Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR in the lower limb motor rehabilitation <s> Development and application of virtual reality (VR) systems for rehabilitation is an iterative process produced by collaboration of an inter-disciplinary team of engineers, neuroscientists and clinician-scientists. In this paper the use of virtual reality technology for the rehabilitation of individuals post-stroke is described. The development of the hardware is based on principles of motor control. Development of the software uses findings from the enrichment and motor plasticity and training literatures as well as principles of motor learning. Virtual environments are created to afford individuals post-stroke opportunities to practice tasks for which they require rehabilitation. These tasks, related to hand function and gait, are trained both at the impairment and functional level. The training engages users to allow for the repetitive intensive practice required for behavioral motor plasticity. Results from a series of upper and lower extremity studies indicate that use of VR technology to augment rehabilitation of individuals post-stroke merits further study. <s> BIB001 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR in the lower limb motor rehabilitation <s> Virtual reality (VR) technology offers a new and safe way to increase practice time and provide the varied environments and constraints needed to optimize locomotor training. Our specific objectives are (1) to create a virtual environment (VE) coupled with a self-paced treadmill for locomotor training; (2) to compare temporal and distance measurements of gait during treadmill walking while looking at different scenarios of VE; and (3) to develop a protocol optimized for the training of locomotor disorders after stroke. A motorized treadmill was mounted on a six-degree-of-freedom motion platform. VEs were created using commercial software (SoftImage) and projected on a large screen, while system control was administered through the CAREN software (Motek BV). The instantaneous treadmill speed and scene progression were servo-controlled. Preliminary results show that healthy subjects are able to have full control of their own walking speed both on the treadmill and within the virtual scene, while experiencing a strong sense of presence. A street crossing training protocol has been developed for locomotor training. It is expected that locomotor training with increasingly complex VEs will allow persons with stroke to increase progressively their locomotor capacity, as required and entrained by the VE. <s> BIB002 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> VR in the lower limb motor rehabilitation <s> Objective: Clinical scales evaluating arm function after stroke are weak at detecting quality of movement. Therefore a new scale, the Motor Evaluation Scale for Upper Extremity in Stroke Patients (MESUPES), was developed, comprising 22 items pertaining to arm and hand performance. The scale was investigated for validity and unidimensionality using the Rasch measurement model, and for inter-rater reliability.Setting: Twelve hospitals and rehabilitation centres in Belgium, Germany and Switzerland.Patients: There were 396 patients (average age 63.38±12.89 years) in the Rasch study and 56 patients (average age 65.68±12.75 years) in the reliability study.Main measures: The scale was examined on its fit to the Rasch model, thereby evaluating the scale’s unidimensionality and validity. Differential item functioning was performed to test the stability of item hierarchy on several variables. Inter-rater reliability was examined with kappa values, weighted percentage agreement and intraclass correlation coefficient... <s> BIB003
Several VR applications were designed to recover efficient walking in patients with lower limb motor impairment after stroke BIB001  . BIB002 BIB003 , performed studies on gait training by using a treadmill mounted on a 6-degree-of-freedom motion platform with a motion-coupled VR environment. The system provided the unique feature of simulated turning within the environment; also provided auditory and visual cues as positive/negative feedback. Subjects were required to wear 3D stereo glasses to visualize the virtual environment. Test results from this project demonstrated improved gait speed with training. More recently, Mirelman et al. studied the effects on impaired gait kinetics of robot-assisted rehabilitation with or without VR support  . Subjects in the two subgroups were trained with the same exercises; requested movements were inversion and eversion, dorsiflexion and plantar flexion, or combinations of these. A motion capture system was used to measure movements in association with a force-feedback system permitting navigation within a virtual environment displayed on a computer screen. Gait was estimated at baseline, one week after the training session, and three months after end of the therapy. Feedback information was provided directly by the system to the patients treated in the VR setting and by the therapist to those undergoing rehabilitation withouth VR support. Both groups improved, but patients treated with VR support did better, with increased ankle strenght at the end of treatment and at follow-up. Patients undergoing robotic-assisted rehabilitation without VR support reported fatigue earlier. Park and colleagues (Park et al, 2007 ) developed a VR system for motor rehabilitation with a PC camera and two markers of movement in a very simple virtual scenario with a crossingstepping stone task. The success rate in 9 hemiplegic patients with stiff-knee gait after stroke was computed as the ratio of successful trials to the total gait cycles, with a ~30% improvement after treatment.