Impact of a virtual reality program on post-stroke upper limb function: a randomized controlled trial

PURPOSE: The objective of this study was to determine the effects of virtual reality training on muscle activation in the elderly. METHODS: The subjects were 32 healthy elderly people aged between 65 and 80, who were divided into the VR(virtual reality) training group(n=17) and the control group(n=15). The Virtual reality training group engaged in a 30-minute exercise session using Wii Fit three times a week for eight weeks. Virtual reality training group used the Ski Slalom, Table tile, Balance bubble programs. low-extremity muscle activation of the two groups were measured before and after the intervention. RESULTS: To investigate the effects of the training on lower-extremity muscle activation, biceps femoris, gastrocnemius, tibialis anterior, vastus lateralis were measured. The results revealed that the activation of gastrocnemius and tibialis anterior significantly increased(p<.05), which indicates virtual reality training is effective in improving the activation of the muscles involved in the movement of the ankle joint. CONCLUSION: Virtual reality training is effective in improving the healthy elderly's activation of the muscles involved in the movement of the ankle joint. Thus, virtual reality training can be proposed as a form of fall prevention exercise for the elderly.

Objective: This study aimed to investigate the upper limb strength, active joint range of motion (AROM), and upper limb function in persons with chronic stroke using virtual reality training in combination with upper limb sensory stimulation. Design: Two-group pretest-posttest design. Methods: 20 subjects were divided into two groups of 10, the sensory motor stimulation and virtual reality training (SMVR) and virtual reality training (VR) groups. The training was conducted for 30 minutes per session, three times a week for 8 weeks.The participants' upper limb strength was measured via the hand-held dynamometer, joint angle AROM was measured via dual inclinometer, function was measured using the Jebson-Taylor hand function test and the manual function test. Results: Significant differences were observed in all groups before and after the training for upper extremity strength, AROM, and function (p<0.05). Between the two groups, the SMVR group showed significant improvement in muscle strength, AROM, and Jebsen-Taylor hand function test scores compared with the VR groups (p<0.05). Conclusions: In this study, we confirmed that sensory stimulation and VR had positive effects on upper extremity strength, AROM, and function of persons with chronic stroke. The results suggest that in the future, VR in combination with sensory stimulation of the upper limb is likely to become an effective method (a rehabilitation training program) to improve the upper limb function of persons with chronic stroke.

The effect of virtual reality training on the daily participation of patients: A meta-analysis

Effectiveness of sensing gloves–applied virtual reality education system on hand hygiene practice: A randomized controlled trial

Background Educational impact of virtual reality (VR) technology for healthcare practitioners has been increasingly acknowledged, including training aids for infection prevention and control (IPC). We developed a VR education system and evaluated its clinical utility for promoting hand hygiene practices. Methods This is a prospective, two-week, randomized-control study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024. The fully immersive 360° VR system (VIVE Pro Eye), using a head-mounted display and sensing gloves, was applied to develop three healthcare tasks in a virtual patient room. We monitored the baseline usage data of portable hand-rubbing alcohol of all the participants in the first week, and subsequently randomized participants into 1:1 groups (VR training group and video lecture group). The primary outcome was the differences in the consumption amount of the hand-rubbing alcohol before and after the interventions. Results A total of 22 participants (18 medical students and 4 residents) were recruited. Before the intervention, alcohol usage was not significantly different between the VR training and video lecture groups (8.2 g vs. 5.3 g). After the intervention, a significant increase in the use of hand-rubbing alcohol was observed in the VR training group (8.2 g vs 16.2 g; p=0.019), whereas there was no significant difference in the video lecture group (5.3 g vs 7.5 g; p=0.83) Conclusion Hand hygiene adherence in healthcare settings can be improved through the introduction of VR-based education owing to its immersive learning capabilities, interactive involvement, and affordability in experiencing complicated scenarios. Disclosures All Authors: No reported disclosures

Purpose: The aim of this study was to investigate the effectiveness of virtual reality training on balance and functionality in children with Cerebral Palsy. Methods: Children with spastic Cerebral Palsy were randomly divided into the virtual reality training group (27 children, mean age: 9.2 years) and control group (25 children, mean age: 9.4 years). The virtual reality training group received virtual reality training using the XBox One Kinect gaming system and the control group received conventional physiotherapy training for eight weeks. The Pediatric Balance Scale, The Gross Motor Function Measurement-88, The Quality of Upper Extremity Skills Test, The Functional Reach Test, The Sit to Stand Test and The Pediatric Disability Evaluation Inventory were measured at baseline and after treatment sessions. Results: Total motor function, upper extremity skills and balance in both groups improved after training (p &lt; 0.05). A comparison between groups demonstrated that the improvements in upper extremity functions was greater in the control group than in the virtual reality training group (p &lt; 0.05). Conclusion: The results of our study showed that Kinect-based virtual reality training is beneficial in improving balance, motor function and upper extremity skills in children with Cerebral Palsy.

Introduction: Previous studies evaluating the effect of virtual reality (VR) training on operating room performance have only analyzed the latter portion of the laparoscopic cholecystectomy (LC), while including many residents beyond their second year of training. The aim of this study was to better understand the impact of VR training on subjects with limited laparoscopic surgical experience during completion of an entire laparoscopic cholecystectomy. Methods: Twelve surgical residents (PGY 1 & 2) were randomized to either standard training (n = 6) or VR training (n = 6). In the VR training group subjects were required to reach expert established performance criterion levels on the manipulation diathermy task of the Minimally Invasive Surgical Trainer (MIST-VR). All subjects then performed a video-recorded LC under the supervision of a surgeon blinded to training status. Recordings were assessed by two blinded surgeon investigators using scores based on expert-defined errors with inter-rater reliability >0.9. Results: VR trained subjects completed the full LC 20% faster than controls (39 min. vs. 31 min.), made half as many errors while exposing cystic structures (5.3 vs 10), and one-third fewer errors in dissecting the gallbladder (5.5 vs. 8.2). Overall, controls made 40% more errors (11.7 vs 19.7, p Conclusions: Criterion based VR training to expert performance levels for junior surgical residents results in fewer intra-operative errors and greater performance consistency during the entire laparoscopic cholecystectomy procedure.

Standard surgical training has traditionally been one of apprenticeship, where the surgical trainee learns to perform surgery under the supervision of a trained surgeon. This is time-consuming, costly, and of variable effectiveness. Training using a virtual reality simulator is an option to supplement standard training. Virtual reality training improves the technical skills of surgical trainees such as decreased time for suturing and improved accuracy. The clinical impact of virtual reality training is not known. To assess the benefits (increased surgical proficiency and improved patient outcomes) and harms (potentially worse patient outcomes) of supplementary virtual reality training of surgical trainees with limited laparoscopic experience. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE and Science Citation Index Expanded until July 2012. We included all randomised clinical trials comparing virtual reality training versus other forms of training including box-trainer training, no training, or standard laparoscopic training in surgical trainees with little laparoscopic experience. We also planned to include trials comparing different methods of virtual reality training. We included only trials that assessed the outcomes in people undergoing laparoscopic surgery. Two authors independently identified trials and collected data. We analysed the data with both the fixed-effect and the random-effects models using Review Manager 5 analysis. For each outcome we calculated the mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals based on intention-to-treat analysis. We included eight trials covering 109 surgical trainees with limited laparoscopic experience. Of the eight trials, six compared virtual reality versus no supplementary training. One trial compared virtual reality training versus box-trainer training and versus no supplementary training, and one trial compared virtual reality training versus box-trainer training. There were no trials that compared different forms of virtual reality training. All the trials were at high risk of bias. Operating time and operative performance were the only outcomes reported in the trials. The remaining outcomes such as mortality, morbidity, quality of life (the primary outcomes of this review) and hospital stay (a secondary outcome) were not reported. Virtual reality training versus no supplementary training: The operating time was significantly shorter in the virtual reality group than in the no supplementary training group (3 trials; 49 participants; MD -11.76 minutes; 95% CI -15.23 to -8.30). Two trials that could not be included in the meta-analysis also showed a reduction in operating time (statistically significant in one trial). The numerical values for operating time were not reported in these two trials. The operative performance was significantly better in the virtual reality group than the no supplementary training group using the fixed-effect model (2 trials; 33 participants; SMD 1.65; 95% CI 0.72 to 2.58). The results became non-significant when the random-effects model was used (2 trials; 33 participants; SMD 2.14; 95% CI -1.29 to 5.57). One trial could not be included in the meta-analysis as it did not report the numerical values. The authors stated that the operative performance of virtual reality group was significantly better than the control group. Virtual reality training versus box-trainer training: The only trial that reported operating time did not report the numerical values. In this trial, the operating time in the virtual reality group was significantly shorter than in the box-trainer group. Of the two trials that reported operative performance, only one trial reported the numerical values. The operative performance was significantly better in the virtual reality group than in the box-trainer group (1 trial; 19 participants; SMD 1.46; 95% CI 0.42 to 2.50). In the other trial that did not report the numerical values, the authors stated that the operative performance in the virtual reality group was significantly better than the box-trainer group. Virtual reality training appears to decrease the operating time and improve the operative performance of surgical trainees with limited laparoscopic experience when compared with no training or with box-trainer training. However, the impact of this decreased operating time and improvement in operative performance on patients and healthcare funders in terms of improved outcomes or decreased costs is not known. Further well-designed trials at low risk of bias and random errors are necessary. Such trials should assess the impact of virtual reality training on clinical outcomes.

There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture. Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency. At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (p < 0.001) and time required to complete (p = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34s over the VR group when controlling for baseline measures. Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting. The online version contains supplementary material available at 10.1007/s40670-020-01141-6.

Finding enjoyable and effective long-term approaches to rehabilitation for improving the upper limb (UL) function of people with multiple sclerosis (MS) is challenging. Virtual reality (VR) with its engagement, interaction, and real time feedback could be a solution, with immersive VR systems having preliminary evidence in stroke to be more effective in improving UL outcomes in comparison to non-immersive VR. However, immersive VR research is limited within the realm of MS rehabilitation. Therefore, the main aim of the PhD was to explore immersive VR as an approach for UL rehabilitation for people with MS (pwMS). This was achieved in four stages: 1) a systematic review of the current evidence for VR in UL rehabilitation in MS; 2) predevelopment focus groups to determine requirements for the development of bespoke immersive VR games; 3) software development of bespoke VR games to potentially improve UL function for pwMS; and 4) a feasibility study of the games and immersive VR for pwMS’ UL rehabilitation. The systematic review initially yielded ten articles with varying study design, VR intervention and UL outcome measures used. There were some statistically significant improvements after VR interventions in outcomes such as in nine-hole peg test (NHPT), hand grip strength and active range of motion. There were however conflicting results regarding if VR was more effective than conventional approaches. Whilst the review demonstrated there were positive results for VR improving UL function, most of the studies had small sample sizes and were inadequately powered, and the level of immersion on effectiveness in MS remains unknown. The predevelopment focus groups recruited ten pwMS and eight specialist clinicians to explore their views on immersive VR as an approach to UL rehabilitation and determine requirements to develop VR games for this purpose. PwMS commonly reported that their UL problems interfered with activities of daily living and resulted in the loss of meaningful hobbies such as writing. Many pwMS neglected UL exercise and found strategies for adapting to their UL impairments. Similarly, clinicians stated UL rehabilitation was neglected within their service and that it was challenging to find interesting treatment strategies. VR was suggested by both participant groups as a potential solution, as it was convenient for pwMS to access and could provide a more engaging and disguised approach to exercise. Although, there were shared concerns about cybersickness and disengagement while using VR approaches. Finally, both groups agreed games should be meaningful and adaptable for users but suggested different VR activities, with clinicians suggesting games directly reflecting activities of daily living and pwMS suggesting more abstract activities. Recommendations were made for the development of VR rehabilitation games which could be personalised and customisable for the varying abilities of pwMS. Using theme-based content analysis and requirement analysis, requirements for the software development of immersive VR games were created and developed using Unity game engine. Three games, “Piano”; “Catch-a-falling-star” and “VR Whack-a-mole” which targeted dexterity and strength for pwMS were developed, with different difficulty levels implemented to adapt to varying ability of pwMS. The final stage of this PhD was a randomised, controlled feasibility study to investigate an intervention of immersive VR involving the three co-produced games for pwMS’ UL rehabilitation. Participants were randomised to either an intervention group consisting of 30 minutes of VR co-produced games, twice/week, for eight weeks, or to a control group of usual care. Participants were recruited from the NHS and third sector organisations. Nineteen pwMS were recruited (intervention n=11, control n=8), with a recruitment rate of 3.2 participants/month. Only minor adverse events were reported (n=9), such as fatigue and UL pain. Adherence was good with 87% (±12%) session completed, and two dropouts were reported in the control group. There were positive trends for improving NHPT and hand grip strength, but there was an observed ceiling effect in the Action Research Arm Test. Participants reported high levels of satisfaction and good usability of the co-produced VR games, as measured by the USE questionnaire. Thematic analysis revealed participants enjoyed the distraction and atmospheres that immersive VR provided, and believed the games were fit for purpose with the majority of participants reporting improvements in their UL function. Participants suggested more variety and progression of exercises for future development. Overall, these studies show that immersive VR has the potential to be beneficial for UL rehabilitation and is feasible and safe for pwMS. Therefore, future work should refine VR games for long-term application and explore the clinical and cost effectiveness of this approach.

Background:Despite the potential benefits of virtual reality technology in physical rehabilitation, only a few studies have evaluated the efficacy of this type of treatment in patients with neck pain.Objective:The aim of this study was to compare the effects of virtual reality training (VRT) versus conventional proprioceptive training (CPT) in patients with neck pain.Materials and Methods: Forty four participants with nonspecific chronic neck pain were randomly assigned to VRT or CPT in this assessor-blinded clinical trial. A novel videogame called Cervigame® was designed for VRT. It comprises of 50 stages divided into unidirectional and two-directional stages ordered from easy to hard. CPT consisted of eye-follow, gaze stability, eye-head coordination and position and movement sense training. Both groups completed 8 training sessions over 4 weeks. Visual analogue scale score, neck disability index and Y-balance test results were recorded at baseline, immediately after and 5 weeks post-intervention. Mixed repeated measure ANOVA was used to analyze differences between mean values for each variable at an alpha level of 0.05.Results:There were significant improvements in all variables in both groups immediately after and 5 weeks after the intervention. Greater improvements were observed in the visual analogue scale and neck disability index scores in VRT group, and the results for all directions in Y-balance test were similar in both groups. No side effects were reported. Conclusion:Improvements in neck pain and disability were greater in VRT than CPT group. Cervigame® is a potentially practical tool for rehabilitation in patients with neck pain.

Background: Despite the potential benefits of virtual reality technology in physical rehabilitation, only a few studies have evaluated the efficacy of this type of treatment in patients with neck pain.Objective: The aim of this study was to compare the effects of virtual reality training (VRT) versus conventional proprioceptive training (CPT) in patients with neck pain.Methods: Forty four participants with nonspecific chronic neck pain were randomly assigned to VRT or CPT in this assessor-blinded clinical trial. A novel videogame called Cervigame® was designed for VRT. It comprises of 50 stages divided into unidirectional and two-directional stages ordered from easy to hard. CPT consisted of eye-follow, gaze stability, eye-head coordination and position and movement sense training. Both groups completed 8 training sessions over 4 weeks. Visual analogue scale score, neck disability index and Y-balance test results were recorded at baseline, immediately after and 5 weeks post-intervention. Mixed repeated measure ANOVA was used to analyze differences between mean values for each variable at an alpha level of 0.05.Results: There were significant improvements in all variables in both groups immediately after and 5 weeks after the intervention. Greater improvements were observed in the visual analogue scale and neck disability index scores in VRT group, and the results for all directions in Y-balance test were similar in both groups. No side effects were reported.Conclusion: Improvements in neck pain and disability were greater in VRT than CPT group. Cervigame® is a potentially practical tool for rehabilitation in patients with neck pain.

&lt;p&gt;&lt;strong&gt;Context and relevance&lt;/strong&gt;. Training cadets to work with combat weapons is part of firearms training and is conducted in many departmental educational organizations. The initial use of combat weapons at the firing range is a significant stressor for students, affecting their emotional well-being; failures in handling weapons can reduce cadets' motivation to acquire the specialty. Therefore, finding new methods to reduce cadets' stress during their first interaction with combat weapons is highly relevant. &lt;strong&gt;Hypothesis.&lt;/strong&gt; Conducting weapons interaction training in virtual reality improves the emotional state of cadets and increases their confidence in firearms training. &lt;strong&gt;Methods and materials.&lt;/strong&gt; Methods: emotional state questionnaire &amp;ldquo;Thermometer Scale&amp;rdquo; by T.N. Berezina, SAN Questionnaire, &amp;ldquo;Self-assessment of emotional states&amp;rdquo; technique (authors: A. Wessman and D. Ricks), expert assessment of confidence in handling weapons; methods of mathematical statistics (Mann-Whitney U criterion, Wilcoxon T criterion). &lt;strong&gt;Subjects&lt;/strong&gt;: 100 people aged 18 to 22, cadets of the Russian National Guard. All subjects were divided into 3 groups. Experimental group: 31 cadets, underwent preliminary training in virtual reality, and then participated in real shooting ranges at the training ground. Control group 1: 39 cadets, did not undergo preliminary training, immediately participated in the shooting ranges. Control group 2: 30 people, did not undergo training, did not participate in the shooting ranges. The experimental group underwent training in interaction with weapons in virtual reality, 1&amp;mdash;3 lessons of 40 minutes, the VR simulator PavlovVR was used. &lt;strong&gt;Results.&lt;/strong&gt; Immediately after the first shooting ranges with combat weapons, the cadets' anxiety index increases and there is a general depression of the emotional sphere; the number of both positive and negative emotions decreases, and the mood decreases at the trend level. Preliminary training in virtual reality leads to an improvement in the &amp;ldquo;Activity&amp;rdquo; and &amp;ldquo;Mood&amp;rdquo; indicators, there is an increase in the number of positive emotions and a decrease in negative ones. According to the results of the expert assessment, during the shooting ranges, 90% of the cadets in the experimental group demonstrated confidence in handling weapons (in relation to 59% of the control group). &lt;strong&gt;Conclusions.&lt;/strong&gt; Conducting virtual reality training for Russian National Guard cadets can be an effective way to train them in firearms.&lt;/p&gt;

Objectives This study is aimed at exploring the effects of virtual reality (VR) training on postural control, measured by anticipatory and compensatory postural adjustments (APAs and CPAs, respectively), in patients with chronic nonspecific low back pain (CNLBP) and the potential neuromuscular mechanism of VR training. Methods Thirty-four patients were recruited and randomly assigned to the VR group (n = 11), the motor control exercise group (MCE, n = 12) and the control group (CG, n = 11). The VR group received VR training using Kinect Xbox 360 systems and magnetic therapy. Besides magnetic therapy, the participants in the MCE group performed real-time ultrasound-guided abdominal drawing-in maneuver (ADIM) and four-point kneeling exercise. The CG only received magnetic therapy. Surface muscle electromyography (sEMG) was used to record the muscle activities of transverse abdominis (TrA), multifidus (MF), lateral gastrocnemius (LG), and tibialis anterior (TA) during ball-hitting tasks. The muscle activation time and integrals of the electromyography activities (IEMGs) during the APA and CPA stages were calculated and used in the data analysis. The visual analogue scale (VAS) and Oswestry dysfunction index (ODI) scores were also recorded. Results A significant interaction effect of time × group was observed on the activation time of TrA (p = 0.018) and MF (p = 0.037). The post-intervention activation time of the TrA was earlier in the VR group (p = 0.029). In contrast, the post-intervention activation time of the MF was significantly delayed in the VR group (p = 0.001). The IEMGs of TrA (p = 0.002) and TA (p = 0.007) during CPA1 significantly decreased only in the VR group after the intervention. The VAS scores of three group participants showed significant decreases after intervention (p < 0.001). Conclusions Patients with CNLBP showed reciprocal muscle activation patterns of the TrA and MF muscles after VR training. VR training may be a potential intervention for enhancing the APAs of the patients with CNLBP.

Cortical excitability of motor anticipatory in subacute stroke patients after virtual reality training: A preliminary movement-related potential study