A computer-generated scenario (a virtual world), engaging the mirror-neuron

A
second mechanism underlying recovery of function is physiological
reorganization of the brain and spinal cord motor networks.  Although spontaneous regeneration of lesioned
fibres is limited in the adult CNS, rehabilitative therapies can promote
plasticity both rostral and caudal to injury in the spinal cord by activating
the nervous system and influencing multiple substrates20.

Recovery
of function by both spontaneous and secondary to intense rehabilitative
treatments is sustained by plasticity and rewiring in the injured brain in
adults. Neurons in the brain increase their firing rates when a subject
observes movements performed by other persons. Activation of this mirror-neuron
system, including areas of the frontal, parietal and temporal lobes, can induce
cortical reorganization and contributes to functional recovery. Virtual-Reality
based Neurorehabilitation are novel and potentially useful technologies that
allow users to interact in three dimensions with a computer-generated scenario
(a virtual world), engaging the mirror-neuron system21.

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In
the subacute stages, intervention for the upper limb targets relearning of
motor abilities using intensive task-specific training22. Skills
learning after SCI draws upon spared neural networks for motor, sensory,
perception, planning, memory motivation, reward, language and higher
level-cognitive functions as well as progressive practice of subtasks in
everyday activities using physical and cognitive cues with feedback about
performance and results to increase participation23,24. Patients
must have some access to voluntary movement for motor intervention to work23.

Recent
advancement in the computer-game technology provides innovative ways of
encouraging patients to engage in intensive task-specific training19.
Virtual reality (VR) is a computer-based, interactive, multisensory simulation
environment that occurs in real time. It presents users with opportunities to
engage that appear similar to real world objects and events. These environments
are three dimensional and are of two types- immersive and non-immersive22,
24.  Immersive VR system
involves the whole body in the synthetic world by means of devices such as
head-mounted display (HMD)22,24,25, or large screen projector (LSP),
or cave (BNAVE) systems, where the environment is projected on a concave
surface to create a sense of immersion. They also use environments such as
video capture systems (e.g., IREX), where the users view themselves as an
avatar in the scene on a computer or television screen.  Non-immersive VR system users interact to
different degrees with the environment displayed on a computer screen, with or
without interface devices such as a computer mouse or haptic devices such as
cyber gloves/ cyber grasps, joysticks or force sensors22,24. Non-immersive
systems engage only a single limb or sensory modality. They create less sense
of “presence”25.

The
cornerstones of VR technologies are “interactivity” and “immersion”26.
Interactivity is defined as the
extent to which users can participate in modifying the form and content of a
mediated environment in real time. The three factors that contribute to
interactivity are: speed, which
refers to the rate at which input can be assimilated into the mediated
environment; range, which refers to
the number of possibilities for action at any given time; and mapping, refers to the way in which
human actions are connected to actions within a mediated environment27.
Immersion refers to that the user has
a strong “sense of presence”, which
is the illusion of going into the computer-generated world and depends on the
convergence of multisensory input (vision, auditory, and tactile) in the
virtual environment22. This environment can be either temporally or
spatially distant “real” environment such as a distant space viewed through a
video camera or an animated “world” created in a video game27.

Virtual
reality, whether immersive or non-immersive, has the potential to create
stimulating and fun environments and develop a range of skills and task-based
techniques to sustain participant interest and motivation. This results in
better movement outcomes for rehabilitation purposes, demonstrating a greater
range of functional improvements, including both active and passive upper limb
joint range of motion, and a transfer of therapy gains into activities of daily
living25.

Advantages of VR
Rehabilitation

1.     VR
provides a realistic28, non-threatening and positive learning
experience which can be tailored to the individual’s level of ability22,28.

2.     It
is both fun and motivating by providing feedback in the form of visual and
auditory information22,28. Haptic feedback devices include gloves
and joysticks that simulate the feel of forces, surfaces and textures as users
interact with virtual objects. Feedback can either be absolute (correct/
incorrect) or graded information (error score, deviation from optimum)28.

It allows for
interactive observation of avatar movements captured on the screen and combine
features of increasing rehabilitation intensity for induction of
neuroplasticity21, 28.A
second mechanism underlying recovery of function is physiological
reorganization of the brain and spinal cord motor networks.  Although spontaneous regeneration of lesioned
fibres is limited in the adult CNS, rehabilitative therapies can promote
plasticity both rostral and caudal to injury in the spinal cord by activating
the nervous system and influencing multiple substrates20.Recovery
of function by both spontaneous and secondary to intense rehabilitative
treatments is sustained by plasticity and rewiring in the injured brain in
adults. Neurons in the brain increase their firing rates when a subject
observes movements performed by other persons. Activation of this mirror-neuron
system, including areas of the frontal, parietal and temporal lobes, can induce
cortical reorganization and contributes to functional recovery. Virtual-Reality
based Neurorehabilitation are novel and potentially useful technologies that
allow users to interact in three dimensions with a computer-generated scenario
(a virtual world), engaging the mirror-neuron system21.

In
the subacute stages, intervention for the upper limb targets relearning of
motor abilities using intensive task-specific training22. Skills
learning after SCI draws upon spared neural networks for motor, sensory,
perception, planning, memory motivation, reward, language and higher
level-cognitive functions as well as progressive practice of subtasks in
everyday activities using physical and cognitive cues with feedback about
performance and results to increase participation23,24. Patients
must have some access to voluntary movement for motor intervention to work23.

Recent
advancement in the computer-game technology provides innovative ways of
encouraging patients to engage in intensive task-specific training19.
Virtual reality (VR) is a computer-based, interactive, multisensory simulation
environment that occurs in real time. It presents users with opportunities to
engage that appear similar to real world objects and events. These environments
are three dimensional and are of two types- immersive and non-immersive22,
24.  Immersive VR system
involves the whole body in the synthetic world by means of devices such as
head-mounted display (HMD)22,24,25, or large screen projector (LSP),
or cave (BNAVE) systems, where the environment is projected on a concave
surface to create a sense of immersion. They also use environments such as
video capture systems (e.g., IREX), where the users view themselves as an
avatar in the scene on a computer or television screen.  Non-immersive VR system users interact to
different degrees with the environment displayed on a computer screen, with or
without interface devices such as a computer mouse or haptic devices such as
cyber gloves/ cyber grasps, joysticks or force sensors22,24. Non-immersive
systems engage only a single limb or sensory modality. They create less sense
of “presence”25.

The
cornerstones of VR technologies are “interactivity” and “immersion”26.
Interactivity is defined as the
extent to which users can participate in modifying the form and content of a
mediated environment in real time. The three factors that contribute to
interactivity are: speed, which
refers to the rate at which input can be assimilated into the mediated
environment; range, which refers to
the number of possibilities for action at any given time; and mapping, refers to the way in which
human actions are connected to actions within a mediated environment27.
Immersion refers to that the user has
a strong “sense of presence”, which
is the illusion of going into the computer-generated world and depends on the
convergence of multisensory input (vision, auditory, and tactile) in the
virtual environment22. This environment can be either temporally or
spatially distant “real” environment such as a distant space viewed through a
video camera or an animated “world” created in a video game27.

Virtual
reality, whether immersive or non-immersive, has the potential to create
stimulating and fun environments and develop a range of skills and task-based
techniques to sustain participant interest and motivation. This results in
better movement outcomes for rehabilitation purposes, demonstrating a greater
range of functional improvements, including both active and passive upper limb
joint range of motion, and a transfer of therapy gains into activities of daily
living25.

Advantages of VR
Rehabilitation

1.     VR
provides a realistic28, non-threatening and positive learning
experience which can be tailored to the individual’s level of ability22,28.

2.     It
is both fun and motivating by providing feedback in the form of visual and
auditory information22,28. Haptic feedback devices include gloves
and joysticks that simulate the feel of forces, surfaces and textures as users
interact with virtual objects. Feedback can either be absolute (correct/
incorrect) or graded information (error score, deviation from optimum)28.

It allows for
interactive observation of avatar movements captured on the screen and combine
features of increasing rehabilitation intensity for induction of
neuroplasticity21, 28.