**6. Implementation of neurofeedback in VR**

Optimization of training and an increase in its effectiveness arises with the meaningfulness of the exercises performed and their optimal complication [58]. As a rule, only one repetition for training is not enough, since the formation of a motor skill occurs because of multiple repetitions with their use in solving real physical motion problems [68, 69]. For this, it is necessary to achieve an optimal combination of cognitive efforts required by the patient to solve motor problems during repetition of movements, and the complexity of the rehabilitation task.

The use of neuro-feedback contributes to an increase in the activation of structures that are usually not involved in the implementation of the performed movement in the norm. For example, in experiments on healthy subjects, it was demonstrated that the addition of neuro-feedback when performing a movement in VR leads to a more significant activation of the contrateral sensorimotor cortex according to the motor evoked potential [40]. In studies conducted in patients with hemiplegic infantile cerebral palsy, VR rehabilitation has demonstrated bilateral activation of the sensorimotor cortex and ipsilateral activation of the premotor cortex. After the completion of rehabilitation, bilateral activation disappeared, and the contralateral sensorimotor cortex continued to maintain a high level of activity [70].

Increasing the efficiency of neuro-feedback through the use of sensory channels is the most promising way to increase the possibility of motor learning using VR and ensure sufficient cognitive immersion in the VR environment.

The effectiveness of neuro-feedback can be assessed by such a parameter as productivity, which characterizes the quality of the movement performed by a person. The neural feedback obtained directly in the process of performing a rehabilitation exercise to restore motor function, after the completed rehabilitation task, can act as a criterion for evaluating the effectiveness. Some studies demonstrate that the enhancement of neurofeedback has an additional value in increasing the

**141**

*Proprioception in Immersive Virtual Reality DOI: http://dx.doi.org/10.5772/intechopen.96316*

principle unable to perform (such as walking or running).

of the frontal and parietal lobes of the cerebral cortex.

cognitive and emotional-volitional disorders.

which will contribute to solving most tasks.

**7. Additional prospects for using VR**

These effects make it possible to neutralize sensory deprivation, which is observed in a patient after a pathological condition has arisen with gross damage to the CNS and manifests itself in pronounced motor disorders. Such patients are usually bedridden or wheelchair-bound and do not receive in full all those sensory sensations that a person experiences while freely moving in the physical world without physical limitations. Long-term sensory deprivation ultimately leads to neurotransmitter rearrangements, the clinical manifestation of which may be not only difficulty in restoring stato-locomotor function, but also the development of

Thus, rehabilitation measures, which are based on the activation of neuroplastic processes in the CNS after its damage, can be sufficiently fully modeled in an immersive environment, and multisensory neuro-feedback allows us to model the process of interaction with the VR environment as realistic and efficient as possible,

Also, it should be noted that the concept of motor learning forms the basis for the scientific substantiation of the integration of vocational training into rehabilitation practice, which will expand the possibilities of social adaptation of patients with a disabling disease, will contribute to their subsequent professional integration through training in professional activities, taking into account the existing motor or

effectiveness of motor rehabilitation in patients after acute cerebrovascular accident [71]. At the same time, the direct implementation of neuro-feedback in the process of performing the rehabilitation task will be more promising, because on the basis of this approach, it is possible not only to visualize the performed movement and its quality, but also to carry out additional motivation of the patient by, for example, completing the construction of the full range of motion with a pronounced motor deficit in paralyzed limbs, or visualizing such a movement, which is the patient's in

Perhaps, in some cases, this will cause a certain dissonance between real proprioceptive sensations and visual information provided to the rehabilitated person. However, in the end it will be perceived by the subject only from the positive side, since will allow him to demonstrate his independence and the ability to perform all the same actions without taking into account the existing disabling state. Such additional motivation will lead to the fact that the person being rehabilitated will be more motivationally involved in the process of restoring motor function, which will lead to better results in restoring motor function both in the short and long term. As a complement to neuro-feedback, mainly implemented through the visual analyzer, VR provides the ability to use auditory and proprioceptive feedback, which are intuitively interpreted and implemented in real time, but with increased accuracy and consistency compared to the stimuli available in the physical world [4, 72]. The use of this technology as a supplement to visual information in an immersive environment through the activation of additional sensory systems also makes it possible to increase the degree of cognitive and emotional immersion in the VR environment and the task performed in it. This is especially in demand in patients with a certain damage to one or another sensory system at a different level from the peripheral part of the sensory analyzer to the cortical representation. It does not matter whether this damage arose because of a real disease, was acquired by the patient earlier, or was congenital. Thus, it is possible to achieve a more complete sensory saturation and get the maximum effect on the motor and premotor regions

#### *Proprioception in Immersive Virtual Reality DOI: http://dx.doi.org/10.5772/intechopen.96316*

*Proprioception*

the patient's movement disorders.

driving a car, etc. [67].

well as when using neuro-feedback [57, 66].

**6. Implementation of neurofeedback in VR**

The flexibility of most VR applications suggests that learning in a meaningful, enriched environment can be started earlier in recovery from an emerging CNS disease, such as a traumatic brain injury, compared to conventional exercise. An early start increases the rehabilitation potential by influencing neuroplastic processes and ensuring the activation of latent connections and cortical structures, which is also necessary to prevent the onset and progression of functional maladaptive processes. The same statement is relevant for patients with acute cerebrovascular accident, where verticalization in the first days after a stroke is limited due to pronounced concomitant pathology, which is usually the cause of the stroke, or the severity of

The possibility of automating the rehabilitation process in VR makes training more accessible for patients, and in the future can be used in telemedicine [65]. The hypothesis underlying the substantiation of the effectiveness of motor rehabilitation says that the success of motor learning occurs only at the moment of the maximum approximation of the rehabilitation exercise to real motor skills, which the rehabilitated person will use in the future in the real physical world, as

In addition to using a simulated VR environment to restore basic movements or simple functions necessary to perform everyday household tasks, VR can become a training platform for developing patients' skills in using various means of individual rehabilitation, for example, for teaching the use of a motorized wheelchair or

Optimization of training and an increase in its effectiveness arises with the meaningfulness of the exercises performed and their optimal complication [58]. As a rule, only one repetition for training is not enough, since the formation of a motor skill occurs because of multiple repetitions with their use in solving real physical motion problems [68, 69]. For this, it is necessary to achieve an optimal combination of cognitive efforts required by the patient to solve motor problems during

repetition of movements, and the complexity of the rehabilitation task.

and ensure sufficient cognitive immersion in the VR environment.

The use of neuro-feedback contributes to an increase in the activation of structures that are usually not involved in the implementation of the performed movement in the norm. For example, in experiments on healthy subjects, it was demonstrated that the addition of neuro-feedback when performing a movement in VR leads to a more significant activation of the contrateral sensorimotor cortex according to the motor evoked potential [40]. In studies conducted in patients with hemiplegic infantile cerebral palsy, VR rehabilitation has demonstrated bilateral activation of the sensorimotor cortex and ipsilateral activation of the premotor cortex. After the completion of rehabilitation, bilateral activation disappeared, and the contralateral sensorimotor cortex continued to maintain a high level of

Increasing the efficiency of neuro-feedback through the use of sensory channels is the most promising way to increase the possibility of motor learning using VR

The effectiveness of neuro-feedback can be assessed by such a parameter as productivity, which characterizes the quality of the movement performed by a person. The neural feedback obtained directly in the process of performing a rehabilitation exercise to restore motor function, after the completed rehabilitation task, can act as a criterion for evaluating the effectiveness. Some studies demonstrate that the enhancement of neurofeedback has an additional value in increasing the

**140**

activity [70].

effectiveness of motor rehabilitation in patients after acute cerebrovascular accident [71]. At the same time, the direct implementation of neuro-feedback in the process of performing the rehabilitation task will be more promising, because on the basis of this approach, it is possible not only to visualize the performed movement and its quality, but also to carry out additional motivation of the patient by, for example, completing the construction of the full range of motion with a pronounced motor deficit in paralyzed limbs, or visualizing such a movement, which is the patient's in principle unable to perform (such as walking or running).

Perhaps, in some cases, this will cause a certain dissonance between real proprioceptive sensations and visual information provided to the rehabilitated person. However, in the end it will be perceived by the subject only from the positive side, since will allow him to demonstrate his independence and the ability to perform all the same actions without taking into account the existing disabling state. Such additional motivation will lead to the fact that the person being rehabilitated will be more motivationally involved in the process of restoring motor function, which will lead to better results in restoring motor function both in the short and long term.

As a complement to neuro-feedback, mainly implemented through the visual analyzer, VR provides the ability to use auditory and proprioceptive feedback, which are intuitively interpreted and implemented in real time, but with increased accuracy and consistency compared to the stimuli available in the physical world [4, 72].

The use of this technology as a supplement to visual information in an immersive environment through the activation of additional sensory systems also makes it possible to increase the degree of cognitive and emotional immersion in the VR environment and the task performed in it. This is especially in demand in patients with a certain damage to one or another sensory system at a different level from the peripheral part of the sensory analyzer to the cortical representation. It does not matter whether this damage arose because of a real disease, was acquired by the patient earlier, or was congenital. Thus, it is possible to achieve a more complete sensory saturation and get the maximum effect on the motor and premotor regions of the frontal and parietal lobes of the cerebral cortex.

These effects make it possible to neutralize sensory deprivation, which is observed in a patient after a pathological condition has arisen with gross damage to the CNS and manifests itself in pronounced motor disorders. Such patients are usually bedridden or wheelchair-bound and do not receive in full all those sensory sensations that a person experiences while freely moving in the physical world without physical limitations. Long-term sensory deprivation ultimately leads to neurotransmitter rearrangements, the clinical manifestation of which may be not only difficulty in restoring stato-locomotor function, but also the development of cognitive and emotional-volitional disorders.

Thus, rehabilitation measures, which are based on the activation of neuroplastic processes in the CNS after its damage, can be sufficiently fully modeled in an immersive environment, and multisensory neuro-feedback allows us to model the process of interaction with the VR environment as realistic and efficient as possible, which will contribute to solving most tasks.
