Virtual Environments for Stroke Rehabilitation: Examining a Novel Technology Against End-user, Clinical and Management Demands with Reference to UK Care Provision

By Jamie O’Brien, A thesis for Doctor of Engineering

Introduction

Since there is a growing interest in the use of virtual reality (VR)-based systems for rehabilitation purpose, there is a neediness to understand the strengths and limitations of it. The aim of this paper is to determine the value of the this technology concerning the user focus, clinical effectiveness, marketability and contextual meaningfulness etc. comparing with the end users of those systems. The researcher has given a good introduction about stroke and stroke rehabilitation and done a good literature review as well.

Contribution

As I previously mentioned, stroke and stroke rehabilitation has been described well. His research focuses on treatments for rehabilitation of upper limb (a term used among clinicians to describe the functionality of a patient’s shoulder, arm and hand). He has critically reviewed available literature also.

How does it relate to my work

In the first chapter, the paper gives a brief introduction to stroke and stroke rehabilitation. He has defined Stroke and explained how it occurs. Then, a brief introduction to stroke rehabilitation is given. The term - neuroplasticy  is introduced. The researcher discussed about physiotherapy and occupational therapy which leads neuroplasticy  into success. 

Next, He explains the function of the upper limb. In this section, he describes open chain and closed chain movements and three common types of grip (Power grip, Dynamic grip and Pinch grip). Then he gives an introduction to the rehabilitation of the upper limb.

In the following section, widely used clinical approaches which are common to both  occupational and physiotherapy are explained. Those are:  Carr and Shepherd’s motor optimisation approach, Bobath Approach and Brunnstrom Movement Therapy.

A basic framework for participating in an virtual environment is described. It consists of following sections,

• Vision: abstraction and ‘ecology’
• Prehension: the problem of degrees of freedom
• Sensory feedback and motor control
• Gesture in a virtual environment

Then he outlined skills relearning in a virtual environments. stages of engram, close skills and open skills, the process which skills are acquired also explained. 

The literature review is give inside the third chapter. He has categorized the review in to selected titles. 

• Physiotherapy: Upper limb function (Purdue pegboard test, PHANToM, box and block test, Fugl-Meyer Assessment, manual function test)
• Occupational Therapy: Task- and game - based interventions
• Occupational Therapy: Activities of daily living (ADL) interventions
• Neuropsychology: Way-Finding, Urban environment training, Public transport navigation, Virtual shopping mall, 
• Telerehabilitation

I think that physiotherapy and occupational therapy relate to my research since it directly targets a VR for upper limb function. But in occupational therapy goes far from my research since my aim is not to implement a VR game or related solution.

After reviewing those literature, researches has come up with some parameters which need to be considered. those are,

• Simplicity in system design tends to result in clearer methods and outcomes 
• Outcome measurements of the system must relate to clinical concerns
• The system can only be deemed usable if its acceptability to the therapist and patient has been evaluated
• Clinical disparities in the sample population have an effect in outcome measurements which ought to be included in the analysis
• The technology must interface with clinical practice
• There may a range of unseen factors impact on the recovery process which ought to be considered and precluded
• The consequences of ‘risky’ virtual environments are not well understood

Finally he has shown research areas reviewed in his review using a table as well.