Successful rehabilitation with respect to the activities of daily living (ADL) requires accurate and effective assessment and training. A number of studies have emphasized the requirement for rehabilitation methods that are both relevant to the patient's real world environment, and that can also be transferred to other daily living tasks. Virtual reality (VR) has many advantages over other ADL rehabilitation techniques, and offers the potential to develop a human performance testing and training environment. Therefore, in this study, the virtual supermarket was developed and the possibility of using a VR system to assess and train cognitive ability in ADL investigated. This study demonstrates that VR technology offers great promise in the field of ADL training.

Kim YJ, et al. Ann Rehabil Med. 2013 Dec;37(6):766-776. http://dx.doi.org/10.5535/arm.2013.37.6.766

Stroke and traumatic brain injury affect an increasing number of people, many of whom retain permanent damage in cognitive functions. Conventionally, cognitive function has been assessed by a paper-based neuropsychological evaluation. However these test environments differ substantially from everyday life. This problem can be overcome by using virtual reality (VR) to objectively evaluate behaviors and cognitive function in simulated daily activities. With our virtual shopping simulation, we compared people who had undergone a stroke with control participants in an immersive VR program that used a head-mounted display (HMD). We evaluated user satisfaction with the tests, complications, and the user interface. Significant differences were consistently found between the stroke group and the control group for the following tasks: stage 1 performance index, interaction error; stage 2 delayed recognition memory score, attention index; and stage 3 executive index (p < 0.001). Perceptive dysfunction, visuospatial dysfunction, level of computer experience, and level of education affected the performance of the stroke group. The frequency of complications in the stroke group, calculated using the cut-off score for the Simulator Sickness Questionnaire, was 9.6% for nausea, 41.9% for oculomotor complications, and 25.8% for disorientation. The frequency of complications between the stroke and control groups was not significantly different. Thirty-five percent of participants in the stroke group and 13% in the control group reported difficulties with using the joystick. This computer-generated VR-based cognitive test shows promise in assessing cognitive function in patients with stroke. More refinements are needed in the user interface and the projection methods.

Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described.

We attempted to evaluate the clinical efficiency of a novel three-dimensional interactive augmented reality system (3D-ARS) for balance and mobility rehabilitation. This system enables participant training with a realistic 3D interactive balance exercise and assessing movement parameters and joint angles by using a kinetic sensor system. We performed a randomized controlled trial in a general hospital. Thirty-six participants (age, 56–76 years) who could independently walk and stand on one leg were recruited. The participants were randomly assigned to either group. The control group ( n = 18) underwent a conventional physical fitness program such as lower-extremity strengthening and balance training thrice per week for 1 month. The experimental group ( n = 18) experienced 3D-ARS training thrice per week (1 session = 30 minutes) for 4 weeks. Training comprised a balloon game for hip exercise, cave game for knee exercise, and rhythm game for one-leg balance exercise. Lower-extremity clinical scale scores, fall index, and automatic balance score were measured by using Tetrax ^® posturography before, during, and after training. Significant group (3D-ARS vs. control) × time (before and after exercise) interaction effect was observed for Berg balance scale (BBS) scores ( p = 0.04) and timed-up-and-go (TUG; p < 0.001). Overall improvements occurred in stability index, weight distribution index, fall risk index, and Fourier transformations index of posturography for both groups. However, score changes were significantly greater in the 3D-ARS group. Significant group × time interaction effect was observed for the fall risk index. This demonstrates that the 3D-ARS system can improve balance in the elderly more effectively.