Archive for category Virtual reality rehabilitation
[Abstract] An Automated Game-Based Variable-Stiffness Exoskeleton for Hand Rehabilitation – Full Text PDF
In this paper, we propose and demonstrate the functionality of a novel exoskeleton which provides variable resistance training for human hands. It is intended for people who suffer from diminished hand strength and low dexterity due to non-severe forms of neuropathy or other ailments. A new variable-stiffness mechanism is designed based on the concept of aligning three different sized springs to produce four different levels of stiffness, for variable kinesthetic feedback during an exercise. Moreover, the design incorporates an interactive computer game and a flexible sensor-based glove that motivates the patients to use the exoskeleton. The patients can exercise their hands by playing the game and see their progress recorded from the glove for further motivation. Thus the rehabilitation training will be consistent and the patients will re-learn proper hand function through neuroplasticity. The developed exoskeleton is intrinsically safe when compared with active exoskeleton systems since the applied compliance provides only passive resistance. The design is also comparatively lighter than literature designs and commercial platforms.
[Abstract] An interactive and innovative application for hand rehabilitation through virtual reality
Physiotherapy has been very monotonous for patients and they tend to lose interest and motivation in exercising. Introducing games with short term goals in the field of rehabilitation is the best alternative, to maintain patients’ motivation. Our research focuses on gamification of hand rehabilitation exercises to engage patients’ wholly in rehab and to maintain their compliance to repeated exercising, for a speedy recovery from hand injuries (wrist, elbow and fingers). This is achieved by integrating leap motion sensor with unity game development engine. Exercises (as gestures) are recognised and validated by leap motion sensor. Game application for exercises is developed using unity. Gamification alternative has been implemented by very few in the globe and it has been taken as a challenge in our research. We could successfully design and build an engine which would be interactive and real-time, providing platform for rehabilitation. We have tested the same with patients and received positive feedbacks. We have enabled the user to know the score through GUI.
[ARTICLE] An interactive and low-cost full body rehabilitation framework based on 3D immersive serious games – Full Text
- Generation of customizable 3D immersive serious games.
- An interactive and low-cost full body rehabilitation framework.
- Integration of a Head Mounted Display, a Time-of-Flight and an infrared camera.
- A Gated Recurrent Unit Recurrent Neural Network (GRU-RNN) reference model.
Strokes, surgeries, or degenerative diseases can impair motor abilities and balance. Long-term rehabilitation is often the only way to recover, as completely as possible, these lost skills. To be effective, this type of rehabilitation should follow three main rules. First, rehabilitation exercises should be able to keep patient’s motivation high. Second, each exercise should be customizable depending on patient’s needs. Third, patient’s performance should be evaluated objectively, i.e., by measuring patient’s movements with respect to an optimal reference model. To meet the just reported requirements, in this paper, an interactive and low-cost full body rehabilitation framework for the generation of 3D immersive serious games is proposed. The framework combines two Natural User Interfaces (NUIs), for hand and body modeling, respectively, and a Head Mounted Display (HMD) to provide the patient with an interactive and highly defined Virtual Environment (VE) for playing with stimulating rehabilitation exercises. The paper presents the overall architecture of the framework, including the environment for the generation of the pilot serious games and the main features of the used hand and body models. The effectiveness of the proposed system is shown on a group of ninety-two patients. In a first stage, a pool of seven rehabilitation therapists has evaluated the results of the patients on the basis of three reference rehabilitation exercises, confirming a significant gradual recovery of the patients’ skills. Moreover, the feedbacks received by the therapists and patients, who have used the system, have pointed out remarkable results in terms of motivation, usability, and customization. In a second stage, by comparing the current state-of-the-art in rehabilitation area with the proposed system, we have observed that the latter can be considered a concrete contribution in terms of versatility, immersivity, and novelty. In a final stage, by training a Gated Recurrent Unit Recurrent Neural Network (GRU-RNN) with healthy subjects (i.e., baseline), we have also provided a reference model to objectively evaluate the degree of the patients’ performance. To estimate the effectiveness of this last aspect of the proposed approach, we have used the NTU RGB + D Action Recognition dataset obtaining comparable results with the current literature in action recognition.[…]
[ARTICLE] Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial – Full Text
Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient’s disability and while investigating the influence of comorbidities.
Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up.
At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention ( (2) = 9.57, p < .01), spatial awareness ( (2) = 11.23, p < .01) and generalized cognitive functioning ( (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = − 2.76, r = − .60, p < .01) and (Ws = 92, z = − 2.03, r = − .44, p < .05).
ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients.
The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.
Cognitive impairments are common after stroke, with incident rates up to 78% . Patients with mild cognitive impairment are at risk for developing dementia . Cognitive deficits correlate with poor functional outcomes and increased risk of dependence , have negative effects on the patient’s quality of life , and alter the patient’s ability to socialize . However, the current clinical practice seems to lack methods that specifically address cognitive sequelae. According to a meta-analysis that aimed at proposing recommendations for new clinical standards, currently available treatments that are used as control conditions are conventional therapies like physical therapy or occupational therapy, pseudo treatments like mental or social stimulation without therapeutic intent, as well as psychosocial interventions like psychotherapy or emotional support for individuals or groups . Besides, it has been shown that cognitively impaired patients participate less in rehabilitation activities, which potentially contributes to the poorer functional outcome they display . Finding effective cognitive rehabilitation methods that can be incorporated in clinical practice is therefore crucial. Numerous methods to improve cognitive deficits, for instance, specifically attention , memory , executive function , or spatial abilities , have been proposed. However, the results show mixed efficacies. A meta-analysis on the impact of attentional treatments showed an effect on divided attention in the short-term, but found no evidence for persisting effects on other attentional domains, global attention, or functional outcomes . Similarly, a meta-review that investigated the effect of memory rehabilitation found that training might benefit subjective reports of memory in the short term, but shows no effect in the long term, on objective memory measures, mood, functional abilities or quality of life . Ultimately, a meta-analysis over 6 Cochrane reviews shows insufficient research evidence or evidence of insufficient quality to support any recommendation for cognitive stroke rehabilitation . Besides methodological issues, one limitation of existing methods could be that they focus on one deficit only, ignoring that patients typically express deficits in multiple cognitive domains [1, 2]. A study on a large sample of heterogeneous stroke patients which aimed at linking lesions to cognitive deficits found that a given lesion location leads to cognitive impairments in several domains . This emphasizes that cognitive functions rely on a network of brain regions. A lesion in one of those regions might cause a disturbance to the network, which leads to a multitude of symptoms. This is further supported by studies that revealed that pathological changes in brain structures are related to the occurrence of various cognitive deficits and symptoms for instance, in Alzheimer’s disease  or spatial neglect . Moreover, the presence of multiple cognitive deficits seems to be a marker in patients that are at risk of developing Alzheimer’s disease later in life . To what extent rehabilitation could potentially drive structural or functional changes to alleviate the symptoms of stroke is still under debate [19, 20]. Nevertheless, rehabilitation methods have to aid the patient in obtaining enough functionality to independently perform instrumental activities of daily living, be it through restoration of function or compensation. With this in mind, focusing on training a single cognitive skill might not be efficient because many daily tasks or jobs require several cognitive abilities for their execution . For instance, most patients would like to be mobile and drive a car again after their stroke. Driving requires the individual to use selective attention to deal with the traffic, traffic signs and distractions, to be cognitively flexible to react to changing situations on the road, to visually scan the mirrors at the front, at the side, and in the back, to have a visual field that includes the sidewalks and to perform all of this while steering the car effectively in real-time . Consequently, rehabilitation methods that address one specific cognitive ability only do not address the requirements of performing the activities of daily living and might not stimulate and train the underlying brain processes adequately. If a stroke leads to impairments in various cognitive domains, then these domains should be treated together to benefit a patient’s performance in everyday life.[…]
After stroke, sustained hand rehabilitation training is required for continuous improvement and maintenance of distal function. In this paper, we present a system designed and implemented in our lab: the Home-based Virtual Rehabilitation System (HoVRS). Eleven subjects with chronic stroke were recruited to test the feasibility of the system and refine its design and the training protocol to prepare for a future efficacy study. HoVRS was placed at subjects’ homes, and subjects were asked to use the system at least 15 minutes every weekday for 3 months (12 weeks) with limited technical support and remote clinical monitoring. All subjects completed the study without any adverse events. Subjects on average spent 12 hours using the system. Nine out of the eleven subjects improved on the Box and Blocks Test (BBT), and ten improved on the Upper Extremity Fugl-Meyer Assessment (FM) and the Action Research Arm Test (ARAT). The outcomes of this pilot study warrant further investigation of the system’s ability to promote recovery of hand function in subacute and chronic stroke.
Stroke is a leading cause of serious long-term disability in the United States. The incidence of new or recurrent stroke in the US is 795,000 per year and the prevalence of chronic stroke is approximately 7 million (Go et al., 2014). Projections show that by 2030, an additional 3.4 million people or 3.88% of U.S. adults 18 and older will have had a stroke, a 20.5% increase from 2012 (American Stroke Association 2018). At six months post-stroke, about 65% of affected persons continue to have hand deficits that profoundly affect their ability to perform their usual activities and their independence (Dobkin, 2005; Lang, et al. 2006). This leaves a potential market segment of approximately 640,000 persons that may need long-term arm and hand rehabilitation. Restoration of hand function is of utmost importance since it is the loss of hand function that profoundly decreases quality of life by limiting the ability to perform feeding, dressing, and grooming, and further may limit the use of assistive as well as telecommunications technology (Brown et al. 1987, Grimby et al. 1998, Andren et al. 2004, Kwakkel et al. 2008).
Therapy in an inpatient rehabilitation center only lasts about 2-3 weeks. As outpatients, stroke survivors are typically only seen two to three times a week for short time periods. This volume of intervention falls far short of the hundreds of hours needed to re-establish normal hand function. Recently published results of innovative lab-based interventions appear to have a similar problem (Lang et al., 2015, Winstein et al., 2016). It is therefore imperative to develop an intervention that can be delivered at home over a sufficient period of time to elicit improvements.
Innovative telerehabilitation systems have been developed using information and communication technologies to provide rehabilitation services at a distance. Many studies have developed video-game driven systems from commercially available gaming consoles such as Wii and Microsoft Kinect (Metcalf et. al, 2013), however, these systems do not address hand rehabilitation. Other groups, including members of our own team, have examined the use of custom-made telerehabilitation systems (Adamovich et. al, 2005, Turolla et. al., 2013) but they are not commercially available. An ideal home-based telerehabilitation system has to be low cost, easy to setup, able to motivate the user for everyday use, generate progress reports for the user for self-tracking, and provide daily monitoring to remote clinicians. Exciting new technologies have now made this approach possible and hold promise for long-term benefit. These technological advances – for the first time – allow for virtual reality simulations interfaced with discrete finger and hand tracking that are affordable and easy to use.
Our product, the Home Virtual Rehabilitation System (HoVRS), provides intense upper extremity rehabilitation at home. It will allow patients to access hand/arm rehabilitation without the cost and transportation challenges associated with outpatient rehabilitation. HoVRS will consist of five elements: 1) an infrared camera specifically designed to capture finger and arm movements – a substantial improvement over rehabilitation activities provided by commercial game consoles like Kinect or Wii, 2) multiple engaging games that train the hand and arm using commercial gaming mechanics designed to optimize players’ motivation to perform these activities for long periods of time, 3) an optional exoskeleton designed to assist the patient’s arm as it moves against gravity (use of this support can be weaned and eliminated as patients get stronger), 4) monitoring and archiving software that will allow clinicians to design custom rehabilitation interventions, track a patient’s progress, and modify a patient’s rehabilitation program, in-person or remotely, and 5) a secure wireless data connector to collect detailed information on patient movement in real time. The secure communication channel will allow for remote monitoring by clinicians, remote technical support, and remote patient and clinician interaction face to face, while the patient uses HoVRS.
This study describes the experiences of the first eleven persons with stroke that participated in pilot testing of HoVRS in their homes.[…]
Continue —-> HoVRS: Home-based Virtual Rehabilitation System
[Abstract] Artificial intelligence-based interactive virtual reality-assisted gaming system for hand rehabilitation
Date: February 28, 2020, Source: University of Warwick
Summary: Virtual reality could help physiotherapy patients complete their exercises at home successfully thanks to researchers who managed to combine VR technology with 3D motion capture.
Virtual reality could help physiotherapy patients complete their exercises at home successfully thanks to researchers at WMG, University of Warwick, who managed to combine VR technology with 3D motion capture.
Currently prescribed physiotherapy often requires patients to complete regular exercises at home. Outside of the clinic, patients rarely receive any guidance other than a leaflet of sketches or static photographs to instruct them how to complete their exercises. This leads to poor adherence, with patients becoming anxious about not getting the exercise right, or simply getting bored by the repetitiveness of the movements.
The advent of consumer virtual reality technology combined with 3D motion capture allows real movements to be accurately translated onto an avatar that can be viewed in a virtual environment. Researchers at the Institute of Digital Healthcare, WMG, University of Warwick are investigating whether this technology can be used to provide guidance to physiotherapy patients, by providing a virtual physiotherapist in the home to demonstrate the prescribed exercises.
Their paper, ‘Timing and correction of stepping movements with a virtual reality avatar’ published today the 28th of February, in the Journal PLOS ONE, has focused on whether people are able to accurately follow the movements of a virtual avatar.
Researchers had to investigate whether people were able to accurately coordinate and follow the movements of an avatar in a virtual environment. They asked participants to step in time with an avatar viewed through a VR headset.
Unknown to the participants, the researchers subtly slowed down or speeded up one of the avatar’s steps, such that the participants would have to correct their own stepping movement to stay in time. The effect this correction had on their step timing and synchronisation with the avatar was measured.
Lead author, Omar Khan from WMG, University of Warwick commented:
“If participants were observed to correct their own stepping to stay in time with the avatar, we knew they were able to accurately follow the movements they were observing.
“We found that participants struggled to keep in time if only visual information was present. However, when we added realistic footstep sounds in addition to the visual information, the more realistic multisensory information allowed participants to accurately follow the avatar.”
Dr Mark Elliott, Principal investigator on the project at WMG, University of Warwick added:
“There is huge potential for consumer VR technologies to be used for both providing guidance to physiotherapy exercises, but also to make the exercises more interesting. This study has focused on the crucial question of how well people can follow a virtual guide.”
Prof. Theo Arvanitis, co-author and Director of the Institute of Digital Healthcare, said:
“Our work and digitally-enabled technological solution can underpin transformative health innovations to impact the field of physiotherapy, and have a direct benefit to patients’ rehabilitation. “We now plan to investigate other types of movements working closely in partnership with physiotherapists, to establish the areas of physiotherapy that will benefit most from this technology.”
- Omar Khan, Imran Ahmed, Joshua Cottingham, Musa Rahhal, Theodoros N. Arvanitis, Mark T. Elliott. Timing and correction of stepping movements with a virtual reality avatar. PLOS ONE, 2020; 15 (2): e0229641 DOI: 10.1371/journal.pone.0229641
[Abstract] Effectiveness of home-based virtual reality on vestibular rehabilitation outcomes: a systematic review
Background: A 2015 systematic review evaluated the efficacy of utilizing virtual reality in vestibular rehabilitation programs. However, the biggest limitation with most of the included virtual reality systems was the associated cost of the equipment. In addition, home-based exercises are the preferred method of vestibular rehabilitation treatments.
Objectives: The purpose of this systematic review was to examine the effectiveness of home-based virtual reality systems on vestibular rehabilitation outcomes.
Methods: The following databases were examined: CINAHL Complete, ProQuest Medical Database, and PubMed. The following search terms were utilized: ‘video OR computer’ AND ‘vestibular’ AND ‘home’. The evidence level for all of the included articles was evaluated using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and the methodological rigor for all of the included articles was evaluated using a 10-item tool created by Medlicott and Harris.
Results: Based on the inclusion and exclusion criteria, seven articles were selected for inclusion in this systematic review. This systematic review found that home-based virtual reality interventions were able to effectively achieve the primary objectives of vestibular rehabilitation and that the use of these interventions was equally as effective as the use of a traditional vestibular rehabilitation program. In addition, it may be most beneficial to combine virtual reality with traditional vestibular rehabilitation.
Conclusions: Clinicians should consider using a combination of virtual reality and traditional vestibular rehabilitation when treating individuals who have been diagnosed with a vestibular dysfunction.
XRHealth, formerly known as VRHealth, announces the opening of reportedly the first virtual reality (VR) telehealth clinic. Patients can now obtain virtual reality treatment without leaving their homes.
VR telehealth clinicians providing care are currently certified in Massachusetts, Connecticut, Florida, Michigan, Washington D.C., Delaware, California, New York, and North Carolina and will be expanding their presence in additional states in the coming months. The XRHealth telehealth services are covered by Medicare and most major insurance providers.
XRHealth is designed to use virtual reality to help rehabilitate patients via an immersive and engaging experience in the comfort of their own home. It combines therapeutic software with virtual reality technology solutions to treat a variety of health conditions. VR therapy transports patients to an environment where they can view and experience treatment as a fun activity, increasing patient participation in prescribed therapeutic treatments, according to XRHealth in a media release.
The XRHealth VR telehealth clinicians will provide an initial patient assessment, ship a VR headset to patients who do not currently have access to one, train them on how to use the technology, provide ongoing telehealth care and remote monitoring, using video call and VR technology, and manage the insurance billing for patients. As the patient is using the XRHealth VR technology for therapeutic treatment, the clinical staff can control the unit remotely and see exactly what the patient is viewing and adjust the settings and treatment in real-time, remotely.
After the initial training session, the patient can then use the headset independently while data from the therapy is stored and analyzed in real-time so that clinicians can monitor patient status regularly while in compliance with the HIPAA privacy rules. Once a week, a report will be generated to the payor/provider that referred the patient.
“XRHealth is modernizing and revolutionizing the way healthcare is operating today,” says Eran Orr, CEO of XRHealth, in the release. “We are utilizing the most advanced forms of technology like virtual reality to provide patients with optimal care in the comfort of their own homes while providing top-notch clinicians with ongoing status of their progress. Patients can now ‘go’ to a virtual clinic without the need to leave their homes at all.”
The XRHealth VR telehealth clinics will open on March 1, and patients can join by submitting a request to enroll for the XRHealth services on the company website.
Background: Stroke is the leading cause of disability worldwide, with many stroke survivors having persistent upper limb functional impairment. Aside from therapist-directed rehabilitation, few efficacious recovery tools are available for use by stroke survivors in their own home. Game-based virtual reality systems have already shown promising results in therapist-supervised settings and may be suitable for home-based use.
Objective: We aimed to assess the feasibility of unsupervised home-based use of a virtual reality device for hand rehabilitation in stroke survivors.
Methodology: Twenty subacute/chronic stroke patients with upper extremity impairment were enrolled in this prospective single-arm study. Participants were instructed to use the Neofect Smart Glove 5 days per week for 8 weeks, in single sessions of 50 minutes or two 25-minute sessions daily. We measured (1) compliance to prescribed rehabilitation dose, (2) patient impression of the intervention, and (3) efficacy measures including the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT) and the Stroke Impact Scale (SIS).
Results: Seven subjects (35%) met target compliance of 40 days use, and 6 subjects (30%) used the device for 20-39 days; there were no age or gender differences in use. Subjective patient experience was favorable, with ninety percent of subjects reporting satisfaction with their overall experience, and 80% reporting perceived improvement in hand function (figure 1). There was a mean improvement of 26.6±48.8 seconds in the JTHFT (p=0.03) and 16.1±15.3 points in the domain of the SIS that assesses hand function (p<0.01). There was a trend towards improvement in the UE-FM (2.2±5.5 points, p=0.10).
Conclusions: A novel virtual reality gaming device is suitable for unsupervised use in stroke patients and may improve hand/arm function in subacute/chronic stroke patients. A large-scale randomized controlled trial is needed to confirm these results.