Medical  Background

Evidence

Neuroplasticity

Multisensory

Embodiment

 

Neuroregulation

Neuroregulation refers to the regulatory circuitry by which the brain regulates physical activity based on sensory input and internal information processing. The body's neurochemical messengers are used in this process.

Functional neuroregulation plays a vital role in anxiety, pain and stress management, but also in healing and regeneration processes.

CUREO® is module-based and thus uniquely positioned as a VR medical product. Individual modules address a variety of topics, including neuroregulation through breathing, pain reduction through immersion, and general stress reduction through playful tasks.

Scientific background studies and research

Studies using VR devices such as CUREO® have shown significant pain reduction through immersive therapy. Immersive realities have been found to distract from patients' pain and permanently reduce perceived pain levels. In addition, neuroregulation through breathing tasks in VR has been shown to promote heart rate variability and respiratory rate. VR-based breathing exercises were found to lower perceived levels of stress, anger and anxiety. Finally, VR-based scenarios used in therapy were shown to reduce signs of anxiety and depression in PTSD patients.

  1. Wiederhold, M. D., & Wiederhold, B. K. (2007)

  2. Malloy, K. M., & Milling, L. S. (2010)

  3. Hoffman, H. G. et al. (2011)

  4. Arane, K., Behboudi, A., & Goldman, R. D. (2017)

  5. Sato, K. et al. (2010)

  6. Ding, L. et al. (2020)

  7. Chittaro, L., & Sioni, R. (2014)

  8. Czub, M., & Kowal, M. (2019)

  9. Cook, N. E., Huebschmann, N. A., & Iverson, G. L. (2021)

  10. Azam, M. A., Latman, V. V., & Katz, J. (2019)

  11. Navarro-Haro, M. V. et al. (2017)

  12. Maples-Keller, J. L., Yasinski, C., Manjin, N., & Rothbaum, B. O. (2017)

 

Multisensory

Multisensory feedback refers to the principle that a user can receive responses from a system through multiple senses. In other words, the combination of visual, tactile and auditory cues leads to an integration of feedback sources. An immersive reality offers the possibility to deliver multisensory feedback in a way that was not possible before. Users experience scenarios in 3D and receive acoustic feedback at the same time. Multisensory feedback has been shown to enhance effective immersion in virtual realities through the integration of cues.

CUREO® takes advantage of multisensory feedback by using visual, auditory and haptic feedback for a given task. Patients experience immersive tasks via a VR headset, are guided by auditory cues and receive tactile responses via hand controls.

Scientific background studies and research

Multisensory feedback has been shown to create stimulatory integration necessary for cognitive and motor rehabilitation. Studies found significant improvements in motor tasks through neural reorganisation following VR tasks with visual and auditory feedback. In general, multisensory therapy was found to be a viable intervention for movement rehabilitation in stroke patients.

  1. Teo, W. P. et al. (2016)

  2. Effenberg, A. O. et al. (2016)

  3. Saposnik, G., Levin, M., & Outcome Research Canada Working, G. (2011)

  4. Ripolles, P. et al. (2016)

  5. Leonardis, D. et al. (2014)

 

Neuroplasticity

Neuroplasticity is the brain's ability to structurally adapt to new stimuli or demands through new neural connections. Until recently, neuroplasticity was thought to stop in the early years of development, making it more challenging to learn tasks in adulthood. 

Lifelong process of plasticity

However, research has found that neuronal connections are, in fact, constantly changing, and plasticity is a lifelong process. There is a constant turnover and generation of neurons, which means that the connections in our brains are continually changing. Habitual responses can be conditioned and deconditioned, new skills can be learned, and memory can be improved at any time. These processes play an essential role in successful rehabilitation.

CUREO® purposefully uses the concept of neuroplasticity to help patients regain impaired cognitive and motor functions. Through the use of immersive tasks, low-latency feedback and clever cognitive techniques, the nervous system is stimulated, and neural pattern formation is activated.

Neural remapping

CUREO® prepares patients for optimal neural remapping in small-scale learning steps using associative networks.

It also uses the findings of sports science and gamification.

Scientific background studies & research

A review of therapy methods for stroke survivors concludes that virtual therapy shows significant success in motor rehabilitation and achieves lasting neuroplastic changes. Another review, focusing on head-mounted displays such as the CUREO® therapy system, reports promising results in rehabilitation, noting that "VR-based therapies can induce cortical reorganisation and promote activation of different neural connections over a wide range of ages, resulting in contrasting improvements in motor and functional abilities." (4)

  1. Straudi, S., & Basaglia, N. (2017)

  2. You, S. H. et al. (2005)

  3. Arya, K. N. et al. (2011)

  4. Coco-Martin, M. B. et al. (2020)

 

Embodiment

Our perception of our own body and the world around us is based on sensory inputs, e.g. visual, auditory, tactile, olfactory, etc., and on feedback from motor activities.

Neuronal patterns emerge in the brain, which creates an internal map that provides an image of the body and its surroundings.

In daily activities, people experience task-relevant inputs and continuously compare their internal map with them. In this way, humans learn to navigate through interaction in a dynamically changing environment - a functional triad.

Motor skills, sensors, internal map

In the case of neural impairment, if one of the three components, motor skills, sensory functions or the internal map, is damaged, this usually inevitably affects the other components.

For example, faulty sensory input can lead to motor disorders and distortions of the internal map. The disturbed body image makes therapy difficult because learned patterns are no longer effective.

Adaptive adjustments and phantom pain

In some cases, the body adapts to a change in input, as it is often seen in amputees. After losing a limb, regions of the brain that no longer receive input are taken over by neighboring neurons. However, many affected people still perceive phantom pain, in which the "missing" limb causes painful discomfort. In these cases, mirror therapy has been shown to be an effective method of pain relief.

Embodiment in hemiparesis and neglect

In other cases, such as post-stroke hemiparesis and neglect, patients exhibit impaired motor function due to a disruption of sensory input from one side of the body. In these cases, problems with posture and balance may arise due to the interruption in information processing.

Even if the cause of the damage is effectively contained, significant functional gaps remain that are difficult to treat. This is because the comparison of the distorted map with the changed sensorimotor situation no longer works.

No adequate therapy possible due to limited resources

The task-relevant inputs and outputs would have to be deformed to be accessible to the injured party and gradually generate a new, suitable, internal mapping. In addition, a high frequency of therapy is required to pave the way for new pattern formation and consolidation. This is challenging to implement in a physical therapy situation, and therapy is mainly inaccessible to affected people. Therefore, many people have to come to terms with severe disabilities after neurological damage.

CUREO® takes a new approach

CUREO® is the first immersive, interactive VR therapy system in which the perception of the body and the environment can be fine-tuned to the patient's limitations. In this way, the neglected areas can be addressed.

CUREO® offers a virtual embodiment via a biomechanical avatar, multi-sensory feedback as input and motor movement tracking for sensorimotor feedback. Unilateral and bilateral movements are visually facilitated via a motion control system.

Immersive mirror therapy

For the first time, a system-wide avatar-based mirror function enables fully immersive mirror therapy for motor movement therapy. CUREO® thus offers a unique opportunity to efficiently use embodiment as therapy.

  1. Lopez, C. E., & Tucker, C. S. (2017)

  2. Karamians, R. et al. (2020)

  3. Craighero, L. et al. (1996)

 

Evidence

Research in the last decade has been centred around a multifaceted topic of virtual reality (VR). One of the most exciting fields of VR technology development is rehabilitation and the incredible practicality and usability of virtual VR tools for successful therapy.

CUREO® is not only a state-of-the-art device; it also combines a long list of validated concepts to offer the ultimate rehabilitation therapy for patients with a range of indications.

Scope of application

Multiple studies have shown that VR-based therapy significantly improves cognitive function (1). More specifically, attention (2, 3), spatial perception (4), and memory (3, 5) have been shown to improve using VR tools in different patient populations.

Motor training has been of particular interest for many researchers (6), as VR therapy presents an unparalleled opportunity for rehabilitation of patients with, i.e., Parkinson’s, paresis, or neglect, due to the accessibility of the devices alone. In addition, muscle strength and tone (7, 8) are improved through neuroplastic changes and increased motivation (9, 10, 11), while pain is significantly reduced through distraction and neuroregulation (12, 13, 14).

Therapy methods

Research shows that established rehabilitation approaches such as multi-sensory feedback (15), sonification (16) and mirror therapy (17) achieve similar if not better results when delivered in VR. Furthermore, methods that are novel to VR, such as enriched environments (18) and immersive gamification (11, 19), have shown exciting results when used as part of rehabilitation programs.

Usability and acceptance

The usability of VR devices has received widely positive feedback in many studies. Our own testing of the CUREO® device in several clinics has also shown the natural acceptance of VR rehabilitation. Patients reported increased motivation, an enjoyable therapy experience and intuitive usability of the device. Most of our Test-Patients expressed the desire to incorporate CUREO in their future therapy plan.

Unique value

CUREO® is a state-of-the-art device that is based on validated research findings combined with unique technological expertise. Our philosophy is to take available VR technology available on the market and go “one step further” to optimize the experience for our patients.

From studies with proven benefits using equivalent or less advanced devices, we set out to achieve the next level of patient-VR integration to accelerate therapy success and address existing shortcomings of otherwise available technology.

With unique features such as sonification and mirror therapy in VR, CUREO® redefines the game of virtual rehabilitation and, at the same time, markets it available to everybody

  1. Massetti, T. et al. (2018)

  2. Coleman, B. et al. (2019)

  3. Dascal, J. et al. (2017)

  4. Hill, N. T. et al. (2017)

  5. Yip, B. C. B., & Man, D. W. K. (2013)

  6. Laver, K. E. et al. (2017)

  7. Yeo, E. et al. (2019)

  8. Lee, H. S., Park, Y. J., & Park, S. W. (2019)

  9. de Araujo, A. V. L. et al. (2019)

  10. Maggio, M. G. et al. (2019)

  11. Karamians, R. et al. (2020)

  12. Park, M. J. et al. (2019)

  13. Malloy, K. M., & Milling, L. S. (2010)

  14. Arane, K., Behboudi, A., & Goldman, R. D. (2017)

  15. Saposnik, G., Levin, M., & Outcome Research Canada Working, G. (2011)

  16. Effenberg, A. O. et al. (2016)

  17. Giroux, M. et al. (2018)

  18. Yun, S. J. et al. (2020)

  19. Chen, W. et al. (2020)