Application of virtual reality to the rehabilitation field to aid amputee rehabilitation: Findings from a systematic review

Purpose.?To determine the scope and use of virtual reality (VR) applications in the gait rehabilitation field and to review and characterise VR approaches for application in amputee rehabilitation.

Method.?A state-of-the-art research analysis was completed to review different approaches of VR to the gait rehabilitation field. Systematic research using Medline, EBSCOhost and Science Direct (ISI Web of Knowledge) was conducted to analyse various VR rehabilitation methods, and we developed a framework to characterise different research findings.

Results.?Framework for a research approach in the field of VR and rehabilitation was developed based on the literature review. On the basis of outcomes from gait rehabilitation using VR, trials for amputee rehabilitation using VR is warranted and an outline of this potential VR rehabilitation area was identified.

Conclusions.?Evidence supports the investigation of VR as applied to amputee rehabilitation based on general gait rehabilitation results. Research should be expanded to better understand the role and use of technology in community-based rehabilitation to enhance the quality of life of individuals.     

同期康复锻炼在人工全肩胛骨肩关节置换术中的应用研究

目的：探讨肩部恶性肿瘤行人工全肩胛骨肩关节置换术同期康复锻炼的方法与效果。方法：回顾性分析2009-01-2014-04我院骨科收治肩部恶性肿瘤患者12例,采用肩部肿瘤广泛切除术、人工全肩胛骨肩关节置换及功能重建术。术后患肢外展支架固定,手术同期分三阶段行肩关节康复锻炼：被动辅助运动、主动运动、抗阻力肌力增强练习。结果：12例患者在术后3个月,用肩关节Neer评分系统进行疗效评价,得分78～89分,平均83分,总体效果良。并且在术后1周、4周和术后3个月,肩关节的功能评分与术前比较,差异有统计学意义（P〈0.05）。结论：人工全肩胛骨肩关节置换术是治疗肩部恶性肿瘤的有效方法,手术同期康复锻炼能促进肩关节功能的全面恢复。     

Not just fun and games: applications of virtual reality in the identification and rehabilitation of cognitive disorders of the elderly

Purpose.?To outline the evidence in the published medical literature suggesting the potential applications of virtual reality (VR) for the identification and rehabilitation of cognitive disorders of the elderly.

Method.?Non-systematic literature review.

Results.?VR, despite its more common usage by younger persons, is a potentially promising source of techniques useful in the identification and rehabilitation of cognitive disorders of the elderly. Systems employing VR can include desktop and head-mounted visual displays among other devices. Thus far, published studies have described VR-based applications in the identification and treatment of deficits in navigational skills in ambulation and driving. In addition, VR has been utilised to enhance the ability to perform activities of daily living in patients with dementia, stroke, and Parkinson's Disease. Such investigations have thus far been small, and unblinded.

Conclusions.?VR-based applications can potentially offer more versatile, comprehensive, and safer assessments of function. However, they also might be more expensive, complex and more difficult to use by elderly patients. Side effects of head-mounted visual displays include nausea and disorientation, but, have not been reported specifically in older subjects.     

Feasibility of incorporating functionally relevant virtual rehabilitation in sub-acute stroke care: perception of patients and clinicians

Purpose: To determine user satisfaction and safety of incorporating a low-cost virtual rehabilitation intervention as an adjunctive therapeutic option for cognitive-motor upper limb rehabilitation in individuals with sub-acute stroke.

Methods: A low-cost upper limb virtual rehabilitation application incorporating realistic functionally-relevant unimanual and bimanual tasks, specifically designed for cognitive-motor rehabilitation was developed for patients with sub-acute stroke. Clinicians and individuals with stroke interacted with the intervention for 15–20 or 20–45 minutes, respectively. The study had a mixed-methods convergent parallel design that included a focus group interview with clinicians working in a stroke program and semi-structured interviews and standardized assessments (Borg Perceived Exertion Scale, Short Feedback Questionnaire) for participants with sub-acute stroke undergoing rehabilitation. The occurrence of adverse events was also noted.

Results: Three main themes emerged from the clinician focus group and patient interviews: Perceived usefulness in rehabilitation, satisfaction with the virtual reality intervention and aspects to improve. All clinicians and the majority of participants with stroke were highly satisfied with the intervention and perceived its usefulness to decrease arm motor impairment during functional tasks. No participants experienced major adverse events.

Conclusions: Incorporation of this type of functional activity game-based virtual reality intervention in the sub-acute phase of rehabilitation represents a way to transfer skills learned early in the clinical setting to real world situations. This type of intervention may lead to better integration of the upper limb into everyday activities.

• Implications for Rehabilitation

• ??Use of a cognitive-motor low-cost virtual reality intervention designed to remediate arm motor impairments in sub-acute stroke is feasible, safe and perceived as useful by therapists and patients for stroke rehabilitation.

• ??Input from end-users (therapists and individuals with stroke) is critical for the development and implementation of a virtual reality intervention.

     

综合康复联合悬吊训练治疗冻结肩的疗效观察

目的:观察常规综合康复联合悬吊训练(SET)治疗对于冻结肩患者肩关节功能恢复的影响。方法:选取55例病程>6周且2周内自感肩关节功能恢复受限的冻结肩患者,随机分为2组,对照组28例,观察组27例,最终2组分别有2例和1例脱落,故2组均为26例。对照组接受常规综合康复治疗,观察组在常规治疗的基础上进行SET治疗,通过肩关节功能评价量表(SJFA)、Constant-Murley肩关节功能评价量表(CMS)、视觉模拟评分(VAS)评估肩关节功能的改善情况。结果:治疗4周后,2组患者的SJFA、CMS评分均升高(均P<0.05),VAS评分降低(均P<0.05);观察组患者SJFA、CMS评分高于对照组(均P<0.05),VAS评分无统计学差异。结论:常规综合康复联合SET技术治疗冻结肩患者,可以有效改善肩关节功能,提高患者日常生活能力。     

Bilateral upper limb trainer with virtual reality for post-stroke rehabilitation: case series report

Purpose.?Stroke is a leading cause of disability with many survivors having upper limb (UL) hemiparesis. UL rehabilitation using bilateral exercise enhances outcomes and the Bilateral Upper Limb Trainer (BUiLT) was developed to provide symmetrical, bilateral arm exercise in a ‘forced’ and self-assistive manner, incorporating virtual reality (VR) to provide direction and task specificity to users as well as action observation–execution and greater motivation to exercise.

Methods.?The BUiLT + VR system was trialled on five post-stroke participants with UL hemiparesis: one sub-acute and four chronic. The intervention was supplied for 45?min, 4 days/week for 6 weeks. The Fugl-Meyer Upper Extremity score (FMA-UE) was used as the primary outcome measure. Secondary outcome measures used were UL isometric strength and the Intrinsic Motivation Inventory (IMI) questionnaire.

Results.?The BUiLT + VR therapy increased FMA-UE scores from 1 to 5 and overall strength in the shoulder and elbow. Motivation at the end of intervention was positive.

Conclusions.?Therapy using the BUiLT + VR system is reliable, can be administered safely and has a positive trend of benefit as measured by the FMA-UE, isometric strength testing and IMI questionnaire.     

Integrative rehabilitation of residents chronic post-stroke in skilled nursing facilities: the design and evaluation of the BrightArm Duo

Purpose: To describe the novel BrightArm Duo bimanual upper extremity (UE) rehabilitation system; to determine its technology acceptance and clinical benefit for older hemiplegic participants. Methods: The system table tilted to adjust arm gravity loading. Participants wore arm supports that sensed grasp strength and wrist position on the table. Wrist weights further increased shoulder exertion. Games were designed to improve UE strength, motor function, cognition and emotive state and adapted automatically to each participant. The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities (SNFs). Participants were evaluated pre-therapy and post-therapy using standardized clinical measures. Computerized measures of supported arm reach, table tilt and number of arm repetitions were stored on a remote server. Outcomes: Seven participants had significant improvements in their active range of shoulder movement, supported arm reach, shoulder strength, grasp strength and their ability to focus. The group demonstrated higher arm function measured with FMA (p?=?0.01) and CAHAI (p?=?0.05), and had an improvement in depression (Becks Depression Inventory, II). BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points. Conclusions: Given these findings, it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs.

• Implications for Rehabilitation

• Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities.

• Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke.

• Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly.

     

世界卫生组织康复胜任力架构及其在康复领域的系统应用：理论架构、方法和应用领域

目的 分析世界卫生组织康复胜任力架构(RCF)的理论架构、方法及其在康复领域的应用。方法 运用RCF的理论与方法,分析康复胜任力的领域和关键特征,及其在康复人力资源规划、职业能力评价和教育项目和课程开发中的应用。结果 RCF包含实践、专业精神、学习与发展、管理与领导力、研究5个领域,康复工作者的工作表现是他们的核心价值观和信念、胜任力、活动、知识和技能交互作用的结果。RCF可以规划康复人力资源,建立基于胜任力的康复教育项目和课程体系,开发康复职业能力认证标准和执业资格鉴定标准。结论 本研究分析世界卫生组织RCF产生的影响、核心内容与应用架构,系统地探讨运用RCF构建国家康复人力资源发展规划、建立基于RCF的康复教育项目和课程体系,建立康复人力资源的认证和评估标准等相关的理论和方法。     

Virtual reality in the rehabilitation process for individuals with cerebral palsy and Down syndrome: A systematic review

BackgroundChildhood neurological diseases result in neuromotor impairment, which affects selective motor control, compromising the acquisition of motor skills and functional independence. The positive results achieved with virtual reality are believed to be related to training in an interactive environment that provides a broad range of activities and scenarios with multiple sensory channels, enabling the creation of exercises at an intensity based on individual need. Therefore, a review was conducted to answer the following question: What are the possible effects of virtual reality for the pediatric population, specifically children with cerebral palsy and Down syndrome?ObjectiveThe objective of the present study was to conduct a systematic review of the literature to determine the possible effects of virtual reality therapy in children with cerebral palsy and Down's syndrome.MethodsThe PubMed, Bireme, Scielo and PEDro electronic databases were searched in the period from January to March 2016 using the following keywords: Down syndrome and virtual reality, virtual reality and cerebral palsy, virtual reality and neuropediatrics, and Down's syndrome and virtual reality. Only randomized controlled trials published in English in the previous 10 years (2007–2016) that addressed the specific purpose of this review and achieved a score of at least 4 points on the PEDro methodological quality scale were eligible for inclusion.ResultsThe initial research led to the retrieval of 214 articles, which were analyzed considering the inclusion criteria. Eighteen articles were submitted to an appraisal of methodological quality using the PEDro scale, only five of which received a score of four or more points and were described in the present review. Three of the studies selected analyzed children with cerebral palsy and two analyzed children with Down syndrome. Despite the different physiopathological characteristics of the two conditions, the authors employed similar therapeutic methods and evaluations. The results of the studies demonstrated that virtual reality training either alone or combined with motor training leads to improvements in sensory-motor functions and can be used as a complement to other successful rehabilitation interventions in the two populations.ConclusionBased on the results of the studies included in the present systematic review, despite differences in the characteristics of each population, the objectives and methods proposed by the authors were similar and virtual reality demonstrated promising effects for individuals with cerebral palsy and Down syndrome.     

快速康复外科理念在腹腔镜胆囊切除术患者护理中的应用及价值

目的 探讨快速康复外科理念在胆结石行腹腔镜胆囊切除术患者护理中的应用效果及价值,旨在为今后临床护理提供参考依据.方法 选取本院2014年4月至2016年2月收治的120例胆结石行腹腔镜胆囊切除术患者为研究对象,采用单双号法将其分为两组,各60例,对照组给予传统常规护理,研究组给予快速康复外科理念护理,观察两组患者术中情况及并发症发生情况.结果 研究组并发症发生率为18.33%明显低于对照组的85.00%(P<0.05);研究组在手术时间、肠道排气时间、下床活动时间、住院时间、出血量及住院总费用均少于对照组(P<0.05).结论 对胆结石行腹腔镜胆囊切除术患者实施快速康复外科理念取得显著效果,值得临床应用与推广.     

A hand rehabilitation system with force feedback for children with cerebral palsy: two case studies

Purpose.?To investigate whether the provision of force feedback as guidance in a computer-assisted training environment was feasible for improving handwriting ability of children with cerebral palsy.

Method.?Two children at the age of 7, diagnosed with dystonia and dyskinesia, respectively, took part in a 2-week pre-post test study. A desktop computer system equipped with a haptic device was developed to provide visual and haptic cues for practising Chinese handwriting. The system was used by the subjects two times a week. Average writing time and path length of 10 test characters and the trajectory of the pen tip were used to evaluate their performance. Paper-based test on handwriting legibility before and after the intervention were also conducted and video taped for subjective comparison.

Results.?The subjects were able to reduce the writing time through repeated practice. Path length also appeared to decrease, suggesting improvement in fine motor control ability and handwriting accuracy. One subject showed slight progress in legibility, while both of them developed a better sense of the proper ways of handwriting.

Conclusion.?Provision of haptic feedback in a virtual environment appears to be a feasible approach to improve cerebral palsy children's handwriting skills.     

基于虚拟现实技术的颈部康复训练治疗颈型颈椎病的临床研究

目的：观察基于虚拟现实（VR）技术的颈部运动评估及康复训练系统对颈型颈椎病患者颈痛和运动功能的疗效。方法：收集2023年3月～11月我院60例颈型颈椎病患者,随机分为对照组和研究组,每组30例,2组均接受常规康复治疗,在此基础上,对照组进行颈部主动康复训练,研究组进行虚拟现实颈部康复训练,每周5次,共4周。分别于治疗前和治疗后采用疼痛数字评价量表（NRS）、颈部残疾指数量表（NDI）进行评定,采用VR技术的颈部运动评估系统测量患者颈椎关节活动度。结果：治疗后,2组患者的NRS、NDI评分均较治疗前降低(P＜0.05）,研究组更低于对照组(P＜0.05）;2组患者的颈椎活动度（前屈、后伸、左屈、右屈、左旋、右旋）均大于治疗前（P＜0.05）,研究组更大于对照组（P＜0.05）。结论：基于VR技术的颈部运动评估及康复训练系统可改善颈型颈椎病患者的颈椎运动功能,增加颈椎关节活动度,减少疼痛。     

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: A comparison between four European rehabilitation centres

Purpose. The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries.

Method. Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units.

Results. The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units.

Conclusions. Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.     

Use of time by physiotherapists and occupational therapists in a stroke rehabilitation unit: a comparison between four European rehabilitation centres

Purpose. The aim of this study was to compare the time allocated to therapeutic activities (TA) and non-therapeutic activities (NTA) of physiotherapists (PT) and occupational therapists (OT) in stroke rehabilitation units in four European countries.

Method. Therapists documented their activities in 15-min periods for two weeks. They recorded: activity, number of patients, number of stroke patients, involvement of other people, location and frequency of each activity. Kruskal-Wallis tests and negative binomial regression models were used to compare activities between professional groups and between units.

Results. The average proportion of TA per day ranged between 32.9% and 66.1% and was higher for PT than for OT in each unit. For OT, significant differences emerged between the units in the proportion of time allocated to TA compared to NTA with British OTs spending significantly less time in TA. In the Belgian unit, three times less time was spent on patient-related co-ordination activities (e.g., administration, ward rounds) compared to the British and Swiss units.

Conclusions. Time allocation differed between PT and OT and between units, affecting the time available for TA. Further investigation is necessary to study the effect of work organization in stroke rehabilitation units on the efficiency of rehabilitation regimes.     

脑血管病后肩手综合征康复治疗的探讨

目的:探讨脑血管病后肩手综合征的康复治疗方法及对其症状、肢体功能的影响。方法:分别利用冰水浸泡法、冷热水交替浸泡法、压迫性向心缠绕法对54例脑血管病后肩手综合征进行治疗,治疗前后评定上肢疼痛、水肿、掌指关节活动范围、皮肤颜色、肩部症状及上肢功能以判断其疗效。结果:①治疗前后冰水浸泡法组、冷热水交替浸泡法组、压迫性向心缠绕法组肩手综合征的症状及上肢功能均有显著改善(P<0.01);②皮肤颜色的改善冰水浸泡法和冷热水交替浸泡法优于压迫性向心缠绕法(P<0.01和P<0.05);③上肢疼痛的改善冷热水交替浸泡法优于压迫性向心缠绕法(P<0.05)。结论:本工作采用的治疗方法对脑血管病后肩手综合征具有较好的治疗效果。     

The feasibility,acceptability and preliminary efficacy of a low-cost,virtual-reality based,upper-limb stroke rehabilitation device: a mixed methods study

Purpose: To establish feasibility, acceptability, and preliminary efficacy of an adapted version of a commercially available, virtual-reality gaming system (the Personalised Stroke Therapy system) for upper-limb rehabilitation with community dwelling stroke-survivors.

Method: Twelve stroke-survivors (nine females, mean age 58 years, [standard deviation 7.1], median stroke chronicity 42 months [interquartile range 34.7], Motricity index 14–25 for shoulder and elbow) were asked to complete nine, 40-min intervention sessions using two activities on the system over 3 weeks. Feasibility and acceptability were assessed through a semi-structured interview, recording of adverse effects, adherence, enjoyment (using an 11-point Likert scale), and perceived exertion (using the BORG scale). Assessments of impairment (Fugl–Meyer Assessment Upper extremity), activity (ABILHAND, Action Research Arm Test, Motor Activity Log-28), and participation (Subjective Index of Physical and Social Outcome) were completed at baseline, following intervention, and at 4-week follow-up. Data were analysed using Thematic Analysis of interview and intervention field-notes and Wilcoxon Signed Ranks. Side-by-side displays were used to integrate findings.

Results: Participants received between 175 and 336 min of intervention. Thirteen non-serious adverse effects were reported by five participants. Participants reported a high level of enjoyment (8.1 and 6.8 out of 10) and rated exertion between 11.6 and 12.9 out of 20. Themes of improvements in impairments and increased spontaneous use in functional activities were identified and supported by improvements in all outcome measures between baseline and post-intervention (p?<?0.05 for all measures).

Conclusions: Integrated findings suggested that the system is feasible and acceptable for use with a group of community-dwelling stroke-survivors including those with moderately-severe disability.

• Implications for rehabilitation

• To ensure feasibility of use and maintenance of an appropriate level of challenge, gaming technologies for use in upper-limb stroke rehabilitation should be personalised, dependent on individual need.

• Through the use of hands-free systems and personalisation, stroke survivors with moderate and moderately-severe levels of upper-limb impairment following stroke are able to use gaming technologies as a means of delivering upper-limb rehabilitation.

• Future studies should address issues of acceptability, feasibility, and efficacy of personalised gaming technologies for delivery of upper-limb stroke rehabilitation in the home environment.

• Findings from this study can be used to develop future games and activities suitable for use in stroke rehabilitation.

     

虚拟现实技术联合下肢康复机器人训练对缺血性脑卒中患者下肢功能及平衡能力影响的研究

目的:探讨虚拟现实技术联合下肢康复机器人训练对缺血性脑卒中患者下肢功能及平衡能力的影响。方法:收集60例缺血性脑卒中下肢功能障碍患者,随机分为对照组和观察组各30例,对照组进行常规康复训练和Lokomat下肢机器人训练,观察组在此基础上再联合虚拟现实技术,治疗前和治疗4周后分别对2组患者进行Berg平衡量表(BBS)、Fugl-Meyer下肢运动功能量表(FMA-LE)、功能性步行量表(FAC)评定。结果:治疗4周后,2组患者BBS和FMA-LE评分较治疗前均明显提高(均P<0.01),且观察组以上评分均更高于对照组(均P<0.05);2组患者FAC分级较治疗前均明显改善(均P<0.01),且观察组分级较对照组改善更显著(P<0.05)。结论:虚拟现实技术联合下肢康复机器人训练能改善缺血性脑卒中患者的下肢功能及平衡能力。     

网球肘的综合康复治疗

目的探讨网球肘的综合康复疗效。方法对50例网球肘患者行局部封闭、理疗、按摩、运动疗法及小针刀等综合康复治疗，观察患者症状和体征的改善情况。结果综合康复治疗痊愈率、显效率、好转率、总有效率分别为68．0％、16、0％、12．0％、96．0％。结论局部封闭、理疗、运动疗法及小针刀等综合治疗是治疗网球肘的有效方法。     

基于快速康复外科理念的早期康复护理干预对中老年结直肠癌术后恢复的影响

目的探讨基于快速康复外科理念的早期康复护理对中老年结直肠癌术后恢复的影响。方法选取2017年1月至2019年1月我院择期手术的结直肠癌老年患者98例作为研究对象,按照数字随机法将其等分为观察组和对照组,对照组给予常规护理干预,观察组给予基于快速康复外科理念的早期康复护理,比较两组术后首次排气时间、排便时间、并发症发生率及应激水平变化情况。结果观察组术后排气、排便时间优于对照组(P <0. 05);观察组术后并发症发生率低于对照组(P <0. 05);观察组应激水平改善情况优于对照组(P <0. 05)。结论实施基于快速康复外科理念的早期康复护理,能有效促进中老年结直肠癌术后肠功能恢复,降低术后应激水平及并发症发生率,值得临床推广。