Quantification and Rehabilitation of Unilateral Spatial Neglect in Immersive Virtual Reality: A Validation Study in Healthy Subjects.

Unilateral spatial neglect is a common sensorimotor disorder following the occurrence of a stroke, for which prismatic adaptation is a promising rehabilitation method. However, the use of prisms for rehabilitation often requires the use of specific equipment that may not be available in clinics. To address this limitation, we developed a new software package that allows for the quantification and rehabilitation of unilateral spatial neglect using immersive virtual reality. In this study, we compared the effects of virtual and real prisms in healthy subjects and evaluated the performance of our virtual reality tool (HTC Vive) against a validated motion capture tool. Ten healthy subjects were randomly exposed to virtual and real prisms, and measurements were taken before and after exposure. Our findings indicate that virtual prisms are at least as effective as real prisms in inducing aftereffects (4.39° ± 2.91° with the virtual prisms compared to 4.30° ± 3.49° with the real prisms), but that these effects were not sustained beyond 2 h regardless of exposure modality. The virtual measurements obtained with our software showed excellent metrological qualities (ICC = 0.95, error = 0.52° ± 1.18°), demonstrating its validity and reliability for quantifying deviation during pointing movements. Overall, our results suggest that our virtual reality software (Virtualis, Montpellier, France) could provide an easy and reliable means of quantifying and rehabilitating spatial neglect. Further validation of these results is required in individuals with unilateral spatial neglect.

Validity and Reliability of Kinect v2 for Quantifying Upper Body Kinematics during Seated Reaching.

Kinematic analysis of the upper limbs is a good way to assess and monitor recovery in individuals with stroke, but it remains little used in clinical routine due to its low feasibility. The aim of this study is to assess the validity and reliability of the Kinect v2 for the analysis of upper limb reaching kinematics. Twenty-six healthy participants performed seated hand-reaching tasks while holding a dumbbell to induce behaviour similar to that of stroke survivors. With the Kinect v2 and with the VICON, 3D upper limb and trunk motions were simultaneously recorded. The Kinect assesses trunk compensations, hand range of motion, movement time and mean velocity with a moderate to excellent reliability. In contrast, elbow and shoulder range of motion, time to peak velocity and path length ratio have a poor to moderate reliability. Finally, instantaneous hand and elbow tracking are not precise enough to reliably assess the number of velocity peaks and the peak hand velocity. Thanks to its ease of use and markerless properties, the Kinect can be used in clinical routine for semi-automated quantitative diagnostics guiding individualised rehabilitation of the upper limb. However, engineers and therapists must bear in mind the tracking limitations of the Kinect.

What Makes Parkour Unique? A Narrative Review Across Miscellaneous Academic Fields.

Parkour is a growing sport that mostly involves jumping, vaulting over obstacles, and climbing in a non-dedicated setting. The authors gathered all known relevant literature across miscellaneous academic fields in order to define parkour with regard to other sports disciplines. Parkour is a lifestyle sport, and as such provides an alternative to mainstream sports, away from strict rules, standardized settings, and necessary competitions. Traceurs (parkour adepts) consider the city as a playground and as an outlet for their creativity, but they also have a strong taste for hard and individualized challenges. They usually train on non-specific structures, at ground level. Although their social background is not clear, they are mostly young and male. Traceurs are stronger than recreational athletes, especially in eccentric exercises. However, their endurance skills may be below average. One of the core specificities of parkour is its precision constraint at landing, which turns a standing long jump into a precision jump, regulated in flight so as to prepare for landing. The running precision jump follows the same landing pattern, and its flight phase contrasts with long jump techniques. Injuries, which are not more frequent than in other sports, often occur at landing and to lower limb extremities. This risk is mitigated by targeting the landing area with the forefoot instead of letting the heel hit the ground like in gymnastics, or with rolling in order to dissipate the impact. Overall, parkour focuses on adaptability to new environments, which leads to specific techniques that have not yet been extensively addressed by the literature.

The reserve of joint torque determines movement coordination.

Humans coordinate biomechanical degrees of freedom to perform tasks at minimum cost. When reaching a target from a seated position, the trunk-arm-forearm coordination moves the hand to the well-defined spatial goal, while typically minimising hand jerk and trunk motion. However, due to fatigue or stroke, people visibly move the trunk more, and it is unclear what cost can account for this. Here we show that people recruit their trunk when the torque at the shoulder is too close to the maximum. We asked 26 healthy participants to reach a target while seated and we found that the trunk contribution to hand displacement increases from 11 to 27% when an additional load is handled. By flexing and rotating the trunk, participants spontaneously increase the reserve of anti-gravitational torque at the shoulder from 25 to 40% of maximal voluntary torque. Our findings provide hints on how to include the reserve of torque in the cost function of optimal control models of human coordination in healthy fatigued persons or in stroke victims.

Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomized controlled trial.

BACKGROUND: After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. METHODS: The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1 × 30 min session/day) and conventional therapy (3 × 30 min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2 mA, 20 min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2 mA, 30 s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block Test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index). Other/exploratory outcomes will include pain, fatigue, effort and performance, kinematics, and motor cortical region activation during functional motor tasks. DISCUSSION: This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesize that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham. TRIAL REGISTRATION: The ReArm project was approved by The French Research Ethics Committee, (Comité de Protection des Personnes-CPP SUD-EST II, N°ID-RCB: 2019-A00506-51, http://www.cppsudest2.fr/ ). The ReArm project was registered on ClinicalTrials.gov ( NCT04291573 , 2nd March 2020.