Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Systems and applications 4.1 Systems and applications for VR-supported upper limb rehabilitation <s> Traditional methods of movement assessment in clinical rehab are often labor intensive and provide a limited number of outcome variables for tracking recovery. Entry level virtual reality (VR) systems afford new possibilities for systematic assessment and treatment. This paper describes the development of a virtual tabletop environment for the assessment of upper limb function in Traumatic Brain Injury (TBI). The system is designed to present realistic virtual workspaces and to measure performance at both a functional and kinematic level. In addition, we incorporate the use of Tangible User Interfaces (TUIs) as a means of integrating performance with the workspace. Unlike top-end movement analysis systems, the experimental system utilizes readily available computing technologies: mid-range PC, LCD panels, stereo camera, Virtools software, and TUI enabled by Wii Remote, Wii Sensor Bar (Nintendo?) and passive markers. The combination of vision-based marker tracking with a low cost game controller (viz Wii system) provides a stable and accurate means of tracking the TUI on the virtual workspace, and for interactivity within this space. The system provides a compelling sense of realism for the performer and an innovative means of assessing movement capabilities over time. <s> BIB001 </s> Application of Virtual Reality in Neuro-Rehabilitation: An Overview <s> Systems and applications 4.1 Systems and applications for VR-supported upper limb rehabilitation <s> We are attempting to develop therapeutic technology that individuals with substantial arm weakness and minimal hand function after stroke can use to improve their movement ability without the continuous presence of a rehabilitation therapist. We have developed a device called Therapy WREX (T-WREX) that is comprised of four main features: 1) a passive, gravity-balancing arm support (based on WREX ?Wilmington Robotic Exoskeleton) that allows a wide range of arm motion 2) a grip sensor that detects even trace amounts of grasp 3) virtual reality exercises that simulate activities of daily living, and 4) software that provides feedback about task performance. Initial clinical testing indicates that chronic stroke patients can significantly improve their movement ability with T-WREX. We have also found that patients strongly prefer using T-WREX for therapy compared to conventional, self-directed, tabletop exercises. This paper reports the results of a follow-up survey conducted with 11 subjects to gain further understanding about the basis for this preference. The results suggest that subjects prefer T-WREX because it is more interesting, and because it allows them to be more successful with their movement attempts. Further, each of the four features of TWREX had significant value to the subjects, suggesting that their combination is synergistic. <s> BIB002
A VR system purported to measure the impairment in speed, strength, fractionation and range of fingers movements was designed to be distributed over three sites connected via Internet (for rehabilitation, data storage and data access, respectively)  . At the rehabilitation site, the system featured a workstation and two sensing (cyber and haptic) gloves; the data storage site organized the information acquired during the VR-supported rehabilitation; open access to data was through Internet. An algorithm was implemented to increase or decrease according to the achieved performance the difficulty of the target task. The system was tested in a pilot study on 4 patients with stroke. A screen provided the patients with knowledge-of-results and performance (feedback) through a transparent hand representing the target and numerical scores about the trial execution. Trained patients achieved various degrees of improvement, with a good retention in gains and a positive evaluation of the system both by patients and therapists. A virtual tabletop environment for the upper limb rehabilitation after traumatic brain injury was developed BIB001 to measure the residual function and kinematic markers like speed, precision, distance, accuracy of targeting. The system was innovative because flexible, automated, and relatively inexpensive, with components specifically designed to be user-friendly: LCD panels easy to carry and reducing the set-up time were favored; the virtual environment was displayed on the LCD panel placed horizontally on a tabletop surface, and users could interact with the system by moving sensing-objects over it; knowledge of results was provided to the patient via another LCD panel. Distractive elements appeared on the LCD to increase or decrease the task difficulty. Low-cost implements, such as commercial game controllers and marker tracking were used. Wilson and coworkers suggested that psychometric measures should be preferred in the future and predicted broad application in assessing movement impairment after stroke and ischemic or traumatic brain damage or in movement disorders (e.g. Parkinson or Huntington's diseases). Therapy WREX (T-WREX) was designed by BIB002 for the hand and arm rehabilitation after stroke to make rehabilitation possible also in the absence of the therapist, with exercises mimiking the daily living activities in VR environment and a feedback information procedure. The system featured a passive gravity-balancing orthosis based on the Wilmington Robotic Esoskeleton (WREX)  , a hand grip sensor and the software needed for VR and performance evaluation, but was not a robotics/VR integration because WREX assisted patients only against gravity and by elastic bands. It focused on the retraining of function on a plane, therefore displaying the movement on the plane of interest. The system bypassed the problems of 3D complexity, but limitated the movements to be relearned. Most patients nevertheless found T-WREX less boring than conventional therapy and their progress during rehabilitation easier to track. Reiteration of motor training by T-WREX reduced motor impairment (as measured by the Fugl-Meyer scale) in a preliminary randomized controlled study (Reinkensmaeyer & Housman, 2007) .