Posts Tagged Virtual Environment

[ARTICLE] Gamification in a Physical Rehabilitation Setting: Developing a Proprioceptive Training Exercise for a Wrist Robot – Full Text

Proprioception or body awareness is an essential sense that aids in the neural control of movement. Proprioceptive impairments are commonly found in people with neurological conditions such as stroke and Parkinson’s disease. Such impairments are known to impact the patient’s quality of life. Robot-aided proprioceptive training has been proposed and tested to improve sensorimotor performance. However, such robot-aided exercises are implemented similar to many physical rehabilitation exercises, requiring task-specific and repetitive movements from patients. Monotonous nature of such repetitive exercises can result in reduced patient motivation, thereby, impacting treatment adherence and therapy gains. Gamification of exercises can make physical rehabilitation more engaging and rewarding. In this work, we discuss our ongoing efforts to develop a game that can accompany a robot-aided wrist proprioceptive training exercise.

 

Figure 1: Left. WristBot being used by a participant. Right. Screenshot of the virtual environment showing an avatar controlled by user’s wrist movements.

1 INTRODUCTION

Proprioception, the sense of body awareness, is essential for normal motor function. Proprioceptive deficits are common in neurological conditions [Coupar et al. 2012; Konczak et al. 2009]. Such deficits cause a decline in precision of goal-directed movements, and altered postural and spinal reflexes resulting in balance and gait problems [Rothwell et al. 1982]. Proprioceptive training is an intervention aiming to improve proprioceptive function [Aman et al. 2015]. Previous work has established the efficacy of a robot-aided proprioceptive training using WristBot [Elangovan et al. 201720182019]. The WristBot (Figure 1. Left) is a three degrees-of-freedom (3-DoF) exoskeleton robot that allows full range of motion (ROM), delivers precise haptic, position, and velocity stimuli at the wrist, and accurately encodes wrist position across time. Additional details about the WristBot can found in [Cappello et al. 2015].

Nevertheless, while the WristBot has demonstrated its efficacy, it shares a limitation that is often encountered in rehabilitation settings. In a clinical setting, patients are often required to perform task-specific and repetitive movements [Kwakkel et al. 1999]. Initial patient enthusiasm to complete such activities rapidly declines as a result of the monotonous nature of movements. Patient engagement can be improved by complementing therapy with a virtual environment (VE). Prior research has shown that users have favored exercises complemented with a VE rather than conventional approaches [Hoffman et al. 2014]. Thus, our project objective is to turn these tedious movements into an interactive VE experience.

2 GAMIFICATION OF PROPRIOCEPTIVE TRAINING

Gamification process accounted for two key considerations: (1) the game should foster patient motivation and attention (2) and be clinically meaningful. To address these objectives, we reviewed the literature on game development [Bond 2014; Fullerton 2018] and identified four essential components: (1) Variability, (2) Feedback, (3) Rewards, and (4) a Compelling Purpose. The user will be gradually exposed to increasing levels of difficulty, which will likely reduce user frustrations. The user will receive meaningful feedback on concurrent metrics (e.g., Optimal ROM), as well as on previous treatment sessions. During game progress, the user will be alerted about deviations from the target movement requirements. Achievement badges will be rewarded to the user upon reaching therapy milestones, such as target ROM. Lastly, to encourage game completion, we establish an interesting backstory and a meaningful character arc for our virtual avatars. The developed game will be adaptable based on the user’s current clinical status, thus, making the game clinically meaningful. The clinician will have the ability to prescribe exercises based on user needs such as 1 DoF vs 3 DoF movements, continuous vs discrete movements, and strength training vs mobility training. WristBot will provide supportive forces aiding the user to achieve therapy milestones.

Gamified exercise is being developed using the Unity Game Engine, Python and libraries which interface with the WristBot. The game closely resembles an endless runner type game (Figure 1. Right) and utilizes the WrsitBot’s 3-DoF functionality to interact with the VE. Wrist flexion, extension, and abduction can be used to traverse their environment. The remaining 3 movements will allow interactions with their VE in unique ways, such as opening/closing doors, crouching, and pulling levers. In the VE, coins are strategically placed to maximize and improve the use of available ROM. Upon contact with either a wall or obstacle, visual feedback will be provided in the form of avatar damage and coin deduction. Consequently, users achieve improved mobility.

In Python, the connection between Unity and the WristBot library is managed through the use of a local WebSocket, a protocol for two-way communication over a single Transmission Control Protocol (TCP) connection [Fette and Melnikov 2011]. Through the WebSocket, reciprocal data are transferred between the WristBot and Unity. For example, wrist kinematic data will be streamed to the game while game progress is being relayed to the WristBot library. Game progress data will be utilized to compute and deliver haptic feedback to the user. Haptic feedback provided in the form of haptic assistance will aid users to improve their available ROM, while haptic resistance will improve muscle strength within the desired ROM. The clinical motive of the game is to transition the user from use of haptic assistance to resistance during game play. WristBot will adapt haptic feedback based on time spent and progress achieved in game play.

3 USABILITY TESTING

Usability testing will be conducted to ensure proper game usage by the clinical population and healthcare professionals. Specifically, the usability testing will evaluate areas such as 1) ease of game play, 2) game efficiency, and 3) user engagement. We will test the assumptions in each of these areas are accurately depicted in game development and met during game play. For example, we expect online visual feedback of deviations from target to help user focus on achieving the movement requirements. The users will be asked to verify the benefits of visual feedback in modifying their movements. Similarly, other assumptions such as performance badges and coins as rewards, and increase in difficulty levels will be evaluated. A common pitfall of usability studies involving physical rehabilitation setting is not recruiting from the representative population, most notably elderly population [Laver et al. 2017] as age has been shown to interfere with interactions in VE [Meldrum et al. 2012]. Therefore, to ensure our game is intuitive, we will recruit representative users from our patient populations.

ACKNOWLEDGMENTS

This project was supported by National Science Foundation Partnerships For Innovation Technology Translation Award to Jürgen Konczak (1919036). Christopher Curry was supported by National Research Trainee-Understanding the Brain: Graduate Training Program in Sensory Science: Optimizing the Information Available for Mind and Brain (1734815).

REFERENCES

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  • Naveen Elangovan, Paul Tuite, and Jürgen Konczak. 2018. Somatosensory training improves proprioception and untrained motor function in Parkinson’s disease. Frontiers in neurology 9(2018), 1053. 
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[Abstract + References] Training of Hand Rehabilitation Using Low Cost Exoskeleton and Vision-Based Game Interface

Abstract

Motivating game-based training have the potential to improve therapy for people with neurological impairments. In recent years, the serious games have become extremely useful tools in rehabilitation field. They aim to stimulate the mobility of the body through an immersive experience that puts the user in interactive virtual environment. This paper is concerned about developing a customized augmented reality system for stroke rehabilitation. This will be done through integrating an interactive serious game interface with a hand exoskeleton device. This game-based rehabilitation system allows users to carry out physical rehabilitation therapies using a natural user interface based on Kinect’s skeletal tracking features and the electromyography (EMG) sensor. During game playing, the interactive user interface provides useful real-time feedback information such as the time required to grasp a desired dynamic virtual object, and the assigned score and thus the ability of the proposed system to provide a compensatory action regarding the dynamic behavior of the virtual target. The main goal of the developed virtual environment is to create positive influences on the rehabilitation process. Patient movement information and signals obtained from the developed exoskeleton device are used together to monitor the rehabilitation progress. The developed exoskeleton hand is a 3D printed low cost device suitable for grasping tasks that can be used even for domestic stroke patients. The developed exoskeleton device is not only a mechanical system able to perform the rehabilitation act but also it presents an effective tracking and traceability software solution. The EMG signals measured during hand motion are used to detect the intention of hand opening or closing which in turn will actuate the mechanical structure to accomplish the desired task. Parameters and results of patients’ exercises are stored and analyzed when needed to evaluate patients’ progress. The developed system is tested experimentally and it is able to restore the functions of the upper limb and mainly give patients more motivation to undergo the rehabilitation exercises.

Supplementary material

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10846_2018_966_MOESM2_ESM.mp4 (412 kb)

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[ARTICLE] Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training – Full Text

Robot-assisted therapy affords effective advantages to the rehabilitation training of patients with motion impairment problems. To meet the challenge of integrating the active participation of a patient in robotic training, this study presents an admittance-based patient-active control scheme for real-time intention-driven control of a powered upper limb exoskeleton. A comprehensive overview is proposed to introduce the major mechanical structure and the real-time control system of the developed therapeutic robot, which provides seven actuated degrees of freedom and achieves the natural ranges of human arm movement. Moreover, the dynamic characteristics of the human-exoskeleton system are studied via a Lagrangian method. The patient-active control strategy consisting of an admittance module and a virtual environment module is developed to regulate the robot configurations and interaction forces during rehabilitation training. An audiovisual game-like interface is integrated into the therapeutic system to encourage the voluntary efforts of the patient and recover the neural plasticity of the brain. Further experimental investigation, involving a position tracking experiment, a free arm training experiment, and a virtual airplane-game operation experiment, is conducted with three healthy subjects and eight hemiplegic patients with different motor abilities. Experimental results validate the feasibility of the proposed scheme in providing patient-active rehabilitation training.

Introduction

Stroke is a severe neurological disease caused by the blockages or rupture of cerebral blood vessels, leading to significant physical disability and cognitive impairment (12). The recent statistics from the World Health Organization indicate that worldwide 15 million people annually suffer from the effect of stroke, and more than 5 million stroke patients survive and, however, require a prolonged physical therapy to recover motor function. Recent trends predict increased stroke incidence at younger ages in the upcoming years (34). Approximately four-fifths of all survived stroke patients suffer from the problems of hemiparesis or hemiplegia and, as a result, have difficulties in performing activities of daily living (ADL). Stroke causes tremendous mental and economic pressure on the patients and their families (5). Medical research has proved that, owing to the neural plasticity of the human brain, appropriate rehabilitation trainings are beneficial for stroke survivors to recover musculoskeletal motor abilities. Repetitive and task-oriented functional activities have substantial positive effects on improving motor coordination and avoiding muscle atrophy (67). Traditional stroke rehabilitation therapy involves many medical disciplines, such as orthopedics, physical medicine, and neurophysiology (89). Physiotherapists and medical personnel are required to provide for months one-on-one interactions to patients that are labor intensive, time consuming, patient-passive, and costly. Besides, the effectiveness of traditional therapeutic trainings is limited by the personal experiences and skills of therapists (1011).

In recent decades, robot-assisted rehabilitation therapies have attracted increasing attention because of their unique advantages and promising applications (1213). Compared with the traditional manual repetitive therapy, the use of robotic technologies helps improve the performance and efficiency of therapeutic training (14). Robot-assisted therapy can deliver high-intensive, long-endurance, and goal-directed rehabilitation treatments and reduce expense. Besides, the physical parameters and the training performance of patients can be monitored and evaluated via built-in sensing systems that facilitate the improvement of the rehabilitation strategy (1516). Many therapeutic robots have been developed to improve the motor functions of the upper extremity of disabled stroke patients exhibiting permanent sensorimotor arm impairments (17). The existing robots used for upper limb training can be basically classified into two types: end-point robots and exoskeleton robots. End-point robots work by applying external forces to the distal end of impaired limbs, and some examples are MIME (18), HipBot (19), GENTLE/s (20), and TA-WREX (21). Comparatively, exoskeleton robots have complex structures similar to anatomy of the human skeleton; some examples of such robots are NMES (22), HES (23), NEUROExos (24), CAREX-7 (25), IntelliArm (26), BONES (27), and RUPERT (28). The joints of the exoskeleton need to be aligned with the human anatomical joints for effective transfer of interactive forces.

The control strategies applied in therapeutic robots are important to ensure the effectiveness of rehabilitation training. So far, according to the training requirement of patients with different impairment severities, many control schemes have been developed to perform therapy and accelerate recovery. Early rehabilitation robot systems implemented patient-passive control algorithms to imitate the manual therapeutic actions of therapists. These training schemes are suitable for patients with severe paralysis to passively execute repetitive reaching tasks along predefined trajectories. Primary clinical results indicate that patient-passive training contributes to motivating muscle contraction and preventing deterioration of arm functions. The control of the human–robot interaction system is a great challenge due to its highly nonlinear characteristics. Many control algorithms have been proposed to enhance the tracking accuracy of passive training, such as the robust adaptive neural controller (29), fuzzy adaptive backstepping controller (30), neural proportional–integral–derivative (PID) controller (31), fuzzy sliding mode controller (32), and neuron PI controller (33).

The major disadvantage of patient-passive training is that the active participation of patients is neglected during therapeutic treatment (34). Several studies suggest that, for the patients who have regained parts of motor functions, the rehabilitation treatment integrated with the voluntary efforts of patients facilitates the recovery of lost motor ability (35). The patient-active control, normally referred as patient-cooperative control and assist-as-needed control, is capable of regulating the human–robot interaction depending on the motion intention and the disability level of patients. Keller et al. proposed an exoskeleton for pediatric arm rehabilitation. A multimodal patient-cooperative control strategy was developed to assist upper limb movements with an audiovisual game-like interface (36). Duschauwicke et al. proposed an impedance-based control approach for patient-cooperative robot-aided gait rehabilitation. The affected limb was constrained with a virtual tunnel around the desired spatial path (37). Ye et al. proposed an adaptive electromyography (EMG) signals-based control strategy for an exoskeleton to provide efficient motion guidance and training assistance (38). Oldewurtel et al. developed a hybrid admittance–impedance controller to maximize the contribution of patients during rehabilitation training (39). Banala et al. developed a force-field assist-as-need controller for intensive gait rehabilitation training (40). However, there are two limitations in the existing patient-cooperative control strategies. Firstly, the rehabilitation training process is not completely patient-active, as the patient needs to perform training tasks along a certain predefined trajectory. Secondly, existing control strategies are executed in self-designed virtual scenarios that are generally too simple, rough, and uninteresting. Besides, applying a certain control strategy to different virtual reality scenarios is difficult.

Taking the above issues into consideration, the main contribution of this paper is to develop a control strategy for an upper limb exoskeleton to assist disabled patients in performing active rehabilitation training in a virtual scenario based on their own active motion intentions. Firstly, the overall structure design and the real-time control system of the exoskeleton system are briefly introduced. A dynamic model of the human–robot interaction system is then established using the Lagrangian approach. After that, an admittance-based patient-active controller combined with an audiovisual therapy interface is proposed to induce the active participation of patients during training. Existing commercial virtual games without a specific predetermined training trajectory can be integrated into the controller via a virtual keyboard unit. Finally, three types of experiments, namely the position tracking experiment without interaction force, the free arm movement experiment, and the virtual airplane-game operation experiment, are conducted with healthy and disabled subjects. The experimental results demonstrate the feasibility of the proposed exoskeleton and control strategy.

Exoskeleton Robot Design

The architecture of the proposed exoskeleton is shown in Figure 1. This wearable force-feedback exoskeleton robot has seven actuated degrees of freedom (DOFs) and two passive DOFs covering the natural range of movement (ROM) of humans in ADL. The robot has been designed with an open-chain structure to mimic the anatomy of the human right arm and provide controllable assistance torque to each robot joint. There are three actuated DOFs at the shoulder for internal/external rotation, abduction/adduction, and flexion/extension; two DOFs at the elbow for flexion/extension and pronation/supination; and two DOFs at the wrist for flexion/extension and ulnal/radial deviation. Besides, since the center of rotation of the glenohumeral joint varies with the shoulder girdle movement, the robot is mounted on a self-aligning platform with two passive translational DOFs to compensate the human–robot misalignment and to guarantee interaction comfort. […]

Figure 1. Architecture of upper limb rehabilitation exoskeleton (1-Self-aligning platform; 2-AC servo motor; 3-Bowden cable components; 4-Support frame; 5-Wheelchair; 6-Elbow flexion/extension; 7-Proximal force/torque sensor; 8-Wrist flexion/extension; 9-Wrist ulnal/radial deviation; 10-Distal force/torque sensor; 11-Forearm pronation/supination; 12-Auxiliary links; 13-Shoulder flexion/extension; 14-Shoulder abduction/adduction; 15-Shoulder internal/external; 16-Free-length spring).

 

Continue —>  Frontiers | Patient-Active Control of a Powered Exoskeleton Targeting Upper Limb Rehabilitation Training | Neurology

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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.

[…]

Continue —> Development of a 3D, networked multi-user virtual reality environment for home therapy after stroke | Journal of NeuroEngineering and Rehabilitation | Full Text

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[ARTICLE] Neurologic Music Therapy to Facilitate Recovery from Complications of Neurologic Diseases – Full Text 

Abstract

Neurologic music therapy (NMT) has fostered recovery from complications in patients suffering from a wide variety of neurologic diseases. Combining music and virtual reality with standard rehabilitation therapies can improve patient compliance and make therapy more enjoyable. Listening to music can reduce epileptiform discharges and enhances brain plasticity. Music produces variations in brain anatomy between musicians and non-musicians. Music therapy is an inexpensive intervention to help post-stroke patients to recover faster and more efficiently if applied soon after the event. There is evidence that incorporating music into a rehabilitation program fosters recovery of hand function, dexterity, spatial movement, cognitive function, mood, coordination, stride length and memory. Learning words as lyrics, melodic intonation therapy and singing can help the aphasic patient to recover faster. NMT therapists are valuable members of the rehabilitation team. NMT has been approved by the World Rehabilitation Federation as an effective evidence based method of treatment.

Introduction

Incorporating music into routine rehabilitation programs not only fosters initial recovery but also contributes to improvement and enduring benefit after stopping the treatment. Disabilities stem from different neurologic disorders, work-related injuries and trauma such as motor vehicle accidents and sport injuries. Disabilities can have devastating physical, emotional and financial effects on the lives of patients and their families. It is important to identify and incorporate strategies that supplement traditional rehabilitation therapy in order to optimize the recovery of function and quality of life. NMT, by facilitating the patients’ recovery, contributes to positive patient outcomes. The following reviews the evidence base highlighting the importance of adding music to more standard forms of rehabilitation therapy. It references the neurobiological foundation of NMT, its history and applications. Evidence in support of its use to facilitate recovery from a wide range of complications related to specific neurological diagnoses will be discussed.[…]

Continue —>  Neurologic Music Therapy to Facilitate Recovery from Complications of Neurologic Diseases | Insight Medical Publishing

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[Conference paper] 3D Virtual System Using a Haptic Device for Fine Motor Rehabilitation -Abstract+References

Abstract

It is presented a 3D Virtual system with a haptic device that allows the interaction between a user and a virtual environment developed in Unity3D. This System was designed for rehabilitation of paretic hands in adult people with Stroke; the virtual environment was developed considering a daily life’s activity (watering plants in pots). The system was used by five people with mild and moderate Stroke according to ASWRTH 1+ scale, which completed the exercise showed in the virtual application. Patients performed a usability test SUS with outcomes (79, 5 ± 3, 67) this allows to define that the system has a good acceptance for rehabilitation.

Source: 3D Virtual System Using a Haptic Device for Fine Motor Rehabilitation | SpringerLink

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[WEB SITE] TherapWii – game suggestions

Why TherapWii

Gaming activates and is fun to do! In a playful and often unnoticed way skills are trained. Adolescents grow up in a digital world; they enjoy gaming and do it frequently. For adults and elderly gaming has been shown to be a useful type of therapy.

In a virtual environment moving, executing, learning and enjoying are appealing; if circumstances or limitations keep you from going to the bowling alley or playing an instrument, gaming can broaden your boundaries.

Gaming with the Wii can complement therapy, can make therapy more attractive, intenser and more provocative.

TherapWii has been developed to support therapists in an effective and specific way while using the Nintendo Wii and offer options to game in the home environment.

TherapWii is the product of an exploratory research project done by the Special Lectorship Rehabilitation at the Hague University. The results of this project can be found by clicking on the header ‘research’ at the end of the page.

How does TherapWii work?

Per therapy goal there are three colored tabs to help find the most suitable games. Each game lists specific information in text and symbols. There is also a level of difficulty; by moving the cursor over this button you see more information.

User information is saved in ‘explanation and tips’. To enhance this section you can email recommendations and suggestions to the email address listed below.

TherapWii has been developed, also for home use, so that experience lead to personal growth.

Advice for game adjustments

It is important that the therapist stays close to the patient’s goals and abilities and adjusts the game program appropriately. If you, as therapist, want to make the game easier, more difficult or more daring, you can change the instruction, implementation or setting.

A few examples:

Physical: strength (add weights to the arms or legs or change the starting position); balance/stability (play while standing on an instable foundation (ball, mat). Or play the games while sitting on a stationary bicycle!

Cognition: create double tasks (ask mathematics, questions or riddles); spatial orientation or visual adjustments (play with one eye covered or in front of a mirror).

Social-emotional: stimulate cooperation or competition (create bets or role-playing).

Let us know if you have other ideas to make the games more provoking.

How are the games rated?

The games were tested by several professionals (physical therapists, occupational therapists and sport therapists). Differences in opinion or scores were discussed and voted on.

Give us feedback, corrections and advice, we will adjust the TherapWii program monthly and will use your suggestions.

Which ability do you choose?

Social-Emotional

Physical

Cognitive

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[CONFERENCE PAPER] Patient motivation in virtual environments for arm rehabilitation at home – Full Text PDF

ABSTRACT

Many technologies have been deployed for motor rehabilitation at home, but most patients do not comply with the exercise regimen due to lack of motivation. This can be addressed with virtual environments that engage and motivate the patient. We will therefore investigate different methods of increasing patient motivation during arm rehabilitation at home. As a first step, we will focus on virtual environments where patients can compete or cooperate with their caretakers in different gamelike tasks. Different games will be developed and augmented with difficulty adaptation methods, then tested in multisession studies to determine their effect on motivation. Later, we will also investigate other ways of motivating the patient as well as ways to train coordinated motion of both arms.

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[ARTICLE] Increasing Patient Engagement in Rehabilitation Exercises Using Computer-Based Citizen Science – Full Text HTML

Abstract

Patient motivation is an important factor to consider when developing rehabilitation programs. Here, we explore the effectiveness of active participation in web-based citizen science activities as a means of increasing participant engagement in rehabilitation exercises, through the use of a low-cost haptic joystick interfaced with a laptop computer. Using the joystick, patients navigate a virtual environment representing the site of a citizen science project situated in a polluted canal. Participants are tasked with following a path on a laptop screen representing the canal. The experiment consists of two conditions: in one condition, a citizen science component where participants classify images from the canal is included; and in the other, the citizen science component is absent. Both conditions are tested on a group of young patients undergoing rehabilitation treatments and a group of healthy subjects. A survey administered at the end of both tasks reveals that participants prefer performing the scientific task, and are more likely to choose to repeat it, even at the cost of increasing the time of their rehabilitation exercise. Furthermore, performance indices based on data collected from the joystick indicate significant differences in the trajectories created by patients and healthy subjects, suggesting that the low-cost device can be used in a rehabilitation setting for gauging patient recovery.

Continue–>  PLOS ONE: Increasing Patient Engagement in Rehabilitation Exercises Using Computer-Based Citizen Science.

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[ARTICLE] A Novel Study on Natural Robotic Rehabilitation Exergames using the unaffected Arm of Stroke Patients – Full Text PDF

Abstract

It is well known that home exercise is as good as rehab center. However, people with severe stroke typically lack the ability to move their affected arm, and hence they need a very special rehabilitation program that usually available in hospitals or professional centers. Therapists train the affected hand of those patients by using robotic-assisted therapy devices, or sometimes by holding the affected arms of the patients and stretching it for them.

However, such robotic devices and professional therapists are not available at home. In this study, we design and implement a low-cost rehabilitation glove to meet the needs of those patients who have paralysis in their affect hand. The novelty of this glove is that it is to be worn on the unaffected hand which acts as a natural robotic arm during the rehabilitation session. The glove is equipped with FSR sensors that measure the forces exerted by the affected hand on the unaffected hand.

A virtual reality rehabilitation game is developed using Microsoft Kinect to facilitate the exercises and motivate the patients. The system is tested on three patients for six weeks. Objective measurements showed that patients have significantly improved over the study period. Moreover, the patients themselves gave a positive feedback about the whole system; wearing the glove on the unaffected hand made their life easier and let them enjoyed the rehabilitation sessions.

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