***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Stroke patients usually suffer from asymmetric posture due to hemi-paresis that can result in reduced postural controllability leading to a balance deficit . This deficit increases the risk of falls , which often makes them dependent on caregivers for community ambulation , thus deteriorating their quality of life . Conventional balance training involves rehabilitation exercises performed under physiotherapist ’s supervision , where the scarcity of trained professionals as well as the cost of clinic-based rehabilitation programs can deter stroke survivors from undergoing regular balance training . Thus , research ers have been exploring technology-assisted solutions , e.g. , home-based virtual reality ( VR ) setup . In this paper , we developed a VR-based balance training ( VBaT ) platform , where VR-augmented user-interface using Nintendo Wii balance boardwas tested in a laboratory setting for its feasibility . The VBaT offered tasks of varying difficulties to the participants that adapted to individual performance capability during balance training . We performed a preliminaryusability study with 7 stroke survivors ( post-stroke period > 6 months ) . Preliminary results indicate the potential of theVBaT system to cause improvement in overall average task performance over the course of training while using the VBaT. Thus the VBaT system is proposed to be a step toward an effective balance training platform for people with balance disorder Abstract Objective : To contrast changes in clinical and kinematic measures of upper extremity movement in response to virtually simulated and traditionally presented rehabilitation interventions in persons with upper extremity hemiparesis due to chronic stroke . Design : Non-r and omized controlled trial . Setting : Ambulatory research facility . Participants : Subjects were a volunteer sample of twenty one community-dwelling adults ( mean age : 51 ± 12 years ) with residual hemiparesis due to stroke more than 6 months before enrollment ( mean : 74 ± 48 months ) , recruited at support groups . Partial range , against gravity shoulder movement and at least 10 ° of active finger extension were required for inclusion . All subjects completed the study without adverse events . Interventions : A 2 weeks , 24-hour program of robotic/virtually simulated , arm and finger rehabilitation activities was compared to the same dose of traditionally presented arm and finger activities . Results : Subjects in both groups demonstrated statistically significant improvements in the ability to interact with real-world objects as measured by the Wolf Motor Function Test ( P = 0.01 ) . The robotic/virtually simulated activity ( VR ) group but not the traditional , repetitive task practice ( RTP ) group demonstrated significant improvements in peak reaching velocity ( P = 0.03 ) and finger extension excursion ( P = 0.03 ) . Both groups also demonstrated similar improvements in kinematic measures of reaching and grasping performance such as increased shoulder and elbow excursion along with decreased trunk excursion . Conclusions : Kinematic measurements identified differing adaptations to training that clinical measurements did not . These adaptations were targeted in the design of four of the six simulations performed by the simulated activity group . Finer grained measures may be necessary to accurately depict the relative benefits of dose matched motor interventions Abstract Purpose state : The aim of this preliminary study was to test a data glove , CyberTouch ™ , combined with a virtual reality ( VR ) environment , for using in therapeutic training of reaching movements after spinal cord injury ( SCI ) . Method : Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments : patients in the intervention group ( IG ) conducted a VR training based on the use of a data glove , CyberTouch ™ for 2 weeks , while patients in the control group ( CG ) only underwent the traditional rehabilitation . Furthermore , two functional parameters were implemented in order to assess patient ’s performance of the sessions : normalized trajectory lengths and repeatability . Results : Although no statistical significance was found , the data glove group seemed to obtain clinical changes in the muscle balance ( MB ) and functional parameters , and in the dexterity , coordination and fine grip tests . Moreover , every patient showed variations in at least one of the functional parameters , either along Y-axis trajectory or Z-axis trajectory . Conclusions : This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation , making it possible to train activities of daily living ( ADLs ) in motivational environments while measuring objective ly the patient ’s functional evolution . Implication s for Rehabilitation Key findings : A motion capture application based on a data glove is presented , for being used as a virtual reality tool for rehabilitation . This application has provided objective data about patient ’s functional performance . What the study has added : ( 1 ) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools , making it possible to train Activities of Daily Living in motivational environments . ( 2 ) Furthermore , this study could be a contribution for the development of clinical protocol s to identify which types of patients will benefit most from the VR treatments , which interfaces are more suitable to be used in neurorehabilitation , and what types of virtual exercises will work best Background Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training ( RAGT ) devices , including Lokomat , for the treatment of lower limb paresis .  Virtual reality ( VR ) has proved to be a valuable tool to improve neurorehabilitation training . The aim of our pilot r and omized clinical trial was to underst and the neurophysiological basis of motor function recovery induced by the association between RAGT ( by using Lokomat device ) and VR ( an animated avatar in a 2D VR ) by study ing electroencephalographic ( EEG ) oscillations . Methods Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were r and omized into two groups . One group performed 40 sessions of Lokomat with VR ( RAGT + VR ) , whereas the other group underwent Lokomat without VR ( RAGT-VR ) . The outcomes ( clinical , kinematic , and EEG ) were measured before and after the robotic intervention . Results As compared to the RAGT-VR group , all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment . Moreover , they showed stronger event-related spectral perturbations in the high-γ and β b and s and larger fronto- central cortical activations in the affected hemisphere . Conclusions The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance . EEG data suggest that the use of VR may entrain several brain areas ( probably encompassing the mirror neuron system ) involved in motor planning and learning , thus leading to an enhanced motor performance . Trial registration Retrospectively registered in Clinical Trials on 21 - 11 - 2016 , n . NCT02971371 Abstract Purpose : To describe the novel BrightArm Duo bimanual upper extremity ( UE ) rehabilitation system ; to determine its technology acceptance and clinical benefit for older hemiplegic participants . Methods : The system table tilted to adjust arm gravity loading . Participants wore arm supports that sensed grasp strength and wrist position on the table . Wrist weights further increased shoulder exertion . Games were design ed to improve UE strength , motor function , cognition and emotive state and adapted automatically to each participant . The system underwent feasibility trials spanning 8 weeks in two skilled nursing facilities ( SNFs ) . Participants were evaluated pre-therapy and post-therapy using st and ardized clinical measures . Computerized measures of supported arm reach , table tilt and number of arm repetitions were stored on a remote server . Outcomes : Seven participants had significant improvements in their active range of shoulder movement , supported arm reach , shoulder strength , grasp strength and their ability to focus . The group demonstrated higher arm function measured with FMA ( p = 0.01 ) and CAHAI ( p = 0.05 ) , and had an improvement in depression ( Becks Depression Inventory , II ) .  BrightArm Duo technology was well accepted by participants with a rating of 4.4 out of 5 points . Conclusions : Given these findings , it will be beneficial to evaluate the BrightArm Duo application in SNF maintenance programs . Implication s for Rehabilitation Integrative rehabilitation that addresses both physical and cognitive domains is promising for post-stroke maintenance in skilled nursing facilities . Simultaneous bilateral arm exercise may improve arm function in older hemiplegic patients several years after stroke . Virtual reality games that adapt to the patient can increase attention and working memory while decreasing depression in elderly Background Down syndrome ( DS ) has unique physical , motor and cognitive characteristics . Despite cognitive and motor difficulties , there is a possibility of intervention based on the knowledge of motor learning  . However , it is important to study the motor learning process in individuals with DS during a virtual reality task to justify the use of virtual reality to organize intervention programs . The aim of this study was to analyze the motor learning process in individuals with DS during a virtual reality task . Methods A total of 40 individuals participated in this study , 20 of whom had DS ( 24 males and 8 females , mean age of 19 years , ranging between 14 and 30 yrs . ) and 20 typically developing individuals ( TD ) who were matched by age and gender to the individuals with DS . To examine this issue , we used software that uses 3D images and reproduced a coincidence-timing task . Results The results showed that all individuals improved performance in the virtual task , but the individuals with DS that started the task with worse performance showed higher difference from the beginning . Besides that , they were able to retain and transfer the performance with increase of speed of the task . Conclusion Individuals with DS are able to learn movements from virtual tasks , even though the movement time was higher compared to the TD individuals . The results showed that individuals with DS who started with low performance improved coincidence- timing task with virtual objects , but were less accurate than typically developing individuals . Trial registration Clinical Trials.gov Identifier : NCT02719600 Background Dexterous manipulation of the h and , one of the features of human motor control , is often compromised after stroke , to the detriment of basic functions . Despite the importance of independent movement of the digits to activities of daily living , relatively few studies have assessed the impact of specifically targeting individuated movements of the digits on h and rehabilitation . The purpose of this study was to investigate the impact of such finger individuation training , by means of a novel mechatronic-virtual reality system , on fine motor control after stroke . Methods An actuated virtual keypad ( AVK ) system was developed in which the impaired h and controls a virtual h and playing a set of keys . Creation of individuated digit movements is assisted by a pneumatically actuated glove , the PneuGlove . A study examining efficacy of the AVK system was subsequently performed . Participants had chronic , moderate h and impairment result ing from a single stroke incurred at least 6 months prior . Each subject underwent 18 hour-long sessions of extensive therapy ( 3x per week for 6 weeks ) targeted at finger individuation . Subjects were r and omly divided into two groups : the first group ( Keypad : N = 7 ) utilized the AVK system  while the other group ( OT : N = 7 ) received a similarly intensive dose of occupational therapy ; both groups worked directly with a licensed occupational therapist . Outcome measures such as the Jebsen-Taylor H and Function Test ( JTHFT ) , Action research Arm Test ( ARAT ) , Fugl-Meyer Upper Extremity Motor Assessment /H and subcomponent ( FMUE/FMH ) , grip and pinch strengths were collected at baseline , post-treatment and one-month post-treatment . Results While both groups exhibited some signs of change after the training sessions , only the Keypad group displayed statistically significant improvement both for measures of impairment ( FMH : p = 0.048 ) and measures of task performance ( JTHFT : p = 0.021 ) . Additionally , the finger individuation index – a measure of finger independence – improved only for the Keypad group after training ( p = 0.05 ) in the subset ( Keypad : N = 4 ; OT : N = 5 ) of these participants for which it was measured . Conclusions Actively assisted individuation therapy comprised of non task-specific modalities , such as can be achieved with virtual platforms like the AVK described here , may prove to be valuable clinical tools for increasing the effectiveness and efficiency of therapy following stroke Immersive virtual reality ( IVR ) offers new possibilities to perform treatments in an ecological and interactive environment with multimodal online feedbacks . Sixteen school-aged children ( mean age 11 ± 2.4 years ) with Bilateral CP — diplegia , attending mainstream schools were recruited for a pilot study in a pre – post treatment experimental design . The intervention was focused on walking competences and endurance and performed by the Gait Real-time Analysis Interactive Lab ( GRAIL ) , an innovative treadmill platform based on IVR . The participants underwent eighteen therapy sessions in 4 weeks . Functional evaluations , instrumental measures including GAIT analysis and parental question naire were utilized to assess the treatment effects . Walking pattern ( stride length left and right side , respectively p = 0.001 and 0.003 ; walking speed p = 0.001 ) , endurance ( 6MWT , p = 0.026 ) , gross motor abilities ( GMFM-88 , p = 0.041 ) and most kinematic and kinetic parameters significantly improved after the intervention . The changes were mainly predicted by age and cognitive abilities . The effect could have been due to the possibility of IVR to foster integration of motor/perceptual competences beyond the training of the walking ability , giving a chance of improvement also to older and already treated children The video game-based therapy emerged as a potential valid tool in improving balance in several neurological conditions with controversial results , whereas little information is available regarding the use of this therapy in subacute stroke patients . The aim of this study was to investigate the efficacy of balance training using video game-based intervention on functional balance and disability in individuals with hemiparesis due to stroke in subacute phase . Fifty adult stroke patients participated to the study : 25 subjects were r and omly assigned to balance training with Wii Fit , and the other 25 subjects were assigned to usual balance therapy . Both groups were also treated with conventional physical therapy ( 4 
    Output:
    
Results : We summarize the literature which highlights that a range of effective VR approaches are available .
A range of benefits were associated with VR interventions , including improvement in motor functions , greater community participation , and improved psychological and cognitive function .
Conclusions : The results from this review provide support for the use of VR as part of a neurorehabilitation program in maximizing recovery