Virtual reality in telerehabilitation is a method used first in the training of musculoskeletal patients using asynchronous patient data uploading, and an internet video link. Subsequently, therapists using virtual reality-based telerehabilitation prescribe exercise routines via the web which are then accessed and executed by patients through a web browser. Therapists then monitor the patient's progress via the web and modify the therapy asynchronously without real-time interaction or training. [1]
The computer technology that allows development three-dimensional virtual environments consists of both hardware and software. The current popular, technical, and scientific interest in virtual environments is inspired, in large part, by the advent and availability of increasingly powerful and affordable visually oriented, interactive, graphical display systems and techniques lacking only sense and sensibility.
The term "virtualized reality" (VR) was coined and introduced in a paper by Kanade. The traditional virtual reality world is typically constructed using simplistic, artificially created computer-aided design (CAD) models. VR starts with the real-world scene and virtualizes it. [2] Virtual reality is a practical, affordable technology for the practice of clinical medicine, and modern, high-fidelity virtual reality systems have practical applications in areas ranging from psychiatry to surgical planning and telemedicine. [3] Through VR's capacity to allow the creation and control of dynamic 3-dimensional, ecologically valid stimulus environments within which behavioral response can be recorded and measured, it offers clinical assessment and rehabilitation options not available with traditional methods. [4]
The value of VR systems for the investigation and rehabilitation of cognitive and perceptual impairments and current and potential applications of VR technology address six neurorehabilitation issues. [5] Korean researchers developed and assessed the value of a new rehabilitation training system to improve postural balance control by combining virtual reality technology with an unfixed bicycle. The system was effective as a training device; in addition, the technology might have a wider applicability to the rehabilitation field. [6]
Tracy and Lathan investigated the relationship between motor tasks and participants' spatial abilities by training participants within a VR based simulator and then observing their ability to transfer training from the simulator to the real world. The study demonstrated that subjects with lower spatial abilities achieved significant positive transfer from a simulator based training task to a similar real world robotic operation task. [7]
Virtual environments were applied to assess the training of inexperienced powered wheelchair users and demonstrated that the two virtual environments represent a potentially useful means of assessing and training novice powered wheelchair users. [8] A recently completed project at the University of Strathclyde has resulted in the development of a wheelchair motion platform which, in conjunction with a virtual reality facility, can be used to address issues of accessibility in the built environment. [9]
Many cases have applied virtual reality technology to telemedicine and telerehabilitation service development. Because telemedicine focuses principally on transmitting medical information, VR has potential to enhance the practice. One significant advancement [10] is the use of VR in telerehabilitation to help patients overcome geographic and mobility barriers by enabling them to engage in therapy remotely. This is particularly important in regions with limited access to healthcare services, where VR-based telerehabilitation can significantly improve patient outcomes without requiring physical attendance at medical facilities. State of the art of VR-based telemedicine applications is used in remote or augmented surgery as well as in surgical training, both of which are critically dependent on eye–hand coordination. Recently, however, different researchers have tried to use virtual environments in medical visualization and for assessment and rehabilitation in neuropsychology. [11]
Case studies for VR applications were conducted that were internet deliverable and they identified technical, practical, and user challenges of remote VR treatment programs. [12] To improve understanding of deficits in autism and in left visual-spatial neglect, Trepagnier et al. investigated face gaze behavior in autism and right hemisphere stroke, using virtual reality and gaze sensing technology. [13]
An at-home stroke telerehabilitation service was developed using virtual reality haptics. [14] Researchers from Rutgers University and Stanford University developed a virtual reality-based orthopedic telerehabilitation system. [15] [16] [17]
The use of virtual reality technologies in the rehabilitation of patients with vestibular system disorders and in the provision of remote medical consultation for those patients. He stated that an appropriately designed VR experience could greatly increase the rate of adaptation in these patients. [18]
While VR enables greater accessibility for some, it also carries the risk of exclusion for others, particularly those without adequate resources to access VR technology and those with disabilities that restrict them from the use of virtual reality in telerehabilitation.
Remote VR treatment programs require both a stable access to the internet and varying VR equipment. With one third of the world population not having any access to the internet(UN SOURCE), the access to remote VR treatment programs might be limited. At the same time, the price of the VR headset combined with the specialized accessories for the remote VR treatment programs may exacerbate existing economic disparities in healthcare.
Epilepsy is a chronic neurological disorder that is typically the case of recurrent seizures. These seizures are sudden, temporary alterations of brain function that cause involuntary movements, sensations, or changes in consciousness. These epileptic episodes can be triggered by various light patterns. With VR being a bright screen so close to the eyes, epilepsy patients are generally excluded from VR telerehabilitation due to the concern that using it may trigger seizures. [19]
People’s social identities, such as class and disorders as mentioned above, unfortunately play a role in patients' accessibility to the use of VR telerehabilitation. Because this technology is so new, medical engineers have not had the time or resources to make the proper advancements to this technology to make it more accessible.
Telerehabilitation has made a huge improvement in rehab accessibility and efficiency. For instance, in fields such as Musculoskeletal Rehabilitation, Stroke Recovery, Parkinson’s Disease, and Chronic Pain Management in Cancer Patients, improvements have been quite apparent.
Musculoskeletal Rehabilitation:
Virtual Reality plays a very important part in musculoskeletal rehab. Studies show that 80% of patients using VR for muscle and joint issues reported better mobility and pain relief. [20] Physical Therapy is made a lot more efficient and effective through VR. It’s not just about helping patients get better—it also allows them to do their exercises right at home. Because VR makes exercises more immersive and fun, patients are more likely to stick with their routines, which speeds up their recovery.
Stroke Recovery:
Virtual reality has made a huge difference in patients who have had recent strokes. Patients who participated in VR therapy reportedly improved their motor function abilities by 20% after just four weeks. [21] Since Virtual Reality boosts neuroplasticity, which allows the brain the ability to rewire itself, this greatly impacts the patient in a positive manner. By having patients do controlled movements in VR, it will allow them to regain control of their bodily functions faster and more efficiently. This is life-changing as this in many cases will allow the patient to be able to perform everyday tasks once again.
Parkinson’s Disease:
Patients with Parkinson’s Disease who engage in VR-based rehabilitation have shown a 30% reduction in fall risk along with notable improvements in gait speed and balance. [22] Since older adults with Parkinson's have a much greater risk of falling, this statistic remains very important. With this VR technology patients can practice balance and coordination in simulated virtual environments without the risk of falling and injuring themselves, making this method more safe and effective.
Chronic Pain Management in Cancer Patients:
Virtual Reality therapy has provided much comfort and relief to cancer patients who have reported unbearable pain. According to data from Cedars-Sinai Medical Center, patients using Virtual Reality reported a decrease of about 1.7 points on the pain scale compared to those who were going through traditional pain management methods such as watching relaxing TV channels or listening to soothing music. [23] This means that the immersive VR provides therapy for patients through a distraction method. Putting their focus on the Virtual environments rather than their pain makes it a lot easier to deal with. This also results in the patient's mental well-being improving significantly during the therapy sessions.
Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention, and health promotion. Physical therapist is the term used for such professionals in the United States, and physiotherapist is the term used in many other countries.
Virtual reality (VR) is a simulated experience that employs 3D near-eye displays and pose tracking to give the user an immersive feel of a virtual world. Applications of virtual reality include entertainment, education and business. VR is one of the key technologies in the reality-virtuality continuum. As such, it is different from other digital visualization solutions, such as augmented virtuality and augmented reality.
Kinesiology is the scientific study of human body movement. Kinesiology addresses physiological, anatomical, biomechanical, pathological, neuropsychological principles and mechanisms of movement. Applications of kinesiology to human health include biomechanics and orthopedics; strength and conditioning; sport psychology; motor control; skill acquisition and motor learning; methods of rehabilitation, such as physical and occupational therapy; and sport and exercise physiology. Studies of human and animal motion include measures from motion tracking systems, electrophysiology of muscle and brain activity, various methods for monitoring physiological function, and other behavioral and cognitive research techniques.
Physical medicine and rehabilitation (PM&R), also known as physiatry, is a branch of medicine that aims to enhance and restore functional ability and quality of life to people with physical impairments or disabilities. This can include conditions such as spinal cord injury, brain injury, musculoskeletal injury, stroke, pain and spasticity from muscle, ligament, or nerve damage. PM&R physicians lead rehabilitation teams and are trained in medication management, electrodiagnosis, and targeted injections. A physician having completed training in this field may be referred to as a physiatrist.
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.
Fitness game, exergame, and gamercise are terms used for video games that are also a form of exercise. Fitness games rely on technology that tracks body movement or reaction. The genre has been used to challenge the stereotype of gaming as a sedentary activity, and promoting an active lifestyle among gamers. Fitness games are seen as evolving from technology aimed at making exercise more fun.
Telerehabilitation (or e-rehabilitation is the delivery of rehabilitation services over telecommunication networks and the internet. Telerehabilitation allows patients to interact with providers remotely and can be used both to assess patients and to deliver therapy. Fields of medicine that utilize telerehabilitation include: physical therapy, occupational therapy, speech-language pathology, audiology, and psychology. Therapy sessions can be individual or community-based. Types of therapy available include motor training exercises, speech therapy, virtual reality, robotic therapy, goal setting, and group exercise.
Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological or occupational therapy and in affecting virtual rehabilitation. Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures. Technology can range from a simple PC and keyboard setup, to a modern virtual reality headset. It is widely used as an alternative form of exposure therapy, in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia, and to improve social skills in those diagnosed with autism.
Immersion therapy is a psychological technique which allows a patient to overcome fears (phobias), but can be used for anxiety and panic disorders.
Neurorehabilitation is a complex medical process which aims to aid recovery from a nervous system injury, and to minimize and/or compensate for any functional alterations resulting from it.
Aquatic therapy refers to treatments and exercises performed in water for relaxation, fitness, physical rehabilitation, and other therapeutic benefit. Typically a qualified aquatic therapist gives constant attendance to a person receiving treatment in a heated therapy pool. Aquatic therapy techniques include Ai Chi, Aqua Running, Bad Ragaz Ring Method, Burdenko Method, Halliwick, Watsu, and other aquatic bodywork forms. Therapeutic applications include neurological disorders, spine pain, musculoskeletal pain, postoperative orthopedic rehabilitation, pediatric disabilities, pressure ulcers, and disease conditions, such as osteoporosis.
Swami Vivekanand National Institute of Rehabilitation Training and Research (SVNIRTAR) is an autonomous institute functioning under the Ministry of Social Justice and Empowerment of India. It is located in Olatpur, 30 km from Cuttack.
Rehabilitation robotics is a field of research dedicated to understanding and augmenting rehabilitation through the application of robotic devices. Rehabilitation robotics includes development of robotic devices tailored for assisting different sensorimotor functions(e.g. arm, hand, leg, ankle), development of different schemes of assisting therapeutic training, and assessment of sensorimotor performance of patient; here, robots are used mainly as therapy aids instead of assistive devices. Rehabilitation using robotics is generally well tolerated by patients, and has been found to be an effective adjunct to therapy in individuals with motor impairments, especially due to stroke.
The use of electronic and communication technologies as a therapeutic aid to healthcare practices is commonly referred to as telemedicine or eHealth. The use of such technologies as a supplement to mainstream therapies for mental disorders is an emerging mental health treatment field which, it is argued, could improve the accessibility, effectiveness and affordability of mental health care. Mental health technologies used by professionals as an adjunct to mainstream clinical practices include email, SMS, virtual reality, computer programs, blogs, social networks, the telephone, video conferencing, computer games, instant messaging and podcasts.
Burke Rehabilitation Hospital is a non-profit, 150-bed acute rehabilitation hospital located in White Plains, New York. It is the only hospital in Westchester County entirely dedicated to rehabilitation medicine. Opening in 1915, Burke has been involved in medical rehabilitation for over one hundred years. As of January 2016, Burke is a member of the Montefiore Health System, Inc.
Vision rehabilitation is a term for a medical rehabilitation to improve vision or low vision. In other words, it is the process of restoring functional ability and improving quality of life and independence in an individual who has lost visual function through illness or injury. Most visual rehabilitation services are focused on low vision, which is a visual impairment that cannot be fully corrected by regular eyeglasses, contact lenses, medication, or surgery. Low vision interferes with the ability to perform everyday activities. Visual impairment is caused by factors including brain damage, vision loss, and others. Of the vision rehabilitation techniques available, most center on neurological and physical approaches. According to the American Academy of Ophthalmology, "Provision of, or referral to, vision rehabilitation is now the standard of care for all who experience vision loss.."
CAREN (Assisted) protocol—is a versatile, multi-sensory virtual reality system used for the treatment and rehabilitation of human locomotion, walking, as well as pain, posture, balancing spinal stability and motor control integration.
Video game rehabilitation is a process of using common video game consoles and methodology to target and improve physical and mental weaknesses through therapeutic processes. Video games are becoming an integral part of occupational therapy practice in acute, rehabilitation, and community settings. The design for video games in rehabilitation is focused on a number of fundamental principles, such as reward, goals, challenge, and meaningful play. 'Meaningful play' emerges from the relationship between player action and system outcome, apparent to the player through, visual, physical and aural feedback. Platforms that feature motion control, notably the Nintendo Wii, Microsoft's Xbox Kinect, Sony's Eye Toy, and virtual reality have all been effective in this field of research. Methodologies have been applied to all age groups, from toddlers to the elderly. It has been used in a variety of cases ranging from stroke rehabilitation, cerebral palsy and other neurological impairments, to tendinitis and multiple sclerosis. Researchers have promoted such technology based on the personalization of gaming systems to patients, allowing for further engagement and interaction. Additionally, gaming consoles have the ability to capture real-time data and provide instant feedback to the patients using the systems. Currently, several researchers have performed case studies to demonstrate the benefits of this technology. Repeat trials and experiments have shown that outcomes are easily replicated among various groups worldwide. Additionally, the outcomes have increased interest in the field, growing experiments beyond simple case studies to experiments with a larger participant base.
There are many applications of virtual reality (VR). Applications have been developed in a variety of domains, such as architectural and urban design, industrial designs, restorative nature experiences, healthcare and clinical therapies, digital marketing and activism, education and training, engineering and robotics, entertainment, virtual communities, fine arts, heritage and archaeology, occupational safety, as well as social science and psychology.
Julie Kathleen Silver is an American medical researcher who is an Associate Professor in the Department of Physical Medicine and Rehabilitation at the Harvard Medical School. Her research considers musculoskeletal disorders and cancer rehabilitation. Silver is involved with several initiatives to improve gender equity in medicine. She is the 2022 recipient of the Elizabeth Blackwell Medal.
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