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Introduction: Neuroplasticity refers to changes in neural pathways and synapses which are due to changes in behavior, environment and

neural processes, as well as changes resulting from bodily injury. Virtual reality (VR) is a computer-simulated environment that can simulate physical presence in places in the real world or imagined worlds. Virtual reality environments are primarily visual experiences, displayed either on a computer screen or through special stereoscopic displays, but some simulations include additional sensory information, such as sound through speakers or headphones or tactile information(force feedback) as in haptic systems. Haptic systems are primarily used in medical applications. It is observed that enhancement of the sensory-motor skills of persons with significant neuromuscular disabilities (e.g. cerebral palsy, stroke and brain injury) is the main objective of many therapeutic interventions in rehabilitation. This necessitates the combination of virtual systems and robotics to facilitate neuroplasticity in order to bring about faster and a healthier recovery.

Theory: Intensive and repetitive training can modify neural organization and provide improved sensory-motor function by encouraging healthy neurons to take the role of those cells that are damaged. This is referred to as neuroplasticity. It is observed that neuroplasticity is less evident following passive movement of the limbs, and is more likely when the individual voluntarily begins and attempts to control the movement. Thus we see that neural learning occurs most strongly when intention is confirmed by visual and proprioceptive feedback of movement to the brain. Another important factor is that changes in muscle tissue may contribute to the paresis or movement impairment in these individuals. When muscles are not used throughout their normal range of extension and contraction, the muscle is biologically remodeled by reducing the number of sarcomeres and can no longer function over its original range of movement. This results in greatly reduced range of joint movement, known as a contracture. Prevention of contracture requires continual use of the limbs throughout their normal range of motion, while recovery from contracture can be encouraged by repeated use of the joints at the extremes of their compromised range of motion. A number of emerging therapeutic interventions make use of specialized exercise devices, modified robotic systems, and a number of virtual reality approaches. These technologies have the potential to provide repeatable and measurable training, increase the duration of the intervention by extending it from the clinical setting to the home, and allow for individualized interventions that address user-specific goals along a continuum of treatment. State of the art: --Krebs et al. (1998) and Lum et al. (1995) have applied robotic manipulators in the rehabilitation of persons with stroke. These technologies offer electromechanical support for movement of the paretic limb along desired trajectories, external resistance to unwanted movements and haptic sensations that reinforce the feedback to the user. ---A combination of physical intervention with virtual reality is described by Jack et al. (2001) in which persons with stroke interact with virtual objects that are presented visually with computer graphics, and haptically use a force reflecting glove.

--Use of virtual reality-based therapy for persons with cerebral palsy is described by Wann and Turnbull (1993), with head injury by Rizzo and Buckwalter (1997), and with multiple sclerosis by Stefin (1997). --Telerehabilitation of orthopedic disabilities are reported by Popescu et al.(2000). --Additional reports on the use of virtual reality include the use of game-like technologies to increase the motivation of children with disabilities (McComas et al.1998; Helsel 1992). Reviews of early applications of virtual reality in rehabilitation are provided by Greenleaf and Tovar (1994) and Kuhlen and Dohle (1995). More current reviews are provided by Riva (2003) and Sveistrup (2004). -MANUS robot was developed by N.Hogan and H.Krebs(2003). It took 10 years to complete and is 2 DOF system allowing displacements of the elbow and the shoulder during hand movements made in the horizontal plane. -ARM guide robot(Assisited Rehabilitation and Measurement Guide-2006) is a robot which has been designed in order to be simple and inexpensive. The system consists of a handle mounted on a motorized linear side which can assist the patients movement. This slide is fixed to a system with two rotations thus allowing 3D varaiations in movement orientation. It has 4 DOF. As it tis fixed to the patients hand, The ARM guide can provide active assistance to movement and can also function in the active constrained mode. Hand kinematics and forces generated by the aptient can also be recorded. - the MIME robot (Mirror Image Movement Enabler,Stanford University and Veteran Administration-2002) was developed from a classic industrial robot (PUMA 562). The particularity of this robot is that its distal end is fixed in an orthosis in which the patients arm is placed. As a result of this coupling, the MIME system allows the patient to make large amplitude movements in 3 dimensional space. It contains a 6 axis force sensor which allows interaction forces and moments applied to the patient and the robot. The MIME robot uses a bimanual mode during which the robot guides the hemiparetic limb along the trajectory symmetrical to that of the healthy limb.

Different methodologies: Many immersive technologies include head-mounted displays to create the sensation of being in a virtual environment. Others provide a sense of presence by means of haptic representation of virtual objects and forces. The sense of presence is especially important when the therapeutic intervention requires tactile feedback to the user. For example, the Perception-Inspired Haptic Force Sensor A Concept Study paper proposes a new perception-based concept for force sensing in haptic systems. By using two different sensing principles, a better adaption to the human sensory system can be achieved. Based on the tactile and kinesthetic parts of haptic perception, this is done using different sensing principles, nominal ranges, bandwidth and degrees of freedom for each part. The proposed concept allows for a better quality of haptic feedback at lower costs. The segmentation of force sensing into two different principles originates mainly in the proportional resolution of HFP. Resolution and nominal range of the sensors are derived from the main tasks for the tactile and kinaesthetic sensory system. While tactile interaction focuses on surface properties (i.e. texture recognition, braille reading) the kinesthetic system allows for larger-scale interactions and the manipulation of objects The mechanoreceptors involved in these interactions determine the requirements for bandwidth, sensing degrees of freedom and the spatial resolution. Possible realizations for both sensor parts were derived from a creative process based on the 6-3-5 method with experts from the fields of haptics, MEMS, and sensor design. The graphical results were analyzed in terms of the functional parts of a sensor. These are type of the force application structure, mechanical-mechanical transduction, mechanical-electrical transduction, and the means of overload capacity.

Similarly, strong arguments can be made for the use of immersive systems employing head-mounted displays that graphical environments with considerable fidelity. As an example is a novel tool in neuro-rehabilitation based on Virtual Reality (VR) technologies. These have the advantage of flexibly deploying scenarios that can be directed towards specific needs. Rehabilitation Gaming System (RGS), a VR based neuro-rehabilitation paradigm for the treatment of motor deficits resulting from lesions to the central nervous system that exploits the cognitive processes that mediate between perception and action The RGS tracks arm and finger movements and maps them onto a virtual environment. In this manner, the user controls the movements of two virtual limbs that are viewed in a first person perspective. The rehabilitation scenario described here, Spheroids, consists of intercepting, capturing and placing spheres that move towards the user. The main rationale behind this rehabilitation scenario of RGS is the hypothesis that bimanual task oriented action execution combined with the observation of virtual limbs that mirror the executed or intended movement create conditions that facilitate the functional reorganization of the motor and pre-motor systems affected by stroke.

The application of microrobotics to biomedical systems is commonly referred to as bio- microrobotics. The aggregation of complex hybrid 3D MEMS devices in such microrobotic systems demands advanced micro-assembly systems which fulfill a set of requirements such as an assembly with full 6 degrees of freedom, access to the workbench, transparent kinematic configuration, integration of advanced vision feedback, flexible design for fast reconfiguration, interfacing etc. Micro-assembly systems can be divided into two sections, according to their principle of operation: serial assembly or parallel assembly. In serial assembly objects are assembled part by part following the traditional pick-and-place paradigm. Each element is picked from a part feeder by a robotic manipulator, translated, rotated, and then added to an intermediate position for re-grasping or to its final destination. It is a sequential process where one product after the other is assembled. Serial microassembly techniques require advanced sensory feedback of the assembly scene (vision feedback in most cases) as well as high precision positioning and part-handling tools. The automation of serial processes can vary between manual, tele-operated and fully automated assembly. For automated assembly systems, vision based control mechanisms are vital. The throughput of serial microassembly is limited by the number of micromanipulators in the array and their individual bandwidth.

Milestones and achievements: The field of rehabilitative robots and the use of virtual reality systems in rehabilitation therapy has come a long way from the MANUS robot developed in 2003 to the Haptic Master. Given below are some of the achievements over the years which has contributed to the increasing interest in this type of rehabilitative therapy. 2001: Virtual reality systems-Glove This kind of glove enables continuous tactile feedback to the patient and is seen to motivate the patients to work more towards recovery. A personal computer (PC)-

based desktop virtual reality (VR) system was developed for rehabilitating hand function in stroke patients. The system uses two input devices, a Cyber-Glove and a Rutgers Master II-ND (RMII) force feedback glove, allowing user interaction with a virtual environment. This consists of four rehabilitation routines, each designed to exercise one specific parameter of hand movement: range, speed, fractionation or strength. The use of performance-based target levels is designed to increase patient motivation and individualize exercise difficulty to a patients current state. Pilot clinical trials have been performed using the above system combined with noncomputer tasks, such as peg-board insertion or tracing of two-dimensional (2-D) patterns. Three chronic stroke patients used this rehabilitation protocol daily for two weeks. Objective measurements showed that each patient showed improvement on most of the hand parameters over the course of the training. Subjective evaluation by the patients was also positive. The VR rehab system was evaluated on three stroke patients in an intensive therapy program. Typically, three or four sessions of the four training exercises detailed here were run every day, five days a week, for a total of nine days followed, on the tenth day, by a re-evaluation. Objective measurements revealed that each patient showed improvement on most of the hand parameters over the course of the training. Independent dynamometer measurements also showed significant grasp-force increases in two of the three patients right hands. Two of the patients had improvements in their left (good) hands, as well. One patient had no improvement in the left hand-grasping force, but did show a 59% increase in right hand grasping force. Because the VR-based therapy was the only training that included a force exertion exercise, this result may be indicative of positive effects. The subjects showed improvement in functional activities of daily living, although is not possible, at this point, to distinguish the contributions of the VR training and the real-world training. Further studies are planned to elucidate these distinctions and to quantify the overall clinical efficacy of VR-based therapy for stroke patients. A web interface to the Oracle database is being developed to provide easy access for data retrieval and analysis .A left-handed RMII glove is under development to support patients with left handed deficits. Also, other haptic devices for applying force feedback to the elbow and shoulder are under consideration.

2009: Piezoelectric polymer based Multi Electrode arrays Multielectrode arrays (MEAs) or microelectrode arrays are devices that contain multiple plates or shanks through which neural signals are obtained or delivered, essentially serving as neural interfaces that connect neurons to electronic circuitry. Piezoelectric polymers are anisotropic in nature - which makes them suitable for detecting the direction of force. This property can also be exploited in future to use the tactile sensing chips for detecting and measuring the forces applied in shear direction. The paper Development of Fingertip Tactile Sensing Chips for Humanoid Robots presents the development of tactile sensing chips, for the fingertips of humanoid robots. In the first phase of development, piezoelectric polymer-MEA (microelectrode array) based test chips have been realized. Each chip comprises of 32 microelectrodes, epoxy-adhered with a thin piezoelectric polymer (PVDF-TrFE) film. The diameter of each microelectrode or 'taxel' (tactile element) is 500 11m and the center to center distance between taxels is 1 mm. The tactile sensing chips have been experimentally evaluated over a wide range (0.02 - 4N or 2 gmf- 400 gmt) of dynamic normal forces and frequencies (2 Hz - 5 KHz) by applying variable force with constant frequency in the first case and constant force with variable frequency in latter. The cross-talk, among adjacent taxels on the chips, is found to be approximately 20%. The MEA based chips have been experimentally evaluated by applying dynamic normal forces up to 4 N. The output-input relation is linear and cross talk is ~ 20%. The gain and phase plots obtained in the frequency range (2 Hz 5 KHz) have been presented. Further the ability of chips to differentiate objects on the basis of their hardness has been demonstrated. The lack of flexibility is the major disadvantage of tactile sensing arrays based on standard silicon IC technology. Using soft and compliant polymer as substrate, having mechanically integrated, but, otherwise distinct and stiff islands of the tactile sensing arrays, connected to each other by flexible and stretchable metal interconnects, could be a plausible solution for having a conformable electronic surface. Another possible trade off is to cover the chip with a thick and protective layer of silicone. Due to low thermal conductivity, such a layer would be helpful in reducing the effect of ambient temperature variations also - which otherwise introduces noise in the output during measurement of forces.

2011:PNEU-WREX PNEU-WREX is a pneumatic-driven robotic device for upper limb rehabilitation developed by the University of California and is an evolution of a previous work called WREX. This device is an orthosis for the rehabilitation of arm and hand. This system uses five degrees of freedom, four of them on the shoulder and one for the elbow. This robot is capable of therapies for arm and hand, the therapy for the hand is only for a full opening and closing, like an on-off system. The device is immersed in a virtual environment designed specifically for rehabilitation therapies based on ADL. The system also provides information about the patients progress and, with this information, it is possible to evaluate the therapy progress. The active degrees of freedom are driven by pneumatic cylinders. Each active degree of freedom uses a pressure low control loop in each chamber of the cylinder to control the force exerted by each cylinder. One valve for each chamber is necessary to implement the loop pressure in each cylinder. To solve the issues of friction in pneumatic cylinders, lowfriction cylinders have been used. It uses a passive gravity compensation to achieve both the compensation of its own weight and the weight compensation patients arm. The philosophy is based on building a sphere around the target point so that the diameter of the sphere is reduced as time goes by integral action. When the patient is out of the area, the high level control commands to the joints pairs so that the endeffector is approaching to the target. If the patient does fall within the sphere, the high control level operates completely free with the gravity compensator. With this operation mode, it is possible to assess patients progress. An information table for each patient can be created for adapting the control to each patient individually. The force control of each chamber is based in nonlinear control techniques because of the nonlinear nature of the system. Therefore, it is necessary to install pressure sensors in each camera. Due to control complexity, Kalman filters are used in combination with MEMs accelerometers and two levels of control. Moreover, methods for dead zone compensation in pneumatic systems are implemented. Control runs on a personal computer in real time via a data acquisition card type XPC. So the reliability of the control loop depends on the reliability of the operating system used on the PC. The robot is capable of performing forces up to 89 N with a bandwidth around 4 Hz, what is according to the authors, near the bandwidth of the human arm. There are no published clinical trials with patients using the PNEU-WREX robot. But there are some results with T-WREX. These first studies indicate that the repetitive motor training with T-WREX can reduce motor impairment for chronic stroke survivors with moderate to severe upper extremity hemiparesis. The authors expect similar results in clinical trial with the pneumatic version of the robot. This system intended to be a low cost system, keeping the passive gravity compensation of the previous version, and add only the devices necessary to expand the workspace and make attendance at therapy. As drawback, it has not all natural movement of human arm.

Advantages: MEMS have several distinct advantages Virtual Reality systems and Robotics: 1. In the first place, the interdisciplinary nature of MEMS technology and its micromachining techniques, as well as its diversity of applications has resulted in an unprecedented range of devices and synergies across previously unrelated fields (for example biology and microelectronics). 2. Secondly, MEMS with its batch fabrication techniques enables components and devices to be manufactured with increased performance and reliability, combined with the obvious advantages of reduced physical size, volume, weight and cost. 3. Thirdly, MEMS provides the basis for the manufacture of products that cannot be made by other methods. These factors make MEMS potentially a far more pervasive technology than integrated circuit microchips.

Current status: The current status of MEMS technology in rehabilitative therapy is focused on producing LOCs that can perform functions of entire systems as well as improving the quality and effectiveness of existing virtual reality and robotic systems. 2012: Lab On Chips (LOCs) Computer and robotic engineers are interested in culturing neurons in Multi electrode Arrays(MEAs) which has led to the attraction to LOCs in the recent past. Engineers are inclined to take advantage of cultured neurons to design adaptive man-made complex decision making systems. Robotic engineers, neuromorphic researchers and electrical power grid designers culture neurons to translate knowledge and insights from neuroscience into robotics, control and new computer architectures.Warwick et al. developed rat-brained autonomous robots by culturing and conditioning primary neurons from the embryonic mice. In addition to MEAs, microfluidic chips are fabricated in PDMS (polydimethylsiloxane), polycarbonate, PMMA(Polymethylmethacrylate) and silicon for neuron culturing. However, MEA and microfluidic based LOC have to be incubated inside a bench-top cell incubating chamber. A cell culture LOC system with integrated perfusing, warming, pH and temperature regulating capabilities will make a MEALOC portable and self-sustainable. It can lead to the new fully autonomous robots computationally powered by rat or worm neurons. Christen and Andreou developed a complementary-metal-oxidesemiconductor (CMOS) silicon and PDMS based cell culturing micro-system. They validated LOC by culturing kidney cells.

2013: Inertial Measurement Units (IMUs) An extremity rehabilitation program based on inertial measurement units (IMU) and virtual reality was proposed in 2013. A single IMU consists of a three-axis accelerometer, gyroscope, and geomagnetic sensors. One IMU is attached to the upper arm (master) and another to the forearm(slave).The IMUs are connected using a distributed sensor network implemented with inter-integrated circuit communication. The motion-tracking algorithm running on a PC tracks the subjects hand based on the estimated IMU orientation and segment lengths through forward kinematics. A motion-tracking system is present based on the use of inertial sensors and a distributed sensor network and show the functional feasibility of the rehabilitation system. This motion-tracking system consists of two inertial sensors attached to the upper limb of the subject and a motion tracking algorithm running on a PC. The inertial sensor consists of a three-axis microelectromechanical system (MEMS) accelerometer, a gyroscope, and geomagnetic sensors. The sensor data are transmitted wirelessly to a PC, where the orientation and position of the subject are tracked. The proposed system consists of a motion tracker and rehabilitation content. The motion tracker consists of two inertial measurement units (IMU) attached to segments of the subjects upper limb and a motion-tracking algorithm running on a PC. The IMUs are connected with a proprietary distributed sensor network. One IMU collects the sensor data of the other IMU and transmits both sensor data packets wirelessly to the PC. The motiontracking algorithm on the PC receives the data packets, estimates the orientations of the IMSs from the sensor data, and finally calculates the segment positions of the subject along with the estimated orientation and segmental length. The rehabilitation content, which also runs on the PC, provides the trajectory of the upper limb using a graphic library and evaluates the subjects real trajectory. Each IMU (17.8mm, 13.0 mm) is composed of a microcontrol unit (MCU), microelectromechanical system (MEMS) inertial sensors, and a Bluetooth communication module (Figure 2(a)). A three-axis accelerometer/magnetometer (LSM303DLHM, STMicroelectronics) and a three axis gyroscope (L3GD20, STMicroelectronics) were used as the inertial sensors. The gyroscope was set to a full scale

of 500/s and a sampling rate of 100Hz. The MCU (STM32F103C8, STMicroelectronics) reads the sensors using inter integrated circuit (I2C) communication. The master and slave IMUs were attached to the upper arm and forearm of the subject, respectively. The communication between the master and slave IMUs was conducted using a distributed sensor network implemented based on another I2C communication. The I2C master and slave protocols were programmed in the master and slave IMUs, respectively. The MCU in the master IMU reads the sensor data of the slave IMU through I2C communication and sends the master and slave data packets using a Bluetooth module to the PC. To quantitatively differentiate the evaluations, the proposed system was tested on both a group of healthy subjects and a group of subjects with a simulated elbow stiffness achieved by taping the elbow.

Limitations: Limitations of MEMS in Virtual Reality systems and Robotics: 1. Plant establishment requires huge investment 2. Micro components are costlier than macro components. 3. Design includes very complex procedures 4. Prior knowledge is needed to integrate MEMS devices. Therefore these challenges and technological obstacles associated with miniaturization need to be addressed and overcome before MEMS can realize its overwhelming potential in virtual reality systems.

Discussion:
One major problem that occurs in all studies related to rehabilitation therapy is that so much is depending on the choice of patients participating in the study. It is not possible to

have a totally objective view, since patients who are believed to be suffering from the same disease or disability still may show very different results in a study. All people are different, in a physiological way so that what is normal in one person may be an abnormality in another. Some patients are really eager to try all kinds of new rehabilitation and assistive aids and put in great effort in making them work, whereas some other are depressed about their condition and feel that nothing can help them. Patients who have recently turned ill are generally more hopeful about their recovery and willing to do all they can in order to speed up the rehabilitation. If the rehabilitation is not very successful their enthusiasm normally drops. Thus it is necessary to consider many aspects apart from the purely technical when planning such studies and choosing the patient group. When studies are based on results from human beings the experimenter needs to be a bit of an amateur psychologist as well. People who are facing problems with their health every day often need encouragement to try new assisting devices and yet the researcher needs to keep a neutral attitude towards the results. Another problem is when there are cases where the combination of technology and medicine can be difficult. A device is constructed based on the condition in healthy people but meant to work for people with some kind of illness. The illness in question may have made the patients loose some ability that were crucial for the function of the device. Thus every device will require some sort of customisation to make it compatible to every patient. The third area of consideration is the cost of the proposed systems and devices. Huge advancements in technology may not always go hand in hand with the accessibility of these therapy aids for the common people. Even while creating new technologies, it is important to keep in mind the cost of the device and implementation difficulties that may arise to make the device accessible.

Perspective : The future perspectives on this technology focuses on new and fascinating technologies that could redefine the way rehabilitation therapy is being done today. Here are some of the few new age technologies in the research field. Movable adaptable microelectrodes: Implantable microelectrodes that are currently used to monitor neuronal activity in the brain in vivo have serious limitations both in acute and chronic experiments. Movable microelectrodes that adapt their position in the brain to maximize the quality of neuronal recording have been suggested and tried as a potential solution to overcome the challenges with the current fixed implantable microelectrodes. While the results so far suggest that movable microelectrodes improve the quality and stability of neuronal recordings from the brain in vivo, the bulky nature of the technologies involved in making these movable microelectrodes limits the throughput (number of neurons that can be recorded from at any given time) of these implantable devices. Emerging technologies involving the use of microscale motors and electrodes promise to overcome this limitation. Advantages:Technologies that enable us to move the microelectrodes after implantation promise to dramatically enhance our ability to (a) isolate activity from single neurons and maintain stable neuronal recordings over longer durations and also to carefully and unambiguously monitor changes in small population of single neurons undergoing neuronal

plasticity, for instance (b) enhance and maintain the signal-to-noise ratio in the neuronal recordings (c) seek neurons of interest after implantation and probe neuronal tracts and connectivity (d) overcome the inherent bias in the neuronal recordings toward the more active neurons. Movable microelectrodes now give us the opportunity to seek other neurons that might have been silent during the time of implantation. (e) Potentially enhance the reliability of prosthetic devices in applications that require neuronal recordings over the life-time of the patient. Movable microelectrode technology appears to be particularly suited to recording from neurons in banks of sulci where the neurons are located at multiple different depths along the banks of sulci. The reason for expecting movable microelectrodes to offer advantages (a)(d) is quite intuitive and some of the above capabilities have already been demonstrated. Microelectrodes have to be typically positioned within tens or hundreds of microns (depending on the type and orientation of the neuron) from a neuronal cell body to record its action potentials. Therefore, any ability to fine-tune the geographical position of the microelectrode after implantation will allow us to potentially maintain the microelectrodes within the recording radius of a neuron over a reasonable length of time. Microscale electro-mechanical systems (MEMS) offers an attractive array of technologies (includ-ing micromotors or microactuators) to realize a movable microelectrode array system that is high- density, light-weight, and small in size. Besides, MEMS based microfabrication technologies provide other significant advantages such as (a) a batch fabrication approach (b) reliable intercon-nects and (c) possibilities for seamless integration of other functional modules such as on-board signal conditioning (amplification, filtering, etc.), control and telemetry modules. Current movable microelectrode technologies are typically large which hinders the development of large arrays of movable microelectrodes to sample ensembles of neurons. MEMS based technologies outlined here potentially fill the need for movable microelectrode systems that can record from large ensembles of neurons with high yield, stability, and reliability with overall form factors that do not hinder behavior in awake animals and patients. Within the MEMS approaches available, the electrothermal actuation approach offers significant advantages over an electrostatic actuation approach and is therefore recommended for future work. The key knowledge gaps that hinder us from realizing movable microelectrode systems that can record from large numbers of neurons in long-term experiments or over the life-time of a patient are (a) response of the brain tissue surrounding the microelectrode and (b) relative micromotion between the implanted microelectrode and brain tissue surrounding and how these two factors impact neuronal recording in acute and chronic experiments. Further development of moveable microelectrode systems and the optimal control algorithms to move the microelectrodes to achieve the goal of neuronal recordings in chronic experiments or over the life-time of the patient will be guided by new knowledge in the above two areas. Customised gaming system: In one of the papers Supporting Therapists In Motion-Based Gaming For Brain Injury Rehabilitation published in 2013, they have described a work-in-progress that involves therapists who use commercial motion-based video games (e.g. Wii) in therapies involving patients who have had a brain injury (BI). We are collecting data to inform a case-based recommender (CBR) system that will help therapists stay current and choose appropriate motion-games for their patients. Data from the CBR system will (1) establish commercial motiongame efficacy among a larger and more diverse BI patient population than in previous work and (2) inform custom games that better meet needs for BI therapies. Despite their obvious potential, commercial motiongames have limitations for use in BI therapies. We and

the other researchers have found that commercially available motion-games are often too fast, too physically/cognitively challenging, and are designed for a learning curve that is inappropriate for many who have had a BI .Researchers have addressed these limitations by creating custom games for non-commercial consoles, including games with adjustable parameters. We plan to use (and share) the CBR system data (e.g., effective core game mechanics) to inform the design of adjustable mini motion-games to support BI therapies; we plan to target commercial consoles to address scalability. In conclusion, this work contributes to research concerned with therapeutic motion-games. The CBR system will (1) establish commercial motion-game efficacy among a larger and more diverse BI patient population than in previous work and (2) inform custom games that better meet BI therapy needs. The system will also help therapists choose/share information about games and stay up to date with the rapid proliferation of new games. This approach acknowledges that because of their availability (despite limitations) commercial games will continue to play an important role in BI therapies. Ultimately, we hope this work helps people recover faster/better from BI. Conclusion: The above report thus summarises the various technologies involved in rehabilitative therapy. These new rehabilitative techniques, which involve virtual reality systems and robotics, depend on neuroplasticity playing an important role in faster recovery of the patient. There are many diverging research areas which may contribute directly or indirectly to improving rehabilitative therapy techniques. To sum it up, the present status is that there is a wide opportunity for the use of virtual reality systems in the medical field. The only disadvantage is the lack of objective results in the studies which needs to be considered for future research.

References: 1.Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation Mnica S Cameiro1, Sergi Bermdez i Badia1, Esther Duarte Oller2, Paul FMJ Verschure1,3* 2. Development and Functional Evaluation of an Upper Extremity Rehabilitation System Based on Inertial Sensors and Virtual Reality Je-Nam Kim,1 Mun-Ho Ryu,2,3 Ho-Rim Choi,1 Yoon-Seok Yang,2,3 andTae-Koon Kim4 3. Virtual Reality-Enhanced Stroke Rehabilitation David Jack( Member IEEE), Rares Boian( Student Member, IEEE), Alma S. Merians, Marilyn Tremaine, Grigore C. Burdea (Senior Member IEEE),Sergei V. Adamovich, Michael Recce, and Howard Poizner 4.Supporting Therapists In Motion-Based Gaming For Brain Injury Rehabilitation Cynthia Putnam ,Jinghui Cheng ,Doris Rusch ,Andr Berthiaume ,Robin Burke 5. Development and Functional Evaluation of an Upper Extremity Rehabilitation System Based on Inertial Sensors and Virtual Reality Je-Nam Kim,1 Mun-Ho Ryu,2,3 Ho-Rim Choi,1 Yoon-Seok Yang,2,3 and Tae-Koon Kim4

6.Adaptive movable neural interfaces for monitoring single neurons in the brain Jit Muthuswamy*, Sindhu Anand and Arati Sridharan School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA 7. Pneumatic robotic systems for upper limb rehabilitation Ricardo Morales, Francisco Javier Badesa , Nicolas Garca-Aracil, Jose Mara Sabater, Carlos Perez-Vidal 8. Neuroscience goes on a chip Aung K. Soea,, Saeid Nahavandia, Khashayar Khoshmaneshb a Centre for Intelligent Systems Research, Deakin University, Australia b School of Electrical and Computer Engineering, RMIT University, Australia 9. Perception-Inspired Haptic Force Sensor A Concept Study Christian Hatzfeld*, Sebastian Kassner, Thorsten Mei, Holger Minger, Carsten Neupert, Peter P. Pott, Jacqueline Rausch, Tim Rossner, Matthias Staab, and Roland Werthschtzkya Institute of Electromechanical Design, Technische Universitt Darmstadt, Merckstr. 25, 64283 Darmstadt, Germany 10. Sensory-motor enhancement in a virtual therapeutic environment Richard A. Foulds David M. Saxe Arthur W. Joyce III Sergei Adamovich 11. Development of Fingertip Tactile Sensing Chips for Humanoid Robots Ravinder S. Dahiya1,2, G. Metta1,2, M. VaIle2 lRobotics, Brain and Cognitive Sciences Department, Italian Institute of Technology, Genoa, Italy, 16163 2University of Genoa, Genoa, Italy, 16145 12. A Microassembly System for the Flexible Assembly of Hybrid Robotic MEMS Devices Martin Probst, Christoph Hrzeler, Ruedi Borer, and Bradley J. Nelson Institute of Robotics and Intelligent Systems, Zurich, Switzerland