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      Virtual Reality–Based Executive Function Rehabilitation System for Children With Traumatic Brain Injury: Design and Usability Study

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          Abstract

          Background

          Traumatic brain injury (TBI) poses a significant threat to children’s health. Cognitive rehabilitation for pediatric TBI has the potential to improve the quality of life following the injury. Virtual reality (VR) can provide enriched cognitive training in a life-like but safe environment. However, existing VR applications for pediatric TBIs have primarily focused on physical rehabilitation.

          Objective

          This study aims to design and develop an integrative hardware and software VR system to provide rehabilitation of executive functions (EF) for children with TBI, particularly in 3 core EF: inhibitory control, working memory, and cognitive flexibility.

          Methods

          The VR training system was developed by an interdisciplinary team with expertise in best practices of VR design, developmental psychology, and pediatric TBI rehabilitation. Pilot usability testing of this novel system was conducted among 10 healthy children and 4 children with TBIs.

          Results

          Our VR-based interactive cognitive training system was developed to provide assistive training on core EF following pediatric TBI. Pilot usability testing showed adequate user satisfaction ratings for both the hardware and software components of the VR system.

          Conclusions

          This project designed and tested a novel VR-based system for executive function rehabilitation that is specifically adapted to children following TBI.

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          Most cited references33

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          The Sense of Embodiment in Virtual Reality

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            The influence of irrelevant location information on performance: A review of the Simon and spatial Stroop effects.

            The purpose of this paper is to investigate the effect of irrelevant location information on performance of visual choice-reaction tasks. We review empirical findings and theoretical explanations from two domains, those of the Simon effect and the spatial Stroop effect, in which stimulus location has been shown to affect reaction time when irrelevant to the task. We then integrate the findings and explanations from the two domains to clarify how and why stimulus location influences performance even when it is uninformative to the correct response. Factors that influence the processing of irrelevant location information include response modality, relative timing with respect to the relevant information, spatial coding, and allocation of attention. The most promising accounts are offered by models in which response selection is a function of (1) strength of association of the irrelevant stimulus information with the response and (2) temporal overlap of the resulting response activation with that produced by the relevant stimulus information.
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              Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system.

              Given the incidence of stroke, the need has arisen to consider more self-managed rehabilitation approaches. A promising technology is Virtual Reality (VR). Thus far, however, it is not clear what the benefits of VR systems are when compared to conventional methods. Here we investigated the clinical impact of one such system, the Rehabilitation Gaming System (RGS), on the recovery time course of acute stroke. RGS combines concepts of action execution and observation with an automatic individualization of training. METHODS. Acute stroke patients (n = 8) used the RGS during 12 weeks in addition to conventional therapy. A control group (n = 8) performed a time matched alternative treatment, which consisted of intense occupational therapy or non-specific interactive games. RESULTS. At the end of the treatment, between-group comparisons showed that the RGS group displayed significantly improved performance in paretic arm speed that was matched by better performance in the arm subpart of the Fugl-Meyer Assessment Test and the Chedoke Arm and Hand Activity Inventory. In addition, the RGS group presented a significantly faster improvement over time for all the clinical scales during the treatment period. CONCLUSIONS. Our results suggest that rehabilitation with the RGS facilitates the functional recovery of the upper extremities and that this system is therefore a promising tool for stroke neurorehabilitation.
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                Author and article information

                Contributors
                Journal
                JMIR Serious Games
                JMIR Serious Games
                JSG
                JMIR Serious Games
                JMIR Publications (Toronto, Canada )
                2291-9279
                Jul-Sep 2020
                25 August 2020
                : 8
                : 3
                : e16947
                Affiliations
                [1 ] Center for Biobehavioral Health Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus, OH United States
                [2 ] Center for Injury Research and Policy Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus, OH United States
                [3 ] Research Information Solutions and Innovation Abigail Wexner Research Institute at Nationwide Children's Hospital Columbus, OH United States
                [4 ] Department of Speech & Hearing Science The Ohio State University Columbus, OH United States
                [5 ] Inpatient Rehabilitation Program Nationwide Children's Hospital Columbus, OH United States
                [6 ] Trauma Program Nationwide Children's Hospital Columbus, OH United States
                Author notes
                Corresponding Author: En-Ju Deborah Lin deborah.lin@ 123456nationwidechildrens.org
                Author information
                https://orcid.org/0000-0001-6625-5215
                https://orcid.org/0000-0001-8112-319X
                https://orcid.org/0000-0002-6404-8770
                https://orcid.org/0000-0003-0910-460X
                https://orcid.org/0000-0002-7832-9127
                https://orcid.org/0000-0001-8686-1933
                https://orcid.org/0000-0002-6850-1667
                https://orcid.org/0000-0002-9113-7875
                https://orcid.org/0000-0002-1334-8415
                https://orcid.org/0000-0001-5964-5901
                https://orcid.org/0000-0002-0998-593X
                https://orcid.org/0000-0003-3265-9902
                https://orcid.org/0000-0003-4365-8227
                Article
                v8i3e16947
                10.2196/16947
                7479584
                32447275
                5ed24696-809c-489c-be94-b0d47165547b
                ©Jiabin Shen, Henry Xiang, John Luna, Alice Grishchenko, Jeremy Patterson, Robert V Strouse, Maxwell Roland, Jennifer P Lundine, Christine H Koterba, Kimberly Lever, Jonathan I Groner, Yungui Huang, En-Ju Deborah Lin. Originally published in JMIR Serious Games (http://games.jmir.org), 25.08.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included.

                History
                : 6 November 2019
                : 16 December 2019
                : 14 April 2020
                : 24 April 2020
                Categories
                Original Paper
                Original Paper

                traumatic brain injury,virtual reality,neurological rehabilitation,executive function,cognitive rehabilitation

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