On October 28, 2020, the International Society of Virtual Rehabilitation presented its first online symposium. The symposium consisted of three 30 minute presentations on topics of current interest to the virtual rehabilitation community. In one of the presentations, Mindy Levin from McGill University and Judy Deutsch from Rutgers University made a presentation entitled “From video games to interactive software applications – cutting through the virtual reality terminology”. The presentation described the evolution and definitions of virtual reality, videogames and exergames for rehabilitation with the ultimate goal of embarking on the road of consensus on the use of this terminology in the field and provided definitions summarized in the boxes below. Building consensus in terms of definitions and terminology is important to facilitate communication within the interdisciplinary field of virtual rehabilitation. After a brief historical perspective of the development of virtual rehabilitation and exergames was illustrated, Dr. Levin discussed the concepts of immersion and presence and how they are applied in VR while Dr. Deutsch shared a brief history of video games and exergames and how their terminology is intertwined with virtual reality. The terms defined in Dr. Deutsch’s section included video games, commercial off-the-shelf video game (COTS), interactive video game, serious games, serious digital health games and active games and exergames. In the discussion that ensured, it was agreed that further efforts are needed to reach consensus in the terminology used in virtual rehabilitation and exergame applications.

 

Virtual rehabilitation for coping with pandemic: success stories and clinical implications

Marika Demers, University of Southern California, USA
Roberto Llorens, Universitat Politecnica de Valencia, Spain

In their talk, Marika Demers and Roberto Llorens described their experiences with telerehabilitation during the past months as a response to the global pandemic. The past months taught us that people around the world could develop creative solutions to adapt to the COVID-19 pandemic. Their presentation focused on how virtual rehabilitation could be one creative and evidence-based solution to deliver rehabilitation interventions and drive a positive impact for people with disabilities. Specifically, they described the unique benefits of virtual rehabilitation offered synchronously or asynchronously with telerehabilitation to implement home-delivered rehabilitative interventions. We also presented two success stories for coping with the pandemic: 1) Virtual-reality based telerehabilitation initiative to improve balance recovery after stroke and 2) Remote assessment of posture and gait characteristics. The results suggest that a virtual rehabilitation with telerehabilitation is well-accepted by stroke survivors and was not inferior to in-person treatment to address balance impairments. Open-source assessment tools using commercial gaming accessories also show promise for remote assessment of posture and gait in stroke survivors. The presentation concluded with resources to support clinicians, as they play a crucial role in the selection of appropriate platform and games to meet individual rehabilitation needs.

 

Human-avatar interactions in virtual environments: opportunities and challenges for locomotor assessment and training

Anouk Lamontagne and Sean D. Lynch

McGill University, Montreal, Canad and Jewish Rehabilitation Hospital Research Site – CISSS de Laval, Laval, Canada Virtual reality is an increasingly validated approach for the study of human interactions in controlled but ecological environments, and for the clinical assessment and training of locomotor disorders for those that would otherwise be at risk in a real-world setting. The presentation focussed on two types of interaction, namely the interactions with avatars and those with virtual pedestrians. Avatars are a representation of one’s self, which can be presented to a participant in real-time that in turn allows for feedback of one’s own performance. Potential challenges of self-representation training can include the different viewing perspectives of an avatar and the contribution of different sensory modalities. Initial findings collected in stoke survivors with post-stroke gait asymmetry suggest that certain participant profiles benefit from a visual avatar presented in the side view to enhance their symmetry of gait. In addition, most participants appear to experience further benefit in gait symmetry when exposed to multimodal sensory feedback (avatars presented in the combined visual and auditory modality) compared to avatars presented in the auditory or visual modality in isolation. With this knowledge pertaining to the quality of feedback and its benefits, future directions can consider the potential benefits of repeated exposure. The second type of interaction concerns virtual humans that represent other pedestrians from a typical community setting. Current work has shown how behaviours of navigation are preserved within virtual reality and lead to similar adaptations to those observed in the physical world. Such validation has presented new horizons to investigate more complex community settings that include the avoidance of collisions with pedestrians, the effects of additional cognitive tasks, and the role of agent-specific gait characteristics during collision avoidance tasks. We reflect on the potential opportunities and challenges from the addition of integrated eye-tracking technology with virtual reality headsets to how virtual pedestrian can aid locomotor assessment and training for populations with gait disorders.