title: Increasing patient engagement during virtual reality-based motor rehabilitation.
abstract: OBJECTIVE
  To investigate the influence of different design characteristics of virtual reality exercises on engagement during lower extremity motor rehabilitation.
  
  
  METHODS
  Correlational study.
  
  
  METHODS
  Spinal cord injury (SCI) rehabilitation center.
  
  
  METHODS
  Subjects with SCI (n=12) and control subjects (n=10).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Heart rate and electromyographic activity from both legs at the tibialis anterior, the gastrocnemius medialis, the rectus femoris, and the biceps femoris were recorded.
  
  
  RESULTS
  Interactivity (ie, functionally meaningful reactions to motor performance) was crucial for the engagement of subjects. No significant differences in engagement were found between exercises that differed in feedback frequency, explicit task goals, or aspects of competition.
  
  
  CONCLUSIONS
  Functional feedback is highly important for the active participation of patients during robotic-assisted rehabilitation. Further investigations on the design characteristics of virtual reality exercises are of great importance. Exercises should thoroughly be analyzed regarding their effectiveness, while user preferences and expectations should be considered when designing virtual reality exercises for everyday clinical motor rehabilitation.
authors.affiliation: Sensory-Motor Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland. lukas.zimmerli@hest.ethz.ch
authors.forename: Lukas
authors.initials: L
authors.lastname: Zimmerli
authors.forename: Mario
authors.initials: M
authors.lastname: Jacky
authors.forename: Lars
authors.initials: L
authors.lastname: Lünenburger
authors.forename: Robert
authors.initials: R
authors.lastname: Riener
authors.forename: Marc
authors.initials: M
authors.lastname: Bolliger
mesh_terms: D000328:Adult; D004576:Electromyography; D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods*; D005246:Feedback; D005260:Female; D005684:Gait; D006339:Heart Rate; D006801:Humans; D007866:Leg; D008297:Male; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012371:Robotics; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D014584:User-Computer Interface
keywords: BDI II; Beck Depression Inventory II; EMG; Gait; LEMS; Motor activity; RMS; Rehabilitation; SCI; SCIM III; Spinal Cord Independence Measure III; Spinal cord injuries; VR; Virtual systems; WISCI II; Walking Index for Spinal Cord Injury II; electromyogram; lower extremity motor score; root mean square; spinal cord injury; virtual reality