Focus on Patient in Virtual Reality-Assisted Rehabilitation

Introduction: A Patient-Centered Vision

Different sociologists and physicians have underlined the changing of patient’s position in medicine from a leading role to a supporting one. According to Nicholas Jewson (sociologist in seventies of nine hundreds), eighteenth century English medicine was gradually moving away from a model in which the patient had considerable interaction with the physician – and, through this consultative relationship, had an equal influence on the physician’s therapeutic approach. It was moving towards a paradigm in which the patient became the recipient of a more standardized form of intervention that was determined by the prevailing opinions of the medical profession of the day (Jewson, 1974). The concept of patient in eighteenth century was holistic and oriented to the single person (Chin-Yee, 2015). The nineteenth century represented a transition towards “object-orientated” medicine (Jewson, 1976; Foucault, 2012). The examinations and medical investigations were the objective of studies more than the patient and his/her story. Despite criticisms that Jewson’s vision arose, his point of view is confirmed by some case studies by Mary Fissell, a professor in the Department of the History of Medicine at the Johns Hopkins University: study of illness narratives at the Bristol Infirmary during the eighteenth century reveals a diminishing role of the patient history in hospital medicine (Fissell, 2005).

Engel, (1977) and Armstrong, (1982) analysed medical/patient relation in nineties but more focus on clinical psychology and bio-psychosocial concepts of illness underlined the status of the patient history in medical practice during the twentieth century (Engel, 1977; Armstrong, 1982).

“It is hard to escape the implicit conviction that laboratory and technologic data are more objective, and therefore more scientific, than the subjective information gathered by listening to a patient tell his or her story” (Henderson, 2012). This is the conclusion of the history of the Evidence Based Approach and the technological development of the medicine was on the same line. Scientists and technicians prefer to have clear data and numbers to be inserted in machine language. Having a patient and his/her stories, as a central point of the healing process, it is difficult because the technician must translate the complexity of natural/human language into the machine language.

Since several years, scientists are carrying on research about innovative systems, based on robotics, mechatronics devices and IT tools – especially the graphical ones – to support patients in rehabilitation programs for rescuing from various brain damages due to adverse events as stroke (Chang, 2013; Lohse, 2014; Lum, 2002). Training sessions with a combination of robot and virtual reality (VR) lead to better rehabilitation outcomes than using only a robot (Mirelman, 2009; Brutsch, 2011) and evidence from the field proved the importance of the use of VR interfaces in rehabilitation. The main aim of such a kind of applications is to monitor, motivate and drive the patient during the rehabilitation sessions (Shah, 2014; Novak, 2014), measuring patients’ performance and other observable variables in order to provide motor guidance through multimedia communication channels. The most common approach in the development of a rehabilitation virtual environment is the implementation of a game-like solution, where the patient becomes the “player”, who performing certain tasks or movements controls the game, making the injured part to be moved with the goal of a functional recovery (Borghese, 2013).