The benefits of using Virtual Reality in rehabilitation
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Currently, he is an Associate Professor at Physics Department, Kasetsart University, Thailand. He is a specialist in the development of smart sensors and intelligent systems for food, agricultural and environmental applications. He has received over twenty-eight research awards such as TRF–OHEC–SCOPUS Young Researcher Award in physical science, Invention Award from National Research Council of Thailand, Highest Citation Award for the young researcher, etc. He has served as a reviewer, guest editor, and associate editor for several scientific journals. He is Top 2% World Ranking of Scientists in Electrical & Electronic Engineering in 2020 and 2021 ranked by the Stanford University researcher team. He has published several dozens of articles in reputed journals, proceedings, book chapters, patents, and copyrights. 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That is the most common cause of physical disability in the early childhood period and a serious disorder also affecting the family, and the child’s education and social life [3]. Recent researches, finding an accepted international definition of CP have been somewhat a challenge, but the proposed prevailing international definition [3-5]. In the last decade, the International Classification of Functioning, Disability and Health “ICF” developed by The World Health Organization constituted a new defining to understand CP and to think about intervention possibilities for clinicians, researchers as well as families [6, 7].
ICF is the transition from an “outcome of disease” classification to a “components of health” classification. This system, which aims to develop a common language and framework among health professionals considering above-mentioned multidisciplinary approach and communication, has rapidly become a focus worldwide. ICF is a system that classifies health and health-related fields. These fields are divided into two parts as the body, and the individual and social perspective: “body functions” and “body structures” form the first group, and the “activity and participation” field forms the second group. In recent literature, assessment tools, intervention techniques and researches outcomes are investigated in according to the dimensions (ICF): body function (e.g. physiological, psychological); structures (e.g. anatomical); activities (tasks); and participation (life roles). Thus, this “bio psychosocial” model of disability encourages a more holistic approach to rehabilitation (Figure I) [6]. “ICF Classification” for children with CP is a beneficial system that can be used in the formulation of problems in different areas, to build a bridge between professionals themselves and with the family. ICF can help the child\'s physiotherapist in deciding about the process and in determining special functional objectives [4]. ICF-CY (Child and Youth version: ICF-CY) is the updated version that specially attended to aspects of learning, behavior and development for use in children and adolescents from 2007 [8].
ICF bio psychosocial model
When viewed from ICF aspect, CP affect on a child’s “functioning” (including of body structures [e.g. limbs, eyes], body functions [e.g. sensory, neuromusculoskeletal and mental functions], activities [e.g. walking, writing, learning] and participation [e.g. playing sport, going to concert] and besides that personal [e.g. motivation, anxiety, toleration, age, gender] and environmental factors [e.g. architectural accessibility, policies, physical accessibility of cultural, athletic or recreational centers] influence independence of CP children in their daily life and leisure activities. Moreover, CP may cause “disabilities”, such as impairment, activity limitations and participation restrictions [9, 10]. Beckung et al. have investigated activity limitations and participation restrictions with gross and fine motor functions under the mobility, education and social relationship sub-headings proposed by ICF in children with CP. They indicated that effect of a child’s impairment or activity limitation on participation might vary depending on environmental factors [11].
At first, most clinicians and researchers thought that CP is primarily a movement disorder but recently it is an umbrella term used to define a group of permanent conditions, indicating that there is heterogeneity in these conditions such as visual, cognition, perceptual and/or behavior, sensation problems and learning disabilities [12]. Neural disorders such as spasticity, co activation of agonist-antagonist muscles, muscle weakness, lack of selective motor control and restriction of normal joint movement and knee pain affect gross and fine motor functions in CP [9]. Many children with CP may never attain the abilities of their peers who are typically developing or lose some of them with growing [13]. There are many potential problems children with CP and these influence complexity of therapy planning and execution.
In CP treatment, the rehabilitation modalities are considerably wide including conventional interventions and new rehabilitation techniques. Medical and surgical approaches, physiotherapy, ergotherapy, speech therapy, orthoses and other supportive devices, recreational activities, school and education adaptation and psychological support can be considered in these modalities. The main aims of the rehabilitation in CP are to help the child achieve the highest possible physical, cognitive, psychological and social independence level within his/her physiological and anatomical deficiencies and environmental limitation, to reduce the effects of physical disorder to minimum, to improve the independence in daily life activities and social life, to increase the life quality of the child and thus support the quality of parents and siblings life [14].
Physiotherapy modalities in CP aim not only to improve the movement ability of the child, but also to reach normal level in all development stages. Rehabilitation in the children with CP depends on the clinical type, accompanying disorders, chronological age and the socio-economic factors. Especially visual, hearing, cognitive disorders, attacks, learning disorder, emotional state problems are among the problems that affect the success of the rehabilitation [15]. Thus, a multidisciplinary team is required in the treatment of these heterogeneous groups of problems. This team must include specialist physicians (pediatricians, pediatric neurologist, orthopedist, neurosurgeon, neonatologist, child psychiatrist, dentist and all related physicians), physiotherapist, ergotherapist, psychologist, child development specialist, dietitian, social service expert and caregivers for the child.
The children with CP are referred routinely to physiotherapy in the very early ages. But the main question is whether there is a scientific evidence to confirm the use of physiotherapy so often. Recently the most debated subject is if the treatment modalities performed in CP have an effect on the neurological process. The studies and clinical literature about the effects and density of the treatment are still unclear with lack of evidence and discussions on the field are predicted to continue in the future. Over the past 20 years, the early interventions for the children with disabilities have focused on evidence-based practice including the child and family centered approach. Therefore the examination of the efficiency of these applications is of great importance for clinicians and researchers [16]. It is accepted that physiotherapy applications play an important role in the CP rehabilitation, but which method, how much intensity and how long should be applied? These questions cannot be answered easily. The most criticism of denominated therapy modalities is that the lack of scientific baseline and evidence of activity. The evidences that support any efficiency of modality or that indicate the superiority of any other modality, are limited, and physiotherapists have been increasingly searching to evidence- based applications. To evaluate the efficiency of the therapy modality, which is performed for any motor problem or physical deficiency, is difficult due to several reasons. The main reason is the absence of standardized specific treatment. In other words there is no dosage application under the specific, stable procedures in many cases. Researches regarding interventions in CP indicate that 30%-40% of interventions have no reported evidence-based, other 20% of interventions informed ineffective, unnecessary or harmful. The current review is showed botulinum toxin (BoNT), selective dorsal rhizotomy, casting, constraint-induced movement therapy, bimanual training, context-focused therapy, goal-directed treatment, and occupational therapy following BoNT are effective interventions for body structures and functions level or the activity levels on the ICF but unfortunately, there were no evidence-based effective interventions for improving participation, environment or personal factors levels of the ICF. A high incidence of CP intervention studies, approximately 70% are low level evidence-based and required to increase their research quality to prove effectiveness of treatment. These modalities are assistive technologies, animal assisted therapy, strengthening, hippotherapy, hydrotherapy, early intervention, cognitive behavior therapy, communication training, orthoses, oral-motor therapy, play therapy, stretching, treadmill training and parent training. In addition, ineffective interventions are determined neurodevelopmental therapy (NDT), craniosacral therapy, hyperbaric oxygen, hip bracing and sensory integration [10]. There is a contradiction for NDT that is commonly used interventions all over the world. Todays’ Bobath therapists focus on motor learning principles, family-centered practice, orthoses, BoNT, assistive devices, functional training, constraint movement treatment, strengthening and bimanual treatment within right body alignment and aim to improve posture. NDT may influence functional motor gains (low-evidence) but there are great requirement rigorous future researches to demonstrate effectiveness of NDT.
Also, physiotherapist focuses on the functional movement and gross motor skills in the treatment of motor disorder of the child with CP. Positioning, sitting, gait with or without orthoses, the use of wheelchair, transfers are some of the areas on which the physiotherapist work. Physiotherapist plans the physiotherapy and home programs, provides the school arrangements, and makes decision about orthoses and supportive devices. Physiotherapists teach the families how to feed, bath, cloth and hold their children during daily living activities; and also give advices about assistive devices [17]. Thus, the physiotherapists aim to maximize the child’s performance by focusing the needs of the child [16].
The frequency of physiotherapy is not definitive, but some families and professionals think that physiotherapy is more useful when its frequency is increased. Recently, physiotherapist focus to solve the needs of the family and child and decide which therapy and frequency should be applied to the child [16]. Dosage or duration of treatment can be arranged coherently, but the procedures are based on the skill levels and specific aims of physiotherapists, therefore they can be varied. Even if the arrangements of treatment can be standardized (a condition of the treatment), the family of the child can never be standardized (another condition of treatment). All problems that accompany a research included low incidence and high heterogeneous condition, become complex with the process of growth and maturation.
All in all for the physiotherapists it is important to separate the evidence-based applications and clinical applications [10]. Therapists try to find a balance between the attractive and effective activities in the treatment process of children with CP [18]. CP is a heterogeneous group, so more general principles are used for treatment and rehabilitation [19]. During the last 10 years, popularity of performance based or “top-down” approaches based on motor learning theory in which interventions focus directly specific task training in activities of interest and are not concerned with underlying impairments body structures and function, are gradually increasing such as goal directed therapy, constraint induced movement therapy [10]. While technologies come into our life, physiotherapy approaches changed and developed. Treatment of motor impairments with new complementary technologies such as robot-assisted therapy, locomotor therapy or computer based rehabilitation systems would improve motor development in children with CP, especially intense growth and adolescent period also after the multilevel surgical intervention, that effect muscle strength and body alignment. The success of the rehabilitation process depends on several factors: the intensity of therapy, repetition, and goal-directed or task-oriented therapy program are considered essential in achieving motor outcomes. During the past decades new technologies have been developed to improve sensory motor learning in children with CP. Motivation and active participation of children in intervention program play a fundamental role in the sensory-motor learning process and these are the key factors of successful outcomes [20]. Over the last three decades, there has been an increase in the number of individuals engaging in interactive computer plays [21]. Therefore, current studies focus on Virtual Reality (VR). VR as an intervention for sensory motor rehabilitation is promising tool in order to improve lower and upper limb function and also postural control in children with CP.
Virtual reality is a technology that provides a sense of presence in a real environment with the help of 3D pictures and animations formed in a computer environment and enable the person to interact with the objects in that environment. In other words, VR described as an improved form of human-computer interaction that allows the user to be part of and interact with a computer-generated environment [22]. A virtual environment (VE) is created by various computer technologies. The key specialty that separates VE from other forms of visual imaging, like video games or television, is real-time interaction. However, the interaction can be achieved in various ways. VE shows virtual or artificially produced sensory information, and allows the user to feel experiences similar to the events and activities in real life [23]. Interactive simulations that enable the participant to create an interaction between body movements and 3D area are therefore constituted [24]. The person sees and feels objects and events similar to those in the real world, can manipulate and move the virtual objects, and can do other things in the virtual environment he/she is in. Thus, "an imaginary presence feeling" occurs in the virtual world. In short, VR is the rebuilding of reality [25]. Some studies named these systems “Interactive computer play-ICP” is defined as any kind of any computer game or VR technology where the individual can interact and play with virtual objects in a computer generated environment. Fehlings et al indicated that there is a significant similarity between terms ICP and VR [26].
The use of VR applications started in the 1950s with a theatre machine called Sensorama. This machine, developed by the cinematographer Morton Heilig, was constructed to address all senses. Sensorama combined projected film, audio, vibration, wind, and odors, all to make the user feel as if they were actually being in the film rather than simply watching it. For example, one experience provided was driving a motorbike on the streets of New York. In addition VR was developed by the USA air and airplane industry during the 2nd World War. The Head Mounted Display (HAD) that appeared in 1965 has been a milestone for VR applications. Ivan Sutherland developed (HMDs), which allowed users to be immersed inside a virtual environment with computer-generated scenes. To compare to the technology of 21th century both interface and realism were primitive, and the HMD was so heavy it had to be suspended from the ceiling. The potential of VR was recognized by researchers from many different areas and especially military [27]. The following decades VR is growing rapidly both regarding technological advancements and in areas of implementations. In order to accomplish the feeling of a strong presence, various stimulation modalities are provided to the users (audiovisual feedback). Since then VR has been successfully integrated into several areas of medicine and psychology as for example: training and education in surgical procedures; education of medical students; assessment and treatment of mental health problems including phobias and post-traumatic stress disorders; pain management through distraction; and in motor rehabilitation, where examples of explored areas are upper limb rehabilitation in persons with acquired brain injury; fall risk reduction in Parkinson’s disease, particularly stroke rehabilitation and in pediatric rehabilitation field [28].
VR use in physiotherapy and rehabilitation has increased significantly in the last 6-7 years. Depending on the characteristics of the software used, VR-based therapies provide significant experiences to the user within the targets of the therapy. VR applications became the spark among new treatment modalities used for individuals with CP as computer technology became intriguing and motivating for children and young people and interest on the subject gradually increased. VR provides an opportunity for active learning, encourages the participant, and ensures motivation. It enables performing difficult movements in a secure environment and objectively shows the behaviors that are a result of these motions. An ever-increasing number of studies report that VR implementation in children with CP positively affects brain reorganization, plasticity, motor capacity, visual perceptive skills, social participation and personal factors [29].
VR therapy includes the basic principles of the motor learning theories [19]. It provides this by enabling the user to continuously see the movements in 3D from the computer screen. VR provides repetitive practical and positive feedback in order to increase the functional independence in daily tasks. Holden et al reported the possibility of learning motor abilities in the virtual environment by individuals with a disorder. Movements learned in VE can be transferred to real life with equivalent motor tasks [30]. The first studies on this subject reported that the VR method was usable, a lot of fun but not successful for treatment. However, VR has been shown to provide motor recovery in the upper extremity in adult stroke rehabilitation [31].
According to the motor control and motor learning theories, motivation, repetition, and purposeful and special target-directed training should be used in the treatment of children with CP. The addition of games and social activities during rehabilitation is also important for ensuring the development of the child. A good treatment should enable the therapy to be transferred to daily living activities and tasks. Treatment techniques based on motor learning theories use intensive practice of functional activities and show good results [32].
Active participation instead of passive practice is recommended for motor learning and cortical reorganization. Passive exercises have been shown not to enable maximum improvement in the affected upper extremity in patients with stroke. It is also necessary to provide and strengthen new motor skills, provide functional and duty- focused practices and increase motivation for re-learning and recovery after a stroke. Although motor learning is quite different in children with CP compared to patients with stroke and spinal cord injury, focusing on the activity and task is one of the most important aspects of the treatment in children [19, 33].
One of the major purposes of rehabilitation in child and adult patients is to restore the basic abilities. Recovery after neural damage usually depends on various factors such as the nature and amount of the rehabilitation. Conventional rehabilitation programs are shorter and less intensive to ensure optimal therapeutic results. They cannot adequately increase the motivation of the patient or support activity participation. Many studies have shown that the motivation of patients plays a critical role in treatment results. The virtual environment can also provide more intriguing and competitive conditions, by increasing the motivation of the patient and ensuring active participation, so that less time is used for regaining motor skills [34].
The results of the use of VR as a treatment approach in adults and children are promising. There are many factors lying behind the use of VR in rehabilitation; it provides a variety of environments, and an environment that is similar to the natural one can be designed to test performance and provide independent training. Designed scenarios can be used to train functional behavior in real life and improve functional performance [29]. The "mirror neuron system" is considered to be a mediator for relearning in cases of disturbed cortico-motor function [35]. The mirror neurons activate not only when performing a motor activity but also when observing, imagining, or listening to the same motor activity [7]. There are many important views on the development and structure of the mirror neuron system in children [36]. The development of this system in children supports motor learning and social function in daily life. Cortical reorganization implementations have been developed with mirror neuron system features. The results revealed the usefulness of transferring mirror neuron information to the treatment in the clinic. The premotor cortex has critical importance in motor learning and motor control. This cortex is divided into dorsal and ventral parts. The ventral premotor cortex (PMv), hand area of the primary motor cortex, anterior intraparietal area, and the supplementary motor area are associated with Brodmann 3, 1, 2. The dorsal premotor cortex (PMd) has more projection than PMv with the lateral intraparietal area, primary motor cortex, supplementary motor area, cingulate gyrus and Brodmann 5 [37, 38]. (Figure II). The position of movement towards the target has been coded in PMd cells. PMd neurons are active in the preparation phase of the movement and play a critical role in motor planning. They are responsible for planning and learning the movement and the constitution of the postural responses for the future. The ventral premotor cortex (PMv) is important in the sensorimotor processing of movement and is considered to be associated with the cognitive aspect of target-directed activities. It is a part of the mirror neuron mechanism. Brief pictures for motor movements are coded with two-way activation of PMv mirror neurons during the implementation and observation of the movement. We are therefore able to understand the movements of others in advance. Learning a motor skill is a cognitive and motor process. Motor learning is briefly gaining the movement skills for a complex target with practice. PMd is active during the early phase of motor learning, and is associated with spatial mapping while PMv is critical for motor learning in the sensorimotor transfer of vision-based motions. PMv neurons are involved in monitoring performance and deciding on the choice of motion in practical terms. The mirror neurons inside PMv play an important role in observational and mimic learning [7, 39].
Kantak et al with kind permission “Premotor cortex (PMC) forms a part of the neural network involved in integration of sensory and cognitive information into goal-directed actions. PMC receives sensory information from the parietal cortex (PC), cognitive information from the dorsolateral prefrontal cortex (DLPFC) and supplementary motor cortex (SMA), and projects to the primary motor cortex (M1). In addition, it also has direct projections to the spinal cord via the corticospinal tract. These connections within the neural networks are plastic and are modified in response to injury, learning, and training/therapy [
The mirror neuron mechanism constitutes a physiological basis for motor memory and motor learning. The mirror neurons map the observed target activity in a pictorial and kinematic manner and activate with the mobility recognition mechanism. It is believed that the primary motor cortex is facilitated with VR implementations [7]. In conclusion, activation of the mirror neuron system stimulates cortical reorganization and contributes to functional improvement [38].
The first results in the literature showed that VR was a robust treatment method that was functional, target-directed and motivating [30, 40]. Studies, especially in the field of pediatric rehabilitation, have taken the various aspects into account (such as development of life skills, mobility, cognitive abilities, entertainment, motivation). VR provides specific and intensive treatment for children. However, evidence supporting VR implementation for the rehabilitation of children with neurological disorders is still limited [28, 31].
New technologies like VR play an important role in functional training and performance. VR allows intensive and motivational training. It enables the use of many interactive environments and multiple sensory feedbacks [41]. The use of this technology in disabled individuals ensures communication with others, improves social relations, and increases independence. VR meets important criteria for motor learning and motor control. VR applications also enable the therapist to train the child at home [30]. High levels of motivation, participation, and cooperation are essential components of a game system. These characteristics of the training support behavioral changes and neural plasticity. In conclusion, multi-sensory feedback explains the improvement in learning and performance. VR implementation in children with CP positively affects brain reorganization, plasticity, motor capacity, visual perceptive skills, social participation and personal factors (Table I) [42, 43].
\n | \n
Increases motivation | \n
Demonstrate target-directed functions more realistically | \n
Provide an experience for the child according to his/her own motor learning capacity | \n
Support motor learning | \n
Support cortical reorganization | \n
Provide interactive treatment | \n
The benefits of using Virtual Reality in rehabilitation
The popularity of computer technologies has increased between both children and adults. In addition video games are an important part of leisure activities for the young. Actually, one of every 4 children in the USA now has his/her own video game console at home. In last 10 years, active video game consoles give an opportunity to transform sedentary screen time into a period of physical activity. Examples are Sony PlayStation, Nintendo Wii, etc. [21]. Active video consoles based on VR concept and allow interactive physical activity. Nowadays, the computers systems focus on touch technology that are rapidly improved and become significant part of our personal, social and occupational life. Touch technology is frequently used in most area such as airports, cell phones, tablets due to easy manipulation of touch interface, flexibility and convenience [44]. The numbers of touch screen devices are gradually increased from 665 million in 2011 to 1350 million by 2014 [45]. According to our clinical experience many therapist use these touch technologies and active video consoles in CP rehabilitation to motivate children and take advantage of variable applications. Thus, children and young people with disabled or not are now more familiar with such technologies. They can be used as free-time activity and a socializing method.
VR is used in rehabilitation for the development of an interactive game environment so that the special aims of the treatment can be achieved. The first purpose of VR as a treatment modality is to develop the confidence and adequacy in motor-based and game-based activities that are impossible for the patient to accomplish in the real world [29, 31].
There are several methods where the users are in interaction with virtual reality technologies. The phrase \'interactive computer game\' has been created to understand these differences [23]. An interactive computer game is any kind of computer game using virtual reality where the child can play and interact with virtual objects on the computer or the created environment. There are different types of VR systems that separate according to immersion degree and how the users interact with the system [25].
The virtual environment can be divided into 2 subgroups;
1 Immersion VR; the virtual environment is shown with a screen mounted on the head. Immersion means how much the user feels virtual environment like real. All immersive systems, users wear a head mounted display that brings them into a 3D virtual environment. Movement through VE is controlled by head movement.
2 Desktop VR; the designed images are seen on the computer screen, or on the TV screen together with the voice of an external speaker. The other VR systems the users feel the VE in a 2 dimensional flat screen and they focus on total body movement that controlled a mouse, joystick, keyboard [22].
Tactile feedback can be provided by a feedback glove, and force feedback by providing resistance with the joystick in the virtual environment (VE). Systems connected to the internet (tele-rehabilitation) have the potential to reach out to children who are in distant areas where healthcare services are limited [30]. (Figure III-IV)
Those that were not specially designed for use in rehabilitation
The cost of simple VR game systems like Nintendo Wii is low and they are available in the physiotherapy departments of many third world countries. The use of Nintendo Wii may be beneficial in the rehabilitation process for physiotherapists who work in an area with limited resources [18]. Current virtual reality systems like Interactive Rehabilitation Exercise System (IREX) are expensive and inaccessible for the majority of the population. Therefore, the use of mainstream game consoles for treatment has become popular [46].
VR application with The Rutgers Ankle CP. Copyright Rutgers University Tele-Rehabilitation Institute and Washington University in St. Louis. Reprinted by permission.
The Rutgers Ankle CP: Game starting screens. Copyright Rutgers University Tele-Rehabilitation Institute and Washington University in St. Louis. Reprinted by permission.
These products (Nintendo Wii, Wii sport games, Wii fit) use motion-sensing technology. The technology perceives speed and orientation with the manual remote control. The player mimics the physical movements of games such as baseball and skiing with the remote control. A pressure-sensitive balance board can be used. Physical activities in yoga and similar balance games can be mimicked [47, 48]. Sony Eye-Toy is another video game and used with PlayStation 2. This system contains a small camera and perceives the body of the person and then transfers the appearance to the imaginary system [23]. Dance Dance Revolution (DDR) can be used with Nintendo, PlayStation and Xbox game. It contains a pressure-sensitive mat. It follows dance movements and transfers them to a virtual environment with e-dimensions [47].
Marketed games are not appropriate for patients with "severe spasticity". Pressing on a button in an extremely difficult way or holding the remote control for a long time can be required during the game. The failure of patients to finish the game is due to games being designed for young healthy adults and this decreases self-respect while leading to depression. Games that can automatically adapt to the decreased functions of each patient and that can provide the repetition necessary for neural change are necessary for amusing game-based hand therapy in children with CP who have severe spasticity [49]. Examples are Sony PlayStation 3-supported sensory glove and the Pediatric Intensive Therapy System (PITS); contains a sensory glove and games appropriate for rehabilitation. PITS has been developed for children with upper extremity dysfunction and decreases the dependence of patients, increases self-sufficiency in exercise control and decreases the therapy cost [50]. The Interactive Rehabilitation Exercise System (IREX); uses motion-sensing technology and video capture [46].
Knowing the advantages and disadvantages of the systems is important in determining appropriate virtual reality applications for clinical use and research. Galvin et al gathered and classified the VR systems used in the field of pediatric rehabilitation in a very detailed and explanatory manner for clinicians and academicians in their review. This is valuable explanation for researchers, clinicians, master and doctorate students to support, help and make easier in choosing VR systems according to their target functions (Table II) [47].
\n | \n ||
VR systems focused on whole body movement, upper-lower extremities | \nUpper Extremity | \nPITS | \n
PS3 Glove | \n||
Whole Body | \nEye/Eye Toy | \n|
IREX | \n||
Wii/Wii Fit | \n||
Lower Extremity | \nDDR | \n|
Cognitive–Motor relationship | \nThose with cognitive-motor relationship | \nIREX | \n
PITS | \n||
Those without cognitive motor relationship | \nDDR | \n|
Eye/Eye Toy | \n||
Wii/Wii Fit | \n||
PS3 Glove | \n||
Those with the ability to focus on movement quality | \nIREX | \n|
PITS | \n||
PS3 Glove | \n||
Eye/Eye Toy | \n||
Wii/Wii Fit | \n||
Those without the ability to focus on movement quality | \nDDR | \n|
Those that require the ability to maintain the straight posture of the body | \nStanding independently | \nWii Fit | \n
DDR | \n||
Sitting and others | \nIREX | \n|
PITS | \n||
PS3 Glove | \n||
Eye/Eye Toy | \n||
Wii | \n
Classification of Virtual Reality Systems for Rehabilitation
Galvin and Levac with kind permission [47].
Virtual reality studies are promising for clinical use in pediatric rehabilitation, especially in CP. Parsons et al reported using VR treatment as a rehabilitation approach in children with CP to be more effective than in children with autism and attention deficit [51]. Researches focused on using VR systems in CP interventions, aimed to prove effectiveness of VR on the body structures and functions, activity and participation according to the ICF components. Most of them used applications to reduce impairments of body structures and functions [29]. These researches can be separated subgroups according to their goal as upper extremity, lower extremity, postural control, physical-cardiovascular fitness, and education.
All studies aimed to improve function or quality of movement in upper limbs in order to achieve better performance in daily life activities and increased social participation. Researches about this issue are rapidly increasing and then question that “Does VR applications really improve upper limb function?” came up. Accordingly, Galvin et al reviewed 5 studies that used VR to develop upper extremity skills in children with CP. The findings were reported to be limited due to the inconsistencies in result measurements [52]. Also, Wang et al reported that study designs, result measurements, and therapy intensities were heterogeneous and sampling groups small in their review on VR applications and supported the use of VR for upper extremity training in children with CP [53]. However, for CP treatment, it is difficult to demonstrate changes in quality of movement. For instance, Reid et al treated 4 spastic quadriplegia and diplegia patients between the ages of 8 and 12 years. Treatment was implemented for 1.5 hours per week for 8 weeks. They showed that the BOTMP scores increased but the quality of upper extremity movements did not change [31]. In the other study of Reid et al divided 31 children aged 8-12 years as 19 VR subjects and 12 control subjects in their randomized controlled study. Treatment for 1.5 hours per week for 8 weeks was implemented for the children. Canadian Occupational Performance Measurement (COPM) and Quality of
The goal of studies associated with lower extremity generally is to enhance walking ability or strength. Another current review, Meyer-Heim et al focused on the treatment of motor impairments with new complementary technologies such as robot-assisted and computer-based rehabilitation systems. Previously, robot-assisted gait training (RAGT) was developed for adults and researched demonstrated its functional benefits such as increased gait velocity, improve balance, reduction of muscular hypertonia and gait endurance. RAGT is based on neuroplasticity of central nervous system within spinal cord to stimulate a basic locomotor pattern via central pattern generators [5]. Mutlu et al, declared partial weight bearing treadmill training can improve walking capacity in children with CP via motor learning [58]. Besides that, a pediatric model of the Locomat designed for RAGT of children starting from age 5 years old due to beneficial outcomes in adults [59]. But one of the limitations of conventional locomotor training is that walking on a treadmill prevents optic flow. Optic flow is important for arrange gait speed and stride length during walking, which visual motion sensed by the eyes as the body moves through the environment. For that reason, combination between VE and treadmill training provide the optic flow of forward motion and may improve walking patterns and also increase motivation and immersion. Integrated virtual environment rehabilitation treatment gained visual and proprioceptive feedback that are necessary for gait training. Because movement patterns can be modified using visual, auditory and proprioceptive feedback. In addition, it is essential to match proprioceptive feedback from the limbs [60]. Other limitation is that walking monotonously for 30-45 min during Locomat or treadmill can be boring for children because motivation is essential for rehabilitation process. Thus, some pediatric rehabilitation centers play music during the treatment [57]. For this reason, recent studies focused on combination with VR system and RAGT. Brütsch et al investigated the effect of VR and Locomat and created a virtual football scenario for the patients. The therapy of 10 children with a neurological gait disorder and 8 healthy children was conducted with the Locomat alone, with therapist support, with VR, and with VR and the therapist together. Results were obtained in the posture and swing phase from the knee and hip joints. No difference was found between VR and a therapist in cases with a neurological walking disorder. Walking with any motor support in children, whether healthy or with a neurological disorder, significantly increased motor results compared to walking without any motivational support. In other words, active participation increased with the verbal support of the therapist, with VR, or with the support of VR and the therapist at the same time. The VR and therapist combination was found to be more effective. VR games provide the necessary motivation for gait training in children. These studies showed that electromyography activity output was significantly higher during task with VR and physiotherapist motivation than during normal walking conditions when walking on the Locomat [34] (Figure V).
Examples of Pediatric Locomat virtual reality games. This game has been developed in a close collaboration among the Rehabilitation centre Affoltern, the ETH Zurich and the University of the Arts Zurich. (Color version of the figure is available online.) [
Last 20 years, interventions focused on strength training in CP rehabilitation due to understanding important of muscle weakness. In children with CP, muscle weakness influence negatively daily life activities and social participation and decreased functional capacity [61]. Chen et al identified that cycling is an applicable, effective and easy approach for improving muscle strength and developed home-based virtual cycling training (hVCT) program. They included 27 children with CP with GMFCS levels I-II at age of 6-12 years. Children with CP performed hVCT program 40 min/day 3 times per week for 12 weeks, that consisted of a 5 min warm-up exercise, 20 repetition of sitting to standing movements, cycling 20 min and a cool-down exercise for 5 min. They assessed gross motor function with BOTMP and muscle strength with isokinetic dynamometer. The results showed significant effect on muscle strength at post treatment. The hVCT group had greater peak torque of knee extensor and flexor at 600/s and 1200/s angular velocities than control group. Changing in strength indices of knee extensor and knee flexor at 600/s post treatment were 19-41% in the hVCT group while those were -2 to 1 % in the control group. Also, at 1200/s at post treatment were 30-36% in hVCT group while -6 to -19% in control group. They suggested that these findings might be lead clinicians to improve muscle strength more effectively [62]. Bryanton et al investigated ankle dorsiflexion kinematics in observational studies they conducted on 10 children with CP and 6 healthy children. The difficulty in voluntary muscle contradiction results in weak selective motor control in children with CP. Children with CP completed their selective motor control exercises with the VR exercise system and conventional exercises. Ankle movements were recorded with the electro goniometer. VR has been shown to provide more repetition than conventional exercises. The joint range of motion and duration of holding in a stretched position were found to be higher after VR exercises. They proved VR use increased compliance with exercise and its usefulness [63]. Burdea et al investigated ankle strength, motor control, gait, function and quality of life development in children with CP while playing VR games in their study. Plantar flexion strength of the children increased 0.15 Nm/kg and the quality of life increased by 2.8% according to the Pediatric Quality of Life Inventory (PedsQL). 400 repetitions were performed for each ankle with the Rutgers Ankle CP system in a game session [64]. Therefore, clinicians can be used VR systems to increase lower extremity strength in children with CP.
Postural and balance control is one of the key factors that affect performance of most functional skills such as walking and reaching. When children with CP have poor postural control, they may fall in walking or may not regulate the velocity of the reaching arm or to initial pelvis position. The main reasons of dysfunctional postural control are enhanced antagonistic co-activation, reduced capacity to modulate the degree of postural muscle contraction to the specifics of the situation [65]. In last decade, some interventions focused on impaired postural control and balance in children with CP to improve daily life activities [66]. However, there are few evidence-based studies showed effect of VR intervention on postural muscle activity. One of them is a case report by Deutch et al. which is the first study conducted with Wii. A 13-year-old spastic diplegic child was provided VR treatment with the Wii game console for 4 weeks at 11 sessions of 60-90 minutes. They showed that the visual perception process, postural control and functional mobility had increased. They emphasized that stretching behaviors developed with cortical reorganization in the rehabilitation of the upper extremity movements with VR [48]. In another study, Gordon et al included 6 patients between the ages of 6 and 12 years in treatment with Wii twice a week for 6 weeks. Total Gross Motor Function Measure (GMFM) score changed by 7%. The biggest change was seen in the sitting section (12%). The smallest change was seen in the turning section (2%). Two of them used balance assessments to demonstrate differences in postural control [18]. Sharan et al included 16 children (8 study - 8 control) in treatment 3 days a week for 3 weeks with Nintendo Wii sports in a study where they investigated the effect of VR application after surgery in children with CP. An increase was seen after the treatment with PBS. While VR had an important effect on the development of balance, no difference was shown between the control group regarding manual skills. The investigators proved that Wii-Fit use developed balance in the child and balance training decreased the swing of the children with this study [24]. Additionally, Brien et al investigated the functional balance and mobility of adolescents with CP level I according to Gross Motor Function Classification System (GMFCS) after intensive short-term VR application. Four children with CP between the ages of 13 and 18 were treated for 90 minutes per day for 5 days with IREX. Timed Up and Down Stairs (TUDS), 6-Minute Walk Test (6MWT) and Community Balance and Mobility Scale (CB&M) and GMFM E were evaluated. Functional balance and mobility were shown to develop with short-term, intensive VR implementation. The improvement was found to be significant with CB&M and 6MWT in the follow-up period. The development in CB&M is reported to be associated with the development in coordination, time and speed necessary for ambulatory performance of complex motor skills and especially within the society, and this effect was preserved for at least 1 month. The walking endurance necessary for daily life and social participation was proven to be increased [67]. Walking is also influenced of active control of pelvis and trunk. Balance perturbation responses in healthy individuals are formed with the simultaneous contradiction of the neck, body and hip muscles and are seen even before the activation of muscles. Distortion of proprioception in the core environment (body and pelvis) and decreased strength has been found to be associated especially with increased injury risk to the knee in prospective studies. Good control of core movement is therefore a prerequisite for better use of the legs. The interaction between the body and the pelvis is necessary for good control and performance of daily living activities. This interaction during walking depends on the walking speed. While the pelvis and body interact as when the body is standing in the transverse plane at slow speed, the interaction becomes that seen in the swing phase as the rate increases. The protraction of the pelvis together with the retraction of the body in the swing phase increases the step length of the leg. Thus, the walk productivity improves. One of the primary problems in CP is the decrease in selective motor control. Poor selective motor control of the pelvis and body distorts walking and negatively affects daily living activities VR training leads to decreased combination of body and pelvis and increased selective control. Co-contraction and combination decreases with increase of selective control of the muscles in the body and pelvis region, while selective pelvis control increases and pelvis rotation-body rotation is facilitated. Co-contraction is the simultaneous contraction of the agonist and antagonist muscle and is used to prevent errors and increase stability when unaccustomed tasks are being performed. The co-contraction level decreases with increased practice [68, 69]. Due to these reasons, Barton et al treated a child with spastic CP 2 times a week for 30 minutes, for 6 weeks. The combination of pelvis and body increased after the treatment [70].
Physical activity consists of body movements performed by using the skeletal muscles and results in spending energy. According to ICF, activity is divided into 2 areas as performance and capacity. Physical activity is made up of the activities the individual undertakes in regular daily life. Capacity is how much people can achieve, such as walking distance [6]. Increasing spend time on watching television, playing electronic games and computers, are generally associated with decreased physical activity and obesity [71]. On the other hand, the children and adolescents active video games are considered interesting alternatives to passive games. There is gradually increasing evidence that internet-based applications and active games can increase physical activity in healthy children [72]. Physical activity and fitness is reduced in children with CP than their typically developing peers and also spend most of their time with sedentary activities, facing a screen [73]. Examples are watching television and playing video games. For this reasons the risk factors to develop obesity, osteoporosis, diabetes, CVS disease or musculoskeletal pain are increased. There is new evidence indicating that VR implementation and the use of motion interactive games increases physical activity in children with CP. Mitchell et al investigated the effects of VR application in children with CP on physical activity. VR implementations are more intense than one-to-one training. For example, “move it to improve it- (Mitii)” provides a total of 70 hours of therapy. Therefore, these systems may provide an increase in physical activity. Physical activity capacity increased with Wii Sports and Mitii and physical activity performance increased with Eye-Toy 2. Functional strength also increased with Mitii training. A few intervention studies investigated effects on physical activity in home use and/or long-term use of active video games. These researches reported that active games could improve physical activity in a moderate level and reduce sedentary screen time. Home based interventions have ranged from 10-28 weeks in duration so the effects of long term use of active games are uncertain. Several studies indicated playtime was reduced during the intervention [74].
In recent review, Fehlings et al pointed that effect of VR on cardiovascular fitness (CVI) in children with CP. For active video games, it’s necessary to appropriate physical activity. Active video games have great potential to promote increased physical activity and enhanced CVI fitness for children with CP [26]. Hurkmans et al investigated effects on energy expenditure (EE) among adults with CP when playing Wii sports. Several researches compared EE measured with indirect calorimetry or by an activity monitor during play of different motion interactive video games to EE during other activities of various physical exertions [75]. Generally activity levels compare with metabolic equivalent units (MET). MET is a physiological concept expressing the energy cost of physical activities and is determined as the ratio of metabolic rate during a specific physical activity to a reference rate of the metabolic rate at complete rest. Therefore 1 MET corresponds to the metabolic rate while at complete rest and 2 METs represent a doubling of the energy consumption. A common grading of physical activity according to METs is:
Most of children with CP suffer from several comorbidities in addition to motor handicap such as behavioral, cognitive, and learning disabilities, further impeding their overall functional capacity. Approximately 40 percent of them have learning disabilities and common behavioral symptoms in high-functioning children with cerebral palsy are attention deficits and impulsivity, especially premature birth compatible with the diagnosis of attention-deficit hyperactivity disorder (ADHD). ADHD is one of the major causes of behavioral, friendship and school problems [77]. Pollak et al investigated effects of VR intervention on children with ADHD and produced virtual reality schoolroom environment to motivate children, to support active participation, to evaluate attention and motor behaviors in challenging. Their VR classroom designed according to Rizzo et al Digital Media Works and has head mounted display and gives visual-auditory stimuli with in the VE. In experimental group had 20 boys with ADHD, the control group consisted of 17 boys without ADHD. They assessed with Test of Variables of Attention (TOVA) and virtual reality continuous performance tasks (VR-CPT). According to VR-CPT findings, children with ADHD had slower reaction time, higher variability in RT is more errors of omission and commission than control group. They demonstrated VE provide test and training situations that are ecologically valid, motivating and dynamic. These findings consistent with literature that VR-CPT is a user-friendly method for children with ADHD, autism and intellectual disability [78]. Future researches may focus on VR applications on children with ADHD and CP. Akhutina et al administered VR therapy to the treatment group for 30-60 minutes, 6-8 times for 1 month in a semi-experimental study they conducted with 12 treatment and 9 control subjects. They showed that the visual-spatial abilities developed more in the treatment group. They emphasized that VE-based spatial education was effective in children with complex disabilities [79]. Rosenbaum et al originally reported agency is essential component for our self-consciousness and the ability to control movements and interact appropriately with the environment, also the computer model help to investigate sense of agency in our experiment. Rosenbaum et al investigated that CP children’s ability to correctly perceiving their own movement by training with cognitive process and motor control. The study consisted of 20 CP children in training group and 20 CP children in control group trained for at least 30 min daily in the 20 weeks period using the internet based home training system ‘move it to improve it (Mi Tii)” and CP training group continued their routine daily life activities. Their results proved that children with CP improve their ability to determine whether they themselves or a computer are responsible for the movement of an observed object following 20 weeks of an inter active computer training designed to increased sensory-motor interaction [80].
Children with CP also generally occur pain and this affect to daily life activities, participation in rehabilitation, social life. Pain is also important for children to reduce motivation that induce human action. Distraction is one of the successful methods to reduce pain and behavioral distress for children suffered by pain. Pillay reported that interactive distraction that child attend activity the distraction task continuously require central attention resources much more effective than passive distraction activities that do not necessary management of central attentional functions such as watching cartoons. These interactive distraction activities consist of videogames, interactive musical storybooks, interactive toy robots and educational electronic games that reduce acute pain in children [81]. Law et al aimed to investigate effect of passive and active distraction task. They assessed pain by cold pressure tolerance. Participants separated two groups according to their age (6-9 years and 10-15 years). Because children react distraction differently associated to the age. Researches explained that attentional control improve rapidly during early childhood and develop greatly between 7-9 years and is relatively mature by 12 years. They used Nintendo Wii game system. Law et al found that there was significant improvement in pain tolerance all the interactive and passive distraction. But interactive distraction by increasing attentional load resulted higher improvements in pain tolerance. Their results are supported to the other researches in literature. In addition their findings showed that there were developmental differences on response to interactive distraction. Both of children have benefits on passive and interactive distraction but especially interactive distraction is much better. Also, older children response pain interactive distraction better than younger [82]. Current literature is required to research relationship between pain and VR interventions in CP.
We believe that VR provide new possibilities for the rehabilitation team of CP as the effect of active treatment and motivation together with functional use enable minimizing motor problems although the effect has not been completely shown in studies on VR applications in children with cerebral palsy due to heterogeneity of studies, sample size, outcome measures and etc. In addition to many physical benefits the concept of "cerebral plasticity" are important for independent activity perception, especially for the treatment of motor problems from the perspective of physiotherapists, as well as therapy including play, fun and enjoy from the perspective of the child encourage us to complement the use of the VR systems in the rehabilitation of children.
New bio-product materials have been created to reduce dependency on petroleum commodities, potentially leading to sustainable green products and cleaner manufacturing [1]. Many countries have emphasised the use of bio-based renewable resources because of the rising cost of petroleum commodities, climate change, and the world’s drive toward global sustainability [2]. Furthermore, in order to ensure long-term sustainability, the government has recognised the importance of available natural resources, their proper utilisation, and waste management, which has resulted in the development of better schemes, regulations, and promotions for natural bio-based materials, such as natural fibre composites (NFCs). Furniture, automotive, agriculture, construction, packaging, aerospace, and other industries have recently embraced natural fibre composites to replace conventional materials [3]. NFCs provide a number of advantages over traditional synthetic materials, including being recyclable, abundant, lighter in weight, degradable, and less expensive. NFCs also benefit from being a green product since they are recyclable and degradable in nature, contributing to the goal of environmental sustainability. Green commodities generated from agricultural waste would open the way for new renewable resources while also providing a source of revenue for many developing nations [4]. Plants (lignocellulosic) are natural fibres that may be used as polymer reinforcement, making them an excellent renewable resource. To develop new types of biomaterials that are ecologically friendly [5, 6, 7]. They might also be regarded a wonderful solution for reinforcement from an environmental and economic standpoint. They are more ecologically friendly, lighter, and require less energy, making them more sustainable from a sustainability aspect. Natural fibres are classified according to where they come from in the plant: leaf, fruit, seed fibres, stem fibres, bast fibres, and skin. Natural fibres are in great demand in a variety of sectors, including furniture, automotive, agricultural, construction, packaging, and aerospace, due to their high specific characteristics and cheap cost. Constituent qualities, maximum manufacturing temperature, degradability, orientation, volume fraction, fibre length, and geometry all have a role in the overall features and attributes of a bio-composites product. However, while designing green goods, mechanical and chemical qualities are the only two factors that are taken into account to a higher degree, since there is a correlation between natural fibre’s chemical properties and their equal mechanical performance [8, 9].
Nowadays, lignocellulosic fibres are employed as a stand-alone and primary component of bio-composites. They are utilised separately because their inherent qualities are difficult to alter or modify in comparison to their equivalents, such as polymers, whose properties are readily manipulated. This might explain why natural fibres have less applicability in numerous industries than polymers, which have been widely employed in recent years. Natural fibres in bio-composites, on the other hand, might be useful in supplying alternative materials for green solutions [10].
This study presents a fresh approach to researching natural fibres accessible in India’s Jharkhand area, particularly lignocellulosic fibres, and testing their mechanical and environmental behaviour from a variety of technical perspectives. This would ensure the creation of an ideal database of materials that could be crucial in developing green materials that are both eco-friendly and cost-effective, as well as developing future sustainable materials with broad industrial applications and opening doors for further bio-materials research.
Diverse lignocellulosic wastes have been collected in abundance from several areas in Jharkhand (the north-eastern portion of India). In this work, we measured the physical properties of polymers.
Lignocellulosic fibre interface characteristics and thermogravimetric analyses were explored with the purpose of selecting lignocellulosic fibre.
The preliminary inquiry was carried out in a specified manner in accordance with assessment criteria in order to identify the best suited fibres. The basic selection for the compatibility of the different agricultural waste fibres was made. The availability of resources (fibres), cost estimate, dependable qualities necessary to complete the job (mechanical property), renewal duration, and material density are all included in this assessment criteria [11, 12]. A few species were omitted from further examination because they did not meet the original criterion. Lemons, palms,
Following that, suitable fibre samples were investigated for mechanical and thermal examinations to determine their prospective capabilities. Samples were processed and adaptable in accordance with the test’s requirements. The specimen to be tested for the tensile test, for example, was held at 120 mm in length with a gage length of 50 mm. Their diameter, on the other hand, has fluctuated based on the fibre variations and plant type. As a result, the averaged cross-sectional area estimates are based on the measurements recorded for each of the 10 possible gage length interpretations (for every 5 mm). Tensile strength, Young’s modulus, and elongation obtained before the fracture point were all tested on all of the manufactured samples. Five testing trials were conducted for each fibre material, according to ASTM D 3822/01, and the average value was picked for future analysis. The 3365 Instron (Figure 1) is utilised for the tensile test, with a crosshead speed of 2.0 mm/min.
UTM Instron 3365. (a) Tensile, (b) flexural.
Furthermore, all of the fibres used in the study were from agricultural waste and were tested for thermal properties (Table 1). It was examined to determine the percentage loss of weight characteristics in touch with the combustion and the heating impact of the combustion. The conclusion is that they are environmentally beneficial materials for the manufacturing process.
Polymers | Melt flow rate at 230°C and 2.2 kg load | Yield tensile strength (MPa) | Density (kg/m3) |
---|---|---|---|
Polypropylene (PP) | 12.5 g/10 min | 34 | 906 |
Low-density polyethylene (LDPE) | 0.85 dg/min | 11 | 921 |
High-density polyethylene (HDPE) | 0.7 g/10 min | 30 | 960 |
Polyvinyl chloride (PVC) | — | K value 68 | 569 |
Physical properties of the selected polymers.
Thermogravimetric analysis (TGA) is used to identify changes in physical characteristics and biochemical processes that occur to fibres when the temperature is allowed to rise at the same rate as the temperature, since it is critical to retain information on fibres from agricultural wastes in terms of water loss and decomposition. TGA experiments are carried out with the aid of a NETZSCH TG 209/F1 apparatus (Figure 2). Thermal Stability was measured with several specimens at a heating rate of 10°C/min across the whole temperature range of 31–300°C and 500°C.
NETZSCH TG 209/F1.
The pull-out technique is a useful tool for examining the interfacial characteristics of different polymer fibres. Because the properties of the fibre-matrix interface have a substantial influence on composite materials’ mechanical performance. The interfacial effects of the debonding and pull-out processes may be determined using this approach. The fibre was put into the polymer and a tensile test was conducted in the pull-out inquiry. In this testing method, the polymer and the free tip of the fibre are both gripped and pulled apart. The fibre was removed without causing the polymer to split. This data suggests that the fibre/polymer interface was a failure of adhesive rather than polymer or fibre cohesiveness. The durability and capacity of polymers or fibres were explored in order to build environmentally acceptable materials. For this aim, a pull-out technique is employed to determine the maximum load capacity that can sustain the fibre/polymer [13].
The extrusion procedure was chosen for the preparation of the pull-out sample’s method of hot mixing. For each specimen, 31 cm of rectangles were cut. The sample is constructed such that each fibre is implanted along the rectangle’s centre axis. An optical microscope is used to measure the specimen’s length and diameter. With the aid of a universal testing equipment, the specimen is permitted to act a tensile load (Instron 3365). The load-displacement graph is being recorded, and the crosshead speed is being held at 2.0 mm/min.
Various lignocellulosic fibres have been discovered in the Jharkhand region in this investigation. Environmental waste is a consequence of using green bio-based goods instead of conventional resources. Unfortunately, Jharkhand is not doing enough to make use of its agricultural lignocellulosic waste. The qualities of this fibre and the potential alternative uses of global fibres remain unknown to industrialists. In the creation of biomaterials for green goods, as well as the search for materials that will help in the finding of renewable sources of materials for green products, these fibres will be of use. As a result, developing countries and industrial markets like India and its neighbours will see an increase in their gross domestic product.
A mechanical experiment was conducted to determine the mechanical characteristics of Jharkhand’s agriculture waste fibres. The tensile testing procedure is used to determine Young’s modulus, length elongation before fracture, and maximum tensile strength. To determine the tensile strength, all of the samples provided for the research have been finished. The potential possibilities of biomaterials have been discovered as a result of this research [14]. It is comparable to traditional fibres such as coir, sisal, flax, hemp, jute, and others that are often used in literature. Figure 3 depicts the mechanical behaviour (stress-strain) of lignocellulosic fibres. The tensile strength of natural fibres is seen in Figure 4. Because of the larger cellulose concentration in its constituents, palm fibre has the most substantial tensile strength of 160 MPa, whereas mustard fibre has 60 MPa. Datura has the lowest value, which is less than 8 MPa. As a result, the tensile strength of fibres is arranged in the following order: palm, mustard, and lemon fibres.
Stress-strain diagram of (a) palm fibres, (b) lemon, (c) mustard and (d) datura.
Tensile strength of fibres compared.
Figure 5 also depicts the elongation variation required to break the property of Jharkhand agro-based fibres. It demonstrates that palm fibres have the highest elongation value to break the percentage. Palm fibre, mustard, and datura, respectively, have 0.078%, 0.06%, and 0.026%. The lemon type fibre, on the other hand, has the lowest percentage value, at 0.025%. Except for the palm fibres, the previous observations of elongation to break the % value of mechanical qualities are extremely similar. If just a single criterion is used for the selection process, it may result in paying little attention to the other fibre materials if one characteristic is overlooked. As a result, it is concluded that more than one criterion should be used in the selection of natural fibre constituents for biomaterial evaluation.
Elongation to break % of fibres compared.
Young’s modulus criteria with mechanical parameters for Jharkhand agricultural waste fibres is shown in Figure 6. Palm fibres have a Young’s modulus value of 5.02 GPa, whereas lemon fibres have a value of 2.71 GPa. Similarly, mustard-type fibres have a modulus of elasticity closer to 2.35 GPa, but datura only possesses 0.34 GPa. It was discovered that fibres from Jharkhand had a higher Young’s modulus, indicating that they would make superior natural reinforced polymer composites.
Young’s modulus % of fibres compared.
The intrinsic capabilities of regularly used fibre materials and Jharkhand lignocellulosic fibres have been found. Young’s modulus and tensile strength of Jharkhand fibres and fibres from across the globe have been compared. Figures 7 and 8 show how this is done. The table lists all of the governing mechanical characteristics of the most regularly used fibres. Figure 7 shows that palm fibres have the greatest tensile strength value when compared to lemon and mustard fibres.
Tensile strength of fibres compared with other commonly used natural fibres.
Young’s modulus of fibres compared with other commonly used natural fibres.
Figure 8 shows a comparison of the tensile modulus of the most regularly used fibres. Except for sisal, it is obvious that Jharkhand fibres have a higher modulus value than the other fibres. The Young’s modulus of mustard and lemon fibres, for example, is higher than that of palf, oil palm, and piassava fibres. As a consequence, Jharkhand’s agro-based waste fibres have a better chance of becoming biomaterials for industrial use.
Agricultural waste produced all sorts of fibres studied in the literature. Thermal procedures have looked at the influence of heat on their characteristic of weight loss before combustion to see whether this material is acceptable for future manufacturing processes of environmentally friendly products. TGA testing was also used to track the physical vagaries of raising the temperature rate at a regular pace. This approach was also used to regulate the chemical characteristics of the fibres. Water losses must be determined throughout the breakdown process particularly for agricultural waste fibres [15]. The TGA research revealed that palm, datura, lemon, and mustard are all thermally stable, with minor/negligible behaviour when it comes to mass losses.
Thermal stability was measured with many specimens in the temperature range of 31–300°C and 500°C at intervals of 10°C/min heating rate and found to be stable. As the temperature rose, people began to lose weight as a result of the heat. It was discovered that the first percentage loss in mass is 7.2% up to 140°C. The cause for this is the evaporation of water, as well as the presence of lignin. Depending on the fibre type, the moisture content varies. By raising the temperature over this point, the other elements of fibres, such as hemicellulose and lignin type cellulose, were harmed. In this study, the degradation degree of lemon fibres was shown to be divided into three phases. The second and third levels begin from 190–240°C and 240–300°C, respectively. At these two levels, the percentage of deterioration was 5.17% of mass and 14.82% of weight, respectively.
The entire analysis of the fibres addressed in this paper is shown in Figure 9. This diagram depicts the thermal behaviour of fibres in terms of stability and degradation. In the experiments, lemon and datura fibres were shown to be more stable for the initial temperature range of 140–240°C. At a temperature of 240°C, datura and lemon fibres are steadier in percentage weight loss than palm and mustard fibres at 140°C. Except for lemon fibres, all other fibre materials studied had a weight decrease of greater than 30%. This fibre material’s stable feature is better suited for biomaterials based on polymers for industrial applications requiring a greater thermal stability value.
Thermal stability of fibres compared.
As a result of the experiments, it has been theoretically shown that fibres from Jharkhand agricultural wastes are more appropriate for industrial applications owing to their better mechanical and electrical characteristics. Insulation in door panels, covering door racks, window frames, home railings, furniture industries, paper, textiles, insulated electronics, circuit boards, terminals, switches, and dielectrics are just a few examples.
Figure 10 shows that, when it comes to divergence to percentage mass loss, Jharkhand fibres outperform other fibre types. Datura and lemon have been demonstrated to have a lower weight reduction percentage than bagasse, banana, bamboo, pineapple leaf, and phoenix SP. It demonstrates Jharkhand’s increased stability and enhanced opportunities for green product manufacturing.
Weight loss (%) of fibres compared with other commonly used natural fibres.
The pull-out technique is one of the most important ways to confirm that lignocellulosic fibres and the different polymers investigated in this study are compatible. By assuring the interfacial bonding capacity, this approach determines the maximum load applied to the fibre up to which it can withstand the load limit. This approach may be used to determine if agricultural waste fibres and polymer components are compatible. It was decided to prepare samples for the test hot mixing extruding technique. Polypropylene, polyethylene of high density, polyethylene of low density, and epoxy were among the samples bought and prepared for the pull-out test [9, 16, 17].
Figure 11 depicts the shear strength of the different polymer interfaces. The graph shows that datura fibre has the best interfacial bonding, and that PVC polymer has a shear strength of 5.3 MPa. Datura’s most important attribute is its coarser surface compared to other polymers, which allows for sticky properties. Because of their flat surfaces, mustard and palms have reduced interfacial bonding.
Shear strength of fibres compared through use as polymers.
This research successfully achieves the interfacial properties of Jharkhand lignocellulosic fibres. Jharkhand fibres’ thermal and mechanical properties were also examined in laboratory tests. A side-by-by-side comparison of foreign and Jharkhand fibres was carried out in order to assess their inherent capabilities and usefulness. Because of its increased mechanical strength, thermal stability, and strong adhesive forces at surfaces, the Jharkhand lignocellulosic was determined to be more suited. For biomaterials applications, Jharkhand’s fibres have also been shown to be better compatible with a variety of polymers. Palm-type fibre materials have higher mechanical strength, elongation to break, and tensile strength than mustard fibres. The thermal stability of the abovementioned fibres is determined to be better in the case of lemon fibres, while datura fibres are best at 240°C and 290°C owing to their mass to loss percentage.
Lemon and datura fibres are the most ideal for thermal properties when compared to pineapple leaf, bamboo, roselle, bagasse, and phoenix SP, since they have a lower weight ratio at 240°C. Furthermore, after a thorough examination of fibre materials, it is possible to conclude that, due to their cheap cost and environmental friendliness, widespread manufacturing of these green goods might be boosted for developing nations. With the Jharkhand fibre’s better interfacial bonding, sustainable businesses may now produce green products. PVC and datura fibres were found to be the best fibres for shear loads with all types of polymers in this paper. Doors, textiles, packaging and papers, furniture, window frames and electrical applications such as insulators, circuit boards and dielectrics are just a few of the many uses for Jharkhand waste agro fibres.
The authors are extremely grateful to the entire fraternity at the National Institue of Technology, Durgapur, India, for their constant support and guidance.
All data, models, and code generated or used during the study appear in the submitted article.
Supporting women in scientific research and encouraging more women to pursue careers in STEM fields has been an issue on the global agenda for many years. But there is still much to be done. And IntechOpen wants to help.
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Ms. Mehtab has published seven papers in international conferences and one of her papers has been accepted for publication in a reputable international journal. She has won the best paper awards in two prestigious international conferences – BAICONF 2019, and ICADCML 2021, organized in the Indian Institute of Management, Bangalore, India in December 2019, and SOA University, Bhubaneswar, India in January 2021. Besides, Ms. Mehtab has also published two book chapters in two books. Seven of her book chapters will be published in a volume shortly in 2021 by Cambridge Scholars’ Press, UK. Currently, she is working as the joint editor of two edited volumes on Time Series Analysis and Forecasting to be published in the first half of 2021 by an international house. Currently, she is working as a Data Scientist with an MNC in Delhi, India.",institutionString:"NSHM College of Management and Technology",institution:null},{id:"226240",title:"Dr.",name:"Andri Irfan",middleName:null,surname:"Rifai",slug:"andri-irfan-rifai",fullName:"Andri Irfan Rifai",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/226240/images/7412_n.jpg",biography:"Andri IRFAN is a Senior Lecturer of Civil Engineering and Planning. He completed the PhD at the Universitas Indonesia & Universidade do Minho with Sandwich Program Scholarship from the Directorate General of Higher Education and LPDP scholarship. He has been teaching for more than 19 years and much active to applied his knowledge in the project construction in Indonesia. His research interest ranges from pavement management system to advanced data mining techniques for transportation engineering. He has published more than 50 papers in journals and 2 books.",institutionString:null,institution:{name:"Universitas Internasional Batam",country:{name:"Indonesia"}}},{id:"314576",title:"Dr.",name:"Ibai",middleName:null,surname:"Laña",slug:"ibai-lana",fullName:"Ibai Laña",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314576/images/system/314576.jpg",biography:"Dr. Ibai Laña works at TECNALIA as a data analyst. He received his Ph.D. in Artificial Intelligence from the University of the Basque Country (UPV/EHU), Spain, in 2018. He is currently a senior researcher at TECNALIA. His research interests fall within the intersection of intelligent transportation systems, machine learning, traffic data analysis, and data science. He has dealt with urban traffic forecasting problems, applying machine learning models and evolutionary algorithms. He has experience in origin-destination matrix estimation or point of interest and trajectory detection. Working with large volumes of data has given him a good command of big data processing tools and NoSQL databases. He has also been a visiting scholar at the Knowledge Engineering and Discovery Research Institute, Auckland University of Technology.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"314575",title:"Dr.",name:"Jesus",middleName:null,surname:"L. Lobo",slug:"jesus-l.-lobo",fullName:"Jesus L. Lobo",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/314575/images/system/314575.png",biography:"Dr. Jesús López is currently based in Bilbao (Spain) working at TECNALIA as Artificial Intelligence Research Scientist. In most cases, a project idea or a new research line needs to be investigated to see if it is good enough to take into production or to focus on it. That is exactly what he does, diving into Machine Learning algorithms and technologies to help TECNALIA to decide whether something is great in theory or will actually impact on the product or processes of its projects. So, he is expert at framing experiments, developing hypotheses, and proving whether they’re true or not, in order to investigate fundamental problems with a longer time horizon. He is also able to design and develop PoCs and system prototypes in simulation. He has participated in several national and internacional R&D projects.\n\nAs another relevant part of his everyday research work, he usually publishes his findings in reputed scientific refereed journals and international conferences, occasionally acting as reviewer and Programme Commitee member. Concretely, since 2018 he has published 9 JCR (8 Q1) journal papers, 9 conference papers (e.g. ECML PKDD 2021), and he has co-edited a book. He is also active in popular science writing data science stories for reputed blogs (KDNuggets, TowardsDataScience, Naukas). Besides, he has recently embarked on mentoring programmes as mentor, and has also worked as data science trainer.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"103779",title:"Prof.",name:"Yalcin",middleName:null,surname:"Isler",slug:"yalcin-isler",fullName:"Yalcin Isler",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRyQ8QAK/Profile_Picture_1628834958734",biography:"Yalcin Isler (1971 - Burdur / Turkey) received the B.Sc. degree in the Department of Electrical and Electronics Engineering from Anadolu University, Eskisehir, Turkey, in 1993, the M.Sc. degree from the Department of Electronics and Communication Engineering, Suleyman Demirel University, Isparta, Turkey, in 1996, the Ph.D. degree from the Department of Electrical and Electronics Engineering, Dokuz Eylul University, Izmir, Turkey, in 2009, and the Competence of Associate Professorship from the Turkish Interuniversity Council in 2019.\n\nHe was Lecturer at Burdur Vocational School in Suleyman Demirel University (1993-2000, Burdur / Turkey), Software Engineer (2000-2002, Izmir / Turkey), Research Assistant in Bulent Ecevit University (2002-2003, Zonguldak / Turkey), Research Assistant in Dokuz Eylul University (2003-2010, Izmir / Turkey), Assistant Professor at the Department of Electrical and Electronics Engineering in Bulent Ecevit University (2010-2012, Zonguldak / Turkey), Assistant Professor at the Department of Biomedical Engineering in Izmir Katip Celebi University (2012-2019, Izmir / Turkey). He is an Associate Professor at the Department of Biomedical Engineering at Izmir Katip Celebi University, Izmir / Turkey, since 2019. In addition to academics, he has also founded Islerya Medical and Information Technologies Company, Izmir / Turkey, since 2017.\n\nHis main research interests cover biomedical signal processing, pattern recognition, medical device design, programming, and embedded systems. He has many scientific papers and participated in several projects in these study fields. He was an IEEE Student Member (2009-2011) and IEEE Member (2011-2014) and has been IEEE Senior Member since 2014.",institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"339677",title:"Dr.",name:"Mrinmoy",middleName:null,surname:"Roy",slug:"mrinmoy-roy",fullName:"Mrinmoy Roy",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/339677/images/16768_n.jpg",biography:"An accomplished Sales & Marketing professional with 12 years of cross-functional experience in well-known organisations such as CIPLA, LUPIN, GLENMARK, ASTRAZENECA across different segment of Sales & Marketing, International Business, Institutional Business, Product Management, Strategic Marketing of HIV, Oncology, Derma, Respiratory, Anti-Diabetic, Nutraceutical & Stomatological Product Portfolio and Generic as well as Chronic Critical Care Portfolio. A First Class MBA in International Business & Strategic Marketing, B.Pharm, D.Pharm, Google Certified Digital Marketing Professional. Qualified PhD Candidate in Operations and Management with special focus on Artificial Intelligence and Machine Learning adoption, analysis and use in Healthcare, Hospital & Pharma Domain. Seasoned with diverse therapy area of Pharmaceutical Sales & Marketing ranging from generating revenue through generating prescriptions, launching new products, and making them big brands with continuous strategy execution at the Physician and Patients level. Moved from Sales to Marketing and Business Development for 3.5 years in South East Asian Market operating from Manila, Philippines. Came back to India and handled and developed Brands such as Gluconorm, Lupisulin, Supracal, Absolut Woman, Hemozink, Fabiflu (For COVID 19), and many more. In my previous assignment I used to develop and execute strategies on Sales & Marketing, Commercialization & Business Development for Institution and Corporate Hospital Business portfolio of Oncology Therapy Area for AstraZeneca Pharma India Ltd. Being a Research Scholar and Student of ‘Operations Research & Management: Artificial Intelligence’ I published several pioneer research papers and book chapters on the same in Internationally reputed journals and Books indexed in Scopus, Springer and Ei Compendex, Google Scholar etc. Currently, I am launching PGDM Pharmaceutical Management Program in IIHMR Bangalore and spearheading the course curriculum and structure of the same. I am interested in Collaboration for Healthcare Innovation, Pharma AI Innovation, Future trend in Marketing and Management with incubation on Healthcare, Healthcare IT startups, AI-ML Modelling and Healthcare Algorithm based training module development. I am also an affiliated member of the Institute of Management Consultant of India, looking forward to Healthcare, Healthcare IT and Innovation, Pharma and Hospital Management Consulting works.",institutionString:null,institution:{name:"Lovely Professional University",country:{name:"India"}}},{id:"1063",title:"Prof.",name:"Constantin",middleName:null,surname:"Volosencu",slug:"constantin-volosencu",fullName:"Constantin Volosencu",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/1063/images/system/1063.png",biography:"Prof. Dr. Constantin Voloşencu graduated as an engineer from\nPolitehnica University of Timișoara, Romania, where he also\nobtained a doctorate degree. He is currently a full professor in\nthe Department of Automation and Applied Informatics at the\nsame university. Dr. Voloşencu is the author of ten books, seven\nbook chapters, and more than 160 papers published in journals\nand conference proceedings. He has also edited twelve books and\nhas twenty-seven patents to his name. He is a manager of research grants, editor in\nchief and member of international journal editorial boards, a former plenary speaker, a member of scientific committees, and chair at international conferences. His\nresearch is in the fields of control systems, control of electric drives, fuzzy control\nsystems, neural network applications, fault detection and diagnosis, sensor network\napplications, monitoring of distributed parameter systems, and power ultrasound\napplications. He has developed automation equipment for machine tools, spooling\nmachines, high-power ultrasound processes, and more.",institutionString:"Polytechnic University of Timişoara",institution:{name:"Polytechnic University of Timişoara",country:{name:"Romania"}}},{id:"221364",title:"Dr.",name:"Eneko",middleName:null,surname:"Osaba",slug:"eneko-osaba",fullName:"Eneko Osaba",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/221364/images/system/221364.jpg",biography:"Dr. Eneko Osaba works at TECNALIA as a senior researcher. He obtained his Ph.D. in Artificial Intelligence in 2015. He has participated in more than twenty-five local and European research projects, and in the publication of more than 130 papers. He has performed several stays at universities in the United Kingdom, Italy, and Malta. Dr. Osaba has served as a program committee member in more than forty international conferences and participated in organizing activities in more than ten international conferences. He is a member of the editorial board of the International Journal of Artificial Intelligence, Data in Brief, and Journal of Advanced Transportation. He is also a guest editor for the Journal of Computational Science, Neurocomputing, Swarm, and Evolutionary Computation and IEEE ITS Magazine.",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"275829",title:"Dr.",name:"Esther",middleName:null,surname:"Villar-Rodriguez",slug:"esther-villar-rodriguez",fullName:"Esther Villar-Rodriguez",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/275829/images/system/275829.jpg",biography:"Dr. Esther Villar obtained a Ph.D. in Information and Communication Technologies from the University of Alcalá, Spain, in 2015. She obtained a degree in Computer Science from the University of Deusto, Spain, in 2010, and an MSc in Computer Languages and Systems from the National University of Distance Education, Spain, in 2012. Her areas of interest and knowledge include natural language processing (NLP), detection of impersonation in social networks, semantic web, and machine learning. Dr. Esther Villar made several contributions at conferences and publishing in various journals in those fields. Currently, she is working within the OPTIMA (Optimization Modeling & Analytics) business of TECNALIA’s ICT Division as a data scientist in projects related to the prediction and optimization of management and industrial processes (resource planning, energy efficiency, etc).",institutionString:"TECNALIA Research & Innovation",institution:{name:"Tecnalia",country:{name:"Spain"}}},{id:"49813",title:"Dr.",name:"Javier",middleName:null,surname:"Del Ser",slug:"javier-del-ser",fullName:"Javier Del Ser",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/49813/images/system/49813.png",biography:"Prof. Dr. Javier Del Ser received his first PhD in Telecommunication Engineering (Cum Laude) from the University of Navarra, Spain, in 2006, and a second PhD in Computational Intelligence (Summa Cum Laude) from the University of Alcala, Spain, in 2013. He is currently a principal researcher in data analytics and optimisation at TECNALIA (Spain), a visiting fellow at the Basque Center for Applied Mathematics (BCAM) and a part-time lecturer at the University of the Basque Country (UPV/EHU). His research interests gravitate on the use of descriptive, prescriptive and predictive algorithms for data mining and optimization in a diverse range of application fields such as Energy, Transport, Telecommunications, Health and Industry, among others. In these fields he has published more than 240 articles, co-supervised 8 Ph.D. theses, edited 6 books, coauthored 7 patents and participated/led more than 40 research projects. He is a Senior Member of the IEEE, and a recipient of the Biscay Talent prize for his academic career.",institutionString:"Tecnalia Research & Innovation",institution:null},{id:"278948",title:"Dr.",name:"Carlos Pedro",middleName:null,surname:"Gonçalves",slug:"carlos-pedro-goncalves",fullName:"Carlos Pedro Gonçalves",position:null,profilePictureURL:"https://s3.us-east-1.amazonaws.com/intech-files/0030O00002bRcmyQAC/Profile_Picture_1564224512145",biography:'Carlos Pedro Gonçalves (PhD) is an Associate Professor at Lusophone University of Humanities and Technologies and a researcher on Complexity Sciences, Quantum Technologies, Artificial Intelligence, Strategic Studies, Studies in Intelligence and Security, FinTech and Financial Risk Modeling. He is also a progammer with programming experience in:\n\nA) Quantum Computing using Qiskit Python module and IBM Quantum Experience Platform, with software developed on the simulation of Quantum Artificial Neural Networks and Quantum Cybersecurity;\n\nB) Artificial Intelligence and Machine learning programming in Python;\n\nC) Artificial Intelligence, Multiagent Systems Modeling and System Dynamics Modeling in Netlogo, with models developed in the areas of Chaos Theory, Econophysics, Artificial Intelligence, Classical and Quantum Complex Systems Science, with the Econophysics models having been cited worldwide and incorporated in PhD programs by different Universities.\n\nReceived an Arctic Code Vault Contributor status by GitHub, due to having developed open source software preserved in the \\"Arctic Code Vault\\" for future generations (https://archiveprogram.github.com/arctic-vault/), with the Strategy Analyzer A.I. module for decision making support (based on his PhD thesis, used in his Classes on Decision Making and in Strategic Intelligence Consulting Activities) and QNeural Python Quantum Neural Network simulator also preserved in the \\"Arctic Code Vault\\", for access to these software modules see: https://github.com/cpgoncalves. He is also a peer reviewer with outsanding review status from Elsevier journals, including Physica A, Neurocomputing and Engineering Applications of Artificial Intelligence. Science CV available at: https://www.cienciavitae.pt//pt/8E1C-A8B3-78C5 and ORCID: https://orcid.org/0000-0002-0298-3974',institutionString:"University of Lisbon",institution:{name:"Universidade Lusófona",country:{name:"Portugal"}}},{id:"241400",title:"Prof.",name:"Mohammed",middleName:null,surname:"Bsiss",slug:"mohammed-bsiss",fullName:"Mohammed Bsiss",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/241400/images/8062_n.jpg",biography:null,institutionString:null,institution:null},{id:"276128",title:"Dr.",name:"Hira",middleName:null,surname:"Fatima",slug:"hira-fatima",fullName:"Hira Fatima",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/276128/images/14420_n.jpg",biography:"Dr. Hira Fatima\nAssistant Professor\nDepartment of Mathematics\nInstitute of Applied Science\nMangalayatan University, Aligarh\nMobile: no : 8532041179\nhirafatima2014@gmal.com\n\nDr. Hira Fatima has received his Ph.D. degree in pure Mathematics from Aligarh Muslim University, Aligarh India. Currently working as an Assistant Professor in the Department of Mathematics, Institute of Applied Science, Mangalayatan University, Aligarh. She taught so many courses of Mathematics of UG and PG level. Her research Area of Expertise is Functional Analysis & Sequence Spaces. She has been working on Ideal Convergence of double sequence. She has published 17 research papers in National and International Journals including Cogent Mathematics, Filomat, Journal of Intelligent and Fuzzy Systems, Advances in Difference Equations, Journal of Mathematical Analysis, Journal of Mathematical & Computer Science etc. She has also reviewed few research papers for the and international journals. She is a member of Indian Mathematical Society.",institutionString:null,institution:null},{id:"414880",title:"Dr.",name:"Maryam",middleName:null,surname:"Vatankhah",slug:"maryam-vatankhah",fullName:"Maryam Vatankhah",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Borough of Manhattan Community College",country:{name:"United States of America"}}},{id:"414879",title:"Prof.",name:"Mohammad-Reza",middleName:null,surname:"Akbarzadeh-Totonchi",slug:"mohammad-reza-akbarzadeh-totonchi",fullName:"Mohammad-Reza Akbarzadeh-Totonchi",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Ferdowsi University of Mashhad",country:{name:"Iran"}}},{id:"414878",title:"Prof.",name:"Reza",middleName:null,surname:"Fazel-Rezai",slug:"reza-fazel-rezai",fullName:"Reza Fazel-Rezai",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"American Public University System",country:{name:"United States of America"}}},{id:"302698",title:"Dr.",name:"Yao",middleName:null,surname:"Shan",slug:"yao-shan",fullName:"Yao Shan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Dalian University of Technology",country:{name:"China"}}},{id:"125911",title:"Prof.",name:"Jia-Ching",middleName:null,surname:"Wang",slug:"jia-ching-wang",fullName:"Jia-Ching Wang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"National Central University",country:{name:"Taiwan"}}},{id:"357085",title:"Mr.",name:"P. Mohan",middleName:null,surname:"Anand",slug:"p.-mohan-anand",fullName:"P. Mohan Anand",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356696",title:"Ph.D. Student",name:"P.V.",middleName:null,surname:"Sai Charan",slug:"p.v.-sai-charan",fullName:"P.V. Sai Charan",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"357086",title:"Prof.",name:"Sandeep K.",middleName:null,surname:"Shukla",slug:"sandeep-k.-shukla",fullName:"Sandeep K. Shukla",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Indian Institute of Technology Kanpur",country:{name:"India"}}},{id:"356823",title:"MSc.",name:"Seonghee",middleName:null,surname:"Min",slug:"seonghee-min",fullName:"Seonghee Min",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Daegu University",country:{name:"Korea, South"}}},{id:"353307",title:"Prof.",name:"Yoosoo",middleName:null,surname:"Oh",slug:"yoosoo-oh",fullName:"Yoosoo Oh",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"Yoosoo Oh received his Bachelor's degree in the Department of Electronics and Engineering from Kyungpook National University in 2002. He obtained his Master’s degree in the Department of Information and Communications from Gwangju Institute of Science and Technology (GIST) in 2003. In 2010, he received his Ph.D. degree in the School of Information and Mechatronics from GIST. In the meantime, he was an executed team leader at Culture Technology Institute, GIST, 2010-2012. In 2011, he worked at Lancaster University, the UK as a visiting scholar. In September 2012, he joined Daegu University, where he is currently an associate professor in the School of ICT Conver, Daegu University. Also, he served as the Board of Directors of KSIIS since 2019, and HCI Korea since 2016. From 2017~2019, he worked as a center director of the Mixed Reality Convergence Research Center at Daegu University. From 2015-2017, He worked as a director in the Enterprise Supporting Office of LINC Project Group, Daegu University. His research interests include Activity Fusion & Reasoning, Machine Learning, Context-aware Middleware, Human-Computer Interaction, etc.",institutionString:null,institution:{name:"Daegu Gyeongbuk Institute of Science and Technology",country:{name:"Korea, South"}}},{id:"262719",title:"Dr.",name:"Esma",middleName:null,surname:"Ergüner Özkoç",slug:"esma-erguner-ozkoc",fullName:"Esma Ergüner Özkoç",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Başkent University",country:{name:"Turkey"}}},{id:"346530",title:"Dr.",name:"Ibrahim",middleName:null,surname:"Kaya",slug:"ibrahim-kaya",fullName:"Ibrahim Kaya",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Izmir Kâtip Çelebi University",country:{name:"Turkey"}}},{id:"419199",title:"Dr.",name:"Qun",middleName:null,surname:"Yang",slug:"qun-yang",fullName:"Qun Yang",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Auckland",country:{name:"New Zealand"}}},{id:"351158",title:"Prof.",name:"David W.",middleName:null,surname:"Anderson",slug:"david-w.-anderson",fullName:"David W. Anderson",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Calgary",country:{name:"Canada"}}}]}},subseries:{item:{id:"92",type:"subseries",title:"Health and Wellbeing",keywords:"Ecology, Ecological, Nature, Health, Wellbeing, Health production",scope:"\r\n\tSustainable approaches to health and wellbeing in our COVID 19 recovery needs to focus on ecological approaches that prioritize our relationships with each other, and include engagement with nature, the arts and our heritage. This will ensure that we discover ways to live in our world that allows us and other beings to flourish. We can no longer rely on medicalized approaches to health that wait for people to become ill before attempting to treat them. We need to live in harmony with nature and rediscover the beauty and balance in our everyday lives and surroundings, which contribute to our well-being and that of all other creatures on the planet. This topic will provide insights and knowledge into how to achieve this change in health care that is based on ecologically sustainable practices.
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