Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Low-cost and open source systems for VR-supported tele-rehabilitation <s> Stroke is a leading cause of disability in the United States and yet little technology is currently available for individuals with stroke to practice and monitor rehabilitation therapy on their own. This paper provides a detailed design description of a telerehabilitation system for arm and hand therapy following stroke. The system consists of a Web-based library of status tests, therapy games, and progress charts, and can be used with a variety of input devices, including a low-cost force-feedback joystick capable of assisting or resisting in movement. Data from home-based usage by a chronic stroke subject are presented that demonstrate the feasibility of using the system to direct a therapy program, mechanically assist in movement, and track improvements in movement ability. <s> BIB001 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Low-cost and open source systems for VR-supported tele-rehabilitation <s> Research on the effectiveness of robotic therapy for the paretic upper limb after stroke has shown statistically significant reductions in motor impairment during both acute and chronic phases of recovery. Despite growing empirical support for this technology and a stronger focus on optimizing rehabilitation outcomes and productivity, there continues to be a disconnect between research and clinical practice. We review studies on the use of robot-aided neurorehabilitation for the paretic arm after stroke and discuss ways in which this technology may provide opportunities for intensive training that complement more conventional therapy methods. <s> BIB002 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Low-cost and open source systems for VR-supported tele-rehabilitation <s> Abstract Broeren J, Rydmark M, Sunnerhagen KS. Virtual reality and haptics as a training device for movement rehabilitation after stroke: a single-case study. Arch Phys Med Rehabil 2004;85:1247–50. Objective To investigate whether training in a virtual environment with a haptic device will improve motor function in the left hemiparetic arm of a stroke subject. Design Single case, A-B-A design. Setting University hospital research laboratory. Participant A man in his late fifties (right handed), with a right-hemisphere lesion that caused a deficit in the left upper extremity. Intervention The subject trained with a 3-dimensional computer game during a 4-week period that consisted of twelve 90-minute sessions. Main outcome measures Three tests (Purdue pegboard test, dynamometer hand-grip strength, upper-extremity test) and a subjective interview were used to evaluate motor performance. Results Improvements were found in fine manual dexterity, grip force, and motor control of the affected upper extremity. The subject reported that there was a change in his day-to-day use of the upper extremity and that he was able to use it in activities that were previously impossible for him. Conclusions Training with virtual reality and haptics can promote motor rehabilitation. <s> BIB003 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Low-cost and open source systems for VR-supported tele-rehabilitation <s> In this paper we examine the issues pertaining to development of a low-cost telerehabilitation framework for upper-limb dysfunction, that is suitable for deployment in patients' homes. We use the example of a Virtual Driving Environment (VDE) to present the overall architecture and discuss issues of: (i) quantitative data-acquisition using commercial-off-the-shelf gaming devices; (ii) model-based parametric data transmission/playback; and (iii) parametric biomechanical identification and data reduction; to support individualization within the telerehabilitation regimen. <s> BIB004 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Low-cost and open source systems for VR-supported tele-rehabilitation <s> Background: Topographical disorientation represents one of the main consequences of brain injury. Up to now several methodological approaches have been used in the assessment of the brain injured patient's navigational abilities showing a moderate correlation with the impairments observed in everyday contexts. Methods: We propose a combination of standardized neuropsychological tests and a more situated virtual reality-based assessment for the evaluation of spatial orientation in brain injured patients. Results: When tested with this virtual reality integrated procedure patients showed performance and execution times congruent with their neuropsychological evaluation. When compared to a control group, patients revealed significantly slower times and greater errors in solving virtual reality based spatial tasks. Conclusion: The use of virtual reality, when combined with classical neuropsychological tests, can provide an effective tool for the study of topographical disorientation. <s> BIB005
Interest on tele-rehabilitation as a possible alternative to the traditional treatment of inpatients in hospital increased in recent years with the increment of costs and commitment by the private and public healthcare. Sugarman and colleagues assumed it is impossible for the therapist to monitor patients performing rehabilitation at home, emphasized the therapist's role in motivating the patient and the need of efficient communication between the therapist and patients at any time and place, including home  . Approaches combining VR and mechanical devices for rehabilitation BIB002 Coote & Sokes, 2005; BIB003 BIB001 BIB004 appear encouraging, but the systems specifically developed for these purposes have high costs. In alternative, Sugarman and colleagues adopted a commercial feedback joystick in association with a specifically designed armrest and a PC with Internet connection. Their proposed VR solution could be operated in two different modes: stand-alone or cooperative. In the former, patients exercised at home without Internet connection; in the latter, the patient and therapist were online and the therapist could monitor and tutor the patient performing. Open-source tools stand as inexpensive alternatives to promote the development of userfriendly, customized VR systems for rehabilitation and are being tested. Riva and colleagues proposed NeuroVR, a cost-free software platform based on open-source available solutions ). The platform allows users with no technical background to easily interface with the virtual environment and modify the scenario according to the specific needs; 2D and 3D objects may be selected from a database and incorporated into the virtual environment by a user-friendly graphical interface; therapists can supplement the database with pictures of persons or objects belonging to the patient's real life and suitable as stimuli or stressors. A further improvement of NeuroVR ) was the integration with the open-source software CamSpace aimed at developing a cost-free system overcoming some operational limits related to the joypad, mouse or keyboard use. A further extention was CamSpace 7, through which patients can interact with the virtual environment simply by hand or body movements and allowing design both motor and balance rehabilitation exercises  . NeuroVR is also in use in the treatment of a variety of conditions, including obesity , alcohol abuse  , anxiety disorders (Gorini & Riva, 2008a,b) , and in the rehabilitation of cognitive impairment BIB005 .