Markup in the Writing Classroom

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Virtual reality (VR) is a technology that places users in an interactive simulated environment. Today VR is used beyond entertainment purposes to treat various psychological conditions, including social anxiety and PTSD, by simulating situations that trigger targeted symptoms. Expanding upon this, VR can be leveraged in motor-related rehabilitation. Computer engineering focuses on the development of physical devices that reliably gather and relay data as well as software that interprets and displays data in meaningful ways. In relation to VR motor-related therapy, the discipline is responsible for syncing users’ movement virtually to a viewable device, interpreting the results based on specified criteria, adjusting settings accordingly, and iterating procedures. It is also concerned with the cost efficiency and comfort of such devices. Game development can be considered a branch of CS (or perhaps its own discipline) and is the coding and design (level layout, adjusted difficulty settings, art assets) of games. Motor disorders afflict patients from various age groups from children with cerebral palsy to post-stroke elders. Thus, it is important to tailor the virtual environments to the individual to encourage interactivity, especially for children and those with attention deficiencies. Additionally, designing and adjusting difficulty settings in relation to performance is vital to prevent frustration or boredom and further promote self-engagement. Leveraging VR in motor-related rehabilitation has a promising outlook in that it engages users, provides real-time feedback and progress tracking, cuts setup times, is tailored to the patient, and can potentially move therapies to a home setting.

Lange, B., Koenig, S., Chang, C., Mcconnell, E., Suma, E., Bolas, M., & Rizzo, A. (2012). Designing informed game-based rehabilitation tasks leveraging advances in virtual reality. Disability and Rehabilitation, 34(22), 1863-1870. doi:10.3109/09638288.2012.670029

This article provided by USC, Institute for Creative Technologies, in the journal Disability and Rehabilitation, highlights the benefits and challenges of implementing VR in therapeutic strategies. VR can be implemented in various ways. Sometimes head-mounts are used to display the view to the user and adjust in relation to his orientation. Body-tracking sensors can also provide a wider range of interactivity. Other times 6-wall rooms with projections called Cave Automatic Virtual Environments (CAVEs) are implemented to provide a less restrained, though more expensive, experience. Additionally, VR allows for varied perspectives by offering 1st or 3rd person views, which may give new insights to how patients respond to therapy. VR in therapy has long been hindered by costs of equipment, but commercial technology, such as the Wii and Kinect provide affordable ways to introduce rehabilitation to a home setting. Still, commercial technologies were not initially intended for therapeutic practices; therefore, they must be adjusted accordingly; else they may promote improper motor skills. This source is relevant in that it provides a good introduction to VR in therapy and some associated problems.

Merians, A., Jack, D. , Boian, R., Tremaine, M., Burdea, G., Adamovich, S., Reece, M., & Poizner, H. (2002). Virtual Reality–Augmented Rehabilitation for Patients Following Stroke. Physical Therapy, 82(9), 898-915.

This article from Physical Therapy, a journal that focuses on improving patient care, presents a case study following three elderly (50’s, 80’s) post-stroke patients who participated in a 2-week long VR motor training program. For 3.5 hours each training day, the patients practiced 4 VR exercises to test their hand’s: (1) range of movement, measured by how much of a image they could uncover by “wiping” their hand across the screen; (2) speed of movement measured by how fast they could close their hand; (3) finger fractionation measured by their ability to depress a single key on a keyboard piano; and (4) strength of movement measured by how much they could resist pressure applied to their glove. At the end of the program, each improved in all tested areas though those with more severe defects improved less so. Overall, the patients responded positively to the exercises but reported frustration over the length, response times, and clarity in information of the display. This implies that clear, real-time feedback is vital in keeping users engaged. The results of the study show the promise of VR in improving mobility in damaged upper extremities, even for elderly patients. However, a larger patient population is needed to test the validity of the findings accurately.

Sveistrup, H. (2004). Motor rehabilitation using virtual reality. Journal of NeuroEngineering and Rehabilitation, 1(1), 10. doi:10.1186/1743-0003-1-10

Sveistrup is a professor at the University of Ottawa Brain and Mind Institute at the University and focuses on traumatic brain injury, innovative rehabilitation techniques, and motor learning. The article discusses various studies and different VR strategies implemented by them. These include strategies targeting the following: balance and posture using a fixed bicycle, posture platform, flat VR display, and video-capture systems from VividGroup’s GX or IREX; locomotion using GaitMaster2 (a technology that gives the user the illusion of forward movement), and a virtual environment to track walking trajectories; and upper/lower extremities using a CyberGlove (motion capturing glove) and Rutgers ankle/hand systems; exercise and pain tolerance with a mounted bicycle and virtual scene. The article is important in that it cites technologies already used in VR motor-related rehabilitation, which can be implemented in other settings. Additionally, it references real cases in which the technology showed promise compared to regular therapies.

Barrett, N., Swain, I., Gatzidis, C., & Mecheraoui, C. (2016). The use and effect of video game design theory in the creation of game-based systems for upper limb stroke rehabilitation. Journal of Rehabilitation and Assistive Technologies Engineering, 3(0). doi:10.1177/2055668316643644

This article was published to the Journal of Rehabilitation and Assistive Technologies Engineering this year. Rehabilitating limb exercises often involve meaningful repetitive motion to induce neural plasticity and to strengthen neural connections associated with normal motor function. This piece discusses game design principles vital in keeping patients motivated during these exercises. Basic principles include a clear presentation of goals, rewards, low learning curves, and motivational feedback. Adjusting difficulty in response to improvement encourages users to continue play for mastery. Additionally, use of a simple interface (muted colors, low sounds) is important to avoid cognitive overload and fatigue. Multiplayer introduces a social aspect that promotes collaboration and increases interest. It also induces competition, which engages and entertains the user. Presenting varied tasks, tailoring genres, and introducing storylines helps to break the monotony of the exercises. Overall, the layout of games in therapy is important, as patients are more likely to exert effort continually, thus inducing neural plasticity, if they are immersed in the activity. This sets therapeutic VR practices apart from regular practices.

Koenig, S., Ardanza, A., Cortes, C., Mauro, A. D., & Lange, B. (2013). Introduction to Low-Cost Motion-Tracking for Virtual Rehabilitation. Biosystems & Biorobotics Emerging Therapies in Neurorehabilitation, 287-303. doi:10.1007/978-3-642-38556-8_15

An article in Emerging Therapies in Neurorehabilitation (Biosystems & Biorobotics), a collection on the technological advances and practices in neuro-rehabilitation, this piece discusses how the Microsoft Kinect, a platform that uses depth-sensing cameras, can be used in motor-related rehabilitation. Flexible Action and Articulated Skeleton Toolkit (FAAST) is a middleware that maps body movements from the Kinect skeleton to controls in games and VR applications. This allows clinicians to map desired movements and adjust sensitivities to existing games to match the patient’s needs and preferences. MiddleVR is another middleware platform that can be integrated with the Kinect to integrate with custom games created in Unity, an open-source game development engine. Overall, this piece shows techniques on using middleware with the Kinect to adjust existing games or integrate custom games for mobile rehabilitation. Northeastern’s ReGame VR Lab is in the process of conducting studies on children with cerebral palsy by creating tailored VR Kinect video games, so the techniques in this article can be applied in a similar setting.

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