Using virtual environments in neurology (FS-13)


J Deutsch1, K Bower2, L Hassett3, JE Pompeu4
1Rutgers University, Rivers Lab/Department of Rehabilitation and Movement Science, Newark, United States, 2The University of Melbourne, Department of Physiotherapy, Melbourne School of Health Sciences, Melbourne, Australia, 3University of Sydney, Faculty of Medicine and Health, Sydney, Australia, 4School of Medicine, University of Sao Paulo, Brazil, Dept of Physical Therapy, Speech and Occupational Therapy, Sao Paolo, Brazil
Learning objectives:
  1. Be current with the evidence base supporting VEs and serious games to enhance mobility and fitness for person with neurologic conditions.
  2. Understand use, barriers and facilitators to implementing VE and serious games  into different practice settings in different parts of the world.
  3. Implement VE and serious games  into their physical therapy practice setting and education.

Description: Virtual environments (VEs) and serious games for rehabilitation of balance, mobility and fitness for persons with neurological conditions have been developed and tested. Systematic reviews on VEs and serious games for rehabilitation for neurologic health conditions support the use of these technologies for balance and mobility rehabilitation. Evidence, however is not sufficient to transfer the new knowledge into practice. Therefore, the purpose of this session is to present the most current findings on use of VEs and serious games for the rehabilitation of balance, mobility and fitness for persons with neurological conditions and provide concrete examples and strategies for implementing virtual environments and serious games in physical therapy (PT) practice. A brief overview of the state of the science, results from surveys about use of these technologies in several countries and barriers to accessing and implementing them in practice will be presented. Then each presenter will share development and testing of their technology and importantly implementation into practice.

Firstly, Dr. Bower will present examples of technology implementation in both inpatient and outpatient stroke rehabilitation settings. This section will cover her research involving consumer-available and custom-designed video game systems for balance training. Additionally, she will discuss the experiences of implementing these technologies in a clinical setting. Specific focus will be placed on issues related to feasibility, acceptability and safety.

Second, Dr. Pompeu will briefly summarize the evidence supporting serious games and VEs as a tool for sensory-motor-cognitive training and their efficacy to improve postural control, gait and cognition. He will show different strategies to implement cognitive-motor training, with these technologies, in clinical practice. He will then present on the use of immersive VEs to assess spatial orientation and will discuss the feasibility, safety, acceptability and tolerability of immersive VEs developed for cognitive-sensory-motor training.

Dr. Hassett will present experiences from the Activity and MObility UsiNg Technology (AMOUNT) rehabilitation trial describing the use of videogames and VR gaming systems to improve mobility and promote physical activity. She will present data from the inpatient setting about which games/devices were used and provide some examples (with videos and photos) how game play was modified to ensure quality and quantity of practice to match rehabilitation goals. She will also describe implementation strategies that are being tested in a new trial for physiotherapists to incorporate digital devices including videogames and VR gaming systems into clinical practice.

Dr. Deutsch's presentation will synthesize the evidence for VEs and fitness for persons with neurological conditions highlighting recent work comparing custom to off-the-shelf games. The prsentation will primariy address incorporating VEs and serious games into entry-level PT education as well translating knowledge to the immediate clinic and the larger community of clinicians. She will describe incorporating this content in entry-level DPT program through the classroom as well the student run pro-bono clinic that includes circuit training for persons post-stroke Two on-line resources Kinecting with Clinicians (guides clinicians in the application of the Kinect Adventure Games) and the Open Rehabilitation Initiative (on-line community that shares research grade VEs and serious games) will be shared. The session will conclude with audience participation about their barriers and facilitators to implementation and a discussion about creating a community of users that can inform implementation of these technologies.

Implications/conclusions: Adapting and implementing evidence-based virtual environments and serious games for rehabilitation can be a powerful means of augmenting feedback-based interventions. The session will guide participants to the best available evidence for using these tools for training balance, mobility and fitness for persons with neurological conditions. Importantly, the participant will have access to on-line resources to increase the likelihood of transferring the technology and evidence into practice. In addition, participants will be invited to join a community of users that will assist in providing further information to enhance the development and implementation of these technologies into practice.
1. Bower, KJ, Louie, JL., Landesrocha, Y., Seedy, P., Gorelik, A., Bernhardt, J. (2015) Clinical feasibility of interactive motioncontrolled games for stroke rehabilitation. , 48(10)
2. Bower KJ., Clark RA., McGinley JL., Martin C.L., Miller K.J. (2014). Clinical feasibility of the Nintendo Wii™ for balance training post-stroke: a phase II randomized controlled trial in an inpatient setting Clinical Rehabilitation, 28(9): 912-923
3. Bower, K., Thilarajah, S., Pua, YH., Williams, G., Tan, D., Mentiplay, B., . . . Clark, R. (2019). Dynamic balance and instrumented gait variables are independent predictors of falls following stroke. JNER 16(1). doi:10.1186/s12984-018-0478-4.
4. Costa R, QUIMAS M, ; Pompeu, JE; Mello DD, Moretto E, Rodriguez FZ, Santos MDD, Nitrini R, Morganti F, Brucki SMD. (2018) Two new virtual reality tasks for the assessment of spatial orientation Preliminary results of tolerability, sense of presence and usability. DEMENTIA & NEUROPSYCHOLOGIA, (12) 196-204, 2018.
6. Hassett l, vand den Berg, Lindly RI, Crotty M, McClusky A, van del Ploeg HO, et .al., Digitally enabled aged care and neurological rehabilitation to enhance outcomes with Activity and MObility UsiNG Technology (AMOUNT) in Australia: A randomized controlled trial. (accepted Jan 2020 PLOS Medicine)
7. Hamilton C, Lovariini M, McCluskey A, Folly de Campos T, Hassett L. (2019) Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings; a qualitative systematic review. Dis and Rehabil 41 (15)1739-1750.
8. Levac D, Glegg S, Pradhan S, Fox E, Espy D, Deutsch JE (2019) Comparison of VR and active game usage: Attitudes and learning needs among therapists in Canada and the US. ICVR 2019

Key-words: 1. Virtual reality 2. Serious games 3. Knowledge translation

Funding acknowledgements:Deutsch NIH and NSF Hassett: NHMRC; POW Hospital Foundation Grant Pompeu São
Paulo Research Foundation (FAPESP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

All authors, affiliations and abstracts have been published as submitted.

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