Virtual reality in telerehabilitation

Virtual reality in telerehabilitation is one of the newest tools available in that area. The computer technology that allows us to develop three-dimensional virtual environments consists of both hardware and software. The current popular, technical, and scientific interest in virtual environments is inspired, in large part, by the advent and availability of increasingly powerful and affordable visually oriented, interactive, graphical display systems and techniques.

The term “virtualized reality” (VR) was coined and introduced in a paper by Kanade. The traditional virtual reality world is typically constructed using simplistic, artificially created computer-aided design (CAD) models. VR starts with the real-world scene and virtualizes it [1].

Virtual reality is becoming a practical, affordable technology for the practice of clinical medicine, and modern, high-fidelity virtual reality systems have practical applications in areas ranging from psychiatry to surgical planning and telemedicine [2].

Through VR’s capacity to allow the creation and control of dynamic 3-dimensional, ecologically valid stimulus environments within which behavioral response can be recorded and measured, it offers clinical assessment and rehabilitation options not available with traditional methods [3].

Trepagnier described the value of VR systems for the investigation and rehabilitation of cognitive and perceptual impairments and discussed current and potential applications of VR technology to address six neurorehabilitation issues [4].

Korean researchers developed and assessed the value of a new rehabilitation training system to improve postural balance control by combining virtual reality technology with an unfixed bicycle. The system was effective as a training device; in addition, the technology might have a wider applicability to the rehabilitation field [5].

Tracy and Nathan investigated the relationship between motor tasks and participants' spatial abilities by training participants within a VR based simulator and then observing their ability to transfer training from the simulator to the real world. The study demonstrated that subjects with lower spatial abilities achieved significant positive transfer from a simulator based training task to a similar real world robotic operation task [6].

Harrison et al. applied two virtual environments to the assessment and training of inexperienced powered wheelchair users and demonstrated that the two virtual environments represent a potentially useful means of assessing and training novice powered wheelchair users [7].

And a recently completed project at the University of Strathclyde has resulted in the development of a wheelchair motion platform which, in conjunction with a virtual reality facility, can be used to address issues of accessibility in the built environment [8].

Many cases have applied virtual reality technology to telemedicine and telerehabilitation service development. Because telemedicine focuses principally on transmitting medical information, VR has potential to enhance the practice.

Riva and Gamberini described the state of the art of VR-based telemedicine applications. This technology is now used in remote or augmented surgery as well as in surgical training, both of which are critically dependent on eye–hand coordination. Recently, however, different researchers have tried to use virtual environments in medical visualization and for assessment and rehabilitation in neuropsychology [9].

Rizzo et al. conducted three case studies for VR applications that are Internet deliverable and they identified technical, practical, and user challenges of remote VR treatment programs [10].

To improve our understanding of deficits in autism and in left visual-spatial neglect, Trepagnier et al. investigated face gaze behavior in autism and right hemisphere stroke, using virtual reality and gaze sensing technology [11].

Rydmark et al. also developed an at-home stroke telerehabilitation service using virtual reality haptics [12].

Researchers from Rutgers University and Stanford University developed a virtual reality-based orthopedic telerehabilitation system [13, 14, 15].

Viirre discussed the use of virtual reality technologies in the rehabilitation of patients with vestibular disorders and in the provision of remote medical consultation for those patients. He stated that an appropriately designed VR experience could greatly increase the rate of adaptation in these patients [16].

References

1. Kanade T, Narayanan PJ, Rander PW. Virtualized Reality: Concepts and Early Results. IEEE Workshop on the Representation of Visual Scenes, Boston, 1995,

2. Bergeron B. Virtual reality applications in clinical medicine. Journal of Medical Practice Management. 2003; 18(4):211-5,

3. Schultheis MT, Rizzo AA, Application of Virtual Reality Technology in Rehabilitation; Rehabilitation Psychology 2002; 46(3):296-311

4. Trepagnier C. Virtual environments for the investigation and rehabilitation of cognitive and perceptual impairments. NeuroRehabilitation 1999; 12(1): 63-72.

5. Song CG, Kim JY, Kim NG. A New Postural Balance Control System for Rehabilitation Training Based on Virtual Cycling, Information Technology in Biomedicine, IEEE Transactions on 2004; 8(2):200 – 207

6. Tracey MR. Lathan CE. The interaction of spatial ability and motor learning in the transfer of training from a simulator to a real task. [Journal Article] Studies in Health Technology & Informatics. 2001; 81:521-7,

7. Harrison A. Derwent G. Enticknap A. Rose FD. Attree EA. The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users. Disability & Rehabilitation. 2002; 24(11-12):599-606,.

8. Grant M. Wheelchair Simulation in Virtual Reality Space Requirements for Wheeled Mobility An International Workshop http://www.ap.buffalo.edu/idea/space%20workshop/

9. Riva G. Gamberini L. Virtual reality in telemedicine. Telemedicine Journal & E-Health. 2000;6(3):327-40

10. Rizzo AA. Strickland D. Bouchard S. The challenge of using virtual reality in telerehabilitation. Telemedicine Journal & E-Health. 2004;10(2):184-95

11. Trepagnier C, Rosen M, Lathan C. Telerehabilitation and virtual reality technology for rehabilitation: preliminary results, Proceedings of the California State University at Northridge Conference on Technology and Persons with Disabilities. 1999, http://www.dinf.org/csun_99/session0241.html.

12. Rydmark M. Broeren J. Pascher R. Stroke rehabilitation at home using virtual reality, haptics and telemedicine. Studies in Health Technology & Informatics. 2002; 85:434-7

13. Burdea G. Popescu V. Hentz V. Colbert K. Virtual reality-based orthopedic telerehabilitation. IEEE Transactions on Rehabilitation Engineering. 2000;8(3):430-2

14. Popescu VG. Burdea GC. Bouzit M. Hentz VR. A virtual-reality-based telerehabilitation system with force feedback. IEEE Transactions on Information Technology in Biomedicine. 2000; 4(1):45-51

15. Burdea GC. Virtual rehabilitation--benefits and challenges. Methods of Information in Medicine. 2003; 42(5):519-23

16. Viirre E. Vestibular telemedicine and rehabilitation. Applications for virtual reality. Studies in Health Technology & Informatics. 1996;29:299-305