PosterPDF Available

WHAT'S BUZZING IN VR? Use of haptics in virtual rehabilitation of hand function after stroke: a literature review



Numerous virtual reality systems have been studied using different haptic devices to restore hand function post-stroke. These devices enhance immersion through the application of vibrotactile stimulation with kinaesthetic feedback. This multi-modal feedback has been theorized to improve motor control, strength, and dexterity in integration with the repetitive practice of an ecologically relevant motor task through the mechanism of neuroplasticity. Presently, haptic devices are unwieldy, expensive, and impractical for daily clinical use. Therefore, economical, petite, and ergonomically designed haptic devices may allow future studies to make stronger arguments for their inclusion in hand rehabilitation after stroke.
ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Stroke is a leading cause of long-term disability, and virtual reality- (VR-) based stroke rehabilitation is effective in increasing motivation and the functional performance. Although much of the functional reach and grasp capabilities of the upper extremities were regained, the pinch movement remains impaired following stroke. In this study, we developed a haptic-enhanced VR system to simulate haptic pinch tasks to assist the recovery of upper-extremity fine motor function. We recruited 16 adults with stroke to verify the efficacy of this new VR system. Each patient received 30 min VR training sessions 3 times per week for 8 weeks. Outcome measures, Fugl-Meyer assessment (FMA), Test Evaluant les Membres superieurs des Personnes Agees (TEMPA), Wolf motor function test (WMFT), Box and Block test (BBT), and Jamar grip dynamometer, showed statistically significant progress from pretest to posttest and follow-up, indicating that the proposed system effectively promoted fine motor recovery of function. Additionally, our evidence suggests that this system was also effective under certain challenging conditions such as being in the chronic stroke phase or a coside of lesion and dominant hand (nondominant hand impaired). System usability assessment indicated that the participants strongly intended to continue using this VR-based system in rehabilitation.
Full-text available
Objectives The YouGrabber (YG) is a new virtual reality training system that focuses on unilateral and bimanual activities. This nested study was part of a larger multicentre randomised controlled trial and explored experiences of people with chronic stroke during a 4 week intensive upper limb training with YG. Design A qualitative design using semi-structured, face-to-face interviews. A phenomenological descriptive approach was used, with data coded, categorized and summarized using a thematic analysis. Topics investigated included: the experience of YG training, perceived impact of YG training on arm function, and the role of the treating therapist. Results Five people were interviewed (1 female, age range 55-75yrs, 1-6yrs post-stroke). Seven main themes were identified: (1) general experience, (2) expectations, (3) feedback, (4) arm function, (5) physiotherapist’s role, (6) fatigue, (7) motivation. Key experiences reported included feelings of motivation and satisfaction, with positive factors identified as challenge, competition, fun and effort. The YG training appeared to trigger greater effort, however fatigue was experienced at the end of the training. Overall, patients described positive changes in upper limb motor function and activity level, e.g. automatic arm use. While the opportunity for self-practice was appreciated, input from the therapist at the start of the intervention was deemed important for safety and confidence. Conclusions Reported experiences were mostly positive and the participants were motivated to practice intensively. They enjoyed the challenging component of the games.
Full-text available
Robotic systems that are interfaced with virtual reality gaming and task simulations are increasingly being developed to provide repetitive intensive practice to promote increased compliance and facilitate better outcomes in rehabilitation post-stroke. A major development in the use of virtual environments (VEs) has been to incorporate tactile information and interaction forces into what was previously an essentially visual experience. Robots of varying complexity are being interfaced with more traditional virtual presentations to provide haptic feedback that enriches the sensory experience and adds physical task parameters. This provides forces that produce biomechanical and neuromuscular interactions with the VE that approximate real-world movement more accurately than visual-only VEs, simulating the weight and force found in upper extremity tasks. The purpose of this article is to present an overview of several systems that are commercially available for ambulation training and for training movement of the upper extremity. We will also report on the system that we have developed (NJIT-RAVR system) that incorporates motivating and challenging haptic feedback effects into VE simulations to facilitate motor recovery of the upper extremity post-stroke. The NJIT-RAVR system trains both the upper arm and the hand. The robotic arm acts as an interface between the participants and the VEs, enabling multiplanar movements against gravity in a three-dimensional workspace. The ultimate question is whether this medium can provide a motivating, challenging, gaming experience with dramatically decreased physical difficulty levels, which would allow for participation by an obese person and facilitate greater adherence to exercise regimes.
Objective: To compare participation and subjective experience of participants in both home-based multi-user VR therapy and home-based single-user VR therapy. Design: Crossover, randomized trial SETTING: Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants' homes PARTICIPANTS: Stroke survivors with chronic upper extremity impairment (n=20) INTERVENTIONS: 4 weeks of in-home treatment using a custom, multi-user virtual reality system (VERGE): two weeks of both multi-user (MU) and single-user (SU) versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into two groups, first multi-user (FMU) and first single-user (FSU). Main outcome measures: We measured arm displacement during each session (meters) as the primary outcome measure. Secondary outcome measures include: time participants spent using each MU and SU VERGE, and Intrinsic Motivation Inventory (IMI) scores. Fugl-Meyer Upper-Extremity (FMUE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session. Results: Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, p=0.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (p=0.04). FMUE score improved significantly across all participants (Δ3.2, p=0.001). Conclusions: Multi-user VR exercises may provide an effective means of extending clinical therapy into the home.
Reaching and grasping parameters with and without haptic feedback were characterized in people with chronic stroke. Twelve (67 ± 10yrs) individuals with chronic stroke and arm/hand paresis (Fugl-Meyer Assessment-Arm: ≥ 46/66 pts) participated. Three dimensional (3D) temporal and spatial kinematics of reaching and grasping movements to 3 objects (can: cylindrical grasp; screwdriver: power grasp; pen: precision grasp) in a physical environment (PE) with and without additional haptic feedback and a 3D virtual environment (VE) with haptic feedback were recorded. Participants reached, grasped and transported physical and virtual objects using similar movement strategies in all conditions. Reaches made in VE were less smooth and slower compared to the PE. Arm and trunk kinematics were similar in both environments and glove conditions. For grasping, stroke subjects preserved aperture scaling to object size but used wider hand apertures with longer delays between times to maximal reaching velocity and maximal grasping aperture. Wearing the glove decreased reaching velocity. Our results in a small group of subjects suggest that providing haptic information in the VE did not affect the validity of reaching and grasping movement. Small disparities in movement parameters between environments may be due to differences in perception of object distance in VE. Reach-to-grasp kinematics to smaller objects may be improved by better 3D rendering. Comparable kinematics between environments and conditions is encouraging for the incorporation of high quality VEs in rehabilitation programs aimed at improving upper limb recovery.
The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke
  • A Maris
  • K Coninx
  • H Seelen
  • V Truyens
  • De Weyer
  • T Geers
  • R Lemmens
  • M Coolenj
  • S Stupar
  • I Lamers
  • P Feys
Maris A, Coninx K, Seelen H, Truyens V, De Weyer T, Geers R, Lemmens M, CoolenJ, Stupar S, Lamers I, Feys P. The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke. Disabil Rehabil Assist Technol. 2018 Jan;13(1):1-9. doi: 10.1080/17483107.2016.1278467