CLINICAL RESEARCH
Past research includes 45+ studies from reputable sources demonstrating the positive effects of use with IREX. Research and clinical studies involving the IREX have shown its promising potential in the treatment of neurological injury in particular. A fascinating study in 20051 demonstrated improved lower extremity function post stroke, along with cortical reorganization in the primary motor cortex as demonstrated with fMRI. Here are some other examples of the demonstrated benefits with IREX use in brain injured populations from recent peer-reviewed research articles:
Increased mobility through improved lower limb function.
Daniel McEwen, MSc; Anne Taillon-Hobson, PT, MSc; Martin Bilodeau, PT, PhD; Heidi Sveistrup, PhD; Hillel Finestone, MD, FRCPC (2014). Improved lower limb function following stroke. Stroke 45: 1853-1855
Improved aspects of unilateral spatial neglect.
Kim, Y. M., Chun, M. H., Yun, G. J., Song, Y. J., & Young, H. E. (2011). The effect of virtual reality training on unilateral spatial neglect in stroke patients.Annals of rehabilitation medicine, 35(3), 309-315. 
Focused Attention: Neuroplasticity does not occur unless attention is present
“Willed attention can redraw the contours of the mind, and is do doing, can rewire the circuits of the brain, for it is attention that makes neuroplasticity possible.- Dr. Mike Merzenich
In 1993 Merzenich demonstrated passive participation does not lead to lasting cortical changes5. When stimuli identicalto those that created neuroplastic change in the attending brain were delivered to the nonattending brain, there was no induction of cortical plasticity. In other words, if a person is passively engaged in an exercise, little to no brain change actually occurs. IREX creates an immersive experience for the participant, yielding increased focused attention and engagement to the task. Through many different exercises boasting various virtual environments, the therapy session continually introduces novelty, variety and challenge, which happen to be the three pillars essential to neuroplastic change. Compare this to therapy as usual with a familiar therapist, in a static environment, while completing mundane exercises. This is especially important in neurorehabilitation as disruption of attentional systems is pervasive.
Massed Practice: The brain doesn’t change easily.
Neuroplastic change does not happen with tasks that we do with low frequency. Early studies of massed practice based in rehabilitation indicated if a skill is practiced many, many times over, the brain will change to allow recovery of a non-functional arm or leg.6,7,8 However, these conclusions were largely based on rat and monkey models and often times these animals are much faster than humans, performing tasks hundreds or even thousands of times during a session. A study of humans with stroke and traumatic brain injury undergoing rehabilitation indicated an average number of active repetitions per session was 26.44, or 1.29 per minute.9 Accordingly, a major effort of rehabilitation with peripheral or central nervous system injuries should be to increase the number of repetitions per session. This leads directly to improved outcomes. However, this means patients must work through many obstacles including frustration and pain. Virtual reality environments have been demonstrated to increase the amount of time a patient will actively engage in a session, and not only increase pain tolerance, but actually decrease the amount of pain experienced.10,11 Increased time in active engagement and higher number of repetitions leads directly to better outcomes, and is inherent to the IREX’s virtual reality exercise system.
Improved visual attention.
Kim, B. R., Chun, M. H., Kim, L. S., & Park, J. Y. (2011). Effect of virtual reality on cognition in stroke patients. Annals of rehabilitation medicine, 35(4), 450-459.
Improved cognitive function and upper extremity motor performance.
Lee, K. H. (2015). Effects of a virtual reality-based exercise program on functional recovery in stroke patients: part 1. Journal of physical therapy science, 27(6), 1637.
Motivation: A frequently overlooked, yet immensely important aspect of rehabilitation.
“Under conditions of interest, such as that of competition, the resulting movement may be much more efficiently carried out than in the dull, routine training in the laboratory” - Shepherd Ivory Franz (1874-1933)
Anyone would agree that it is important for a patient to be motivated to participate in rehabilitation. Yet, what rehabilitation tools can you think of that are designed to motivate? Research has demonstrated significant gains in performance of brain-injured patients, simply by setting goals for patients that serves to create an internal sense of competition.12,13 IREX was developed to create competition and goal setting. When an individual is competitive and has goals, they are more motivated. Efforts in traditional rehabilitation fall far short of creating a competitive atmosphere. IREX is designed to track progress through producing scores based upon performance. Just as players are highly motivated to play video games in order to achieve higher scores, IREX creates a game-like environment that captures the same conditions of competition and challenge that hook players into wanting to engage more and for longer periods of time.
The Neuroscience Behind IREX for Brain Injury Rehabilitation
Studies from the late 20th century provided refutable evidence for the dynamic nature of brain structure and function.2,3,4 Conclusions from these studies changed our way of thinking in regard to the brain’s ability to adapt to injury. We now realize structural and functional map alterations do occur in the brain post-injury and is referred to as, “neuroplasticity”. This literally means the brain is malleable like plastic and is programmed to change automatically in response to injury, as well as to high task demand. So for tasks the brain has to perform often, the brain changes its structure and function to become more efficient at performing the task.
Science also has reveled conditions by which neuroplasticity occurs with greater magnitude. Focused attention, motivation and repetition or “massed practice,” are three of these conditions that have been woven into the IREX program. By enhancing these conditions, a greater degree of neuroplastic change is possible and therefore, a more optimal outcome of functional restoration.
Improved attention and concentration in patients with brain tumor.
Yang, S., Chun, M. H., & Son, Y. R. (2014). Effect of Virtual Reality on Cognitive Dysfunction
in Patients With Brain Tumor. Annals of rehabilitation medicine, 38(6), 726-733
References
You, S. H., Jang, S. H., Kim, Y. H., Hallett, M., Ahn, S. H., Kwon, Y. H., & Lee, M. Y. (2005). Virtual reality–induced cortical reorganization and associated locomotor recovery in chronic stroke an experimenter-blind randomized study. Stroke, 36(6), 1166-1171.
Liepert, J., Bauder, H., Miltner, W. H., Taub, E., & Weiller, C. (2000). Treatment-induced cortical reorganization after stroke in humans. Stroke, 31(6), 1210-1216.
Buonomano, D. V., & Merzenich, M. M. (1998). Cortical plasticity: from synapses to maps. Annual review of neuroscience, 21(1), 149-186.
Pascual-Leone A, Nguyet D, Cohen LG, Brasil-Neto JP, Cammarota A, Hallett M. (1995). Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor skills. J Neurophysiology, Sep;74(3):1037-45.
Recanzone, G. A., Schreiner, C. E., & Merzenich, M. M. (1993). Plasticity in the frequency representation of primary auditory cortex following discrimination training in adult owl monkeys. The Journal of Neuroscience, 13(1), 87-103.
Kleim, J. A., Barbay, S., & Nudo, R. J. (1998). Functional reorganization of the rat motor cortex following motor skill learning. Journal of neurophysiology,80(6), 3321-3325.
Nudo, R. J., Plautz, E. J., & Milliken, G. W. (1997, December). Adaptive plasticity in primate motor cortex as a consequence of behavioral experience and neuronal injury. In Seminars in Neuroscience (Vol. 9, No. 1, pp. 13-23). Academic Press.
Taub, E., & Uswatte, G. (2000). Constraint-induced movement therapy and massed practice. Stroke, 31(4), 983-991.
Kimberley TJ, Samargia S, Moore LG, Shakya JF, Lang CE. Comparison of amounts and types of practice during rehabilitation for traumatic brain injury and stroke. J Rehabil Res Dev. 2010;47(9):851-62.
Weiss, P. L., Rand, D., Katz, N., & Kizony, R. (2004). Video capture virtual reality as a flexible and effective rehabilitation tool. Journal of neuroengineering and rehabilitation, 1(1), 12.
Hoffman, H. G., Patterson, D. R., Carrougher, G. J., & Sharar, S. R. (2001). Effectiveness of virtual reality–based pain control with multiple treatments. The Clinical journal of pain, 17(3), 229-235.
Gauggel, S., Leinweber, R., & Richard, M. (2001). Goal setting and reaction time performance in brain-damaged patients. Journal of Clinical and Experimental Neuropsychology, 23, 357.
Gauggel, S., & Fischer, S. (2001). The effect of goal setting on motor performance and motor learning in brain-damaged patients. Neuropsychological Rehabilitation, 11(1), 33-44.