Posts Tagged Kinect

[Abstract] GAMEREHAB@HOME: a new engineering system using serious game and multi-sensor fusion for functional rehabilitation at home

Abstract

Biomedical connected objects like kinematic sensors have been commonly used for patient monitoring in many clinical applications. Moreover, serious games have become widely used to improve patients‘ motivation during functional rehabilitation.
In this work, we developed and evaluated a new engineering system as a solution for functional rehabilitation at home. A multi-sensor fusion between Kinect camera and inertial sensors was developed to animate a 3D avatar during rehabilitation and to estimate kinematic data of different joints for clinical monitoring.
Two serious game scenarios were designed for upper and lower limb rehabilitation. The developed system was evaluated through patient kinematic data and a questionnaire-based approach with a panel of eight post-stroke patients and four clinical experts. The evaluation of the system showed that multi-sensor fusion provides useful data for clinical follow-up. The virtual game scenarios lead to a high level of immersion for patients. Feedbacks from clinical experts concerning the system’s GUIs and the clinical relevance of the acquired data for each rehabilitation session are positive. The developed system paves the way to deploy recent technologies, such as multi-sensor fusion and serious games, as a solution for home-based rehabilitation, which can optimize the benefit of the involved patients and medical experts.

via GAMEREHAB@HOME: a new engineering system using serious game and multi-sensor fusion for functional rehabilitation at home – IEEE Journals & Magazine

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[ARTICLE] Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle – Full Text

Abstract

(1) Background: Increasing the amount of therapy time has been shown to improve motor function in stroke survivors. However, it is often not possible to increase the amount of therapy time provided in the current one-on-one therapy models. Rehabilitation-based virtual reality exergame systems, such as Jintronix, can be offered to stroke survivors as an adjunct to traditional therapy. The goal of this study was to examine the safety and feasibility of providing additional therapy using an exergame system and assess its preliminary clinical efficacy.
(2) Methods: Stroke survivors receiving outpatient rehabilitation services participated in this pilot randomized control trial in which the intervention group received 4 weeks of exergaming sessions in addition to traditional therapy sessions.
(3) Results: Nine subjects in the intervention and nine subjects in the control group completed the study. The intervention group had at least two extra sessions per week, with an average duration of 44 min per session and no serious adverse events (falls, dizziness, or pain). The efficacy measures showed statistically meaningful improvements in the activities of daily living measures (i.e., MAL-QOM (motor activity log-quality of movement) and both mobility and physical domains of the SIS (stroke impact scale) with mean difference of 1.0%, 5.5%, and 6.7% between the intervention and control group, respectively) at post-intervention.
(4) Conclusion: Using virtual reality exergaming technology as an adjunct to traditional therapy is feasible and safe in post-stroke rehabilitation and may be beneficial to upper extremity functional recovery.

1. Introduction

Hemiplegia, weakness of one side of the body, is a common consequence of stroke that can lead to significant functional impairments, including loss of arm function that occurs in up to 85% of stroke survivors [1]. The impact of arm-related limitations on activities of daily living, leisure activities, or work is significant as the arm plays a central role in a person’s life from the ability to perform basic activities of daily life to carrying out family and social roles. Guidelines indicate that rehabilitation can improve upper extremity (UE) motor control and functional status post-stroke [2]. Intense and repetitive training post-stroke is widely recognized as being essential to maximize recovery and promote plasticity in the central nervous system [2,3,4,5,6]. However, in reality, the feasibility of providing intensive rehabilitation may be limited in a rehabilitation setting by a lack of resources or motivation from the patient [7]. Furthermore, stroke survivors discharged from acute care receive physical and occupational therapy services primarily in rehabilitation centers, on an in- and out-patient basis or at home, but budgetary constraints and shortage of specialized health care professionals limit accessibility to much needed rehabilitation services.
New models of service delivery and maximizing the use of existing resources are therefore essential. With the emergence of interactive technologies or “gamified” products, innovative treatment strategies are being developed. Virtual reality (VR) and computer games are recent technologies that, as they become more accessible and affordable [8], are increasingly being used in rehabilitation to allow patients to engage in repetitive practice of specific tasks. The so-called exergames or exergaming reflect the idea of exercising through computer games. A number of published reviews and meta-analyses have examined the use of VR and video games for post-stroke rehabilitation, focusing on or including UE rehabilitation [3,4,6,8,9,10,11].
Saposnik and his colleagues [9] examined the effectiveness of rehabilitation using VR on UE motor function post-stroke in a meta-analysis study. In total, 11 of the 12 included studies (5 randomized controlled trials and 7 pre-post interventions) showed a benefit on the primary outcome, with the pooled randomized controlled trials showing a 4.9 higher chance of improvement in motor impairment when VR was used in comparison to control. Similarly, another meta-analysis study included a subgroup of studies related to UE function [6] and showed that VR had a significant effect on arm function (seven studies) and activities of daily living (ADL) (three studies) in comparison to control groups. The updated Cochrane Review of the meta-analysis concluded that virtual reality has a statistically significant effect on upper limb function (based on 12 studies) and ADL outcome (based on 8 studies) [12]. Another meta-analysis looked at the effect of virtual environments and commercial games on each category of the International Classification of Function, Disability, and Health (ICF), i.e., body function, activity, and participation, in post-stroke rehabilitation [11]. The authors reported that there was a significant effect of using virtual environments in improving all three ICF categories and that these outcome improvements by VR rehabilitation are moderately higher than conventional therapy [11]. However, there is still insufficient evidence regarding the best dose of therapy, timing, and types of programs. In addition, few studies report the users’ perception of these technologies, for both patients and therapists, although Lange and her colleagues [4] discussed the importance of activity enjoyment in their review. Celinder and Peoples [13] studied patients’ experiences through interviews and observation of patients using the Wii Sports for in-patient rehabilitation post-stroke. Most patients reported that the Wii provides them with variety, more stimulation, and more meaningful activities in their rehabilitation. Overall, studies agree that there is limited but promising findings that VR and video games, when combined with conventional rehabilitation, have a positive impact on recovery post-stroke. Furthermore, the literature in the field of technology adoption suggests that the user’s perception plays an important role in the actual use of the technology [14].
The Jintronix system (Jintronix Inc., www.jintronix.com), based on the Microsoft Kinect technology, is one such product that allows patients who have had a stroke to train UE movements independently using challenging and engaging programs tailored to their level of ability. This exergame system allows therapists to objectively track patients’ activities during their recovery process and to adjust, as required, the training program. Graded tasks that challenge and provide feedback to the patient can optimize motor learning [2,15]; this system has embedded this concept in their exergames. In addition, eventually, the tracking functionality that the exergame system offers could allow patients to train without direct therapist supervision, thereby offering interesting opportunities for increased dosage of in-clinic rehabilitation as well as for home-based tele-rehabilitation. In other words, following a stroke, people could participate in a more intensive rehabilitation training without increasing staffing. That being said, prior to using this exergame system in a clinical setting when used as an adjunct to conventional therapy, its feasibility, safety, and efficacy must be assessed.
The goals of this pilot study were to assess the feasibility and safety of the rehabilitation exergaming system and to provide preliminary evidence regarding its clinical efficacy for UE functional recovery post-stroke as a supplement to conventional rehabilitation services, as proposed by Saposnik and colleagues [9]. The results of this study will serve as a basis for a larger multicenter trial, in order to determine the effectiveness of exergame systems as a supplement to UE therapy post-stroke.[…]

Continue —->  IJERPH | Free Full-Text | Feasibility, Safety and Efficacy of a Virtual Reality Exergame System to Supplement Upper Extremity Rehabilitation Post-Stroke: A Pilot Randomized Clinical Trial and Proof of Principle | HTML

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Figure 1. The Jintronix rehabilitation exergaming system.

 

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[Abstract] Feature Evaluation of Upper Limb Exercise Rehabilitation Interactive System Based on Kinect – Full Text PDF

ABSTRACT

The virtual rehabilitation system combining virtual rehabilitation environment and upper limb rehabilitation technology is interactive and interesting, which can improve the enthusiasm and initiative of patients for rehabilitation training, improve the efficiency of rehabilitation training and improve the effect of rehabilitation treatment. This paper firstly conducts in-depth research and analysis on the research progress of the upper limb rehabilitation robot system, and deeply studies the principle and rehabilitation principle of the stroke caused by hemiplegic dyskinesia, and summarizes the goals and methods of the upper limb rehabilitation system design. Secondly, the hand motion tracking is realized by Kinect’s bone tracking, and the optimal tracking distance is determined experimentally, which verifies the stability and robustness of the tracking. Static gesture recognition adopts two gesture recognition schemes based on Kinect depth image and color space model respectively. Finally, using the rehabilitation robot and Kinect sensor as the hardware platform, the virtual rehabilitation training system experimental platform is constructed, and the horizontal rehabilitation exercise and the three-dimensional space rehabilitation exercise are respectively studied experimentally, and the exercise data obtained by using healthy subjects as the experimental object is analyzed. Based on this, the validity and feasibility of the Kinect-based upper limb exercise rehabilitation interactive system were verified.

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[ARTICLE] Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System – Full Text

Abstract

Background: New technologies to improve post-stroke rehabilitation outcomes are of great interest and have a positive impact on functional, motor, and cognitive recovery. Identifying the most effective rehabilitation intervention is a recognized priority for stroke research and provides an opportunity to achieve a more desirable effect. Objective: The objective is to verify the effect of new technologies on motor outcomes of the upper limbs, functional state, and cognitive functions in post-stroke rehabilitation. Methods: Forty two post-stroke patients (8.69 ± 4.27 weeks after stroke onset) were involved in the experimental study during inpatient rehabilitation. Patients were randomly divided into two groups: conventional programs were combined with the Armeo Spring robot-assisted trainer (Armeo group; n = 17) and the Kinect-based system (Kinect group; n = 25). The duration of sessions with the new technological devices was 45 min/day (10 sessions in total). Functional recovery was compared among groups using the Functional Independence Measure (FIM), and upper limbs’ motor function recovery was compared using the Fugl–Meyer Assessment Upper Extremity (FMA-UE), Modified Ashworth Scale (MAS), Hand grip strength (dynamometry), Hand Tapping test (HTT), Box and Block Test (BBT), and kinematic measures (active Range Of Motion (ROM)), while cognitive functions were assessed by the MMSE (Mini-Mental State Examination), ACE-R (Addenbrooke’s Cognitive Examination-Revised), and HAD (Hospital Anxiety and Depression Scale) scores. Results: Functional independence did not show meaningful differences in scores between technologies (p > 0.05), though abilities of self-care were significantly higher after Kinect-based training (p < 0.05). The upper limbs’ kinematics demonstrated higher functional recovery after robot training: decreased muscle tone, improved shoulder and elbow ROMs, hand dexterity, and grip strength (p < 0.05). Besides, virtual reality games involve more arm rotation and performing wider movements. Both new technologies caused an increase in overall global cognitive changes, but visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) were statistically higher after robotic therapy. Furthermore, decreased anxiety level was observed after virtual reality therapy (p < 0.05). Conclusions: Our study displays that even a short-term, two-week training program with new technologies had a positive effect and significantly recovered post-strokes functional level in self-care, upper limb motor ability (dexterity and movements, grip strength, kinematic data), visual constructive abilities (attention, memory, visuospatial abilities, and complex commands) and decreased anxiety level.

1. Introduction

Insufficient motor control compromises the ability of Stroke Patients (SP) to perform activities of daily living and will likely have a negative impact on the quality of life. Improving Upper Limb (UL) function is an important part of post-stroke rehabilitation in order to reduce disability []. Recovery in the context of motor ability may refer to the return of pre-stroke muscle activation patterns or to compensation involving the appearance of alternative muscle activation patterns that attempt to compensate for the motor function deficit []. The past decades have seen rapid development of a wide variety of assistive technologies that can be used in UL rehabilitation. These include electromyographic biofeedback, virtual reality, electromechanical and robotic devices, electrical stimulation, transcranial magnetic stimulation, direct current stimulation, and orthoses []. Currently, two effective technologies that provide external feedback to SP during training, improve the retention of learned skills, and may be able to enhance the motor recovery are discussed [].

Virtual Reality (VR): The Microsoft TM Kinect-based system provides feedback on movement execution and/or goal attainment []. Incorporating therapy exercises into virtual games can make therapy more enjoyable and more realistic, such that task-based exercises have increased applicability in the clinical environment [,], increasing motivation and therefore adherence, which are useful for navigating this virtual environment; this has been identified as the most feasible for future implementation [].

Electromechanical and robotic devices can move passive UL along more secure movement trajectories and provide either assistance or resistance to movement of a single joint or control of inter-segmental coordination. Recent technological advances have the ability to control multiple joints accurately at the same time, enabling them to produce more realistic task-based exercises for SP []. Compared to manual therapy, robots have the potential to provide intensive rehabilitation consistently for a longer duration []. Recovery of sensorimotor function after CNS damage is based on the exploitation of neuroplasticity, with a focus on the rehabilitation of movements needed for self-independence. This requires physiological limb muscle activation, which can be achieved through functional UL movement exercises and activation of the appropriate peripheral receptors []. The Armeo Spring robot-assisted trainer device may improve UL motor function recovery as predicted by reshaping of cortical and transcallosal plasticity, according to the baseline cortical excitability []. Knowledge of the potential brain plasticity reservoir after brain damage constitutes a prerequisite for an optimal rehabilitation strategy [,]. There is evidence that robot training for the hand is superior; during post-stroke rehabilitation, hand training is likely to be the most useful [,].

Previous studies have shown that the use of systems based on VR environments, motion sensors, and robotics can improve motor function. Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions [,,].

The objectives of the study are to clarify in which area of functional UL recovery these new technologies are more suitable and effective and how much these interventions affect functional state and cognitive functions.

We raise the hypothesis that a robot-assisted device and virtual reality both have a positive effect on functional independence recovery in stroke-affected patients; however, having a different influence on UL motor function and cognitive changes. We assume that the robot-assisted device is more efficient and more accurately allows selecting tasks for developing specific motor function (range of motion, strength or dexterity of the affected arm), while Kinect-based games provide more free movements that are less suitable for specific motor function development and may be more targeted for cognitive functions.

 

Continue —>  Influence of New Technologies on Post-Stroke Rehabilitation: A Comparison of Armeo Spring to the Kinect System

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[Abstract] Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology

ABSTRACT

Background

Nowadays, information technologies are being widely adopted to promote healthcare and rehabilitation. Owing to their affordability and use of hand-free controllers, vision-based systems have gradually been integrated into motor rehabilitation programs and have greatly drawn the interest of healthcare practitioners and the research community. Many studies have illustrated the effectiveness of these systems in rehabilitation. However, the report and design aspects of the reported clinical trials were disregarded.

Objective

In this paper, we present a systematic literature review of the use of vision-based serious games and virtual reality systems in motor rehabilitation programs. We aim to propose a research methodology that engineers can use to improve the designing and reporting processes of their clinical trials.

Methods

We conducted a review of published studies that entail clinical experiments. Searches were performed using Web of Science and Medline (PubMed) electronic databases, and selected studies were assessed using the Downs and Black Checklist and then analyzed according to specific research questions.

Results

We identified 86 studies and our findings indicate that the number of studies in this field is increasing, with Korea and USA in the lead. We found that Kinect, EyeToy system, and GestureTek IREX are the most commonly used technologies in studying the effects of vision-based serious games and virtual reality systems on rehabilitation. Findings also suggest that cerebral palsy and stroke patients are the main target groups, with a particular interest on the elderly patients in this target population. The findings indicate that most of the studies focused on postural control and upper extremity exercises and used different measurements during assessment.

Conclusions

Although the research community’s interest in this area is growing, many clinical trials lack sufficient clarity in many aspects and are not standardized. Some recommendations have been made throughout the article.

via Vision-Based Serious Games and Virtual Reality Systems for Motor Rehabilitation: A Review Geared Toward a Research Methodology – ScienceDirect

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[Abstract] Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial

Abstract

BACKGROUND: Virtual reality and interactive video games could decrease the demands on the time of the therapists. However, the cost of a virtual reality system and the requirement for technical support limits the availability of these systems. Commercial exergames are not specifically designed for therapeutic use, most patients with hemiplegic stroke are either too weak to play the games or develop undesirable compensatory movements.

 

AIM: To develop Kinect2Scratch games and compare the effects of training with therapist-based training on upper extremity (UE) function of patients with chronic stroke.

DESIGN: A randomized controlled single-blinded trial.

SETTING: An outpatient rehabilitation clinic of a tertiary hospital.

POPULATIONS: Thirty-three patients with chronic hemiplegic stroke.

METHODS: We developed 8 Kinect2Scratch games. The participants were randomly assigned to either a Kinect2Scratch game group or a therapist-based training group. The training comprised 24 sessions of 30 minutes over 12 weeks. The primary outcome measure was the Fugl-Meyer UE scale and the secondary outcome measures were the Wolf Motor Function Test and Motor Activity Log. Patients were assessed at baseline, after intervention, and at the 3-month follow-up. We used the Pittsburgh participation scale (PPS) to assess the participation level of patients at each training session and an accelerometer to assess the activity counts of the affected UE of patients was used at the 12th and 24th training sessions.

RESULTS: Seventeen patients were assigned to the Kinect2Scratch group and 16 were assigned to the therapist-based training group. There were no differences between the two groups for any of the outcome measures post-intervention and at the 3-month follow-up (all p>.05). The level of participation was higher in the Kinect2Scratch group than in the therapist-based training group (PPS 5.25vs. 5.00, p=0.112). The total activity counts of the affected UE was significantly higher in the Kinect2Scratch group than in the therapist-based training group (p<.001).

CONCLUSIONS: Kinect2Scratch game training was feasible, with effects similar to those of therapist-based training on UE function of patients with chronic stroke.

via Comparison of Kinect2Scratch game-based training and therapist-based training for the improvement of upper extremity functions of patients with chronic stroke: a randomized controlled single-blinded trial – European Journal of Physical and Rehabilitation Medicine 2019 Feb 15 – Minerva Medica – Journals

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[ARTICLE] Validation of a Kinect V2 based rehabilitation game – Full Text

Abstract

Interactive technologies are beneficial to stroke recovery as rehabilitation interventions; however, they lack evidence for use as assessment tools. Mystic Isleis a multi-planar full-body rehabilitation game developed using the Microsoft Kinect® V2. It aims to help stroke patients improve their motor function and daily activity performance and to assess the motions of the players. It is important that the assessment results generated from Mystic Isle are accurate. The Kinect V2 has been validated for tracking lower limbs and calculating gait-specific parameters. However, few studies have validated the accuracy of the Kinect® V2 skeleton model in upper-body movements. In this paper, we evaluated the spatial accuracy and measurement validity of a Kinect-based game Mystic Isle in comparison to a gold-standard optical motion capture system, the Vicon system. Thirty participants completed six trials in sitting and standing. Game data from the Kinect sensor and the Vicon system were recorded simultaneously, then filtered and sample rate synchronized. The spatial accuracy was evaluated using Pearson’s r correlation coefficient, signal to noise ratio (SNR) and 3D distance difference. Each arm-joint signal had an average correlation coefficient above 0.9 and a SNR above 5. The hip joints data had less stability and a large variation in SNR. Also, the mean 3D distance difference of joints were less than 10 centimeters. For measurement validity, the accuracy was evaluated using mean and standard error of the difference, percentage error, Pearson’s r correlation coefficient and intra-class correlation (ICC). Average errors of maximum hand extent of reach were less than 5% and the average errors of mean and maximum velocities were about 10% and less than 5%, respectively. We have demonstrated that Mystic Isle provides accurate measurement and assessment of movement relative to the Vicon system.

Introduction

In the past decade and quite rapidly in the past five years, Natural User Interfaces (NUIs) and video games have grown in popularity in both consumer applications and in healthcare []. Specifically, physical rehabilitation (e.g., physical and occupational therapy) has embraced novel NUI applications in clinics, hospitals, nursing homes, and the community []. Robotic systems have long included game-based and NUI-based user interfaces and most robotic devices provide some form of physical assistance to the patient and/or haptic feedback []. With the release of the Nintendo Wii in 2008, many NUI applications for healthcare moved away from bulky, expensive robotics and embraced the portable nature of movement and gesture recognition devices and systems. One of the biggest breakthroughs for this field came in 2010 when Microsoft released the Kinect sensor to accompany its Xbox console system. Within days and weeks of the Kinect’s release, hackers, universities, and companies began to exploit its markerless movement sensing abilities for educational and healthcare use. Since then, there has been an exponential increase in the number of studies that report the use of the Kinect as the input device for a NUI-based rehabilitation game or feedback application [].

In 2014, Jintronix was the first company to receive FDA approval for its rehabilitation game system that uses the Microsoft Kinect. There are a number of similar companies that utilize the Kinect sensor including SeeMee [], VirtualRehab [], Reflexion Health [], MIRA [], MotionCare360 [], and 5Plus Therapy []. Many of these systems are marketed for delivering rehabilitation therapy in the home setting. This type of delivery is termed “tele-rehabilitation” and can involve remote monitoring by the therapist or virtual sessions over teleconferencing software []. For telerehabilitation or remote sessions, it is imperative that the data the therapist receives from the system or movement-sensing device (such as the Microsoft Kinect) are accurate and reliable. If the therapist plans to use the data for documentation or for reimbursement from a health insurance company, the data ought to be as accurate as current clinical tools (e.g., goniometers).

Only one of the listed companies has validated the measurement capabilities of their systems and of the Microsoft Kinect. Kurillo and colleagues evaluated their system used in 5Plus Therapy against the Impulse motion-capture system (PhaseSpace Inc., San Leandro, CA) and found that it had good accuracy of joint positions and small to large percentage errors in joint angle measurements []. However, this study had a small sample size of only 10 subjects and used the first version of the Kinect sensor in its validation. Additionally, the movements used in the assessment were only within a single plane for each movement and all participants were seated during data collection.

Other researchers have validated the Kinect’s measurement and tracking capabilities for both general and specific applications. Hondori and Khademi [] provide an excellent summary of the work completed prior to 2014. It should be noted that all of these studies evaluated the first version of the Kinect. Following the release of the Kinect V2 sensor, most researchers have focused their validation efforts on gait and posture applications []. The Kinect V2 has good-to-excellent tracking and measurement capabilities for gait-specific parameters and clinical outcomes. However, many of these studies tracked only the lower limbs. Furthermore, gait is a relatively consistent, rhythmic motion that is consistent across participants, even in rehabilitation populations (i.e., one foot in front of the other). The full-body movements that participants are not limited to specific planes and could choose to use either hand have not been studied in current and prior comparisons of the Microsoft Kinect and optical marker-based motion capture systems.

We have developed software called Mystic Isle that utilizes the Microsoft Kinect V2 sensor as the input device []. Mystic Isle is designed as a rehabilitation game and has shown good results in improving motor function and daily activity performance in persons with chronic stroke []. The software initially used the first version (V1) of the Microsoft Kinect as the input device and we completed a study that compared it to the OptiTrack optical system []. Based on a visual analysis, we demonstrated that for the hand and elbow, the Kinect V1 has good accuracy in calculating trajectory of movement. For the shoulder, the Kinect V1 tracking abilities limit its validity. Although these findings are promising, the types and number of movements used in the study were limited to those in a seated position and mostly in one plane of movement (e.g., sagittal). Furthermore, the tracking capabilities of the Kinect V2 have substantially improved in the past 7 years and include more data points (joints) for comparison.

The current Mystic Isle game involves multi-planar, full body movements. Designed for individuals with diverse abilities, games can be played in a sitting or standing position, depending on the therapy treatment plan. In standing, the player is able to move around in the 3-dimensional space, akin to real-world rehabilitation. Few studies have evaluated the tracking and measurement capabilities of the Microsoft Kinect V2 for full-body, multi-planar movements in both sitting and standing. The purpose of this study was to determine the spatial accuracy and measurement validity of the Microsoft Kinect V2 sensor in a NUI rehabilitation game in comparison to a gold-standard marker-based motion capture system (Vicon).

Materials and methods

Participants

Participants were recruited via convenience sample at the University of Missouri- Columbia campus. Participants were included if they: 1) were over the age of 18, 2) could understand conversational English, and 3) had no medical conditions which prevented them from playing video games. The study has been approved by the Health Sciences Institutional Review Board at the University of Missouri with the approval number IRB 2005896 HS. All potential participants were screened and all subjects provided written informed consent before beginning the study.

Mystic Isle

Mystic Isle is a platform for rehabilitation that allows a user to interact with a virtual environment by using their body (Fig 1). The Mystic Isle software was created in Unity 3D and Mystic Isle allows the tracked user to interact with virtual environments and objects in a 3-D world. Using Mystic Isle, specific movements, distances, and locations of objects can be tailored to the abilities and requirements of the user. The system uses the Microsoft Kinect V2 camera to track participant movements. The Kinect V2 tracks 20 discrete points/joints on the body of the user. Both gross motor (stepping, jumping, squatting) and fine motor (waving the hand, turning the palm facing up, open/close hand) movements can be tracked. The Kinect V2 tracks the user in 3-dimensional space and then inputs the data in real time to the associated software, Mystic Isle. The Kinect V2 tracks and records the x, y, and z coordinates (and confidence) of each discrete joint at either 15 or 30 frames per second.

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Fig 1
Mystic Isle game environment.(a) A virtual avatar collecting targets in a Kinect-based rehabilitation game, Mystic Isle. (b) A participant playing the game with Vicon markers on the body. Joint data of game trials were recorded by a Kinect and the Vicon system for validation.

[…]

Continue —>  Validation of a Kinect V2 based rehabilitation game

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[ARTICLE] Development of a Novel Home Based Multiscene Upper Limb Rehabilitation Training and Evaluation System for Post-stroke Patients – Full Text PDF

ABSTRACT

Upper limb rehabilitation requires long-term, repetitive rehabilitation training and assessment, and many patients cannot pay for expensive medical fees in the hospital for so long time. It is necessary to design an effective, low cost, and reasonable home rehabilitation and evaluation system. In this paper, we developed a novel home based multi-scene upper limb rehabilitation training and evaluation system (HomeRehabMaster) for post-stroke patients. Based on the Kinect sensor and posture sensor, multi-sensors fusion method was used to track the motion of the patients. Multiple virtual scenes were designed to encourage rehabilitation training of upper limbs and trunk. A rehabilitation evaluation method integrating Fugl-meyer assessment (FMA) scale and upper limb reachable workspace relative surface area (RSA) was
proposed, and a FMA-RSA assessment model was established to assess upper limb motor function.
Correlation based dynamic time warping (CBDTW) was used to solve the problem of inconsistent upper limb movement path in different patients. Two clinical trials were conducted. The experimental results show that the system is very friendly to the subjects, the rehabilitation assessment results by this system are highly correlated with the therapist’s (the highest forecast accuracy was 92.7% in the 13th item), and longterm rehabilitation training can improve the upper limb motor function of the patients statistically significant (p=0.02<0.05). The system has the potential to become an effective home rehabilitation training and evaluation system.[…]
Full Text PDF —>  IEEE Xplore Full-Text PDF:

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[Abstract] Towards Bilateral Upper-Limb Rehabilitation after Stroke using Kinect Game – IEEE Conference Publication

Abstract:

This paper presented a game-based rehabilitation of the upper limb after stroke. We designed and developed a game for supporting stroke patients to have an exercise their arms, and the game had functions for recording their playing and showing a performance report. The performance report can infer the progress of bilateral uppper-limb rehabilitation and use for comparing among patient cases. This is because the game used a Kinect device to detect the arm movements in aspect of precision and speed.

 

1. L. Anderson, G. A. Sharp, R. J. Norton, H. Dalal, S. G. Dean, K. Jolly, A. Cowie, A. Zawada, R. S. Taylor, “Home-based versus centre-based cardiac rehabilitation”, The Cochrane Library, 2017.

2. K. Thomson, A. Pollock, C. Bugge, M. C. Brady, “Commercial gaming devices for stroke upper limb rehabilitation: a survey of current practice”, Disability and Rehabilitation: Assistive Technology, vol. 11, no. 6, pp. 454-461, 2016.

3. L. Y. Joo, T. S. Yin, D. Xu, E. Thia, P. F. Chia, C. W. K. Kuah, K. K. He, “A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke”, Journal of rehabilitation medicine, vol. 42, no. 5, pp. 437-441, 2010.

4. K. Price, “Health promotion and some implications of consumer choice”, Journal of nursing management, vol. 14, no. 6, pp. 494-501, 2006.

5. J. A. M. Bravo, P. Paliyawan, T. Harada, R. Thawonmas, “Intelligent assistant for providing instructions and recommending motions during full-body motion gaming”, Consumer Electronics (GCCE) 2017 IEEE 6th Global Conference on. IEEE, pp. 1-2, 2017.

 

via Towards Bilateral Upper-Limb Rehabilitation after Stroke using Kinect Game – IEEE Conference Publication

 

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[ARTICLE] Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke – Full Text

Abstract

Background

Impairment of upper extremity function is a common outcome following stroke, to the detriment of lifestyle and employment opportunities. Yet, access to treatment may be limited due to geographical and transportation constraints, especially for those living in rural areas. While stroke rates are higher in these areas, stroke survivors in these regions of the country have substantially less access to clinical therapy. Home therapy could offer an important alternative to clinical treatment, but the inherent isolation and the monotony of self-directed training can greatly reduce compliance.

Methods

We developed a 3D, networked multi-user Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system for home therapy. Within this environment, stroke survivors can interact with therapists and/or fellow stroke survivors in the same virtual space even though they may be physically remote. Each user’s own movement controls an avatar through kinematic measurements made with a low-cost, Kinect™ device. The system was explicitly designed to train movements important to rehabilitation and to provide real-time feedback of performance to users and clinicians. To obtain user feedback about the system, 15 stroke survivors with chronic upper extremity hemiparesis participated in a multisession pilot evaluation study, consisting of a three-week intervention in a laboratory setting. For each week, the participant performed three one-hour training sessions with one of three modalities: 1) VERGE system, 2) an existing virtual reality environment based on Alice in Wonderland (AWVR), or 3) a home exercise program (HEP).

Results

Over 85% of the subjects found the VERGE system to be an effective means of promoting repetitive practice of arm movement. Arm displacement averaged 350 m for each VERGE training session. Arm displacement was not significantly less when using VERGE than when using AWVR or HEP. Participants were split on preference for VERGE, AWVR or HEP. Importantly, almost all subjects indicated a willingness to perform the training for at least 2–3 days per week at home.

Conclusions

Multi-user VR environments hold promise for home therapy, although the importance of reducing complexity of operation for the user in the VR system must be emphasized. A modified version of the VERGE system is currently being used in a home therapy study.

Background

Chronic upper extremity impairment is all too common among the more than 7 million stroke survivors in the U.S. [1]. These impairments have disabling effects on all facets of life, including self-care, employment, and leisure activities. Repetitive practice of movement, such as arm movement, is thought to improve outcomes for stroke survivors [234], but access to the clinic for therapy is often limited by geography or lack of transportation. While almost 50 million Americans live in rural areas, 90% of physical and occupational therapists live in major urban areas [5]. Per capita ratios of therapists to overall population are 50% larger in urban as compared to rural regions of the country [6]. Rates of stroke in these rural areas, however, exceed those of major urban areas [789]. Thus, a large number of stroke survivors have limited access to skilled treatment. Data from 21 states found that only 30% of stroke survivors received outpatient rehabilitation, a much lower percentage than that recommended by clinical practice guidelines [10]. Declines seen following discharge from inpatient rehabilitation are undoubtedly exacerbated by limited access to clinical therapy [11].

Disparity in quality of care has been recognized in the acute treatment of stroke for a number of years. This situation has led to the development of telemedicine to extend expert care to individuals during the initial hours and days following the stroke, advance site-independent treatment, and create models of care in rural areas [121314]. Therapy options after this acute period, however, generally remain limited for stroke survivors in rural areas. Akin to the telemedicine efforts, telerehabilitation treatments have been proposed. However, telerehabilitation interactions are typically limited to off-line monitoring by the therapist [8915], phone calls between a therapist and client [1617], or videoconferencing [181920]. While systems allowing more direct interaction have been proposed, the hardware cost and complexity limit applicability for home-based therapy [212223]. Hence, the therapist is relegated to the role of observer and the intimacy of a clinical therapy session is lost. Therapy options are substantially restricted, as is the available feedback.

Recently, multiple investigators have been exploring means of improving home-based therapy through the development of systems or serious games which permit multiple, simultaneous users [24252627282930]. These efforts have proposed the inclusion of multiple users as a means to overcome resistance to home-based therapy that may result due to isolation or lack of engagement. Indeed, studies have observed a preference for multi-user vs, single-user therapy when utilizing these systems [2629]. However, these systems have largely been limited to control of a one-dimensional or two-dimensional space and both users remain in the same physical location (e.g., side by side). One team of researchers did develop a framework for supporting distant users (such as a therapist in the hospital and a stroke survivor in their home), but game control was limited to one or two dimensions [3132].

Here, we describe the development of a fully three-dimensional (3D) virtual reality environment (VRE) for home-based therapy in which multiple, remote users can interact in real time. In this Virtual Environment for Rehabilitative Gaming Exercises (VERGE) system [33], movement of the user is mapped to corresponding movement of an avatar to foster a sense of presence in and engagement with the VRE. The 3D environment encompasses aspects of clinical therapy, such as transport of objects or movement of the hand into specified regions of the upper extremity workspace. Although the importance of 3D movements in VR environments is a topic of debate [3435], movements tested in environments with lesser degrees-of-freedom (DOF) are often very limited and dictated by a one DOF robot. These movements differ substantially from the types of movements normally seen in 3D reaching movements [436]. The network architecture of the system allows users to be located remotely from each other, such as a stroke survivor in their home, a therapist in a clinic, or a stroke survivor’s friend or relative living in another city or state. The virtual nature of the environment allows even very limited movements in the physical world to have successful functional outcomes in the virtual world, thereby offering a sense of accomplishment and motivation for successive attempts. Additionally, task difficulty can easily be modified in order to maintain the proper level of challenge, which is important for motor learning in general [37] and rehabilitation in particular [38].

We developed and performed preliminary testing of the VERGE system to gauge user response in comparison to two other therapy modalities that could be used for home therapy: an existing virtual reality system based on the Alice in Wonderland story (AWVR) [39] and a home exercise program (HEP). Fifteen stroke survivors completed three, one-hour therapy sessions per week with each of the three therapy modalities (9 sessions total). We hypothesized that the use of the VERGE system would not decrease the amount of arm movement promoted, in comparison with the AWVR and HEP modalities. We further expected that users’ self-described engagement would be greatest for the VERGE system due to the presence of a partner.

Methods

VERGE System

Architecture

At its core, VERGE consists of a 3D VRE in which avatars interact with virtual objects. To date, we have created two such VREs, one depicting a dining room and the other a kitchen. The scenes were created in Maya (Autodesk Inc., San Rafael, CA) and imported into Unity 3D (Unity 4.5, Unity Technologies, San Francisco, CA), the software platform controlling VERGE. The VREs are rich in detail in order to provide depth cues [40]. Thus, depth can be conveyed without the need for stereovision, such as that provided by head mounted displays (HMDs). We have found that HMDs can be difficult for stroke survivors to use due to the limited field-of-view and, especially, involuntary coupling between neck and arm motion [4142]. The latter may lead to complications with moving the arm while keeping the head steady.

The avatars were created from a custom skeleton in Maya (Autodesk Inc., San Rafael, CA), which was rigged to an existing mesh of the “casual young man” 3D model, purchased and modified for our project (Fig. 1). We created the custom skeleton to match the topology of the existing character while corresponding to the skeletal joint naming convention in Unity 3D. The skeleton (and thus avatar) is animated according to joint angle data captured with a Kinect™ I optical tracker (Microsoft Corp., Redmont, WA). The 3D motion data from the Kinect™ are transmitted to the Unity code through UDP to drive the movement of the avatar in the virtual environment.

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