Neuroforma - virtual reality games for rehabilitation

What is Neuroforma?

Neuroforma - virtual reality games for rehabilitation

Neuroforma is a modern system that provides support for physical and cognitive rehabilitation as well as balance exercises. It is being designed by specialists in neurorehabilitation and neuropsychology, in cooperation with leading Polish rehabilitation and research centres. Neuroforma allows for conducting virtual reality rehabilitation.

The Neuroforma program is mainly designed for patients with neurological conditions and traumas. A variety of exercises and the possibility to adjust their parameters to the needs of each user make Neuroforma an option also for other groups of patients.

When using Neuroforma, patients are standing or sitting in front of the screen. It displays their mirrored reflection, around which virtual objects appear. The task of the patients is to steer their reflection so as to catch, move or hit the objects that appear. This is how virtual reality games for rehabilitation work.

The patient receives immediate feedback on the correctness and the performance level for each exercise (biofeedback). Neuroforma allows for conducting virtual reality rehabilitation with biofeedback. Moreover, the tasks are devised to be interactive and captivating, which motivates the patient to disciplined work.

Who is Neuroforma for?

Neuroforma is available in three versions: for patients, for therapists and for rehabilitation centres.

Neuroforma version for patients and therapists provides virtual reality games for rehabilitation available on-line that may be used on most personal computers. Thanks to modern technology, just a simple webcam is enough to use the program. The choice of the exercise is up to the user.

In the version for therapists, patients use a ready set adjusted to their needs and capabilities by the therapist. Therapists can use Neuroforma in their office, take it to visits their patients or prescribe exercises to the patient for them to work individually using “Neuroforma for patients”.

Neurofoma version for rehabilitation centres is also a convenient mobile station, which makes virtual reality rehabilitation even more comfortable. It consists of a large display, a computer system and an optical 3D system equipped with the Kinect for virtual reality rehabilitation camera.

It is adapted to be used in a crowded therapy room, it allows precise measurements and it offers the option to use many additional training modules, including a mirror therapy module.

The basic station is complemented with a new module of exercises to control balance, including a force platform, a safety rail and a new set of exercises.

Neuroforma for rehabilitation centres can also be extended with a telerehabilitation module so that it has a functionality of a telerehabilitation platform.

What does Neuroforma offer?

  • Large exercise database​

Program users have access to over 25 training modules. Most exercises have 15 difficulty levels, and between 4 and 10 options of adapting the course of the exercise to the motion range of the patient. This totals up to 150 combinations per training module.

The exercises involve both motor and cognitive functions. When training with Neuroforma, patients improve i.e. their precision of motion, hand and eye coordination, joint mobility, muscle strength and endurance, as well as the processes of perception, decision making, attention and memory. All exercises are devised to be attractive, thus motivating to work regularly with the program.

  • Creating training sessions​

Neuroforma gives you the option to arrange the available training modules into individual training sessions. Exercise within each session are activated one after another, in the pre-selected order. This feature enables the patients using home version independently arrange for themselves a variety of training sessions for any day, while specialists using the version for therapists can prepare a unique session for each of their patients.

  • Feedback and progress tracking​

Patients who train with Neuroforma receive immediate feedback on the correctness of performing the exercise - it is a modern virtual reality rehabilitation with biofeedback. The program records in detail the patient's progress, thus providing grounds for an analysis of the steadiness of work with Neuroforma and its results. Even a little progress will be visible in the results achieved in Neuroforma.

  • Innovative mirror therapy

Neuroforma for rehabilitation centres, equipped with a 3D camera (Kinect virtual reality rehabilitation), offers the option of using an optional mirror therapy module. Application of modern 3D technology allowed to replace the traditional mirror with a camera and a monitor. Hemiplegic patients who use the module sees themselves as performing fully symmetrical movements with both limbs. The mirror therapy module in Neuroforma gives patients a freedom of movement that would be out of their reach in the traditional approach, while they are under a strong impression of the reality of what they see.

  • Rehabilitation of balance using the force platform​

The newest training module for balance control supplements the basic station with a new set of exercises and a force platform with a safety rail. Just like the other tasks in Neuroforma, exercises performed on the balance rehabilitation platform combine improving motor and cognitive functions.

  • Telerehabilitation module

Version of Neuroforma for therapists and rehabilitation centres allows for introducing telemedicine procedures thanks to the functionalities offered by the telerehabilitation platform. Specialists using Neuroforma can set up training sessions and track the progress of patients who use the home version of the program.

Why use Neuroforma?

The value and reliability of Neuroforma have been recognised by the leading Polish scientific institutions who contributed to the program development (details in Scientific Research tab).

Attractive design and the diversity of tasks in Neuroforma increase the motivation to exercise. Progress can be better monitored as the data from training sessions are recorded and analysed by the system. This allows the exercises to be precisely adjusted to patient's needs, which translates into an increase in the efficiency of the rehabilitation process.

Scenarios offered by Neuroforma include both motion and cognitive tasks which are often performed simultaneously. This makes Neuroforma a unique solution. The motor-cognitive training implements the so-called dual-task paradigm.

The functionalities of the telerehabilitation platform allow the specialists who use Neuroforma for continued patient care, which significantly increases the range of the therapeutic benefits offered.

Why is computer cognitive-motor training effective?

Beneficial impact of physical activity​

Scientific studies confirm the effectiveness of motion rehabilitation and physical activity in the treatment of patients with neurological diseases and conditions developed following a brain injury. For example, systematic analyses of the results of many studies involving patients with multiple sclerosis show the positive effects of exercise, such as reduced fatigue1, improved balance2 and walking3, increased muscle strength and mobility4, better life quality5. In addition, analyses of studies involving post-stroke patients show the beneficial impact of exercise, e.g. on walking6 and function of the lower limbs7, increased strength and level of activity8, coping with everyday chores9, overall fitness and endurance10 as well as quality of life11.

Effectiveness of virtual reality in motor training​

Scientific reports support the idea of ​​the use of virtual reality in the motor training of the elderly and patients with neurological disorders and brain injuries. Rehabilitation can successfully involve programs based on virtual reality, e.g. improving the function of the upper limbs in post-stroke patients12, 13, improving walking and balance14, 15 and posture control16, 17 in those with multiple sclerosis, or improving walking in people with the Huntington’s disease18. They are getting thumbs up both from the patients19 and therapists20.

Beneficial impact of cognitive exercises​

As the studies clearly show, both younger and older people can benefit from cognitive training. Cognitive functions, which can be effectively improved even in old age include memory21, attention22, information processing speed23 and executive functions24.

Effectiveness of computer-based cognitive exercises​

A variety of scientific publications confirm the effectiveness of computer systems for training cognitive functions. Positive results of computer training have been observed in patients from various clinical groups, including patients with multiple sclerosis25, 26, after a stroke27, 28 and with brain injuries29, 30. Computer tasks for training mental capabilities are given a warm welcome by patients who see them as attractive and motivating31.

Combined benefits of motor and cognitive training​

Patients who use Neuroforma have the opportunity to perform tasks to improve their cognitive functions, while simultaneously increasing their physical fitness. Thanks to using mental tasks together with modern technology of motion control, Neuroforma exercises combine the benefits of the both types of training for the patient. Ever new studies are available that show combined cognitive-and-motor training brings results that are even better than motor training or physical activity separately32, 33, 34.

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1 Andreasen, A. K., Stenager, E., Dalgas, U. (2011). The effect of exercise therapy on fatigue in multiple sclerosis. Multiple Sclerosis Journal, 17(9), 1041-1054 (full text).

2 Paltamaa, J., Sjögren, T., Peurala, S. H., Heinonen, A. (2012). Effects of physiotherapy interventions on balance in multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials. Journal of rehabilitation medicine, 44(10), 811-823 (abstract).

3 Gallien, P., Nicolas, B., Robineau, S., Pétrilli, S., Houedakor, J., Durufle, A. (2007, July). Physical training and multiple sclerosis. In Annales de réadaptation et de médecine physique (Vol. 50, No. 6, pp. 373-376). Elsevier Masson (full text).

4 Rietberg, M. B., Brooks, D., Uitdehaag, B. M., Kwakkel, G. (2004). Exercise therapy for multiple sclerosis. The Cochrane Library (full text).

5 Motl, R. W., Pilutti, L. A. (2012). The benefits of exercise training in multiple sclerosis. Nature Reviews Neurology, 8(9), 487-497 (full text).

6 van de Port, I. G., Wood-Dauphinee, S., Lindeman, E., Kwakkel, G. (2007). Effects of exercise training programs on walking competency after stroke: a systematic review. American Journal of Physical Medicine & Rehabilitation,86(11), 935-951 (full text).

7 French, B., Thomas, L., Leathley, M., Sutton, C., McAdam, J., Forster, A., ... Watkins, C. (2010). Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis. Journal of rehabilitation medicine, 42(1), 9-15 (full text)

8 Ada, L., Dorsch, S., Canning, C. G. (2006). Strengthening interventions increase strength and improve activity after stroke: a systematic review.Australian Journal of Physiotherapy, 52(4), 241-248 (full text).

9 Kwakkel, G., van Peppen, R., Wagenaar, R. C., Dauphinee, S. W., Richards, C., Ashburn, A., ... Langhorne, P. (2004). Effects of augmented exercise therapy time after stroke a meta-analysis. Stroke, 35(11), 2529-2539 (full text).

10 Pang, M. Y., Eng, J. J., Dawson, A. S., Gylfadóttir, S. (2006). The use of aerobic exercise training in improving aerobic capacity in individuals with stroke: a meta-analysis. Clinical Rehabilitation, 20(2), 97-111 (full text).

11 Chen, M. D., Rimmer, J. H. (2011). Effects of Exercise on Quality of Life in Stroke Survivors A Meta-Analysis. Stroke, 42(3), 832-837 (full text).

12 Yavuzer, G., Senel, A., Atay, M. B., Stam, H. J. (2008). ''Playstation eyetoy games''improve upper extremity-related motor functioning in subacute stroke: a randomized controlled clinical trial. European journal of physical and rehabilitation medicine, 44(3), 237-244 (abstract).

13 Mouawad, M. R., Doust, C. G., Max, M. D., McNulty, P. A. (2011). Wii-based movement therapy to promote improved upper extremity function post-stroke: a pilot study. Journal of Rehabilitation Medicine, 43(6), 527-533 (abstract).

14 Fulk, G. D. (2005). Locomotor Training and Virtual Reality‐based Balance Training for an Individual with Multiple Sclerosis: A Case Report. Journal of Neurologic Physical Therapy, 29(1), 34-42 (abstract).

15 Kramer, A., Dettmers, C., Gruber, M. (2014). Exergaming with additional postural demands improves balance and gait in patients with multiple sclerosis as much as conventional balance training and leads to high adherence to home-based balance training. Archives of physical medicine and rehabilitation,95(10), 1803-1809 (full text

16 Gutiérrez, R. O., Galán, D. R. F., Cano, D. L. C. R., Alguacil, D. I., Gonzàlez, R. A., Page, J. C. (2012). A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients. NeuroRehabilitation, 33(4), 545-554 (abstract).

17 Ortiz-Gutiérrez, R., Cano-de-la-Cuerda, R., Galán-del-Río, F., Alguacil-Diego, I. M., Palacios-Ceña, D., Miangolarra-Page, J. C. (2013). A telerehabilitation program improves postural control in multiple sclerosis patients: a Spanish preliminary study. International journal of environmental research and public health, 10(11), 5697-5710 (full text).

18 Kloos, A. D., Fritz, N. E., Kostyk, S. K., Young, G. S., & Kegelmeyer, D. A. (2013). Video game play (Dance Dance Revolution) as a potential exercise therapy in Huntington’s disease: a controlled clinical trial. Clinical rehabilitation,27(11), 972-982 (full text).

19 Plow, M., Finlayson, M. (2014). A qualitative study exploring the usability of Nintendo Wii Fit among persons with multiple sclerosis. Occupational therapy international, 21(1), 21-32 (abstract).

20 Fung, V., So, K., Park, E., Ho, A., Shaffer, J., Chan, E., Gomez, M. (2010). The utility of a video game system in rehabilitation of burn and nonburn patients: a survey among occupational therapy and physiotherapy practitioners.Journal of Burn Care & Research, 31(5), 768-775 (abstract).

21 Smith, G. E., Housen, P., Yaffe, K., Ruff, R., Kennison, R. F., Mahncke, H. W., Zelinski, E. M. (2009). A cognitive training program based on principles of brain plasticity: Results from the Improvement in Memory with Plasticity‐based Adaptive Cognitive Training (IMPACT) Study. Journal of the American Geriatrics Society, 57(4), 594-603 (full text).

22 Brehmer, Y., Westerberg, H., Bäckman, L. (2012). Working-memory training in younger and older adults: training gains, transfer, and maintenance. Frontiers in human neuroscience, 6 (full text).

23 Edwards, J. D., Ruva, C. L., O’Brien, J. L., Haley, C. B., Lister, J. J. (2013). An examination of mediators of the transfer of cognitive speed of processing training to everyday functional performance. Psychology and aging, 28(2), 314 (full text).

24 Nouchi, R., Taki, Y., Takeuchi, H., Hashizume, H., Akitsuki, Y., Shigemune, Y., ... Kawashima, R. (2012). Brain training game improves executive functions and processing speed in the elderly: a randomized controlled trial. PLoS ONE 7(1): e29676 (full text).

25 Flavia, M., Stampatori, C., Zanotti, D., Parrinello, G., Capra, R. (2010). Efficacy and specificity of intensive cognitive rehabilitation of attention and executive functions in multiple sclerosis. Journal of the neurological sciences,288(1), 101-105 (full text).

26 Bonavita, S., Sacco, R., Della Corte, M., Esposito, S., Sparaco, M., d’Ambrosio, A., ... Tedeschi, G. (2015). Computer-aided cognitive rehabilitation improves cognitive performances and induces brain functional connectivity changes in relapsing remitting multiple sclerosis patients: an exploratory study. Journal of neurology, 262(1), 91-100 (full text).

27 Westerberg, H., Jacobaeus, H., Hirvikoski, T., Clevberger, P., Östensson, M. L., Bartfai, A., Klingberg, T. (2007). Computerized working memory training after stroke-A pilot study. Brain Injury, 21(1), 21-29 (full text).

28 Cha, Y. J., Kim, H. (2012). Effect of computer-based cognitive rehabilitation (CBCR) for people with stroke: a systematic review and meta-analysis. NeuroRehabilitation, 32(2), 359-368 (abstract).

29 Fink, R. B., Brecher, A., Schwartz, M. F., Robey, R. R. (2002). A computer-implemented protocol for treatment of naming disorders: Evaluation of clinician-guided and partially self-guided instruction. Aphasiology, 16(10-11), 1061-1086 (abstract).

30 Tam, S. F., Man, W. K. (2004). Evaluating computer-assisted memory retraining programmes for people with post-head injury amnesia. Brain Injury,18(5), 461-470 (abstract).

31 Cruz, V. T., Pais, J., Bento, V., Mateus, C., Colunas, M., Alves, I., ... Rocha, N. P. (2013). A rehabilitation tool designed for intensive web-based cognitive training: Description and usability study. JMIR research protocols,2(2) (full text).

32 Silsupadol, P. (2008). Effects of single-vs. dual-task training on balance performance under dual-task conditions in older adults with balance impairment: A randomized, controlled trial (Doctoral dissertation, University of Oregon) (full text).

33 Silsupadol, P., Shumway-Cook, A., Lugade, V., van Donkelaar, P., Chou, L. S., Mayr, U., Woollacott, M. H. (2009). Effects of single-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Archives of physical medicine and rehabilitation,90(3), 381-387 (full text).

34 Fritz, N. E., Basso, D. M. (2013). Dual-task training for balance and mobility in a person with severe traumatic brain injury: a case study. Journal of Neurologic Physical Therapy, 37(1), 37-43 (abstract).