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- Virtual reality for sensorimotor rehabilitation post stroke: design principles and evidencePublication . Bermúdez i Badia, Sergi; Fluet, Gerard G.; Llorens, Roberto; Deutsch, Judith E.n the recent years, the use of virtual reality (VR) to enhance motor skills of persons with activity and participation restriction due to disease or injury has been become an important area of research. In this chapter, we describe the design of such VR systems and their underlying principles, such as experience-dependent neuroplasticity and motor learning. Further, psychological constructs related to motivation including salience, goal setting, and rewards are commonly utilized in VR to optimize motivation during rehabilitation activities. Hence, virtually simulated activities are considered to be ideal for (1) the delivery of specifi c feedback, (2) the a bility to perform large volumes of training, and (3) the presentation of precisely calibrated diffi culty levels, which maintain a high level of challenge throughout long training sessions. These underlying principles are contrasted with a growing body of research comparing the effi cacy of VR with traditionally presented rehabilitation activities in persons with stroke that demonstrate comparable or better outcomes for VR. In addition, a small body of literature has utilized direct assays of neuroplasticity to evaluate the effects of virtual rehabilitation interventions in persons with stroke. Promising developments and fi ndings also arise from the use of off-the-s helf video game systems for virtual rehabilitation purposes and the integration of VR with robots and brain-computer interfaces. Several challenges limiting the translation of virtual rehabilitation into routine rehabilitation practice need to be addressed but the fi eld continues to hold promise to answer key issues faced by modern healthcare.
- A virtual reality bus ride as an ecologically valid assessment of balance: a feasibility studyPublication . Gonçalves, A.; Montoya, M. F.; Llorens, R.; Bermúdez i Badia, S.Balance disorders can have substantial adverse implications on the performance of daily activities and lead to an increased risk of falls, which often have severe negative consequences for older adults. Quantitative assessment through computer ized force plate-based posturography enables objective assessment of postural control but could not successfully represent specifc abilities required during daily activities. The use of virtual reality (VR) could improve the representative design of functional activities and increase the ecological validity of posturographic tests, which would enhance the transferability of results to the real world. In this work, we investigate the feasibility of a simulated bus ride experienced in a surround-screen VR system to assess balance with increased ecological validity. Participants were frst evaluated with a posturography test and then with the VR-based bus ride test, while the reactions of their centre of pressure were registered. Lastly, participants provided self-reported measures of the elicited sense of presence during the test. A total of 16 healthy young adults completed the study. Results showed that the simulation could elicit signifcant medial–lateral excursions of the centre of pressure in response to variations in the optical fow. Furthermore, these responses’ amplitude negatively correlated with the participants’ posturography excursions when fxating a target. Although the sense of presence was moderate, likely due to the passive nature of the test, the results support the feasibility of our proposed paradigm, based in the context of a meaningful daily living activity, in assessing balance control components.