We would like to thank the editors of Disability and Rehabilitation for the opportunity to publish a set of articles presented at the 10th International Conference on Virtual Rehabilitation, which was held in Valencia, Spain, in June 2015. The field of virtual rehabilitation is expanding as it matures and the breadth of articles in this special issue reflects this trend nicely. This expansion is characterized by: (1) increased use of virtual environments as a treatment modality; (2) the incorporation of VR technologies into treatment and assessment plans across the entire continuum of rehabilitation; (3) the adoption of lower cost, off-the-shelf systems and equipment; and (4) the use of VR to address a wider variety of diagnoses.
Three of the articles in this special issue present approaches to rehabilitation that address the needs of persons with more severe impairments (i.e. no or minimal finger movement) than those usually addressed in the published virtual rehabilitation literature. All three utilize interventions to increase the cortical excitability of the damaged motor cortex. The article by Hoermann et al. utilizes a mirror activity presenting a virtual image of the impaired hand controlled by the unimpaired hand as it assumes a series of hand gestures. The system described by Patel et al. combines a virtual mirror set-up similar to Hoermann’s with passive movement facilitated by a robotic exoskeleton to further augment cortical excitability. The third article by Fluet et al. utilizes a similar combination of mirror and passive motor priming technique along with graded tasks designed to allow a subject with minimal finger movement to perform a series of simulated tasks. These interventions attempt to address the needs of this group of patients that have shown to be recalcitrant to traditionally and virtually presented rehabilitation.
Three articles address home-based rehabilitation. The article by Kizony et al. addresses logistical efficiency on a broad scale, presenting retrospective data related to a tele-rehabilitation service using a system that allows for synchronous and asynchronous monitoring patients’ rehabilitation activities. The article by Rand et al. demonstrates the feasibility of using off-the-shelf gaming consoles as compared to a traditional program, for home-based self-training to improve the function of the upper extremity in people with stroke. The third paper, by Archambault et al. presents the usability testing of a home-based, simulated power wheel chair mobility skills program.
A large majority of the early work in virtual rehabilitation studied interventions for persons with stroke. The article by Peruzzi et al. present VR-based intervention in a less frequently studied diagnosis. They evaluate the effect of the combination of walking on a treadmill while interacting within virtual environments on gait, in people with Multiple Sclerosis. Articles by Kizony et al. and Wright et al. also present examinations of virtually simulated rehabilitation applications for diagnoses other than stroke.
A frequently cited issue related to the slow adoption of virtual rehabilitation interventions has been the cost of the interfaces needed for users to interact with virtual environments. Consumer electronics represent an important opportunity to lower the cost of virtual rehabilitation systems. Three papers in this issue describe the design and testing of simulations that utilize consumer entertainment electronics as platforms for rehabilitation testing and treatment. Rand et al. present an intervention utilizing off-the-shelf systems (e.g. Microsoft Xbox Kinect) for persons with stroke, while Wright et al. presented the design and validity of a test using a Wii-based system to aid in the diagnosis of concussion.
Looking at the articles in this special issue as a whole, should lead one to the conclusion that much has been accomplished in this field. This said, we feel that this perspective also provides an indication of several issues that need to be addressed. The effective use of simulated activities by subjects without direct, synchronous supervision of rehabilitation professionals is a trend with potentially broad impact on the role of simulated activities in health care delivery. This could also be implemented in conjunction with sub-acute rehabilitation to enhance self-training time of people with neurological deficits. Moreover, the combination of evidence that simulated activities can be used in lower supervision settings along with the adoption of lower cost interfaces will increase the impact of simulated rehabilitation activities dramatically. Another important issue is conducting studies with larger samples as well as using similar outcome measures to enable meta-analysis in this domain.
The papers included in this special issue show a variety of studies and approaches. However, they focus mainly on the physical aspects of rehabilitation. Typically, patients present with constellations of motor, cognitive, perceptual, behavioral and social impairments, especially when expanding the type of diagnosis that can benefit from VR-based intervention (e.g. people with Multiple Sclerosis, Concussions). As the fidelity and precision of sensory presentations afforded by VR technology expands, collaboration with disciplines such as Neuropsychology, Speech Language Pathology, Social Work, etc., on flexible systems that could provide multi-dimensional assessment and interventions addressing complex issues should arise as well.
Again, we are delighted to have had the opportunity to share this exciting body of work and to highlight the accomplishments and opportunities it presents. We also look forward to following these lines of inquiry in the pages of publications like Disability and Rehabilitation and at scientific meetings like the International Conference on Virtual Rehabilitation to be held in Montreal in 2017.
Disclosure statement
The authors report no declarations of interest.