title: Virtual rehabilitation for multiple sclerosis using a kinect-based system: randomized controlled trial.
abstract: BACKGROUND
  The methods used for the motor rehabilitation of patients with neurological disorders include a number of different rehabilitation exercises. For patients who have been diagnosed with multiple sclerosis (MS), the performance of motor rehabilitation exercises is essential. Nevertheless, this rehabilitation may be tedious, negatively influencing patients' motivation and adherence to treatment.
  
  
  OBJECTIVE
  We present RemoviEM, a system based on Kinect that uses virtual reality (VR) and natural user interfaces (NUI) to offer patients with MS an intuitive and motivating way to perform several motor rehabilitation exercises. It offers therapists a new motor rehabilitation tool for the rehabilitation process, providing feedback on the patient's progress. Moreover, it is a low-cost system, a feature that can facilitate its integration in clinical rehabilitation centers.
  
  
  METHODS
  A randomized and controlled single blinded study was carried out to assess the influence of a Kinect-based virtual rehabilitation system on the balance rehabilitation of patients with MS. This study describes RemoviEM and evaluates its effectiveness compared to standard rehabilitation. To achieve this objective, a clinical trial was carried out. Eleven patients from a MS association participated in the clinical trial. The mean age was 44.82 (SD 10.44) and the mean time from diagnosis (years) was 9.77 (SD 10.40). Clinical effectiveness was evaluated using clinical balance scales.
  
  
  RESULTS
  Significant group-by-time interaction was detected in the scores of the Berg Balance Scale (P=.011) and the Anterior Reach Test in standing position (P=.011). Post-hoc analysis showed greater improvement in the experimental group for these variables than in the control group for these variables. The Suitability Evaluation Questionnaire (SEQ) showed good results in usability, acceptance, security, and safety for the evaluated system.
  
  
  CONCLUSIONS
  The results obtained suggest that RemoviEM represents a motivational and effective alternative to traditional motor rehabilitation for MS patients. These results have encouraged us to improve the system with new exercises, which are currently being developed.
authors: Instituto de Automática e Informática Industrial, Universitat Politècnica de València, Valencia, Spain. jlozano@dsic.upv.es.
authors: Jose-Antonio
authors: http://orcid.org/0000-0002-7756-183X
authors: JA
authors: Lozano-Quilis
authors: Hermenegildo
authors: http://orcid.org/0000-0002-7985-2454
authors: H
authors: Gil-Gómez
authors: Jose-Antonio
authors: http://orcid.org/0000-0001-9954-2480
authors: JA
authors: Gil-Gómez
authors: Sergio
authors: http://orcid.org/0000-0002-6280-1474
authors: S
authors: Albiol-Pérez
authors: Guillermo
authors: http://orcid.org/0000-0002-9408-1280
authors: G
authors: Palacios-Navarro
authors: Habib M
authors: http://orcid.org/0000-0002-3641-389X
authors: HM
authors: Fardoun
authors: Abdulfattah S
authors: http://orcid.org/0000-0002-9448-7491
authors: AS
authors: Mashat
keywords: augmented reality; motor rehabilitation; multiple sclerosis; natural interfaces; virtual reality
references: Neurology. 2006 Jan 24;66(2):178-81
references: 16434649
references: Res Dev Disabil. 2011 Nov-Dec;32(6):2566-70
references: 21784612
references: Can J Public Health. 1992 Jul-Aug;83 Suppl 2:S7-11
references: 1468055
references: Arch Phys Med Rehabil. 2005 Feb;86(2):190-6
references: 15706542
references: Stud Health Technol Inform. 2010;154:229-34
references: 20543303
references: NeuroRehabilitation. 2009;25(1):29-44
references: 19713617
references: J Am Geriatr Soc. 1991 Feb;39(2):142-8
references: 1991946
references: J Neurol Phys Ther. 2005 Mar;29(1):34-42
references: 16386159
references: Res Dev Disabil. 2011 Jan-Feb;32(1):312-21
references: 21071171
references: Am J Med. 1986 Mar;80(3):429-34
references: 3953620
references: J Neuroeng Rehabil. 2011 May 23;8:30
references: 21600066
references: Phys Med Rehabil Clin N Am. 2010 May;21(2):339-56
references: 20494281
references: Phys Ther. 2002 Feb;82(2):128-37
references: 11856064
references: Top Stroke Rehabil. 2010 Sep-Oct;17(5):345-52
references: 21131259