Several Kinect-based systems were proposed for rehabilitation, using avatars to portray the correct motion, or using therapy-based games, e.g., Roy et al. The sensors can include accelerometers, gyroscopes, microphones, bio-chemical sensors, motion detectors, GPS, and EMG. These higher-tech exercise programs often use sensors, either to passively monitor a patient's status, provide feedback so an action can be modified, or use actuators to assist the patient in completing a motion (Bamberg et al. While home regimens traditionally involve a physical therapist's verbal instructions and printed pictures, higher-tech initiatives associated with telemedicine, virtual reality, and robotic programs have been shown to be more effective in promoting compliance than traditional paper-based and verbal instructions (Byl et al. For the purpose of our study, the operational definitions for adherence is a patient's ability to perform exercises as prescribed to them, and compliance is the ability for a patient to continue exercising for the frequency and duration of their prescribed rehabilitation program. Patients who set goals collaboratively with their physical therapist have higher compliance rates (Chan et al.

The compliance rate for such programs can be quite low, due to perceived barriers to exercise, lack of positive feedback, and degree of helplessness (Campbell et al. The main issue with relying on patient-initiated exercises outside of the therapy office, however, is that a patient's progress is often dependent on their ability to adhere and comply with such exercise program. Such costs can be reduced by moving inpatient treatment to outpatient programs, which include exercises performed independently by patients outside of the therapy office. This does not cover the needs of all patients 19% of beneficiaries with complex impairments exceed Medicare's cap, spending on average $3,013 out of pocket (for Medicare and Services 2016). Currently, Medicare caps outpatient spending at only $1900 per person per year, which can be spent on physical therapy as well as speech and language pathology payments. In 2014, Medicare spent $7 billions on inpatient rehabilitation therapy (which includes physical therapy) for 339,000 patients. There is significant need for cost-effective yet efficacious treatments to address such conditions (Carter and Rizzo 2007). Long-term intensive and expensive physical therapy is often necessary for patients with orthopedic, neuromuscular, cardiovascular, pediatric, oncological, and other conditions. We conclude the article with a set of considerations for immersive virtual reality therapy game design. The results suggest that we were successful in providing a motivating experience for performing mCIT as well as a cost-effective solution for real-time data capture during therapy. PSC was evaluated by users with combined developmental and physical impairments as well as stroke survivors. Our adaptation changes the physical to psychological binding by providing various types of immersive stimulation to influence the use of the weaker arm. The game mechanics were adapted from modified Constraint Induced Therapy (mCIT), an established therapy method where users are asked to use the weaker arm by physically binding the stronger arm. This article reports the design and evaluation of an immersive virtual reality game using the HTC Vive for upper limb rehabilitation, titled “Project Star Catcher” (PSC), aimed at users with hemiparesis.

Modern immersive virtual reality experiences have the unique potential to motivate patients undergoing physical therapy for performing intensive repetitive task-based treatment and can be utilized to collect real-time user data to track adherence and compliance rates.

J.u.l.i.a. among the stars gameplay