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Virtual Reality and Robotics Interventions for Neurological Diseases

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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Artificial Intelligence in Medicine".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 31124

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Special Issue Editors

Dr. Pawel Kiper

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Guest Editor

Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy
Interests: stroke; virtual reality; robotics; rehabilitation; neurorehabilitation; neurological diseases, motor learning
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Carlos Luque Moreno

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Guest Editor

Physiotherapy Department, University of Seville, 41004 Sevilla, Spain
Interests: virtual reality; gait analysis; physiotherapy; neurorehabilitation; dry needling; neurological disorders, stroke, multiple sclerosis

Dr. Błażej Cieślik

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Guest Editor

Faculty of Health Science, Jan Dlugosz University, 42-200 Częstochowa, Poland
Interests: mental health; psychiatric disorders; body balance; postural stability; telerehabilitation; virtual reality
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the 21st century, the use of technology in the field of medicine looks promising. The utilization of robotics, health wearables, and telemedicine, in general, is becoming more common in clinical practice. Another form of new technology, virtual reality (VR), has become a subject of interest among researchers around the world. VR can cover a wide spectrum of technologies, starting from simple feedback using a monitor, through the very popular head-mounted display (VR goggle), to advanced EMG-based robotic devices that can be integrated within the VR environment. Apart from physical therapy, VR has also been used to improve the mental state of neurological patients. Immersion through VR is also related to the notion of “escapism”, meaning an escape from reality into the world of fiction and illusion, which in turn can positively affect mental health. The above examples show the spectrum of VR applications at random; however, this area is still a technological novelty. Studies focusing on acceptability, feasibility, tolerability, and initial clinical efficacy studies are still needed, but so are randomized controlled trials that compare clinically important outcomes between intervention and control conditions, as well as high-quality systematic reviews and meta-analyses.

Therefore, in light of the rapid expansion of the virtual reality field, we propose this Special Issue for a contribution within the innovative technologies field. We invite the submission of original research on VR support, treatment, and/or assessment in neurological diseases. Systematic reviews and meta-analyses will also be welcomed.

Dr. Pawel Kiper
Prof. Dr. Carlos Luque Moreno
Dr. Błażej Cieślik
Guest Editors

Manuscript Submission Information

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Keywords

virtual reality
neurorehabilitation
stroke
recovery of function
neurological diseases
multiple sclerosis
cerebral palsy
robotics
parkinson’s disease
mental health

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Published Papers (10 papers)

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Research

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19 pages, 1212 KiB

Open AccessArticle

Future of ADHD Care: Evaluating the Efficacy of ChatGPT in Therapy Enhancement

by Santiago Berrezueta-Guzman, Mohanad Kandil, María-Luisa Martín-Ruiz, Iván Pau de la Cruz and Stephan Krusche

Healthcare 2024, 12(6), 683; https://doi.org/10.3390/healthcare12060683 - 19 Mar 2024

Cited by 6 | Viewed by 4247

Abstract

This study explores the integration of large language models (LLMs), like ChatGPT, to improve attention deficit hyperactivity disorder (ADHD) treatments. Utilizing the Delphi method for its systematic forecasting capabilities, we gathered a panel of child ADHD therapy experts. These experts interacted with our custom ChatGPT through a specialized interface, thus engaging in simulated therapy scenarios with behavioral prompts and commands. Using empirical tests and expert feedback, we aimed to rigorously evaluate ChatGPT’s effectiveness in therapy settings to integrate AI into healthcare responsibly. We sought to ensure that AI contributes positively and ethically to therapy and patient care, thus filling a gap in ADHD treatment methods. Findings show ChatGPT’s empathy, adaptability, and communication strengths, thereby highlighting its potential to significantly improve ADHD care. The study points to ChatGPT’s capacity to transform therapy practices through personalized and responsive patient care. However, it also notes the need for enhancements in privacy, cultural sensitivity, and interpreting nonverbal cues for ChatGPT’s effective healthcare integration. Our research advocates for merging technological innovation with a comprehensive understanding of patient needs and ethical considerations, thereby aiming to pioneer a new era of AI-assisted therapy. We emphasize the ongoing refinement of AI tools like ChatGPT to meet ADHD therapy and patient care requirements more effectively. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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12 pages, 1080 KiB

Open AccessArticle

The Effectiveness and Usability of a Rehabilitation Program Using the Nintendo Switch to Promote Healthy Aging in Older People with Cognitive Impairment: A Randomized Clinical Trial

by Melissa Helen Zegarra-Ramos, Cristina García-Bravo, Elisabet Huertas-Hoyas, Gemma Fernández-Gómez, Mª Pilar Rodríguez-Pérez, Jorge Pérez-Corrales and Sara García-Bravo

Healthcare 2024, 12(6), 672; https://doi.org/10.3390/healthcare12060672 - 16 Mar 2024

Cited by 2 | Viewed by 1935

Abstract

(1) Background: Healthy aging is the process of developing and maintaining functional capacity and optimizing involvement in order to improve one’s quality of life as people age. This study aimed to encourage healthy aging in people with cognitive impairment, as well as a control group, via the use of the Nintendo Switch combined with occupational therapy sessions, aiming to improve gross and fine motor skills, functionality, quality of life, and cognitive status. (2) Methods: A randomized clinical trial was undertaken. The sample was randomized using the OxMar software program Attribution 4.0 International, facilitating the division into a control group (CG), who received conventional occupational therapy sessions, and an experimental group (EG), who received therapy incorporating the Nintendo Switch, in addition to conventional occupational therapy sessions. The intervention period with the Nintendo Switch lasted for 8 weeks. (3) Results: Thirty-two participants were included in the study. Significant differences were found in the vast majority of the variables analyzed, which shows an improvement following the intervention; these improvements were mainly observed in measures of skill and the perception of quality of life. (4) Conclusions: An eight-week intervention with the Nintendo Switch alongside conventional occupational therapy helps to maintain cognitive status and functional independence. Following 8 weeks of intervention with the Nintendo Switch, improvements in gross motor dexterity, fine motor dexterity, and quality of life were observed in older people with cognitive impairment. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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12 pages, 2659 KiB

Open AccessArticle

Effects of Therapist Intervention during Upper-Extremity Robotic Rehabilitation in Patients with Stroke

by Si-Yun Kim, Yu-Mi Kim, See-Won Koo, Hyun-Bin Park and Yong-Soon Yoon

Healthcare 2023, 11(10), 1369; https://doi.org/10.3390/healthcare11101369 - 10 May 2023

Viewed by 1660

Abstract

This study aimed to determine whether the treatment effect differs for patients with stroke who perform robot-assisted upper-extremity rehabilitation by themselves compared to those whose rehabilitation is actively assisted by a therapist. Stroke patients with hemiplegia were randomly divided into two groups and received robot-assisted upper-limb rehabilitation for four weeks. In the experimental group, a therapist actively intervened in the treatment, while in the control group, the therapist only observed. After four weeks of rehabilitation, the manual muscle strength, Brunnstrom stage, Fugl-Meyer assessment of the upper-extremity (FMA-UE), box and block test, and functional independence measure (FIM) showed significant improvement in both groups compared to that before treatment; however, no interval change in spasticity was noted. The post-treatment values showed that the FMA-UE and box and block tests were significantly improved in the experimental group compared to those in the control group. Comparing the changes in the pre- and post-treatment values, the FMA-UE, box and block test, and FIM of the experimental group were significantly improved compared to those in the control group. Our results suggest that active intervention by therapists during robot-assisted upper-limb rehabilitation positively impacts upper-extremity function outcomes in patients with stroke. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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11 pages, 581 KiB

Open AccessArticle

Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study

by Silvia Salvalaggio, Luisa Cacciante, Lorenza Maistrello and Andrea Turolla

Healthcare 2023, 11(3), 335; https://doi.org/10.3390/healthcare11030335 - 23 Jan 2023

Cited by 4 | Viewed by 4860

Abstract

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl–Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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13 pages, 1704 KiB

Open AccessArticle

Virtual Feedback for Arm Motor Function Rehabilitation after Stroke: A Randomized Controlled Trial

by Silvia Salvalaggio, Pawel Kiper, Giorgia Pregnolato, Francesca Baldan, Michela Agostini, Lorenza Maistrello and Andrea Turolla

Healthcare 2022, 10(7), 1175; https://doi.org/10.3390/healthcare10071175 - 23 Jun 2022

Cited by 5 | Viewed by 3085

Abstract

A single-blind randomized controlled trial was conducted to compare whether the continuous visualization of a virtual teacher, during virtual reality rehabilitation, is more effective than the same treatment provided without a virtual teacher visualization, for the recovery of arm motor function after stroke. Teacher and no-teacher groups received the same amount of virtual reality therapy (i.e., 1 h/d, 5 dd/w, 4 ww) and an additional hour of conventional therapy. In the teacher group, specific feedback (“virtual-teacher”) showing the correct kinematic to be emulated by the patient was always displayed online during exercises. In the no-teacher group patients performed the same exercises, without the virtual-teacher assistance. The primary outcome measure was Fugl-Meyer Upper Extremity after treatment. 124 patients were enrolled and randomized, 62 per group. No differences were observed between the groups, but the same number of patients (χ² = 0.29, p = 0.59) responded to experimental and control interventions in each group. The results confirm that the manipulation of a single instant feedback does not provide clinical advantages over multimodal feedback for arm rehabilitation after stroke, but combining 40 h conventional therapy and virtual reality provides large effect of intervention (i.e., Cohen’s d 1.14 and 0.92 for the two groups, respectively). Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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13 pages, 1003 KiB

Open AccessArticle

The Use of Virtual Therapy in Cardiac Rehabilitation of Male Patients with Coronary Heart Disease: A Randomized Pilot Study

by Sandra Jóźwik, Adam Wrzeciono, Błażej Cieślik, Paweł Kiper, Joanna Szczepańska-Gieracha and Robert Gajda

Healthcare 2022, 10(4), 745; https://doi.org/10.3390/healthcare10040745 - 16 Apr 2022

Cited by 7 | Viewed by 2537

Abstract

The study aimed to evaluate the effectiveness of virtual reality therapy (VRT) in the treatment of anxiety–depressive disorders and in reducing stress levels in a group of men with coronary heart disease (CHD) participating in cardiac rehabilitation (CR). The study included 34 men with CHD who were assigned to the experimental group (EG) or the control group (CG). CR in the EG was supported by 8 VRT sessions, while CR in the CG was supplemented with 8 SAT sessions. Anxiety–depressive disorders were assessed using the Hospital Anxiety and Depression Scale (HADS). Perceived stress was assessed using the Perception of Stress Questionnaire (PSQ). In the EG, all measured parameters improved after the intervention. Significant reductions in HADS total score, the HADS-A, general stress score, emotional tension, and the external stress were obtained. In the CG, a deterioration in all measured parameters was observed. Significant changes were obtained in the general stress score and intrapsychic stress. The analysis between groups showed that the effectiveness of psychological interventions significantly differed between groups. The study results confirmed that supplementing standard CR with VRT leads to an improvement in the mental state of the patients and thus has a positive effect on the course of CR. However, the small sample size and high withdrawal rate prompt cautious interpretation of the results. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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6 pages, 1202 KiB

Open AccessCommunication

The Application of Balance Exercise Using Virtual Reality for Rehabilitation

by Yukio Urabe, Kazuki Fukui, Keita Harada, Tsubasa Tashiro, Makoto Komiya and Noriaki Maeda

Healthcare 2022, 10(4), 680; https://doi.org/10.3390/healthcare10040680 - 4 Apr 2022

Cited by 4 | Viewed by 2967

Abstract

To prevent falls, it is important to devise a safe balance training program that can be easily performed. This study investigated whether tilting an image in virtual reality (VR) can generate a center-of-gravity sway. Five men and five women were asked to rest standing upright (control condition) and to rest standing upright with a head-mounted display showing a tilted virtual image (VR condition), and changes in their standing balance were observed. Standing balance was assessed by measuring the distance traveled by the center of pressure (COP) of each of the participants’ legs. In order to investigate the effects of different tilt speeds and angles on COP, four different images were displayed in VR: an image tilting to 10° moving at a rate of 1°/s; an image tilting to 20° moving 1°/s; an image tilting to 10° moving 10°/s; an image tilting to 20° moving 10°/s. Change in COP was significantly greater in the VR than in the control condition (p < 0.01), and a tilt of 10° moving 1°/s showed the greatest change in COP (p < 0.01). Tilting an image in VR while in a resting standing position can change an individual’s COP; thus, VR may be applied to balance training. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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Review

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16 pages, 1461 KiB

Open AccessReview

Effectiveness of the Combined Use of a Brain–Machine Interface System and Virtual Reality as a Therapeutic Approach in Patients with Spinal Cord Injury: A Systematic Review

by Amaranta De Miguel-Rubio, Ignacio Gallego-Aguayo, Maria Dolores De Miguel-Rubio, Mariana Arias-Avila, David Lucena-Anton and Alvaro Alba-Rueda

Healthcare 2023, 11(24), 3189; https://doi.org/10.3390/healthcare11243189 - 17 Dec 2023

Cited by 3 | Viewed by 1861

Abstract

Spinal cord injury has a major impact on both the individual and society. This damage can cause permanent loss of sensorimotor functions, leading to structural and functional changes in somatotopic regions of the spinal cord. The combined use of a brain–machine interface and virtual reality offers a therapeutic alternative to be considered in the treatment of this pathology. This systematic review aimed to evaluate the effectiveness of the combined use of virtual reality and the brain–machine interface in the treatment of spinal cord injuries. A search was performed in PubMed, Web of Science, PEDro, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Medline, including articles published from the beginning of each database until January 2023. Articles were selected based on strict inclusion and exclusion criteria. The Cochrane Collaboration’s tool was used to assess the risk of bias and the PEDro scale and SCIRE systems were used to evaluate the methodological quality of the studies. Eleven articles were selected from a total of eighty-two. Statistically significant changes were found in the upper limb, involving improvements in shoulder and upper arm mobility, and weaker muscles were strengthened. In conclusion, most of the articles analyzed used the electroencephalogram as a measurement instrument for the assessment of various parameters, and most studies have shown improvements. Nonetheless, further research is needed with a larger sample size and long-term follow-up to establish conclusive results regarding the effect size of these interventions. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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Other

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14 pages, 1216 KiB

Open AccessSystematic Review

Multi-Modal versus Uni-Modal Treatment for the Recovery of Lower Limb Motor Function in Patients after Stroke: A Systematic Review with Meta-Analysis

by Alex Lando, Luisa Cacciante, Alessio Mantineo, Francesca Baldan, Paolo Pillastrini, Andrea Turolla and Giorgia Pregnolato

Healthcare 2024, 12(2), 189; https://doi.org/10.3390/healthcare12020189 - 12 Jan 2024

Cited by 2 | Viewed by 2093

Abstract

The aim of this study is to evaluate whether the multimodal treatment based on both resistance and endurance training for the recovery of lower limb function in post-stroke patients is more effective than unimodal treatment. Six electronic databases were searched. The included articles were firstly analysed for methodological quality and then quantitatively analysed for the following outcomes: endurance, knee-extensor muscle strength, gait speed, and aerobic capacity. The treatment effect was analysed with the mean difference (MD) or standardised mean difference (SMD). From a total of 4439 records, 10 studies met the inclusion criteria for the qualitative analysis, whereas 7 studies were included in the quantitative analysis. There is a significant difference favourable to the group with multimodal treatment for knee-extensor muscle strength (SMD = 1.25; 95% CI 0.97, 1.53, I² = 42%), both for the affected and the unaffected side. Multimodal treatments are a valid choice in the field of post-stroke rehabilitation. In particular, the combination of resistance and endurance training is useful to maximise the recovery of knee-extensor muscle strength, which in turn could be beneficial for achieving upright position and walking, allowing patients to improve independence levels in their activities of daily life. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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14 pages, 898 KiB

Open AccessSystematic Review

Neurologic Music Therapy in Geriatric Rehabilitation: A Systematic Review

by Jagoda Rusowicz, Joanna Szczepańska-Gieracha and Paweł Kiper

Healthcare 2022, 10(11), 2187; https://doi.org/10.3390/healthcare10112187 - 31 Oct 2022

Cited by 2 | Viewed by 4178

Abstract

(1) Introduction: Neurologic music therapy (NMT) is a non-pharmacological approach of interaction through the therapeutic use of music in motor, sensory and cognitive dysfunctions caused by damage or diseases of the nervous system. (2) Objective: This study aimed to critically appraise the available literature on the application of particular NMT techniques in the rehabilitation of geriatric disorders. (3) Methods: PubMed, ScienceDirect and EBSCOhost databases were searched. We considered randomized controlled trials (RCTs) from the last 12 years using at least one of the NMT techniques from the sensorimotor, speech/language and cognitive domains in the therapy of patients over 60 years old and with psychogeriatric disorders. (4) Results: Of the 255 articles, 8 met the inclusion criteria. All papers in the final phase concerned the use of rhythmic auditory stimulation (RAS) (sensorimotor technique) in the rehabilitation of both Parkinson’s disease (PD) patients (six studies) and stroke patients (SPs) (two studies). (5) Conclusion: All reports suggest that the RAS technique has a significant effect on the improvement of gait parameters and the balance of PD patients and SPs, as well as the risk of falls in PD patients. Full article

(This article belongs to the Special Issue Virtual Reality and Robotics Interventions for Neurological Diseases)

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