore, virtual reality simulation in combination with mechanical stimulation of skin could augment the sensation phenomenon, leading to better interface between human and robotic arms.
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Widmer, Mario, Jeremia P. O. Held, Frieder Wittmann, Belen Valladares, Olivier Lambercy, Christian Sturzenegger, Antonella Palla, Kai Lutz, and Andreas R. Luft. "Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial." Neurorehabilitation and Neural Repair 36, no. 2 (December 22, 2021): 140–50. http://dx.doi.org/10.1177/15459683211062898.
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Background Learning and learning-related neuroplasticity in motor cortex are potential mechanisms mediating recovery of movement abilities after stroke. These mechanisms depend on dopaminergic projections from midbrain that may encode reward information. Likewise, therapist experience confirms the role of feedback/reward for training efficacy after stroke. Objective To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards. Methods This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups. Results The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011). Conclusions Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis. Trial registration ClinicalTrials.gov (ID: NCT02257125).
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Hanapiah, Fazah Akhtar. "Use of Virtual Reality in Rehabilitation." International Journal of Human and Health Sciences (IJHHS), December 7, 2019, 11. http://dx.doi.org/10.31344/ijhhs.v0i0.129.
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Recovery of severe impairment as a result of acquired brain injury from conditions such as stroke and trauma can be limited. However, with neuroplasticity and re-learning of lost skills, the impairment can be overcome or reduced. The use of technology in rehabilitation has become synonymous in most advanced rehabilitation facilities. The outcome of chronic impairment is dependent on the rehabilitation approaches and new ways to address conventional strategies using technology. Technology in rehabilitation is an exciting avenue for research. The use of 3-Dimensional Virtual Reality (3-D VR) in gaming has escalated in the past few years. However, the therapeutic use of 3-D VR in rehabilitation medicine is still lagging, although small studies have shown some potential on its use. We, at Faculty of Medicine UiTM embarked on a study to create a platform for 3-D VR application, (MRVR: Medical Rehabilitation Virtual Reality) with known neuroplastic strategies for individuals with acquired brain injury during rehabilitation. Outcome measures used will be that of standard and validated parameters before and after the application of MRVR. Specific aspects of rehabilita t ion parameters were addressed during the programme development. A low cost commercial 3-D VR system was chosen (HTC VIVE™) to be used for the MRVR and our team developed a number of therapeutic programmes. Individuals with brain injury undergo a sequence of immersive first person experience with the MRVR programme in a safe virtual environme nt. The MRVR also promote recovery through other theories of rehabilitation such as, enriched environment, imagery, increased engagement and participation, accessibility and gamificat ion. We hypothesize that individuals that uses MRVR will have improved outcome parameters post intervention. These findings will assist in changing the standards for neurorehabilitation, by improving functional outcome, productivity, quality of life and overall longevity of individuals with disability. This study is funded by UiTM Research Grant: 600-IRMI/DANA 5/3 BESTARI (057/2017)International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 11
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Perez-Marcos, Daniel. "Virtual reality experiences, embodiment, videogames and their dimensions in neurorehabilitation." Journal of NeuroEngineering and Rehabilitation 15, no. 1 (November 26, 2018). http://dx.doi.org/10.1186/s12984-018-0461-0.
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Moskvina, Ekaterina Y., Larisa I. Volkova, and Oksana V. Koryakina. "Сognitive rehabilitation methods in multiple sclerosis patients." Almanac of Clinical Medicine, November 21, 2022. http://dx.doi.org/10.18786/2072-0505-2022-50-043.
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The prevalence of cognitive impairment in patients with multiple sclerosis is 40 to 65%. Improvement of cognitive-oriented therapy and search for its new techniques is considered to be promising for slowing the progression or for recovery of cognitive functions. It is related to low efficacy of medical treatment, preserved neuroplasticity in most patients with multiple sclerosis, positive results of studies on selected cognitive rehabilitation techniques in other nervous system disorders. The spectrum of techniques for cognitive training varies from technically feasible methods using a sheet of paper and a pen to the most advanced ones, such as the use of immersive virtual reality. The effectiveness of cognitive rehabilitation in patients with multiple sclerosis with virtual reality technologies has not been studied in large-scale randomized placebo-controlled studies.
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Barnes, Nicolas, Maria V. Sanchez-Vives, and Tania Johnston. "On the Practical Use of Immersive Virtual Reality for Rehabilitation of Intimate Partner Violence Perpetrators in Prison." Frontiers in Psychology 13 (May 16, 2022). http://dx.doi.org/10.3389/fpsyg.2022.787483.
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Virtual reality (VR) allows the user to be immersed in environments in which they can experience situations and social interactions from different perspectives by means of virtual embodiment. In the context of rehabilitation of violent behaviors, a participant could experience a virtual violent confrontation from different perspectives, including that of the victim and bystanders. This approach and other virtual scenes can be used as a useful tool for the rehabilitation of intimate partner violence (IPV) perpetrators, through improvement of their empathic skills or for training in non-violent responses. In this perspective, we revise and discuss the use of this tool in a prison environment for the rehabilitation of IPV perpetrators with a particular focus on practical aspects based on our experience.
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Bui, Julie, Jacques Luauté, and Alessandro Farnè. "Enhancing Upper Limb Rehabilitation of Stroke Patients With Virtual Reality: A Mini Review." Frontiers in Virtual Reality 2 (November 8, 2021). http://dx.doi.org/10.3389/frvir.2021.595771.
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Upper limb motor impairment following stroke is a common condition that impacts significantly the independence and quality of life of stroke survivors. In recent years, scholars have massively turned to virtual reality (VR) to develop more effective rehabilitation approaches. VR systems are promising tools that can help patients engage in intensive, repetitive and task-oriented practice using new technologies to promote neuroplasticity and recovery. Multiple studies have found significant improvements in upper limb function for patients using VR in therapy, but the heterogeneity of methods and tools employed make the assessment of VR efficacy difficult. Here we aimed to assess the potential of VR as a therapy tool for upper limb motor impairment and to provide initial assessment of what is the added value of using VR to both patients and clinicians. Our mini-review focuses the work published since the Cochrane review (2017) and suggests that VR may be particularly effective when used in combination to conventional rehabilitation approaches. We also highlight key features integrated in VR systems that appear to influence rehabilitation and can help maximizing therapy outcomes, if exploited properly. We conclude that although promising results have already been gathered, more focused research is needed to determine the optimal conditions to implement VR in clinical settings in order to enhance therapy and to better define and leverage the true potential of VR. The rapid pace of technological development and increasing research interest toward VR-based therapy will help providing extensive knowledge and lead to rapid advancements in the near future.
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Matamala-Gomez, Marta, Mel Slater, and Maria V. Sanchez-Vives. "Impact of virtual embodiment and exercises on functional ability and range of motion in orthopedic rehabilitation." Scientific Reports 12, no. 1 (March 23, 2022). http://dx.doi.org/10.1038/s41598-022-08917-3.
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AbstractRecent evidence supports the use of immersive virtual reality (immersive VR) as a means of applying visual feedback techniques in neurorehabilitation. In this study, we investigated the benefits of an embodiment-based immersive VR training program for orthopedic upper limb rehabilitation, with the aim of improving the motor functional ability of the arm and accelerating the rehabilitation process in patients with a conservatively managed distal radius fracture. We designed a rehabilitation program based on developing ownership over a virtual arm and then exercising it in immersive VR. We carried out a between 3-group controlled trial with 54 patients (mean age = 61.80 ± 14.18): 20 patients were assigned to the experimental training group (immersive VR), 20 to the conventional digit mobilization (CDM) training control group, and 14 to a non-immersive (non-immersive VR) training control group. We found that functional recovery of the arm in the immersive VR group was correlated with the ownership and agency scores over the virtual arm. We also found larger range of joint movements and lower disability of the fractured arm compared with patients in the Non-immersive VR and CDM groups. Feeling embodied in a virtual body can be used as a rehabilitation tool to speed up and improve motor functional recovery of a fractured arm after the immobilization period.
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Barhorst-Cates, Erica M., Mitchell W. Isaacs, Laurel J. Buxbaum, and Aaron L. Wong. "Does spatial perspective in virtual reality affect imitation accuracy in stroke patients?" Frontiers in Virtual Reality 3 (September 7, 2022). http://dx.doi.org/10.3389/frvir.2022.934642.
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Imitation is an important daily activity involved in social interactions, motor learning, and is commonly used for rehabilitation after stroke. Moreover, deficits in imitation of novel movements commonly occur after left hemisphere stroke (LCVA) in the syndrome of limb apraxia. In the current study, we used a novel virtual reality (VR) imitation paradigm to assess two factors that have remained underexplored in novel movement imitation: the imitation of complex, dynamic full-arm movements, and the effect of spatial perspective. VR holds promise as a tool for a number of clinical assessments and treatments, but has very rarely been studied in the context of imitation or diagnosis of apraxia. Thirty participants (18 with LCVA and 12 age- and education-matched controls) wore a VR headset and observed and imitated an instructor avatar demonstrating arm movements. Three spatial perspectives were examined within-subjects: first-person, third-person mirror, and third-person anatomical. Movements of the ipsilesional (left) arm were recorded and qualitatively coded for accuracy compared to the instructor avatar. Participants also completed embodiment questionnaires, a measure of limb apraxia (imitation of video-recorded meaningless movements), and three computerized background tasks that were hypothesized to evoke some of the same processing requirements of each of the three perspective conditions: a block-matching task, a block-mirroring task, and a mental rotation task. Imitation accuracy was highest in the first-person perspective, consistent with predictions, but did not differ between third-person mirror and anatomical. Surprisingly, patients and controls performed similarly on the imitation task for all spatial perspectives, with overall modest accuracy in both groups, and both patients and controls felt a moderate level of embodiment of their own avatar. Higher imitation accuracy related to quicker block-matching reaction times and higher mental rotation accuracy, regardless of perspective, but was unrelated to imitation of video-recorded meaningless movements. In sum, virtual reality provides advantages in terms of experimental manipulation and control but may present challenges in detecting clinical imitation deficits (limb apraxia).
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Fregna, Giulia, Nicola Schincaglia, Andrea Baroni, Sofia Straudi, and Antonino Casile. "A novel immersive virtual reality environment for the motor rehabilitation of stroke patients: A feasibility study." Frontiers in Robotics and AI 9 (August 29, 2022). http://dx.doi.org/10.3389/frobt.2022.906424.
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We designed and implemented an immersive virtual reality (VR) environment for upper limb rehabilitation, which possesses several notable features. First, by exploiting modern computer graphics its can present a variety of scenarios that make the rehabilitation routines challenging yet enjoyable for patients, thus enhancing their adherence to the therapy. Second, immersion in a virtual 3D space allows the patients to execute tasks that are closely related to everyday gestures, thus enhancing the transfer of the acquired motor skills to real-life routines. Third, in addition to the VR environment, we also developed a client app running on a PC that allows to monitor in real-time and remotely the patients’ routines thus paving the way for telerehabilitation scenarios. Here, we report the results of a feasibility study in a cohort of 16 stroke patients. All our patients showed a high degree of comfort in our immersive VR system and they reported very high scores of ownership and agency in embodiment and satisfaction questionnaires. Furthermore, and notably, we found that behavioral performances in our VR tasks correlated with the patients’ clinical scores (Fugl-Meyer scale) and they could thus be used to assess improvements during the rehabilitation program. While further studies are needed, our results clearly support the feasibility and effectiveness of VR-based motor rehabilitation processes.
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Ziadeh, Hamzah, David Gulyas, Louise Dørr Nielsen, Steffen Lehmann, Thomas Bendix Nielsen, Thomas Kim Kroman Kjeldsen, Bastian Ilsø Hougaard, Mads Jochumsen, and Hendrik Knoche. "“Mine Works Better”: Examining the Influence of Embodiment in Virtual Reality on the Sense of Agency During a Binary Motor Imagery Task With a Brain-Computer Interface." Frontiers in Psychology 12 (December 24, 2021). http://dx.doi.org/10.3389/fpsyg.2021.806424.
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Motor imagery-based brain-computer interfaces (MI-BCI) have been proposed as a means for stroke rehabilitation, which combined with virtual reality allows for introducing game-based interactions into rehabilitation. However, the control of the MI-BCI may be difficult to obtain and users may face poor performance which frustrates them and potentially affects their motivation to use the technology. Decreases in motivation could be reduced by increasing the users' sense of agency over the system. The aim of this study was to understand whether embodiment (ownership) of a hand depicted in virtual reality can enhance the sense of agency to reduce frustration in an MI-BCI task. Twenty-two healthy participants participated in a within-subject study where their sense of agency was compared in two different embodiment experiences: 1) avatar hand (with body), or 2) abstract blocks. Both representations closed with a similar motion for spatial congruency and popped a balloon as a result. The hand/blocks were controlled through an online MI-BCI. Each condition consisted of 30 trials of MI-activation of the avatar hand/blocks. After each condition a questionnaire probed the participants' sense of agency, ownership, and frustration. Afterwards, a semi-structured interview was performed where the participants elaborated on their ratings. Both conditions supported similar levels of MI-BCI performance. A significant correlation between ownership and agency was observed (r = 0.47, p = 0.001). As intended, the avatar hand yielded much higher ownership than the blocks. When controlling for performance, ownership increased sense of agency. In conclusion, designers of BCI-based rehabilitation applications can draw on anthropomorphic avatars for the visual mapping of the trained limb to improve ownership. While not While not reducing frustration ownership can improve perceived agency given sufficient BCI performance. In future studies the findings should be validated in stroke patients since they may perceive agency and ownership differently than able-bodied users.
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Cha, Kuan, Jinying Wang, Yan Li, Longbin Shen, Zhuoming Chen, and Jinyi Long. "A novel upper-limb tracking system in a virtual environment for stroke rehabilitation." Journal of NeuroEngineering and Rehabilitation 18, no. 1 (November 27, 2021). http://dx.doi.org/10.1186/s12984-021-00957-6.
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Abstract Background The transfer of the behaviors of a human’s upper limbs to an avatar is widely used in the field of virtual reality rehabilitation. To perform the transfer, movement tracking technology is required. Traditionally, wearable tracking devices are used for tracking; however, these devices are expensive and cumbersome. Recently, non-wearable upper-limb tracking solutions have been proposed, which are less expensive and more comfortable. However, most products cannot track the upper limbs, including the arms and all the fingers at the same time, which limits the limb parts for tracking in a virtual environment and may lead to a limited rehabilitation effect. Methods In this paper, a novel virtual reality rehabilitation system (VRRS) was developed for upper-limb rehabilitation. The VRRS could track the motion of both upper limbs, integrate fine finger motion and the range of motion of the entire arm and map the motion to an avatar. To test the performance of VRRS, two experiments were designed. In the first experiment, we investigated the effect of VRRS on virtual body ownership, agency and location of the body and usability in 8 healthy participants by comparing it with a partial upper-limb tracking method based on a Leap Motion controller (LP) in the same virtual environments. In the second experiment, we examined the feasibility of VRRS in upper-limb rehabilitation with 27 stroke patients. Results VRRS improved the users’ senses of body ownership, agency, and location of the body. The users preferred using the VRRS to using the LP. In addition, we found that although the upper limb motor function of patients from all groups was improved, the difference between the FM scores tested on the first day and the last day of the experimental group was more significant than that of the control groups. Conclusions A VRRS with motion tracking of the upper limbs and avatar control including the arms and all the fingers was developed. It resulted in an improved user experience of embodiment and effectively improved the effects of upper limb rehabilitation in stroke patients. Trial registration The study was registered at the First Affiliated Hospital of Jinan University Identifier: KY-2020–036; Date of registration: June 01, 2020.
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Seinfeld, Sofia, Ruud Hortensius, Jorge Arroyo-Palacios, Guillermo Iruretagoyena, Luis E. Zapata, Beatrice de Gelder, Mel Slater, and Maria V. Sanchez-Vives. "Domestic Violence From a Child Perspective: Impact of an Immersive Virtual Reality Experience on Men With a History of Intimate Partner Violent Behavior." Journal of Interpersonal Violence, June 21, 2022, 088626052211061. http://dx.doi.org/10.1177/08862605221106130.
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Domestic violence has long-term negative consequences on children. In this study, men with a history of partner aggression and a control group of non-offenders were embodied in a child’s body from a first-person perspective in virtual reality (VR). From this perspective, participants witnessed a scene of domestic violence where a male avatar assaulted a female avatar. We evaluated the impact of the experience on emotion recognition skills and heart rate deceleration responses. We found that the experience mainly impacted the recognition of angry facial expressions. The results also indicate that males with a history of partner aggression had larger physiological responses during an explicit violent event (when the virtual abuser threw a telephone) compared with controls, while their physiological reactions were less pronounced when the virtual abuser invaded the victim’s personal space. We show that embodiment from a child’s perspective during a conflict situation in VR impacts emotion recognition, physiological reactions, and attitudes towards violence. We provide initial evidence of the potential of VR in the rehabilitation and neuropsychological assessment of males with a history of domestic violence, especially in relation to children.
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Langener, Simon, Randy Klaassen, Joanne VanDerNagel, and Dirk Heylen. "Immersive Virtual Reality Avatars for Embodiment Illusions in People with Mild to Borderline Intellectual Disability: User-Centered Development and Feasibility Study. (Preprint)." JMIR Serious Games, May 30, 2022. http://dx.doi.org/10.2196/39966.
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Labbe, David R., Kean Kouakoua, Rachid Aissaoui, Sylvie Nadeau, and Cyril Duclos. "Proprioceptive Stimulation Added to a Walking Self-Avatar Enhances the Illusory Perception of Walking in Static Participants." Frontiers in Virtual Reality 2 (June 2, 2021). http://dx.doi.org/10.3389/frvir.2021.557783.
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When immersed in virtual reality, users who view their body as a co-located virtual avatar that reflects their movements, generally develop a sense of embodiment whereby they perceive the virtual body to be their own. One aspect of the sense of embodiment is the feeling of agency over the avatar, i.e., the feeling that one is producing the movements of the avatar. In contexts such as physical rehabilitation, telepresence and gaming, it may be useful to induce a strong sense of agency in users who cannot produce movements or for whom it is not practical to do so. Being able to feel agency over a walking avatar without having to produce walking movements could be especially valuable. Muscle vibrations have been shown to produce the proprioceptive perception of movements, without any movement on the part of the user. The objectives of the current study were to: 1-determine if the addition of lower-limb muscle-vibrations with gait-like patterns to a walking avatar can increase the illusory perception of walking in healthy individuals who are standing still; 2-compare the effects of the complexity of the vibration patterns and of their synchronicity on the sense of agency and on the illusory perception of walking. Thirty participants viewed a walking avatar from a first-person perspective, either without muscle vibrations or with one of four different patterns of vibrations. These five conditions were presented pairwise in a two-alternative forced choice paradigm and individually presented, after which participants answered an embodiment questionnaire. The displacement of center of pressure of the participants was measured throughout the experiment. The results show that all patterns of proprioceptive stimulation increased the sense of agency to a similar degree. However, the condition in which the proprioceptive feedback was realistic and temporally aligned with the avatar’s leg movements led to significantly larger anteroposterior sway of the center of pressure. The frequency of this sway matched the cadence of the avatar’s gait. Thus, congruent and realistic proprioceptive stimulation increases the feeling of agency, the illusory perception of walking and the motor responses of the participants when viewing a walking avatar from a first-person perspective.
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Chang, Huiyeong, Sung-Ho Woo, Sura Kang, Chan Young Lee, Jee-Young Lee, and Jeh-Kwang Ryu. "A curtailed task for quantitative evaluation of visuomotor adaptation in the head-mounted display virtual reality environment." Frontiers in Psychiatry 13 (February 16, 2023). http://dx.doi.org/10.3389/fpsyt.2022.963303.
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To accurately perform a goal-directed movement in continuously changing environments, it is unavoidable for individuals to adapt accordingly. The cerebellum has been known to be responsible for such process, specifically adaptation using sensorimotor information. As shown in previous studies, using HMD-VR technology in an experimental setting has similar advantages as in the real-world environment: researchers can manipulate the experimental environment, precisely control the experiments, and quantitatively analyze errors in real time. Moreover, the HMD-VR environment provides high immersiveness and embodiment which even enhance motor learning and increase engagement and motivation of individuals more than real-world environments do. In our HMD-VR-based task, the subjects were trained to adapt to a condition in which the visual information was artificially 20°clockwise rotated from the actual cursor movement. The subjects used a virtual reality tracker to move the cursor from a starting point to a target that appeared randomly at five locations, 20 cm from the starting point with an interval of 15°. Although no significant side effects were expected from experiencing the HMD-VR environment, we considered the appropriate number of trials for patients with cerebellar disease for future use in clinical settings. To examine the feasibility of our task for analysis of visuomotor adaptation pattern as shown in a real-world-based task, we created and compared two paradigms with a difference in the number of trials. As we expected, the results showed that the heading angle error decreased as the participants of both paradigms continued the task and that there was no significant difference between the two paradigms. Next, we applied our short task paradigm to patients diagnosed with cerebellar ataxia and age-matched controls for further examination of applicability to diagnosis and rehabilitation of the patients. As a result, we observed the distinguishable adaptation pattern of the patient group by using our paradigm. Overall, the results suggest that our paradigm is feasible to analyze the visuomotor adaptation pattern of healthy individuals and patients with cerebellar ataxia so may contribute to the clinical field.
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Moreira, Joao Vitor da Silva, Karina Rodrigues, Daniel José Lins Leal Pinheiro, Thaís Cardoso, João Luiz Vieira, Esper Cavalheiro, and Jean Faber. "Electromyography biofeedback system with visual and vibratory feedbacks designed for lower limb rehabilitation." Journal of Enabling Technologies, January 3, 2023. http://dx.doi.org/10.1108/jet-05-2022-0039.
Full textAbstract:
PurposeOne of the main causes of long-term prosthetic abandonment is the lack of ownership over the prosthesis, which was caused mainly by the absence of sensory information regarding the lost limb. The period where the patient learns how to interact with a prosthetic device is critical in rehabilitation. This ideally happens within the first months after amputation, which is also a period associated with the consolidation of brain changes. Different studies have shown that the introduction of feedback mechanisms can be crucial to bypass the lack of sensorial information. To develop a biofeedback system for the rehabilitation of transfemoral amputees – controlled via electromyographic (EMG) activity from the leg muscles – that can provide real-time visual and/or vibratory feedback for the user.Design/methodology/approachThe system uses surface EMG to control two feedback mechanisms, which are the knee joint of a prosthetic leg of a humanoid avatar in a virtual reality (VR) environment (visual feedback) and a matrix of 16 vibrotactile actuators placed in the back of the user (vibratory feedback). Data acquisition was inside a Faraday Cage using an OpenEphys® acquisition board for the surface EMG recordings. The tasks were performed on able-bodied participants, with no amputation, and for this, the dominant leg of the user was immobilized using an orthopedic boot fixed on the chair, allowing only isometric contractions of target muscles, according to the Surface EMG for Non-Invasive Assessment of Muscles (SENIAM) standard. The authors test the effectiveness of combining vibratory and visual feedback and how task difficulty affects overall performance.FindingsThe authors' results show no negative interference combining both feedback modalities and that performance peaked at the intermediate difficulty. These results provide powerful insights of what can be accomplished with the population of amputee people. By using this biofeedback system, the authors expect to engage another sensory modality in the process of spatial representation of a virtual leg, bypassing the lack of information associated with the disruption of afferent pathways following amputation.Research limitations/implicationsThe authors developed a showcase with a new protocol and feedback mechanisms showing the protocol's safety, efficiency and reliability. However, since this system is designed for patients with leg amputation, the full extent of the effects of the biofeedback training can only be assessed after the evaluation with the amputees, and the results obtained so far establish a safe and operational protocol to accomplish this.Practical implicationsIn this study, the authors proposed a new biofeedback device intended to be used in the preprosthetic rehabilitation phase for people with transfemoral amputation. With this new system, the authors propose a mechanism to bypass the lack of sensory information from a virtual prosthesis and help to assimilate visual and vibrotactile stimuli as a cue for movement representation.Social implicationsWith this new system, the authors propose a mechanism to bypass the lack of sensory information from a virtual prosthesis and help to assimilate visual and vibrotactile stimuli as a cue for movement representation.Originality/valueThe authors' results show that all users were capable of recognizing both feedback modalities, both separate and combined, being able to respond accordingly throughout the tasks. The authors also show that for a one-session protocol, the last difficulty level imposed a greater challenge for most users, explained by the significant drop in performance disregarding the feedback modality. Lastly, the authors believe this paradigm can provide a better process for the embodiment of prosthetic devices, fulfilling the lack of sensory information for the users.