Published in the esteemed International Journal of Medical Informatics, this groundbreaking review article by Ines Ayed, Adel Ghazel, Antoni Jaume-i-Capó, Gabriel Moyà-Alcover, Javier Varona, and Pau Martínez-Bueso, offers a comprehensive and insightful examination of vision-based technologies in motor rehabilitation. In a world increasingly integrating information technologies into healthcare, this paper addresses a critical gap: the often-overlooked reporting and design aspects of clinical trials involving vision-based serious games and virtual reality systems.
Why This Review is Essential:
Vision-based interaction (VBI) systems are rapidly gaining traction in motor rehabilitation due to their affordability, non-invasive nature, and hand-free interaction, which allows patients with physical limitations to engage intuitively through body movements. These systems capture visual information of user actions, providing real-time feedback and offering significant benefits over other systems, including ease of use and reduced calibration needs. While many studies have demonstrated their effectiveness, there’s a growing challenge in interpreting diverse results and standardizing clinical trials. This systematic literature review steps in to provide clarity and guidance.
Key Objectives of the Study:
The primary objective of this systematic literature review (SLR) was to propose a robust research methodology that engineers can utilize to enhance the design and reporting processes of their clinical trials in this field. By synthesizing existing scientific evidence, the authors aim to articulate key themes, identify limitations, explore future directions, and acknowledge influential figures and institutions.
Rigorous Methodology and Key Findings:
The authors conducted a meticulous SLR following Kitchenham guidelines, searching Web of Science and Medline (PubMed) databases. They assessed 86 identified studies using a modified Downs and Black Checklist to ensure quality and relevance. The review uncovered several significant trends and insights:
- Growing Research Interest: The number of studies in this area has steadily increased from 2007 to 2018, with peaks in 2014 and 2015, reflecting the scientific community’s heightened interest [2, 18, Fig. 2].
- Global Leadership: Asia, Europe, and North America lead the research, with Korea and the USA at the forefront [18, Fig. 3].
- Dominant Technologies: Kinect™ emerged as the most widely used technology, featuring in 48 out of 86 studies, alongside EyeToy™ and GestureTek IREX™ [2, 21, Fig. 5]. The advent of Kinect™ significantly boosted research in this domain.
- Primary Target Populations: Stroke and cerebral palsy patients are the main target groups, accounting for 42% and 20% of studies respectively [2, 18, Fig. 4]. There’s also a significant focus on elderly patients, who represent over 50% of participants due to their increased risk of motor impairment.
- Common Rehabilitation Tasks: The majority of studies concentrated on improving balance and postural control, and upper extremity rehabilitation (shoulder, arm, elbow, hand, and wrist movements).
- Measurement Challenges: While around 180 different measurements were used, the joint use of standardized measures was low, making comparisons difficult. Clinical tests like Fugl-Meyer Assessment and Berg Balance Scale were common, along with kinematic parameters and user game performance [22, 23, Fig. 6]. Subjective questionnaires were also employed to gauge user satisfaction and motivation.
A Proposed Research Methodology for Engineers:
Recognizing the lack of standardization and clarity in many clinical trials, a core contribution of this paper is its simple yet comprehensive research methodology tailored for engineers. This methodology, partially inspired by the Downs and Black checklist, guides engineers through critical aspects of designing and reporting interventions:
- Aim of the Study: Clearly define the primary aims and hypotheses, including the assessment of effects on activities (e.g., balance, motor functions), body functions, participation, and feasibility.
- Target Population: Provide detailed information on pathologies (e.g., stroke, cerebral palsy, Parkinson’s disease), demographics, inclusion/exclusion criteria, recruitment numbers, dropout rates, and participants’ history with VBI systems.
- Select the Therapy: Choose an existing therapy suitable for vision-based interaction.
- Outcome Measures: Utilize both quantitative and qualitative assessments (clinical tests, interviews, questionnaires), prioritizing standard, validated measures that evaluate usability, playability, immersion, satisfaction, and engagement.
- Technology: Thoroughly describe the system (platform, interface), game type (commercial or prototype), accessibility, and specific movements/gestures required.
- Study Design: Specify the study type (Uncontrolled Trial, Controlled Trial, Randomized Controlled Trial), and detail randomization, assignment concealment, and blinding procedures, aiming for Randomized Controlled Trials where feasible.
- Vision-based Interaction Features: Outline the type of interaction (natural, intuitive, real-time feedback), interface design (inclusive, friendly), environmental factors (setting, space, lighting), and accessibility (cost, calibration ease). Emphasis is placed on visual and audio feedback, especially mirror feedback, to keep users aware of their actions.
Conclusion and Impact:
This review underscores that while the potential of vision-based serious games and virtual reality in motor rehabilitation is significant, there’s a strong need for improved design and reporting practices in clinical trials. The authors stress the importance of interdisciplinary teams involving engineers, clinicians, ergonomists, and psychologists to tackle development challenges. Recommendations include conducting power analyses, using standardized measurements, and incorporating long-term follow-up studies to ensure the sustained efficacy of these systems. By offering a clear framework and essential insights, this paper serves as an invaluable resource for researchers and practitioners dedicated to advancing motor rehabilitation through innovative technology.
Reference for this article:
Ayed, I., Ghazel, A., Jaume-i-Capó, A., Moyà-Alcover, G., Varona, J., & Martínez-Bueso, P. (2019). Vision-based serious games and virtual reality systems for motor rehabilitation: A review geared toward a research methodology. International Journal of Medical Informatics, 131, 103909. https://doi.org/10.1016/j.ijmedinf.2019.06.016