Posts Tagged augmented reality

[Abstract] Enhancing visual performance of hemianopia patients using overview window

Highlights

 

  • Proposal of a computational glasses for visual field defect
  • Design of a whac-a-mole task for empirical performance evaluation
  • Optimal combinations of size, position, and opacity for overlaid window

Abstract

Visual field defect (VFD) is a type of ophthalmic disease that causes the loss of part of the patient’s field of view (FoV). In this paper, we propose a method to enlarge the restricted FoV with an optical see-through head-mounted display (OST-HMD) equipped with a camera that captures an overview and overlays it on the persisting FoV. Because the overview window occludes the real background scene, it is important to create a balance between the augmented contextual information and the unscreened local information. We recruited twelve participants and conducted an experiment to seek the best size, position, and opacity for the overview window through a Whac-A-Mole task (a touchscreen game). We found that the performance was better when the overview window was of medium size (FoV of 9.148 × 5.153, nearly one third of FoV of the used OST-HMD) and placed lower in the visual field. Either too large or too small a size decreases the performance. The performance increases with increased opacity. The obtained results can legitimate the default setting for the overview window.

Graphical abstract

via Enhancing visual performance of hemianopia patients using overview window – ScienceDirect

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[ARTICLE] Walking with head-mounted virtual and augmented reality devices: Effects on position control and gait biomechanics – Full Text PDF

Abstract

What was once a science fiction fantasy, virtual reality (VR) technology has evolved and come a long way. Together with augmented reality (AR) technology, these simulations of an alternative environment have been incorporated into rehabilitation treatments. The introduction of head-mounted displays has made VR/AR devices more intuitive and compact, and no longer limited to upper-limb rehabilitation. However, there is still limited evidence supporting the use of VR and AR technology during locomotion, especially regarding the safety and efficacy relating to walking biomechanics. Therefore, the objective of this study is to explore the limitations of such technology through gait analysis. In this study, thirteen participants walked on a treadmill in normal, virtual and augmented versions of the laboratory environment. A series of spatiotemporal parameters and lower-limb joint angles were compared between conditions. The center of pressure (CoP) ellipse area (95% confidence ellipse) was significantly different between conditions (p = 0.002). Pairwise comparisons indicated a significantly greater CoP ellipse area for both the AR (p = 0.002) and VR (p = 0.005) conditions when compared to the normal laboratory condition. Furthermore, there was a significant difference in stride length (p<0.001) and cadence (p<0.001) between conditions. No statistically significant difference was found in the hip, knee and ankle joint kinematics between the three conditions (p>0.082), except for maximum ankle plantarflexion (p = 0.001). These differences in CoP ellipse area indicate that users of head-mounted VR/AR devices had difficulty maintaining a stable position on the treadmill. Also, differences in the gait parameters suggest that users walked with an unusual gait pattern which could potentially affect the effectiveness of gait rehabilitation treatments. Based on these results, position guidance in the form of feedback and the use of specialized treadmills should be considered when using head-mounted VR/AR devices.

Introduction

Over the past two decades, the application of virtual reality (VR) technology in a healthcare setting has become increasingly popular. It has been incorporated into clinical practices such as in the rehabilitation of stroke survivors, as well as patients with cerebral palsy and multiple sclerosis []. There is ample evidence suggesting that VR-based rehabilitation facilitates upper limb motion [] and dynamic balance [] among stroke survivors. More recently, research groups have also investigated the use of VR in dynamic situations (i.e. treadmill walking), aiming to improve balance and facilitate gait recovery [].

In current clinical practice, gait retraining often includes treadmill training under the supervision of practitioners or through provision of real-time biofeedback. It is a widely adopted technique that aims to permanently correct faulty gait patterns and has been found to be effective in both walking and running gait modifications []. For example, a recently published randomized controlled trial showed that gait retraining was an effective intervention for reduction of knee loading and also improved symptoms among patients with early knee osteoarthritis []. Incorporation of VR technology into conventional gait retraining has the potential to further enhance training outcomes. VR allows users to actively interact with a simulated environment in real-time and offers the opportunity to practice skills acquired in the virtual environments to everyday life []. VR-based gait retraining has the potential to facilitate implicit learning, enhance variety, and actively engage the patient during training. These attributes are crucial in the optimization of motor learning and could maximize the training effect [].

Walking is normally an automatic process. It has been suggested that conscious modification to walking patterns could affect gait retraining adaptations []. A previous study found that subjects who trained with distraction were able to retain the training effect longer than the group who focused on correction []. VR-based retraining could include different tasks and games while the patients modify their gait pattern as it could help patients to maintain focus and promote implicit motor learning. Moreover, the training environment, feedback type and level of difficulty of tasks can be manipulated within the VR environment relatively effortlessly for the clinician, as compared to conventional gait retraining. Variation in training has been shown to promote a more robust motor pattern and favor adaptation [,]. Moreover, motivation and adherence among patients can also be improved with more variation and an adjustable level of difficulty provided in the VR-based training []. Stroke survivors were previously found to be more actively engaged in a VR-based training than a conventional task-oriented intervention to improve motor function []. The training environment can be designed to simulate real-life activities and include task-specific training and a natural experience can be achieved through immersive VR devices, such as using a head-mounted display (HMD) []. Studies have supported task-specific motor skill training with VR in helping to drive neuroplasticity in individuals with progressive neurodegenerative disorder [,].

Although multiple studies have reported positive results of gait retraining using VR among various patient groups within the lab [,,,], there is still little understanding of the limitations and challenges for using VR technology clinically. One overriding concern for using VR technology in clinical applications, especially an HMD, is safety. The user may not be able to recognize his/her own body position when using an immersive VR device, which could result in physical injuries, particularly if the user fails to stay within the boundaries of the treadmill. Suspension devices (i.e. an over-head harness) have been used for protection during VR-based gait rehabilitation [], and a recent study showed that both young and older adults were able to use HMD during walking without adverse effects []. However, the limit of VR technology on safety was not quantified or discussed. Recent technological advances in both the hardware and software of HMD might allow for safer use. However, there is still a need for evidence-based support and quantifiable data, which could help with practical considerations among VR applications in a clinical setting.

Another concern for gait rehabilitation would be the regularity and quality of gait. Through studying spatiotemporal gait parameters, some studies have reported that walking in a projected VR environment can induce gait instability even in healthy participants [,]. Nowadays, VR-based gait retraining using HMD focuses primarily on gait restoration after stroke []; the changes in natural gait due to the use of HMD may not be clinically significant. However, it is crucial for particular patient groups undergoing gait modification to maintain a certain level of regularity in their gait pattern. For instance, knee loading can be affected by spatiotemporal parameters such as cadence and step length [] and VR was previously found to alter such parameters in an over-ground setting []. The treatment effect of gait retraining in reducing knee loading would likely be affected if the patient’s baseline walking gait was already altered by the use of HMD or other VR devices. The aforementioned studies did not quantify the changes in walking biomechanics when using a HMD, therefore, this study aimed to identify gait parameters that were affected by the use of HMD.

An alternative to VR is Augmented Reality (AR), which does not fully immerse the user in a simulated environment but includes virtual elements that are superimposed on a real-world view []. For example, external cues on foot placement could be overlaid on to the walking surface in order to facilitate gait adjustments [,]. The addition of feedback in AR-based gait retraining allows for variations in training and could enhance the gait retraining effect. Yet, there is also a lack of understanding of the limitation of using AR devices. Therefore, this study also aimed to examine the biomechanical changes induced by the HMD within an AR setting.

This study was designed to assess whether the use of commercially available HMD in VR and AR settings were suitable for clinical gait retraining. Specifically, the aim was to quantify the limitations of current VR and AR technology based on two practical concerns for clinical applications: 1) safety: the ability of the user to maintain a relatively stable position within the treadmill and 2) natural gait patterns: deviation of walking biomechanics from that of normal-treadmill walking. We hypothesized that there would be variations in the control of body position relative to the treadmill between both VR and AR conditions when compared with normal-treadmill walking. Also, based on altered gait biomechanics reported with the use of HMD in an over-ground setting [], we hypothesized there would be variation in the spatiotemporal and joint kinematic measures while walking in VR and AR conditions, when compared with normal-treadmill walking.

Materials and methods

Participants

A total of 13 participants (7 females, 6 males; age = 24.6 ± 4.5 years; weight = 63.1 ± 14.5 kg; height = 1.68 ± 0.11 m) were recruited for this study through convenient sampling, which is a comparable sample size to previous studies []. Participants were free of any musculoskeletal, neurological, neuromuscular or cardiovascular pathology that might hinder walking. The experimental procedures were reviewed and approved by the Departmental Research Committee of the department of Rehabilitation Sciences, The Hong Kong Polytechnic University (Ref.: HSEARS20161018001) and written informed consent was obtained from all participants prior to the experiment.

Experimental procedures

Participants were asked to walk at a self-selected pace for four minutes to allow for treadmill adaptation prior to data collection []. Anthropometric data, including leg length, knee width and ankle width [], were recorded and 39 reflective markers were affixed to specific bony landmarks based on the Vicon Plug-in-Gait® full body model []. The marker model was previously established for the measurement of lower-limb kinematics []. This study was designed to assess HMD in VR and AR settings using a commercially available model within a typical clinical setting. Thus, the conditions were designed to be simple and without the use of additional lab equipment. All walking trials were conducted on a dual-belt instrumented treadmill (Force-sensing tandem treadmill, AMTI, Watertown, MA, USA; length x width = 1.2 x 0.6 m). Participants wore their own usual shoes and walked under different conditions at 3.0 km/h (0.83 m/s) for three minutes each. The three conditions were Control, VR and AR, details were as follows:

Control: Treadmill walking without the HMD;

Virtual reality (VR): Immersive 360° panoramic image of the laboratory captured by the Samsung Gear 360 Cam (Samsung, Seoul, South Korea), set up instructions and image file used are provided in the supporting information (S1 File and S1 Fig).

Augmented reality (AR): Real-time display through the rear camera of the HMD, set up instructions are provided in the supporting information (S2 File).

For the AR and VR conditions, participants wore a head-mounted VR device (Samsung Gear VR SM-R322 and Samsung Galaxy S7, Samsung, Seoul, South Korea; width x height x depth: 201.93 x 92.71 x 116.33 mm). The immersive VR/AR environment within this study refers to the panoramic display in a first-person perspective with complete visual obstruction to the real-world environment. The HMD used in this study weighs a total of 470 g, which is comparable to typical commercial HMD models (HTC VIVE Pro: 555 g [] and Oculus Rift DK2: 440 g []). Adjustments to the device were made for fit, focus, and orientation for each participant. Participant’s comfort was confirmed through subjective reporting before the beginning of each walking trial.

The test sequence was randomized using a web-based software (www.randomizer.org). To ensure safety, participants were supported by an overhead safety harness providing 0% bodyweight support. The experimental setup is indicated in Fig 1. The individual in Fig 1 of this manuscript has given written informed consent (as outlined in PLOS consent form) to publish the photograph.

An external file that holds a picture, illustration, etc.Object name is pone.0225972.g001.jpg

Fig 1
A photograph to illustrate the experimental setup.For condition AR and VR, the participant wore a head-mounted VR device. The participant was protected by an overhead safety harness system. Reflective markers and motion cameras were employed to collect gait biomechanics during the walking trials.

[…]

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[NEWS] Ocutrx Vision Technologies promotes AR for macular degeneration

The Oculenz for macular degeneration

A California-based technology startup has developed an augmented reality headset meant to help patients cope with macular degeneration.

Mitchael Freeman, COO of Ocutrx Vision Technologies, LLC, presented the products and discussed how wearable devices, smartphones and artificial intelligence are changing healthcare at the Medical Design & Manufacturing West Conference.

Freeman highlighted the Oculenz Advanced Macular Degeneration ARwear, which has patented technology that uses complex algorithms to reposition video pixels from blurred vision areas to adjacent areas that still have viable vision.

“The speed at which wearable technology is developing and proving its utility in the healthcare space is raising a lot of eyebrows internationally,” Freeman said. “The Ocutrx technology is aimed at both improving surgery protocols and outcomes as well as assisting patients with low vision conditions such as age-related macular degeneration, amblyopia and hemianopsia. But the reality is that our tech — and other wearable tech currently in our development — can and will be used for everything from general healthcare to fitness; from remote disease monitoring to in-home pharma testing; and into advanced surgical telemedicine — and the list goes on.”

Oculenz is available for pre-order now, with shipping expected by summer.

 

via Ocutrx Vision Technologies promotes AR for macular degeneration – Products – McKnight’s Long Term Care News

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[WEB SITE] Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games – Rehab Managment

Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games

Neofect unveils Neofect Smart Balance, a lower-body rehabilitation device designed to help patients recovering from stroke, ambulatory injuries, and other lower body disabilities regain function in their legs via augmented reality.

Recognized as a 2020 CES Innovation Award honoree, Neofect Smart Balance features 16 rehabilitation games that emphasize core strength, restabilization, and balance, all with the goal of helping patients walk unassisted.

The rehab device features a 2.5-foot by 2.5-foot “Dance Dance Revolution”-esque board designed to evaluate a patient’s posture and gait, then track and analyze motions, providing feedback when it senses an imbalance. Optional handlebars provide additional stability as needed. As patients advance, Neofect Smart Balance games increase speed of movement and coordination as patients step on and off the pad, according to the company, US-based in San Francisco, in a media release.

“For the past decade we’ve focused on hand and upper arm rehabilitation, but we’ve always wanted to create more engaging and measurable therapy for patients who need to recover leg function — whether that’s relearning how to walk or regaining range of motion and confidence,” Scott Kim, co-founder and CEO of Neofect USA, says in the release.

“With Neofect Smart Balance, games like ‘Rock Band’ prompt users to move their feet, in this case to the beat of a song. Patients are physically and cognitively challenged and can also have fun while rehabilitating.”

Neofect Smart Balance is designed for use in healthcare clinics and at home, increasing accessibility of treatment for patients with limited mobility. It securely and remotely shares progress reports with therapists, so they can monitor and adjust patients’ recovery regimen as needed.

Neofect announces it is also showcasing Neofect Connect, a new coaching and companion app, at CES 2020. Designed as an extension of therapy in a clinical setting to support and inspire stroke survivors through recovery at home, Neofect Connect will recommend customized daily exercises and educational materials based on patient ability.

The app, which will be available for any stroke survivor regardless if they use Neofect’s solutions, will include a digital telehealth program where physical and occupational therapists will connect with users remotely to guide their rehabilitation.

Neofect Connect is available on the Apple App Store and on the Google Play Store for homeNeofect users and will be open to any stroke survivor in spring 2020, per the release.

[Source(s): Neofect, Business Wire]

 

via Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games – Rehab Managment

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[Abstract] EVA: EVAluating at-home rehabilitation exercises using augmented reality and low-cost sensors

Abstract

Over one billion people in the world live with some form of disability. This is incessantly increasing due to aging population and chronic diseases. Among the emerging social needs, rehabilitation services are the most required. However, they are scarce and expensive what considerably limits access to them. In this paper, we propose EVA, an augmented reality platform to engage and supervise rehabilitation sessions at home using low-cost sensors. It also stores the user’s statistics and allows therapists to tailor the exercise programs according to their performance. This system has been evaluated in both qualitative and quantitative ways obtaining very promising results.

via EVA: EVAluating at-home rehabilitation exercises using augmented reality and low-cost sensors | SpringerLink

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[ARTICLE] Walking with head-mounted virtual and augmented reality devices: Effects on position control and gait biomechanics – Full Text

Abstract

What was once a science fiction fantasy, virtual reality (VR) technology has evolved and come a long way. Together with augmented reality (AR) technology, these simulations of an alternative environment have been incorporated into rehabilitation treatments. The introduction of head-mounted displays has made VR/AR devices more intuitive and compact, and no longer limited to upper-limb rehabilitation. However, there is still limited evidence supporting the use of VR and AR technology during locomotion, especially regarding the safety and efficacy relating to walking biomechanics. Therefore, the objective of this study is to explore the limitations of such technology through gait analysis. In this study, thirteen participants walked on a treadmill in normal, virtual and augmented versions of the laboratory environment. A series of spatiotemporal parameters and lower-limb joint angles were compared between conditions. The center of pressure (CoP) ellipse area (95% confidence ellipse) was significantly different between conditions (p = 0.002). Pairwise comparisons indicated a significantly greater CoP ellipse area for both the AR (p = 0.002) and VR (p = 0.005) conditions when compared to the normal laboratory condition. Furthermore, there was a significant difference in stride length (p<0.001) and cadence (p<0.001) between conditions. No statistically significant difference was found in the hip, knee and ankle joint kinematics between the three conditions (p>0.082), except for maximum ankle plantarflexion (p = 0.001). These differences in CoP ellipse area indicate that users of head-mounted VR/AR devices had difficulty maintaining a stable position on the treadmill. Also, differences in the gait parameters suggest that users walked with an unusual gait pattern which could potentially affect the effectiveness of gait rehabilitation treatments. Based on these results, position guidance in the form of feedback and the use of specialized treadmills should be considered when using head-mounted VR/AR devices.

Introduction

Over the past two decades, the application of virtual reality (VR) technology in a healthcare setting has become increasingly popular. It has been incorporated into clinical practices such as in the rehabilitation of stroke survivors, as well as patients with cerebral palsy and multiple sclerosis [13]. There is ample evidence suggesting that VR-based rehabilitation facilitates upper limb motion [4] and dynamic balance [5] among stroke survivors. More recently, research groups have also investigated the use of VR in dynamic situations (i.e. treadmill walking), aiming to improve balance and facilitate gait recovery [69].

In current clinical practice, gait retraining often includes treadmill training under the supervision of practitioners or through provision of real-time biofeedback. It is a widely adopted technique that aims to permanently correct faulty gait patterns and has been found to be effective in both walking and running gait modifications [1012]. For example, a recently published randomized controlled trial showed that gait retraining was an effective intervention for reduction of knee loading and also improved symptoms among patients with early knee osteoarthritis [10]. Incorporation of VR technology into conventional gait retraining has the potential to further enhance training outcomes. VR allows users to actively interact with a simulated environment in real-time and offers the opportunity to practice skills acquired in the virtual environments to everyday life [13]. VR-based gait retraining has the potential to facilitate implicit learning, enhance variety, and actively engage the patient during training. These attributes are crucial in the optimization of motor learning and could maximize the training effect [14].

Walking is normally an automatic process. It has been suggested that conscious modification to walking patterns could affect gait retraining adaptations [15]. A previous study found that subjects who trained with distraction were able to retain the training effect longer than the group who focused on correction [15]. VR-based retraining could include different tasks and games while the patients modify their gait pattern as it could help patients to maintain focus and promote implicit motor learning. Moreover, the training environment, feedback type and level of difficulty of tasks can be manipulated within the VR environment relatively effortlessly for the clinician, as compared to conventional gait retraining. Variation in training has been shown to promote a more robust motor pattern and favor adaptation [16,17]. Moreover, motivation and adherence among patients can also be improved with more variation and an adjustable level of difficulty provided in the VR-based training [18]. Stroke survivors were previously found to be more actively engaged in a VR-based training than a conventional task-oriented intervention to improve motor function [19]. The training environment can be designed to simulate real-life activities and include task-specific training and a natural experience can be achieved through immersive VR devices, such as using a head-mounted display (HMD) [20]. Studies have supported task-specific motor skill training with VR in helping to drive neuroplasticity in individuals with progressive neurodegenerative disorder [4,21].

Although multiple studies have reported positive results of gait retraining using VR among various patient groups within the lab [1,5,22,23], there is still little understanding of the limitations and challenges for using VR technology clinically. One overriding concern for using VR technology in clinical applications, especially an HMD, is safety. The user may not be able to recognize his/her own body position when using an immersive VR device, which could result in physical injuries, particularly if the user fails to stay within the boundaries of the treadmill. Suspension devices (i.e. an over-head harness) have been used for protection during VR-based gait rehabilitation [8], and a recent study showed that both young and older adults were able to use HMD during walking without adverse effects [21]. However, the limit of VR technology on safety was not quantified or discussed. Recent technological advances in both the hardware and software of HMD might allow for safer use. However, there is still a need for evidence-based support and quantifiable data, which could help with practical considerations among VR applications in a clinical setting.

Another concern for gait rehabilitation would be the regularity and quality of gait. Through studying spatiotemporal gait parameters, some studies have reported that walking in a projected VR environment can induce gait instability even in healthy participants [24,25]. Nowadays, VR-based gait retraining using HMD focuses primarily on gait restoration after stroke [8]; the changes in natural gait due to the use of HMD may not be clinically significant. However, it is crucial for particular patient groups undergoing gait modification to maintain a certain level of regularity in their gait pattern. For instance, knee loading can be affected by spatiotemporal parameters such as cadence and step length [26] and VR was previously found to alter such parameters in an over-ground setting [24]. The treatment effect of gait retraining in reducing knee loading would likely be affected if the patient’s baseline walking gait was already altered by the use of HMD or other VR devices. The aforementioned studies did not quantify the changes in walking biomechanics when using a HMD, therefore, this study aimed to identify gait parameters that were affected by the use of HMD.

An alternative to VR is Augmented Reality (AR), which does not fully immerse the user in a simulated environment but includes virtual elements that are superimposed on a real-world view [27]. For example, external cues on foot placement could be overlaid on to the walking surface in order to facilitate gait adjustments [28,29]. The addition of feedback in AR-based gait retraining allows for variations in training and could enhance the gait retraining effect. Yet, there is also a lack of understanding of the limitation of using AR devices. Therefore, this study also aimed to examine the biomechanical changes induced by the HMD within an AR setting.

This study was designed to assess whether the use of commercially available HMD in VR and AR settings were suitable for clinical gait retraining. Specifically, the aim was to quantify the limitations of current VR and AR technology based on two practical concerns for clinical applications: 1) safety: the ability of the user to maintain a relatively stable position within the treadmill and 2) natural gait patterns: deviation of walking biomechanics from that of normal-treadmill walking. We hypothesized that there would be variations in the control of body position relative to the treadmill between both VR and AR conditions when compared with normal-treadmill walking. Also, based on altered gait biomechanics reported with the use of HMD in an over-ground setting [24], we hypothesized there would be variation in the spatiotemporal and joint kinematic measures while walking in VR and AR conditions, when compared with normal-treadmill walking.

Materials and methods

Participants

A total of 13 participants (7 females, 6 males; age = 24.6 ± 4.5 years; weight = 63.1 ± 14.5 kg; height = 1.68 ± 0.11 m) were recruited for this study through convenient sampling, which is a comparable sample size to previous studies [3032]. Participants were free of any musculoskeletal, neurological, neuromuscular or cardiovascular pathology that might hinder walking. The experimental procedures were reviewed and approved by the Departmental Research Committee of the department of Rehabilitation Sciences, The Hong Kong Polytechnic University (Ref.: HSEARS20161018001) and written informed consent was obtained from all participants prior to the experiment.

Experimental procedures

Participants were asked to walk at a self-selected pace for four minutes to allow for treadmill adaptation prior to data collection [33]. Anthropometric data, including leg length, knee width and ankle width [3436], were recorded and 39 reflective markers were affixed to specific bony landmarks based on the Vicon Plug-in-Gait® full body model [34]. The marker model was previously established for the measurement of lower-limb kinematics [35]. This study was designed to assess HMD in VR and AR settings using a commercially available model within a typical clinical setting. Thus, the conditions were designed to be simple and without the use of additional lab equipment. All walking trials were conducted on a dual-belt instrumented treadmill (Force-sensing tandem treadmill, AMTI, Watertown, MA, USA; length x width = 1.2 x 0.6 m). Participants wore their own usual shoes and walked under different conditions at 3.0 km/h (0.83 m/s) for three minutes each. The three conditions were Control, VR and AR, details were as follows:

Control: Treadmill walking without the HMD;

Virtual reality (VR): Immersive 360° panoramic image of the laboratory captured by the Samsung Gear 360 Cam (Samsung, Seoul, South Korea), set up instructions and image file used are provided in the supporting information (S1 File and S1 Fig).

Augmented reality (AR): Real-time display through the rear camera of the HMD, set up instructions are provided in the supporting information (S2 File).

For the AR and VR conditions, participants wore a head-mounted VR device (Samsung Gear VR SM-R322 and Samsung Galaxy S7, Samsung, Seoul, South Korea; width x height x depth: 201.93 x 92.71 x 116.33 mm). The immersive VR/AR environment within this study refers to the panoramic display in a first-person perspective with complete visual obstruction to the real-world environment. The HMD used in this study weighs a total of 470 g, which is comparable to typical commercial HMD models (HTC VIVE Pro: 555 g [37] and Oculus Rift DK2: 440 g [38]). Adjustments to the device were made for fit, focus, and orientation for each participant. Participant’s comfort was confirmed through subjective reporting before the beginning of each walking trial.

The test sequence was randomized using a web-based software (www.randomizer.org). To ensure safety, participants were supported by an overhead safety harness providing 0% bodyweight support. The experimental setup is indicated in Fig 1. The individual in Fig 1 of this manuscript has given written informed consent (as outlined in PLOS consent form) to publish the photograph.

thumbnail

Ground reaction force and coordinates of the center of pressure (CoP) were sampled through the instrumented treadmill at 1,000 Hz. Marker trajectories were sampled at 200 Hz using an 8-camera motion capture system (Vicon, Oxford Metrics Group, UK). The instrumented treadmill and motion capture system were synchronized and were set for data collection for three minutes after the treadmill reached the testing speed.[…]

 

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[Systematic Review] Exoskeletons With Virtual Reality, Augmented Reality, and Gamification for Stroke Patients’ Rehabilitation: Systematic Review – Full Text

ABSTRACT

Background: Robot-assisted therapy has become a promising technology in the field of rehabilitation for poststroke patients with motor disorders. Motivation during the rehabilitation process is a top priority for most stroke survivors. With current advancements in technology there has been the introduction of virtual reality (VR), augmented reality (AR), customizable games, or a combination thereof, that aid robotic therapy in retaining, or increasing the interests of, patients so they keep performing their exercises. However, there are gaps in the evidence regarding the transition from clinical rehabilitation to home-based therapy which calls for an updated synthesis of the literature that showcases this trend. The present review proposes a categorization of these studies according to technologies used, and details research in both upper limb and lower limb applications.

Objective: The goal of this work was to review the practices and technologies implemented in the rehabilitation of poststroke patients. It aims to assess the effectiveness of exoskeleton robotics in conjunction with any of the three technologies (VR, AR, or gamification) in improving activity and participation in poststroke survivors.

Methods: A systematic search of the literature on exoskeleton robotics applied with any of the three technologies of interest (VR, AR, or gamification) was performed in the following databases: MEDLINE, EMBASE, Science Direct & The Cochrane Library. Exoskeleton-based studies that did not include any VR, AR or gamification elements were excluded, but publications from the years 2010 to 2017 were included. Results in the form of improvements in the patients’ condition were also recorded and taken into consideration in determining the effectiveness of any of the therapies on the patients.

Results: Thirty studies were identified based on the inclusion criteria, and this included randomized controlled trials as well as exploratory research pieces. There were a total of about 385 participants across the various studies. The use of technologies such as VR-, AR-, or gamification-based exoskeletons could fill the transition from the clinic to a home-based setting. Our analysis showed that there were general improvements in the motor function of patients using the novel interfacing techniques with exoskeletons. This categorization of studies helps with understanding the scope of rehabilitation therapies that can be successfully arranged for home-based rehabilitation.

Conclusions: Future studies are necessary to explore various types of customizable games required to retain or increase the motivation of patients going through the individual therapies.

Introduction

Background

Stroke refers to a sudden, often catastrophic neurological event that can lead to long-term adult disability. The American Heart Association (AHA) is responsible for providing up-to-date statistics related to heart disease and stroke. According to Benjamin et al [1], the AHA released a 2017 statistics report on heart disease and stroke that stated that approximately 795,000 stroke episodes occur in the US each year. With current advancements in medical technology there has been a decrease in the rate of stroke incidents, but it can still cause paralysis and muscle weakness. Such impairments can result in motor deficits that disturb a stroke survivor’s capacity to live independently.

There are several reasons for stroke occurrence, which could be related to an increased risk of a collection of symptoms caused by disorders affecting the brain (eg, dementia) [2]. Various rehabilitation techniques have been used in the area of rehabilitation-based interactive technology to assist patients in recovering from impairments, and those techniques come under the umbrella of conventional therapy, exoskeleton or robot-aided therapy, virtual reality (VR) or augmented reality (AR) therapy, games-based therapy, or a combination of any of these. These forms of therapy can be done either in the clinic or in an in-home setting. In addition to these, there is a new technology known as telerehabilitation [3] that leverages the use of VR in home settings by providing patients access to real-time rehabilitation services through the internet while they sit at home.

One of the most effective techniques is robot-aided therapy, which has been gradually increasing in use primarily because patients may consider traditional rehabilitation therapy to be tiring and exhaustive. This may decrease their motivation and cohesion to the treatment, thus resulting in only minor improvement in the health of poststroke patients [46]. Various experimental evidence suggests that robot-assisted (or exoskeleton) rehabilitation has been effective in keeping patients motivated and interested in treatment for both upper or lower limb impairments [7,8]. With advancements in technology, there has also been an uptake of VR, AR, and Gamification for the purposes of rehabilitation [9], along with robotic rehabilitation [10,11], primarily to increase engagement, immersion and motivation on behalf of the patient. Both Colombo et al and Alankus et al [12,13] concluded and showed the positive effect of exoskeleton robots and games in poststroke rehabilitation. Wearable devices such as exoskeletons can also relay real-time feedback for any VR-based interactions [14].

Apart from these studies, Housman et al [15] showed user satisfaction survey results in which 90% of participants agreed to the fact that robot- or games-assisted therapies were less confusing, and improvements were very easy to track compared to traditional or conventional therapies. Further, it is thought that gamification can increase repetition, engagement, and range of care within the context of rehabilitation [16,17]. Games are not only useful for the field of rehabilitation, but they are also considered to be highly impactful and relevant in other medical and health fields. Russoniello et al [18] conducted a randomized controlled trial (RCT) study in which the effects of video games on stress-related disorders were tested, with the conclusion being that games were beneficial for their prevention and treatment. In another study, children who had cerebral palsy made use of a game (EyeToy) which was able to improve their upper extremity functions over time [19].

[…]

 

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[BOOK Chapter] Assessment and Rehabilitation Using Virtual Reality after Stroke: A Literature Review – Abstract + References

Abstract

This chapter presents the studies that have used virtual reality as an assessment or rehabilitation tool of cognitive functions following a stroke. To be part of this review, publications must have made a collection of data from individuals who have suffered a stroke and must have been published between 1980 and 2017. A total of 50 publications were selected out of a possible 143 that were identified in the following databases: Academic Search Complete, CINAHL, MEDLINE, PsychINFO, Psychological and Behavioural Sciences Collection. Overall, we find that most of the studies that have used virtual reality with stroke patients focused on attention, spatial neglect, and executive functions/multitasking. Some studies have focused on route representation, episodic memory, and prospective memory. Virtual reality has been used for training of cognitive functions with stroke patients, but also for their assessment. Overall, the studies support the value and relevance of virtual reality as an assessment and rehabilitation tool with people who have suffered a stroke. Virtual reality seems indeed an interesting way to better describe the functioning of the person in everyday life. Virtual reality also sometimes seems to be more sensitive than traditional approaches for detecting deficits in stroke people. However, it is important to pursue work in this emergent field in clinical neuropsychology.

References

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[NEWS] The Combination Of Virtual Reality/Augmented Reality And AI: Creating A Loop Of Data For The Healthcare Industry

When most people conjure up an image of virtual reality and augmented reality – the association is very often Pokemon Go or some other type of video game or entertainment platform. The first thought that comes to mind is not usually pain management, rehabilitation, or cognitive testing – in fact, ten years ago no one would have thought that could be possible with a virtual reality headset.

However, the sophisticated technology embedded in a virtual reality headset can be transformed into a medical device given the right software behind it. In fact, Frost & Sullivan predicted that in the next four years 45% of operating rooms will be using artificial intelligence and virtual reality. We are seeing virtual reality making this entrance now in various settings like dentist offices to relieve patients of anxiety and pain from routine to complicated procedures, to being used for chemotherapy patients, childbirth, and throughout the rehabilitation process. The reason virtual reality is so effective for the patient is that it creates a 360-degree world that can distract and redirect the patients focus so that they are no longer thinking about the pain/anxiety but rather guided in a virtual world. In effect, VR “tricks” the patient’s mind to believe they are literally in another surrounding.

However, the patient experience is not in a vacuum – in fact one of the benefits of virtual reality incorporated with artificial intelligence is that it provides comprehensive data on the patient. For instance, if a patient is using VR during the rehabilitation process, data will be produced in real-time highlighting how often the patient is doing exercises, how intense the exercise was, and how the patient is benefitting the most from the rehabilitation process. The doctor can see all of the data on their patients right at their office so they can prescribe additional therapy or make any other additional adjustments to the VR environment, depending on the results and data available.

Additionally, this data is also available to caregivers whether it is someone caring for an elderly parent, a nurse monitoring their patients progress, or a parent monitoring their child – all the data is visible to the patient, caregiver, and doctor – making the assessment of progress easier. This data can enable the physician to pinpoint exactly what part of the regime needs to be modified. This full circle of data provides the best possible results for the patient, creating a loop of data and communication.

As part of Frost & Sullivan’s recent report recognizes the importance of this data. Bejoy Daniel, Senior Industry Analyst, Transformational Health at Frost & Sullivan states that “data interoperability will help analyze past and present data to predict future health outcomes and patient wellness index for optimum use of resources. The shift in favor of data and algorithms will fuel the algorithmic business and endow businesses with a competitive edge.”

For doctors, this data can be crucial to understand more about how an illness works within the body and for a patient this data can transform their life. Who knew that VR – once thought of as a source of entertainment – would be so game-changing?

 

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[WEB SITE] Addison, the Virtual Caregiver set to debut in January at CES

LAS VEGASJan. 8, 2019 /PRNewswire/ — She has a face, body and endearing personality. Meet Addison, a conversational speech interface including visual, Artificial Intelligence and ambient augmented reality, created by electronic caregiver™, a division of SameDay Security, Inc. Designed to transform the home into a fulltime health and wellness environment, Addison appears on 15-inch media screens throughout a residence and provides support to consumers with features including medication management, care plan adherence, social experiences and emergency response.

What began as a futuristic concept for Anthony Dohrmann, Founder and Chief Executive Officer of SameDay Security, Inc., quickly became reality with the design, innovation and creation of Addison Care™. “We wanted to give new life to voice-based virtual assistants in a way that dramatically expands the utility of voice platforms, while significantly enhancing the user experience. Addison will transform the way people interact with technology. She uniquely inspires a feeling of affection, helping people connect and better embrace their new tech,” Dohrmann said.

 

Built using Amazon Sumerian, a service provided by Amazon Web Services (AWS) that helps organizations create and run virtual reality (VR), augmented reality (AR), and 3D applications quickly and easily without requiring any specialized programming or 3D graphics expertise, the team at electronic caregiver™ was able to bring to life something others thought impossible. They sing the praises of Sumerian saying it changed the way and speed at which they were able to develop Addison. “Having a web-based platform like Sumerian that will host the complexity of artwork, skill and technology behind Addison has already set us apart,” says Joseph Baffoe, company President of SameDay Security, Inc. “What used to take us months or even years to create, now takes a matter of days. Amazon Sumerian has saved time and millions of dollars and can be credited with enabling us to create Addison.”

With the significant growth of the aging population, Addison has set her sights on creating an enjoyable user experience in the home, while also helping to shoulder some of the burden home healthcare is experiencing. High costs and low employee retention are two of the consistent pains in home healthcare. “10,000 people turn 65 every day and of the people needing home healthcare, only about 3% can afford it,” said Dohrmann. “We are encouraged that we will be the option these companies are able to provide to a prospective client who otherwise would have been turned away.”

Imagine a 3D, crystal clear health professional and personal assistant in your home. Though she lives with you, Addison is presented in stunning scenes and interactive environments that develop over time and are uniquely targeted to you and your needs. Her features, combined with just a one-hour set up time, will make Addison a staple in home technology. “Addison powered by Sumerian are cutting-edge interactive solutions that can transform home and healthcare. Addison Care represents a quantum leap forward in addressing the medical, financial, and social realities of an aging population and their caregivers,” stated Mark Francis, Head of Product Marketing for Amazon Sumerian, AWS.

Addison currently provides peace of mind with immediate response to emergencies. She monitors vitals via Bluetooth devices while also providing a demonstration. Addison assists with nutrition, weight loss goals, plans of care management, examinations and monitored medication reminders. She even assesses movement and changes in gait during your day-to-day activities to evaluate your risk of falling, all while working to check health status for trends of improvement or decline.

The future looks bright for Addison Care™ and the features that we can expect in the future. “People have always wondered what voice assistants might look like in the real world, and we’re going to show them at CES in January,” said Dohrmann. The company is actively applying features to provide a better user experience for accessing local business services, transportation, physician-on-demand and environmental information. “We want Addison to be the total package – including home healthcare, rehabilitation support, fitness programs, virtual companionship and social engagement with peers,” said Dohrmann. “Addison is already remarkable, but we’re going to continue innovating and researching to continuously create a superior in-home experience.”

In preparation for CES in Las Vegas, Nevada, new disclosures and websites are scheduled to go live in late December 2018. Until recently, most of Addison has been confidential.

Las Vegas, Nevada – Consumer Electronics Show; January 8-11, 2019
Booth: Sands Convention Center Halls A-D – 42142

About SameDay Security, Inc. and Electronic Caregiver

SameDay Security (SDS) is one of the fastest growing monitored technology providers in the U.S. and one of only a handful of nationwide service providers. Known as electronic caregiver™ and founded in 2009, SDS currently provides automated home care solutions and safety devices nationwide to thousands of clients. SDS has invested over $35,000,000 in patient screenings, research and development. SDS will disclose a new capital offering after CES to fuel new product launches and expansion. SDS has developing contracts with hundreds of home care partners across America who will participate in Addison Care™ marketing to their clients. New clinical trials are scheduled with G60 Trauma of Phoenix, Arizona, involving 500 patients over 3 years to determine the impact on patient outcomes, cost reduction, lower hospitalization, chronic disease management and long-term care. electronic caregiver™ employs over 70 employees and is headquartered in Las Cruces, New Mexico.  www.electroniccaregiver.com

About Amazon Sumerian

Amazon Sumerian is a browser-based authoring tool from AWS designed to create and run for the development and publishing of AR, VR and 3D applications. Using Amazon Sumerian, developers and designers can build immersive apps quickly and easily without requiring any specialized programming or 3D graphics expertise. Experiences built with Sumerian are designed to be embedded into a web page or be consumed on popular hardware such as HTC Vive and HTC Vive Pro, as well as Android and iOS mobile devices. For more information, visit https://aws.amazon.com/sumerian.

SOURCE Electronic Caregiver

Related Links

http://electroniccaregiver.com

 

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